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Alcohol in the Workplace: A Qualitative Study of Employees' Experiences With Employer-Supported Alcohol Treatment.

Pistone I et al. · Jul 1, 2026

Introduction Alcohol use disorder is a major public health issue, impacting health, well-being, relationships and work performance. In Sweden, employers are legally required to provide access to and cover the cost of alcohol treatment for individuals with alcohol use disorder. Employer-supported alcohol treatment is therefore rather common in Sweden; however, research on employees' experiences with this type of treatment remains unexplored. This qualitative study investigates how a group of Swedish employees who had received employer-supported alcohol treatment experienced workplace management before, during and after treatment. Method Interviews with 15 participants were analysed using thematic analysis, revealing three key themes. Results The first theme highlights that many participants viewed their employer as a lifeline, experiencing relief when they received support to seek help for their alcohol problems. The second theme captures employees' reliance on their employer's ability to handle the situation, emphasising the crucial role managers play in the process, with varying levels of competence and support. Third, participants often felt alone upon returning to work, facing a discrepancy between their expectations of support and the actual workplace support provided post-treatment. Discussion and conclusions The findings show how employer-supported treatment may facilitate access to care and workplace reintegration under relatively favourable circumstances, particularly when supported by managerial competence, clear routines and continued follow-up.

Medicine

Mental Health Outcome Trends in a Nationally Representative Sample of Canadian Migrant Adolescents From 2014 to 2022.

Ji D et al. · Jul 1, 2026

Background Migrant youth are at disproportionate risk of mental health challenges. Overcoming barriers to accessing services requires large-scale data to inform policies and interventions. This study maps mental health outcome trends of migrant youth over 8 years. Methods Canadian Health Behavior in School-aged Children study data from 2014, 2018, and 2022 were analyzed for mental health outcome trends. Age-adjusted logistic regressions examined health across years stratified by migrant status, separately by sex. Using nonmigrants as the referent group and 2014 as the referent year, contrasts for disparities were examined across migrant status to test widening, narrowing, or stability in differences of outcome prevalences between migrant and nonmigrant youth. Results Health worsened from 2014 to 2022 among migrants, especially migrant girls. Compared to 2014, life satisfaction, health, and self-confidence for migrant youth dropped in 2022. Health complaints and feeling sad/hopeless increased in 2022 among girls. Migrant youth reported fewer health complaints than nonmigrants in 2018 and 2022. Implications Investment in free/affordable, culturally safe/relevant, confidential school-based mental health supports with avenues for community collaboration are recommended. Conclusions Mental health outcomes worsened from 2014 to 2022, especially among migrants and girls; however, migrant youth exhibit resilience to adversity.

Psychology

Fall risk assessment scale for hemodialysis patients (ERQUE_HD): development and validation.

Farina VA et al. · Jul 1, 2026

Introduction Hemodialysis patients present multiple comorbidities and complications during therapy, factors that increase the risk of falls. Adequate risk assessment is essential for implementing effective preventive measures. Objective To develop and validate a scale for assessing fall risk in hemodialysis patients. Method A methodological study with quantitative and qualitative approaches, conducted in five stages: integrative review, focus groups, instrument development, content validation, and scale validation. Results The integrative review included 17 articles and supported the initial item development. Nine focus groups with patients and healthcare professionals enabled the identification of additional risk factors, resulting in the construction of the ERQUE_HD (Fall Risk Assessment Scale for Hemodialysis Patients), composed of 17 items distributed across four domains: health history, dialysis-related factors, functional capacity, and nutrition. Content validation reached a content validity index (CVI) of 0.95, considered highly satisfactory. The scale was then applied to 66 patients and analyzed using logistic regression with generalized estimating equations (GEE), including variables such as post-dialysis fatigue, interdialytic weight gain, and intradialytic hypotension. Patients classified as high-risk were 8.7 times more likely to experience falls compared to the moderate-risk group. The ERQUE-HD demonstrated good accuracy (AUC = 0.817). Post-dialysis fatigue and interdialytic weight gain >4% were identified as significant fall predictors. Conclusion The ERQUE-HD proved to be effective in assessing and predicting fall risk among hemodialysis patients.

Medicine

Helping families thrive while developing a strong working alliance: The benefits of Recipe 4 Success.

Braaten SM et al. · Jul 1, 2026

This study explored whether the strength of parent-home visitor working alliances might alter the benefits of Recipe 4 Success, a highly structured food-based curriculum designed to promote parents' sensitive scaffolding, responsive food parenting practices, toddlers' self-regulation, and healthy eating habits. This study included 242 parents and their toddlers residing in the United States, most of whom were living in poverty (37% white, 25% Black, 19% Latiné, 17% Multiracial, and 2% Asian; median income = $1555 per month). Families were randomly assigned to Recipe 4 Success or usual practice home visits within home visitor caseload. Home visitors tended to rate their working alliance as very strong versus less strong. Within-group regression equations revealed that, among families with a less strong working alliance, Recipe 4 Success was more effective than usual practice home visits in improving parents' sensitive scaffolding, responsive food parenting practices, and toddlers' self-regulation. In contrast, among families who had a strong working alliance, Recipe 4 Success was more effective than usual practice home visits in changing toddlers' healthy eating habits, including reducing body mass index for toddlers with overweight/obesity. These findings highlight how families with varying strengths of working alliances may benefit differently from highly structured evidence-based curricula.

Medicine

Prevalence, Disease Onset and Clinical Outcome in Arginase 1 Deficiency: Cross-Border Surveillance in Germany, Austria, and Switzerland.

Scharre S et al. · Jul 1, 2026

Arginase 1 deficiency (ARG1-D) is an ultra-rare urea cycle disorder characterized by progressive spastic paraplegia, developmental delay, epilepsy, and episodic hyperammonemia. Evidence on prevalence and clinical presentation is scarce. Therefore, epidemiology and the phenotypical spectrum were assessed in Germany, Austria, and Switzerland (DACH region). We conducted a questionnaire-based, cross-sectional study of confirmed ARG1-D patients in the DACH region. Patients were stratified into early-diagnosed (newborn screening [NBS] or high-risk family screening [HR]) and diagnosed after symptom onset. We evaluated clinical, biochemical, and therapeutic characteristics of individuals with confirmed ARG1-D. Epidemiological prevalence estimates were derived using national population data. A total of 20 patients were identified (Germany: 12, Austria: 7, Switzerland: 1). Eight were diagnosed early (NBS: 4, HR: 4) and 12 after symptom onset. Symptomatically diagnosed patients (median age 11 years) presented with a broad range of clinical manifestations, specifically progressive spastic paraplegia (67%), epilepsy (58%), dystonia (46%), developmental delay (58%), and hepatopathy (50%). Median age at diagnosis was 35 months in symptomatic patients versus 1 month in early-diagnosed patients (p = 0.03). Estimated pediatric prevalence was 1:1042080 in the DACH region, with high regional differences. Hyperammonemia was reported in 72%. Enzyme therapy had been initiated in 21%; 2 patients underwent liver transplantation. ARG1-D is a rare disease with a prevalence of approximately 1:1000000 individuals, and a complex and progressive clinical phenotype. Detection via NBS or HR allows early diagnosis and treatment initiation, potentially altering the clinical outcome.

Biochemistry, Genetics and Molecular Biology

Acute Effect of Percussive Massage on Cross-Section Area, Muscle Strength, and Late Muscle Pain of the Quadriceps Muscle Following a Fatigue Protocol in Physically Active Men: Randomized Clinical Trial.

da Rosa Castilho A et al. · Jul 1, 2026

Background and purpose The massage gun is widely used to alleviate delayed-onset muscle soreness (DOMS); however, empirical evidence regarding its physiological effects remains limited. Objectives This study aimed to evaluate the acute effects of percussive massage on the quadriceps muscle's cross-sectional area (CSA), strength performance, and pain perception following a fatigue protocol. Methods A randomized clinical trial was conducted including 37 physically active men. Participants performed a fatigue protocol on a 45° leg press, at 70% of their one-repetition maximum (1RM). The volunteers were allocated to an intervention group (G0 n = 19, mean ± SD; 25.7 ± 4.5 years, 83.7 ± 10.6 kg, 176.8 ± 6.3 cm) and control group (G1 n = 18, mean ± SD; 27.6 ± 5.0 years, 76.8 ± 15.7 kg, 174 ± 7.3 cm). Assessments were performed at baseline, 24 and 48 h, using ultrasound imaging, isometric dynamometer and VAS questionnaire (visual analog pain scale). Results Regarding the muscle area, significant increases were observed in the control group p 2.0) in strength maintenance at 24 and 48 h compared to G1. Both groups showed reduction in pain over time, while G0 demonstrated a significant decrease at 48 h compared to 24 h (53%, p Conclusion Within-group assessments revealed significant reductions in pain perception over time for the intervention group. Regarding muscle strength, despite a large exploratory effect size observed during recovery, no statistically significant between-group superiority over passive rest was established. The findings suggest potential preliminary benefits for symptom relief without acute performance deficits.

Medicine

Accuracy and Documentation of Richmond Agitation-Sedation Scale Assessments in a Cardiothoracic Critical Care Unit: A Prospective, Cross-Sectional Audit.

Szentgyorgyi L et al. · Jul 1, 2026

Background Sedation is a fundamental component of critical care and requires regular, accurate assessment to support its safe titration and minimise harm. International guidelines and local policy at the Wythenshawe Hospital's Cardiothoracic Critical Care Unit mandate hourly documentation of the Richmond Agitation-Sedation Scale (RASS). Aims This audit evaluated adherence to these standards and explored factors associated with documentation completeness and assessment accuracy. Study design A prospective, cross-sectional audit of bedside RASS assessment was conducted without prior notification. Nursing RASS scores were compared with expert auditor ratings. Data were collected using an anonymous, secure, auditor-completed online survey. Statistical analysis examined the relationship between documentation completion and RASS accuracy. Results Seventy-six nursing assessments were included. Most nurses were Band 5, with a median of 3.5 years of experience. Patients were predominantly male, mechanically ventilated and receiving sedation. Overall, 75% of nurse RASS assessments (n = 57) were accurate; however, only 33% (n = 25) were documented hourly as required by policy. Greater nursing experience was associated with improved accuracy in RASS. Deeper sedation was associated with lower agreement between nurse and expert assessments. Higher self-reported confidence was associated with poorer completion of documentation. Most discrepancies were small, with nurse and expert ratings differing by one RASS point. Conclusions This audit identified important gaps in the accuracy and documentation of nurse-led RASS assessment in a cardiothoracic critical care setting. The findings suggest that perceived familiarity and confidence may not be sufficient to ensure accurate and consistently documented sedation assessment. Relevance to clinical practice Suboptimal RASS documentation and scoring accuracy may limit reliable titration of sedation in critically ill patients and reduce the effectiveness of protocolised sedation strategies. These findings support targeted staff education, reinforcement of standardised assessment processes and improvements in documentation systems to strengthen sedation monitoring and patient safety.

Medicine

Lean, Non-Autoimmune Young-Onset Diabetes in Bangladesh: A Metabolically Obese Phenotype With Disproportionate Insulin Secretory Defect.

Hasan M et al. · Jul 1, 2026

Background Young-onset diabetes in South Asians frequently manifests in lean individuals, but the metabolic drivers of this phenotype remain poorlycharacterised. Objective This study aimed to evaluate the clinical, biochemical, and insulin-related indices of lean, non-autoimmune young-onset diabetes mellitus (DM) among Bangladeshi young adults. Methods This comparative cross-sectional study (2023-2024) enrolled 373 participants (aged 18-34 years) categorised into four groups based on glycemic status and body mass index (BMI): Lean DM (n = 53), obese DM (n = 125), lean non-DM (n = 78), and obese non-DM (n = 117) from the Young-diabetes Clinic of the Department of Endocrinology, Bangladesh Medical University, Dhaka after excluding those with positive islet autoantibodies, low C-peptide, pancreatic pathology, and monogenic variants. β-cell function (HOMA2-B) and insulin resistance (HOMA2-IR) were quantified using the HOMA2 C-peptide calculator. Results Lean DM participants were comparable to other groups in age, sex, and family history, though smoking was more prevalent than in lean controls (p Conclusion Lean young-onset diabetes in Bangladesh appears to be a phenotype of disproportionate insulin secretory defect with only modest insulin resistance and metabolic dysfunction. These features highlight the need for targeted screening and individualised management.

Biochemistry, Genetics and Molecular Biology

Feasibility of a field-based submaximal stair ascent test for estimating aerobic capacity and lower-limb strength in middle-aged and older adults.

Hyvärinen M et al. · Jul 1, 2026

Background Assessing functional capacity is a key aspect of exercise testing and offers important insights into health in adult populations. However, accurate assessment often requires laboratory-based maximal tests. This pilot study investigated whether a field-based self-paced submaximal stair ascent test could feasibly assess aerobic capacity and lower-limb strength in middle-aged and older adults. Methods Twenty-eight participants (20 women, 8 men) aged 40 to 70 years completed maximal treadmill and isometric leg press tests to assess maximal oxygen consumption (VO 2 max) and lower-limb strength, respectively. Participants also performed two separate self-paced stair ascents of four and six flights. Ascent time, mean vertical power, as well as rate of perceived exertion, absolute heart rate, and relative heart rate following the test were recorded. Results Ascent time and mean vertical power were associated with VO 2 max and lower-limb strength, with standardized regression coefficients ranging from -0.61 to -0.27 and from 0.41 to 0.73, respectively. However, these associations were attenuated and no longer statistically significant after controlling for age and sex. Predictive models based on the two best-performing stair ascent predictors selected by LASSO regression showed weak-to-moderate ability to predict VO 2 max (R 2 = 0.21-0.52) with cross-validated model performance significantly different from zero. In contrast, the models did not significantly predict lower-limb strength. Conclusions These preliminary findings suggest that a brief self-paced stair ascent test may offer a feasible field-based approach for estimating aerobic capacity in middle-aged and older adults. However, its predictive accuracy appears limited and should be further examined in larger samples.

Medicine

Crossing Borders of Care: The Professionalization of Women in Nursing and China-US Collaboration at Xiangya, 1909-1926.

Tang Y et al. · Jul 1, 2026

This article examines the development of modern nursing education in China through a case study of the Xiangya School of Nursing in Changsha between 1909 and 1926. Founded in 1911 by the Yale-in-China Association, a non-denominational mission, Xiangya was among the earliest nursing schools in China to promote undergraduate nursing education and public health nursing. Drawing on archival materials, published primary sources, and Chinese and English historiography, we analyze the cultural, political, and gendered challenges that shaped the school's development under the leadership of American nurse Nina Gage. While Gage initially sought to implement an Americanized model of nursing education, she and her colleagues adapted admission policies, educational goals, and curricula to local social and cultural conditions. Recognizing the need for Chinese nursing leadership, they prioritized the establishment of a Bachelor of Science degree to prepare nurses for teaching, administration, and public health roles. By 1926, Xiangya had trained approximately 16% of China's qualified nurses and had become one of only two schools in China offering university-level nursing education. This history highlights the interplay of transnational influence, cultural adaptation, and gendered reform in the professionalization of nursing in early 20th-century China.

Nursing