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Background Measurements of nursing workload often fail to reflect the complexity of nursing work. Nurses’ perceived workload is shaped by many factors, including patient characteristics, personal, social, organizational, and environmental factors. There is a demonstrated interest in developing more comprehensive nurse workload measurement strategies, but little research has employed qualitative methods to investigate the beliefs and experiences of frontline staff. The purpose of this study was to explore inpatient nurses’ perceptions of their workload and the factors that impact their percieved workload levels. Methods This was qualitative study using focus groups. Participants were recruited from the cardiac floors of an urban, academic medical center. A total of 17 nurses participated, including nurses from bedside, charge, educator, and nurse manager roles. Focus group transcripts were analyzed by a team of qualitative investigators using conventional content analysis. Results Inpatient nurses’ perceived workload is shaped by their work volume, work attributes, and their ability to complete required tasks while providing meaningful, impactful care. The volume of nursing work is comprised of patient-focused, unit-focused, and institutional-focused tasks. Important work attributes include its perceived urgency, difficulty, alignment to the nurse and unit, interference, unpredictability, and individual nursing burden. Overall, participants expressed deep concern over high workloads that compromise holistic nursing care. Conclusion Strategies to more comprehensively measure nurses’ perceived workload should account for the breadth and complexity of nursing work. Nurses should advocate for workload measurement systems that more closely reflect their subjective work experiences. Clinical trial registration number Not applicable.

Objective Few studies have assessed secular changes in the levels of cardiovascular risk factors (CV-RF) in populations of low or middle income countries. The systematic collection of a broad set of both traditional and metabolic CV-RF in 1989 and 2004 in the population of the Seychelles islands provides a unique opportunity to examine trends at a fairly early stage of the \"diabesity\" era in a country in the African region. Methods Two examination surveys were conducted in independent random samples of the population aged 25–64 years in 1989 and 2004, attended by respectively 1081 and 1255 participants (participation rates >80%). All results are age-standardized to the WHO standard population. Results In 2004 vs. 1989, the levels of the main traditional CV-RF have either decreased, e.g. smoking (17% vs. 30%, p < 0.001), mean blood pressure (127.8/84.8 vs. 130.0/83.4 mmHg, p < 0.05), or only moderately increased, e.g. median LDL-cholesterol (3.58 vs. 3.36 mmol/l, p < 0. 01). In contrast, marked detrimental trends were found for obesity (37% vs. 21%, p < 0.001) and several cardiometabolic CVD-RF, e.g. mean HDL-cholesterol (1.36 vs. 1.40 mmol/l, p < 0.05), median triglycerides (0.80 vs. 0.78 mmol/l, p < 0.01), mean blood glucose (5.89 vs. 5.22 mmol/l, p < 0.001), median insulin (11.6 vs. 8.3 μmol/l, p < 0.001), median HOMA-IR (2.9 vs. 1.8, p < 0.001) and diabetes (9.4% vs. 6.2%, p < 0.001). At age 40–64, the prevalence of elevated total cardiovascular risk tended to decrease (e.g. WHO-ISH risk score ≥10; 11% vs. 13%, ns), whereas the prevalence of the metabolic syndrome (which integrates several cardiometabolic CVD-RF) nearly doubled (36% vs. 20%, p < 0.001). Data on physical activity and on intake of alcohol, fruit and vegetables are also provided. Awareness and treatment rates improved substantially for hypertension and diabetes, but control rates improved for the former only. Median levels of the cardiometabolic CVD-RF increased between 1989 and 2004 within all BMI strata, suggesting that the worsening levels of cardiometabolic CVD-RF in the population were not only related to increasing BMI levels in the interval. Conclusion The levels of several traditional CVD-RF improved over time, while marked detrimental trends were observed for obesity, diabetes and several cardiometabolic factors. Thus, in this population, the rapid health transition was characterized by substantial changes in the patterns of CVD-RF. More generally, this analysis suggests the importance of surveillance systems to identify risk factor trends and the need for preventive strategies to promote healthy lifestyles and nutrition.

Health care personnel (HCP) caring for patients with coronavirus disease 2019 (COVID-19) might be at high risk for contracting SARS-CoV-2, the virus that causes COVID-19. Understanding the prevalence of and factors associated with SARS-CoV-2 infection among frontline HCP who care for COVID-19 patients are important for protecting both HCP and their patients. During April 3-June 19, 2020, serum specimens were collected from a convenience sample of frontline HCP who worked with COVID-19 patients at 13 geographically diverse academic medical centers in the United States, and specimens were tested for antibodies to SARS-CoV-2. Participants were asked about potential symptoms of COVID-19 experienced since February 1, 2020, previous testing for acute SARS-CoV-2 infection, and their use of personal protective equipment (PPE) in the past week. Among 3,248 participants, 194 (6.0%) had positive test results for SARS-CoV-2 antibodies. Seroprevalence by hospital ranged from 0.8% to 31.2% (median = 3.6%). Among the 194 seropositive participants, 56 (29%) reported no symptoms since February 1, 2020, 86 (44%) did not believe that they previously had COVID-19, and 133 (69%) did not report a previous COVID-19 diagnosis. Seroprevalence was lower among personnel who reported always wearing a face covering (defined in this study as a surgical mask, N95 respirator, or powered air purifying respirator [PAPR]) while caring for patients (5.6%), compared with that among those who did not (9.0%) (p = 0.012). Consistent with persons in the general population with SARS-CoV-2 infection, many frontline HCP with SARS-CoV-2 infection might be asymptomatic or minimally symptomatic during infection, and infection might be unrecognized. Enhanced screening, including frequent testing of frontline HCP, and universal use of face coverings in hospitals are two strategies that could reduce SARS-CoV-2 transmission.

Background Preeclampsia (PE) affects 2–8% of pregnant women and is a leading cause of maternal and perinatal morbidity and mortality. In high-risk pregnant women, low-dose aspirin (LDA 100—160 mg/day) started before 16 WG reduces the incidence of PE, prematurity, perinatal mortality and low birth weight. First trimester screening of PE allows the identification of a population of pregnant women at high risk of early onset PE and perinatal mortality. It remains unclear whether, on a population scale, the systematic implementation of first trimester screening of PE with treatment of high-risk patients by LDA leads to an improvement of maternal and perinatal health. Methods This multicenter open randomized controlled trial with two parallel groups will include 14,500 pregnant women between 11–14 WG. Eligible women agreeing to participate in the trial will be randomized either to the experimental group with management including screening of PE, or to the control group with usual care without screening of PE. For women in the screening group, the risk of PE will be calculated according to an algorithm combining clinical characteristics, uterine arteries Doppler profile and PlGF concentration. Women with a positive screening test (i.e. predicted risk > 1/100) will receive aspirin at 160 mg/day. For women with negative screening, usual pregnancy monitoring without aspirin will be offered. The primary outcome is a composite of severe perinatal morbidity including at least one of the following: perinatal mortality, birth before 34 WG and birth weight < 3rd centile. Secondary endpoints include maternal morbidity and mental health outcomes, and a cost-effectiveness evaluation. This study will have a 90% power to show a 50% reduction of the primary outcome in at-risk women, expected to represent 10% of the total population in each group, i.e. an overall expected 3% frequency of the primary outcome in the intervention group as a whole versus 4% in the control group. Discussion This large multicenter randomized trial aims to determine with adequate power if the implementation of first trimester PE screening in all pregnant women would decrease the incidence of perinatal mortality, prematurity before 34 WG and birth weight < 3rd centile. Trial registration ClinicalTrials.gov NCT 05521776 (August 30, 2022).

Most persons infected with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), develop virus-specific antibodies within several weeks, but antibody titers might decline over time. Understanding the timeline of antibody decline is important for interpreting SARS-CoV-2 serology results. Serum specimens were collected from a convenience sample of frontline health care personnel at 13 hospitals and tested for antibodies to SARS-CoV-2 during April 3-June 19, 2020, and again approximately 60 days later to assess this timeline. The percentage of participants who experienced seroreversion, defined as an antibody signal-to-threshold ratio >1.0 at baseline and <1.0 at the follow-up visit, was assessed. Overall, 194 (6.0%) of 3,248 participants had detectable antibodies to SARS-CoV-2 at baseline (1). Upon repeat testing approximately 60 days later (range = 50-91 days), 146 (93.6%) of 156 participants experienced a decline in antibody response indicated by a lower signal-to-threshold ratio at the follow-up visit, compared with the baseline visit, and 44 (28.2%) experienced seroreversion. Participants with higher initial antibody responses were more likely to have antibodies detected at the follow-up test than were those who had a lower initial antibody response. Whether decay in these antibodies increases risk for reinfection and disease remains unanswered. However, these results suggest that serology testing at a single time point is likely to underestimate the number of persons with previous SARS-CoV-2 infection, and a negative serologic test result might not reliably exclude prior infection.

To assess the nutritional adequacy of Seychellois children in relation to nutrients reported to be important for cognitive development. Dietary intakes were assessed by 4 d weighed food diaries and analysed using dietary analysis software (WISP version 3·0; Tinuviel Software, UK). Individual nutrient intakes were adjusted to usual intakes and, in order to investigate adequacy, were compared with the UK Estimated Average Requirements for children aged 4-6 years. Children 5 years old were followed up as part of the Seychelles Child Development Nutrition Study (SCDNS), located in the high-fish-consuming population of Mahé, Republic of Seychelles. Analysis was carried out on a sample of 229 children (118 boys, 111 girls). Children consumed a diet of which fortified cereal and milk products contributed the most to nutrient intakes. The majority (≥80 %) of children met requirements for several nutrients important for child development including Fe, folate and Se. Adjusted dietary intakes of Cu, Zn, iodine, niacin and vitamin A were below the Estimated Average Requirement or Recommended Nutrient Intake. Mean adjusted energy intakes (boys 4769 kJ/d (1139·84 kcal/d), girls 4759 kJ/d (1137·43 kcal/d)) were lower than the estimated energy requirement (boys 5104 kJ/d (1220 kcal/d), girls 5042 kJ/d (1205 kcal/d)) for 88 % of boys and 86 % of girls. Nutrition was adequate for most children within the SCDNS cohort. Low intakes of some nutrients (including Zn, niacin and vitamin A) could reflect nutritional database inaccuracies, but may require further investigation. The study provides valuable information on the adequacy of intakes of nutrients which could affect the growth and development of Seychellois children.

This article reviews the different steps taken during the past 20 years for the prevention and control of non-communicable diseases (NCDs) in the Seychelles. National surveys revealed high levels of several cardiovascular risk factors and prompted an organized response, starting with the creation of an NCD unit in the Ministry of Health. Information campaigns and nationwide activities raised awareness and rallied increasingly broad and high-level support. Significant policy was developed including comprehensive tobacco legislation and a School Nutrition Policy that bans soft drinks in schools. NCD guidelines were developed and specialized ‘NCD nurses’ were trained to complement doctors in district health centers. Decreasing smoking prevalence is evidence of success, but the raising so-called diabesity epidemic calls for an integrated multi-sector policy to mould an environment conducive to healthy behaviors. Essential components of these efforts include: effective surveillance mechanisms supplemented by focused research; generating broad interest and consensus; mobilizing leadership and commitment at all levels; involving local and international expertise; building on existing efforts; and seeking integrated, multi-disciplinary and multi-sector approaches.

In most vertebrate neurons, action potentials are triggered at the distal end of the axon initial segment (AIS). Both position and length of the AIS vary across and within neuron types, with activity, development and pathology. What is the impact of AIS geometry on excitability? Direct empirical assessment has proven difficult because of the many potential confounding factors. Here, we carried a principled theoretical analysis to answer this question. We provide a simple formula relating AIS geometry and sodium conductance density to the somatic voltage threshold. A distal shift of the AIS normally produces a (modest) increase in excitability, but we explain how this pattern can reverse if a hyperpolarizing current is present at the AIS, due to resistive coupling with the soma. This work provides a theoretical tool to assess the significance of structural AIS plasticity for electrical function.

We present measurements of black hole masses and Eddington ratios (λ Edd) for a sample of 38 bright (M 1450 < −24.4 mag) quasars at 5.8 ≲ z ≲ 7.5, derived from Very Large Telescope/X–shooter near–IR spectroscopy of their broad C iv and Mg ii emission lines. The black hole masses (on average, M BH ∼ 4.6 × 109 M ⊙) and accretion rates (0.1 ≲ λ Edd ≲ 1.0) are broadly consistent with that of similarly luminous 0.3 ≲ z ≲ 2.3 quasars, but there is evidence for a mild increase in the Eddington ratio above z ≳ 6. Combined with deep Atacama Large Millimeter/submillimeter Array (ALMA) observations of the [C II] 158 μm line from the host galaxies and VLT/MUSE investigations of the extended Lyα halos, this study provides fundamental clues to models of the formation and growth of the first massive galaxies and black holes. Compared to local scaling relations, z ≳ 5.7 black holes appear to be over-massive relative to their hosts, with accretion properties that do not change with host galaxy morphologies. Assuming that the kinematics of the T ∼ 104 K gas, traced by the extended Lyα halos, are dominated by the gravitational potential of the dark matter halo, we observe a similar relation between black hole mass and circular velocity as reported for z ∼ 0 galaxies. These results paint a picture where the first supermassive black holes reside in massive halos at z ≳ 6 and lead the first stages of galaxy formation by rapidly growing in mass with a duty cycle of order unity. The duty cycle needs to drastically drop toward lower redshifts, while the host galaxies continue forming stars at a rate of hundreds of solar masses per year, sustained by the large reservoirs of cool gas surrounding them.