Florence Nightingale Foundation

Gestational weight gain (GWG) is a modifiable factor associated with maternal and neonatal outcomes. However, whether recommended weight gain ranges are appropriate across different pre-pregnancy body mass index (BMI) categories remains uncertain, particularly in Asian populations. This study examined the associations between GWG and maternal and neonatal outcomes across pre-pregnancy BMI categories using gestational weight management recommendations developed for the Chinese population. A retrospective cohort study was conducted in a public general hospital in Beijing, China. Pregnant women with singleton pregnancies who attended routine antenatal care and delivered between January 2021, and December 2024 were included. Women with incomplete data were excluded. GWG was calculated as the difference between self-reported pre-pregnancy weight and weight recorded before delivery. Weight gain was classified as inadequate, adequate, or excessive within each pre-pregnancy BMI category according to Chinese gestational weight management guidelines. Maternal outcomes included Caesarean section, non-elective caesarean, mode of birth, gestational diabetes, and gestational hypertension. Neonatal outcomes included preterm birth, low birthweight, and macrosomia, neonatal asphyxia. Multivariable logistic regression analyses stratified by pre-pregnancy BMI category were performed. A total of 3,734 women were included, of whom 66.1% had normal pre-pregnancy BMI. Among women with normal BMI, excessive GWG was associated with higher odds of caesarean section (adjusted odds ratio 1.38, 95% confidence interval 1.15–1.66) and non-elective caesarean Sect. (1.56, 1.16–2.11). Inadequate weight gain in this group was associated with increased odds of preterm birth (2.60, 1.46–4.49) and low birthweight (2.48, 1.37–4.32). Excessive GWG was also associated with higher odds of macrosomia among women with normal BMI (3.08, 1.98–4.92) and those who were overweight (2.96, 1.31–7.96). Among women with obesity, inadequate weight gain was associated with increased odds of preterm birth (6.28, 1.70–26.30). Other associations were limited or outcome-specific. Associations between GWG and maternal and neonatal outcomes varied across pre-pregnancy BMI categories. Women with normal pre-pregnancy BMI demonstrated the most consistent associations with adverse outcomes when gestational weight gain fell outside recommended ranges. These findings suggest that gestational weight management should not focus solely on women at the extremes of BMI, and support BMI-stratified approaches to antenatal weight monitoring and counselling using population-specific guidelines.

BackgroundInflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). While several studies have explored patients’ general knowledge of IBD, less is known about their awareness of CRC risk and its management. This systematic review aimed to synthesize the available evidence on IBD patients’ awareness of CRC risk and its related management strategies.MethodsMedline, EMBASE, and PubMed databases were searched from inception to November 2023. All study designs and publication types were considered. Non–English studies and those assessing only general IBD knowledge were excluded. The appraisal tool for cross-sectional studies (AXIS) was used to assess the quality of studies.ResultsTwenty-three studies (17 papers and 6 conference abstracts), including 4674 participants (2481 with ulcerative colitis, 53.5% females) were included. Overall, 18 studies assessed CRC risk knowledge, 7 reported attitudes toward cancer screening, and 8 explored knowledge or attitude regarding colectomy for dysplasia. Patients demonstrated moderate awareness of CRC risk, limited knowledge of risk factors, and moderate levels of fear regarding this complication. Awareness of the diagnostic role of colonoscopy was high, but attitudes toward the procedure were mixed, largely due to concerns about complications. Awareness of appropriate screening initiation and willingness to undergo colectomy for dysplasia, regardless of the risk level, were generally low.ConclusionsEvidence on IBD patients’ awareness of CRC risk and its management remains limited, restricting firm conclusion about the extent of knowledge and educational needs. Further research is required to better characterize patients’ understanding and to inform targeted education strategies.

The authors declare no conflicts of interest. The data that supports the findings of this study is available in the Supporting Information of this article. Data S1: References contained in Table 1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

In February 2023, twin earthquakes struck 11 provinces in Türkiye, devastating infrastructure and healthcare services. Nurses, as both survivors and frontline responders, faced extreme physical, emotional, and organizational challenges. Their experiences offer critical insights into disaster-related occupational risks and the structural gaps in worker health and safety. This study aims to explore the experiences of nurses working in hospitals affected by the twin earthquakes in Türkiye in 2023. A qualitative, descriptive research design was used. Study participants were selected using purposeful sampling among nurses who experienced the earthquakes and continued working in the affected areas. In-depth online interviews were conducted with 17 nurses, achieving data saturation. The data were analyzed using content analysis, and the COREQ checklist was followed for study reporting. As a result of the analysis, four themes were revealed; (1) earthquake shock, (2) working conditions, (3) living conditions, and (4) family and psychosocial situation. Nurses reported overwhelming psychological strain, unsafe working environments, lack of disaster plans, inadequate managerial support, and severe resource shortages-all of which posed significant threats to worker health and safety.Conclusions/Applications to Practice:This study highlights how nurses' dual roles as victims and caregivers during a large-scale disaster exposed critical vulnerabilities in worker health and safety. The findings underline the urgency of disaster-specific worker health and safety strategies, including trauma-informed mental health care, rapid staff support systems, and safety-oriented organizational planning to protect frontline healthcare workers in emergencies.

As a major systemic insult, cardiac surgery can lead to significant muscle loss, which increases the time to recovery as well as being correlated with mortality. Highly variable loss of muscle mass (0%-40% rectus femoris cross-sectional area [RFcsa]) and strength in the week after surgery has aided understanding of mechanisms of sarcopenia after acute illness. To include muscle recovery, patients' muscle phenotype beyond the first week after surgery and up to their return as outpatients was studied and correlated with protein and metabolomic markers. Patients undergoing elective aortic valve surgery were recruited. Muscle mass (RFcsa), strength (handgrip, knee extension and spirometry), body composition (by bioimpedance) and health-related quality of life (generic questionnaire EQ-5D-5L) were determined pre-operatively, 7 days after surgery and at outpatient follow-up. Blood samples were taken on Days 0, 1, 3, 7 and follow-up. The plasma metabolome was determined in 20 patients at Days 0, 3, 7 and follow-up. Of 31 participants, 20 were male: mean age 68.8 years with a range between 48 and 85 years. Proportionate mean loss of RFcsa between pre-op and Day 7 values was 6.44% [95% CI 4.21 to 8.68, n = 31]; between pre-op and follow-up 9.69% [95% CI 4.92 to 14.96, n = 22]; and between Day 7 and follow-up 3.60% [95% CI -1.30 to 8.48, n = 22]. By contrast to measures of muscle bulk, the strength and functionality assessments (knee extension, handgrip, spirometry and short physical performance battery) decreased in the first week after surgery (pre-op to Day 7) followed by a return to baseline (Day 7 to follow-up). Health-related quality of life (cross-walk index) changed little over the course of the study but correlated positively at follow-up with muscle bulk (RFcsa: r = 0.58 [95% CI 0.19 to 0.81] p = 0.005) and strength of knee extension (r = 0.54 [95% CI 0.14 to 0.79] p = 0.010) and handgrip (r = 0.63 [95% CI 0.27 to 0.83] p = 0.002: n = 22). Both pre-operative and peak (Day 3) plasma levels of short-chain acyl-carnitine markers of mitochondrial dysfunction correlated with proportional muscle loss at follow-up and with strength at all timepoints. Prolonged follow-up after aortic surgery demonstrated a divergence between the consistent recovery of strength and a significant proportion of patients continuing to lose muscle bulk. Markers of baseline and acute mitochondrial dysfunction predicted poor muscle outcomes up to outpatient follow-up.

Background: Several treatments are used in the community to improve secretion clearance for patients with neuromuscular disease (NMD). However, the optimal intervention remains unclear with further research required. We aimed to develop a core outcome set (COS) for studies investigating secretion clearance interventions used in the community by patients with NMD. Methods: We conducted a scoping review, qualitative interviews with patients/family, modified e-Delphi survey, and consensus meeting. We recruited health care professionals, patients, and caregivers. Delphi participants were provided a 9-point Likert scale to score outcomes as "not important" (1- 3), "important but not critical" (4-6), or "critical" (7-9). Those scored as critical for inclusion were discussed at the consensus meeting using nominal group technique methods to achieve final consensus. Results: Ninety participants were recruited for the e-Delphi. Twenty-nine outcomes identified from the scoping review and qualitative interviews were taken forward to Round 1. Eleven additional outcomes were suggested by participants during Round 1. Forty outcomes were presented in Round 2. Sixteen outcomes were voted as critical for inclusion and taken forward to the consensus meeting (20 participants). The final COS includes measured cough strength/power, burden of respiratory illness, patient-reported effectiveness of secretion clearance, patient-reported experience of airway clearance, quality of life, adherence to secretion clearance intervention, and adverse events related to secretion clearance intervention. Conclusions: This COS should now be included in all trials investigating secretion clearance interventions in the community for patients with NMD. Next steps are to identify measurement tools and characteristics such as measurement time points for these outcomes using COSMIN methodology.