SAGE Open Medicine最新文献

{"title":"Accelerating autism prevalence in California with changepoint in the mid-2010s and divergence by county and socioeconomic indicators.","authors":"Cynthia Nevison, Walter Zahorodny","doi":"10.1177/20503121261490679","DOIUrl":"10.1177/20503121261490679","url":null,"abstract":"<p><strong>Background/objectives: </strong>The Autism and Developmental Disabilities Monitoring (ADDM) network has observed an ongoing increase in autism spectrum disorder (ASD) among U.S. children, with highest prevalence in California. Recent county-level trends in California were analyzed to provide insight into this increase.</p><p><strong>Methods: </strong>ASD prevalence was estimated from the California Department of Developmental Services (DDS) ASD caseload in 2025, stratified by county, race/ethnicity, and age across birth years 1993-2020. Denominators were estimated from the mean of public school and U.S. census data.</p><p><strong>Results: </strong>Diagnosed ASD prevalence increased among all race/ethnicity groups across this period, with a strong uptick in the mid-2010s, most commonly in birth year 2016, in many low and middle income counties. The estimated values varied widely by county and by race/ethnicity, ranging from 1.2% ± 0.2% in San Mateo to 9.5 ± 1.3% in Los Angeles among white and black children, respectively, born in 2019. The rate of change in diagnosed prevalence from birth year 2015-2019 was significantly correlated to county Medicaid (Medi-Cal) fraction for Hispanics and all races, although this ecological association could not distinguish individual-level risk. Comparison of diagnosed ASD prevalence in San Diego County between DDS and ADDM (for which California is represented by San Diego) suggested that DDS tends to underestimate total ASD, likely because it represents the more severely affected subset. Within DDS, diagnosed prevalence trends in San Diego captured statewide California trends relatively well but prevalence was about 20% higher in San Diego by birth year 2019.</p><p><strong>Conclusions: </strong>Diagnosed ASD prevalence has risen unequally across California counties and race/ethnicity groups since the birth years of the mid-2010s, with the steepest increases in low and middle income counties. Understanding these patterns and disentangling true increases in ASD from diagnostic changes are urgent priorities for future research.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261490679"},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived barriers to research engagement among anesthesia care providers in Saudi Arabia: A cross-sectional study.","authors":"Faraj K Alenezi, Abeer Samman, Rahaf Fahad Alsawilem, Mohammed M Alqahtani, Mohammed A Almeshari, Abdulrhman Yazeed Gazwani, Mohmad H Alsabani, Lafi H Olayan, Mohammed K Al Harbi","doi":"10.1177/20503121261488886","DOIUrl":"10.1177/20503121261488886","url":null,"abstract":"<p><strong>Background: </strong>Research engagement among healthcare professionals is essential for advancing evidence-based practice and improving patient outcomes. In anesthesia, research informs perioperative safety, clinical decision-making, and innovation. This study aimed to identify and describe perceived barriers to research engagement among anesthesia care providers in Saudi Arabia, a population not previously examined in this setting.</p><p><strong>Methods: </strong>A descriptive, cross-sectional survey was conducted between January and August 2025 among anesthesia technicians, technologists, anesthesiologists, and academicians across Saudi Arabia. A structured, web-based questionnaire assessed demographic characteristics and perceived barriers across three domains: personal/professional, workplace, and institutional factors. Data were analyzed using descriptive statistics and are presented as median (interquartile range [IQR]) or frequency (%).</p><p><strong>Results: </strong>A total of 120 participants completed the survey. The median age was 34 years (IQR 27-39), and 79% (95/120) were male. Although 75% (90/120) reported motivation to engage in research and 69% (83/120) perceived adequate research skills, only 41% (49/120) reported having dedicated research time. Administrative workload limited research productivity for 47% (56/120) of participants, and only 23% (28/120) reported protected workplace research time. At the institutional level, 43% (52/120) reported financial support for research, whereas 57% (68/120) agreed that institutional resources were sufficient. Structural constraints were reported more frequently than lack of individual motivation.</p><p><strong>Conclusion: </strong>Despite strong research motivation, anesthesia care providers in Saudi Arabia face substantial structural barriers. Addressing protected time, mentorship, and institutional support may strengthen research engagement and foster a sustainable research culture within anesthesia departments.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261488886"},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual and reproductive health service utilization and associated factors among in-school female adolescents in the Harari region, Eastern Ethiopia: A mixed-methods study.","authors":"Abdi Shafi, Lemessa Oljira, Merhawi Gebremedhin","doi":"10.1177/20503121261486638","DOIUrl":"10.1177/20503121261486638","url":null,"abstract":"<p><p>Adolescents, especially females, are vulnerable to a wide range of sexual and reproductive health problems, including early marriage, unintended pregnancy, unsafe abortion, and sexually transmitted infections, including HIV/AIDS. Despite the increased vulnerability, they often have limited access to sexual and reproductive health services that focus on the special needs of female adolescents. This study aimed to assess sexual and reproductive health service utilization and its associated factors among in-school female adolescents in the Harari Region, Eastern Ethiopia. <b>Methods:</b> A school-based mixed-method cross-sectional study was conducted among female adolescents aged 15-19 years. A total of 456 participants were selected using a simple random sampling technique from eight randomly selected secondary schools, of whom 446 provided complete data. For the qualitative study, 10 participants were purposively selected for interviews. Quantitative data were collected using a structured, pretested, self-administered questionnaire and analyzed with SPSS version 26 after entry into EpiData version 4.6. Bivariable and multivariable logistic regression analyses were performed, with significance set at p < 0.05. Qualitative data were collected using in-depth interviews, analyzed thematically, and integrated with quantitative findings. <b>Results:</b> A total of 446 completed the survey questionnaire, constituting a response rate of 97.8% (446/456). Among those who completed the survey, 27.8% (95% CI: 23.8-32.1) utilized SRH services. Being in grades 11-12 (AOR = 2.17, 95% CI: 1.29-3.63), not living with family (AOR = 4.36, 95% CI: 2.63-7.27), participation in school clubs (AOR = 4.47, 95% CI: 2.68-7.45), exposure to SRH information (AOR = 2.54, 95% CI: 1.39-4.62), and awareness of SRH service-providing facilities (AOR = 2.23, 95% CI: 1.31-3.77) were significantly associated with the utilization of SRH services. Qualitative findings revealed key barriers such as limited awareness, inconvenient service hours, cultural taboos, parental control, and concerns about privacy. <b>Conclusion:</b> Sexual and reproductive health services utilization among female students in the Harari Region was suboptimal (27.8%). Health facilities and schools should work coordinately to enhance the utilization of sexual and reproductive health services among adolescents.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261486638"},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive values of IGF1, IGFBP3 and PCT for patients with sepsis-induced acute respiratory distress syndrome.","authors":"Yanhuo Xia, Yihua Dong, Songzan Qian, Qiuling Tong","doi":"10.1177/20503121261488572","DOIUrl":"10.1177/20503121261488572","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the predictive value of serum IGF1, IGFBP3 and PCT for the development and prognosis of sepsis-induced ARDS.</p><p><strong>Methods: </strong>A total of 276 septic patients enrolled were divided into an ARDS group (144 cases) and a non-ARDS control group (132 cases). On admission, APACHE II and SOFA Scores were calculated, and serum PCT, IGF1, and IGFBP3 were measured. The differences of clinical and biomarkers between groups were analyzed using a Mann-Whitney <i>U</i> test. Multivariable logistic regression was used to screen independent risk factors for sepsis-induced ARDS and its mortality. ROC curves were used to evaluate the predictive value of single and combined biomarkers for the occurrence of ARDS in septic patients.</p><p><strong>Results: </strong>Compared with controls, patients with sepsis-induced ARDS exhibited significantly lower serum IGFBP3 and IGF1 but higher PCT concentrations. Serum IGFBP3 was negatively correlated with APACHE II scores (<i>r</i> = -0.20, <i>P</i> = 0.019), while serum PCT was positively correlated with both SOFA (<i>r</i> = 0.26, <i>P</i> = 0.0014) and APACHE II scores (<i>r</i> = 0.24, <i>P</i> = 0.044). Septic shock, elevated SOFA score, increased PCT and reduced IGF1 were independent risk factors for sepsis-induced ARDS. The combination of IGF1, PCT and SOFA score achieved an AUC of 0.80, superior to any single indicator alone. Among ARDS patients, non-survivors presented markedly lower serum IGF1 and IGFBP3 levels than survivors, with no intergroup difference in serum PCT. Higher serum IGFBP3 was independently associated with lower odds of mortality.</p><p><strong>Conclusion: </strong>Aberrant expressions of circulating IGF1, IGFBP3 and PCT are closely linked to the severity in patients with sepsis-induced ARDS. The combination of serum PCT and IGF1, and SOFA scores had a good predictive performance for identifying septic patients at high risk of ARDS. Serum IGFBP3 can serve as a valuable biomarker to evaluate the outcomes of sepsis-induced ARDS.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261488572"},"PeriodicalIF":2.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intention to use future contraception after abortion and associated factors among women visiting health facilities in Debre Markos town, Northwest Ethiopia, 2024.","authors":"Mamaru Tilahun Afework, Setarg Ayenew Birhanie, Zigale Hibstu Teffera, Mulatu Kassahun","doi":"10.1177/20503121261487541","DOIUrl":"10.1177/20503121261487541","url":null,"abstract":"<p><strong>Background: </strong>Intention to use future contraception after abortion refers to a woman's expressed plan to use a contraceptive method after abortion. Inadequate family planning counselling and limited access to contraceptive services among post-abortion women may increase the risk of repeated unintended pregnancies and induced abortions. Although the Ethiopian Ministry of Health has integrated safe abortion care with post-abortion family planning services, abortion rates remain high and contraceptive utilization remains low in many areas, including the study setting. Limited evidence exists regarding women's intention to use future contraception after abortion in Debre Markos town. This study assessed the intention to use future contraception after abortion and its associated factors among women receiving abortion services in health facilities of Debre Markos town, Northwest Ethiopia.</p><p><strong>Methods: </strong>An institution-based cross-sectional study was conducted among 326 women selected by consecutive sampling. Data were collected using a structured, pretested interviewer-administered questionnaire, entered into EpiData 4.6, and analysed using Stata 17. Binary logistic regression was performed. Variables with <i>p</i> ≤ 0.25 in bivariable analysis were included in the multivariable model. Model fitness was assessed using the Hosmer-Lemeshow test (<i>p</i> = 0.53), and multicollinearity was evaluated using the variance inflation factor (VIF < 2).</p><p><strong>Results: </strong>The proportion intending to use future contraception after abortion was 70.2% (95% CI: 65.0%-75.2%). Higher educational status (AOR = 4.42; 95% CI: 1.34-14.48), unintended pregnancy (AOR = 5.00; 95% CI: 1.29-19.36), desire to avoid pregnancy for at least six months (AOR = 8.14; 95% CI: 3.10-21.38), favourable attitude (AOR = 6.25; 95% CI: 2.31-16.89), and good knowledge (AOR = 7.99; 95% CI: 3.00-21.30) were positively associated with intention. Spontaneous abortion (AOR = 0.15; 95% CI: 0.02-0.52) and not receiving the preferred contraceptive method (AOR = 0.13; 95% CI: 0.05-0.34) were negatively associated.</p><p><strong>Conclusion: </strong>Seven in ten women intended to use future contraception after abortion. Educational status, unintended pregnancy, desire to delay pregnancy, favourable attitude, and good knowledge increased intention, whereas spontaneous abortion and not receiving the preferred contraceptive method reduced intention.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261487541"},"PeriodicalIF":2.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-fatal health outcomes of anxiety disorders in Ethiopia, from 1990 to 2023.","authors":"Sebsibe Tadesse, Musa Jemal, Abdulbasit Sherfa, Begetayinoral Kussia Lahole, Sewhareg Belay, Asqual Gebreslassie Gebremariam, Gelgelo Wodessa, Abinet Zewudie, Gemechis Tuke","doi":"10.1177/20503121261486073","DOIUrl":"10.1177/20503121261486073","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to provide an updated and comprehensive estimate of the non-fatal burden of anxiety disorders in Ethiopia from 1990 to 2023.</p><p><strong>Methods: </strong>This study analyzed the burden of anxiety disorders in Ethiopia using the Global Burden of Diseases (GBD) 2023 estimates. Incidence, prevalence, and years lived with disability (YLDs) were estimated using a Bayesian meta-regression tool for disease modeling (DisMod-MR 2.1).</p><p><strong>Results: </strong>There were a total of 589,076 new cases (95% UI: 408,183-856,726) and 5,222,731 prevalent cases (95% UI: 3,863,241-7,156,038) of anxiety disorders in Ethiopia in 2023, which resulted in 627,465 YLDs (95% UI: 391,935-951,877). The age-standardized rates of anxiety disorders were 512 new cases per 100,000 population (95% UI: 362-689), 4763 prevalent cases per 100,000 population (95% UI: 3535-6068), and 564 YLDs per 100,000 population (95% UI: 367-831). Sub-nationally, the rates were uniformly distributed by sex. The highest rates were estimated among adolescents. The rates remained similar from 1990 to 2019 and then experienced an upward increase thereafter. Compared to the rates in 1990, there was an increase in the ASPR and ASYLDs in 2023.</p><p><strong>Conclusion: </strong>This study revealed that anxiety disorders posed a significant and escalating public health burden in Ethiopia, with adolescents being disproportionately impacted. Policies to prevent anxiety disorders should emphasize improving early detection and care, strengthening adolescent-focused services, and implementing uniform interventions across the country.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261486073"},"PeriodicalIF":2.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, multidrug resistance patterns, and carbapenemase-encoding genes of carbapenemase-producing <i>Klebsiella pneumoniae</i> and <i>Escherichia coli</i> from clinical and non-clinical samples in Ethiopia: Systematic review and meta-analysis.","authors":"Chalachew Genet, Wendemagegn Enbiale, Anna Rommerskirchen, Addisu Melese, Baye Yirga Adugna, Zeleke Ayenew, Hiwot Tadesse, Bayeh Abera, Endalkachew Nibret, Abaineh Munshea Abitew","doi":"10.1177/20503121261488385","DOIUrl":"10.1177/20503121261488385","url":null,"abstract":"<p><strong>Background: </strong>Carbapenems are considered the last resort to treat life-threatening bacterial infections. However, their efficacy is increasingly compromised by carbapenemase-producing <i>K. pneumoniae</i> (CPKP) and <i>Escherichia coli</i> (CPEC). Although these organisms have been reported in Ethiopia, the overall burden and distribution of carbapenemase-encoding genes remain unclear. This study aims to determine the pooled prevalence of CPKP and CPEC from both clinical and non-clinical samples in Ethiopia and to identify the most common carbapenemase-encoding genes.</p><p><strong>Methods: </strong>A systematic search was conducted in electronic databases for studies published in English up to June 30, 2025. The review followed PRISMA guidelines and included 44 eligible studies. Quality assessment was performed using the Joanna Briggs Institute (JBI) checklist. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) software version 2, applying a random-effects model to estimate pooled prevalence. Heterogeneity and publication bias were evaluated using the I² statistic, funnel plot, and Egger's test.</p><p><strong>Results: </strong>The pooled prevalence of CPKP and/or CPEC in Ethiopia was 8.3% (95% CI: 6.3-10.9; I² = 86.41, p < 0.001), with a higher prevalence in non-clinical samples (13.3%) than in clinical ones (8%). Six studies reported 60 carbapenemase-encoding genes in 51 <i>K. pneumoniae</i> isolates. The most dominant resistant gene was the <i>bla</i> _NDM metallo-β-lactamase type, accounting for 85%. The pooled prevalence of multidrug-resistant <i>E. coli</i> and/or <i>K. pneumoniae</i> reported by studies included in the review was 78.4% (95% CI = 71-84.2, I² = 96.10, p< 0.001).</p><p><strong>Conclusions: </strong>This study reveals a high pooled prevalence of CPKP and CPEC in Ethiopia and high dominance of the <i>bla</i> _NDM carbapenemase gene. These findings underscore the need for enhanced antimicrobial resistance surveillance, infection prevention strategies, and stewardship interventions across both clinical and environmental settings.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261488385"},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women's health insurance and institutional delivery in Nepal: Results of the 2022 Nepal demographic Health Survey.","authors":"Mohan Kumar Sharma, Ramesh Adhikari, Samjhana Subedi","doi":"10.1177/20503121261488606","DOIUrl":"10.1177/20503121261488606","url":null,"abstract":"<p><strong>Background: </strong>The Government of Nepal introduced a Health Insurance (HI) program in 2017 to prevent citizens from falling into poverty due to health care costs. This study aimed to assess the association between HI coverage and institutional coverage and institutional delivery among women in Nepal.</p><p><strong>Methods: </strong>This cross-sectional study used secondary data from the Nepal Demographic and Health Survey (NDHS) 2022, conducted every five years since 1996. A total of 1,056 women who had given birth in the past year were included in the analysis. Statistical significance was assessed at the p < 0.05 level. Data analysis was performed using IBM SPSS Statistics version 25.</p><p><strong>Results: </strong>Women covered by HI were more likely to deliver at Health Facilities (HF) within the past year (cOR = 5.775; 95% confidence interval (CI): 2.347 to 14.212; P < 0.001). Women with secondary or higher education were more likely to give birth at an HF (aOR = 3.130; 95% CI: 1.744 to 5.618; P < 0.001). Women residing in Koshi and Madesh provinces were less likely to give birth at HF (aOR = 0.399; 95% CI: 0.177 to 0.901; P < 0.05) and (aOR = 0.198; 95% CI: 0.083 to 0.476; P < 0.001), respectively, compared to those in Bagmati province. Women in the poorer and middle wealth index categories were more likely to give birth at HF (aOR = 1.701; 95% CI: 1.021 to 2.833; P < 0.05) and (aOR = 2.597; 95% CI: 1.461 to 4.615; P < 0.01), respectively.</p><p><strong>Conclusions: </strong>HI coverage, educational level, province, and wealth index were significantly associated with the delivery practice for their most recent child at HF. To increase the use of HF during delivery, targeted interventions addressing educational and economic disparities, particularly in provinces with lower utilization, are needed.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261488606"},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoring architecture and transparency in healthcare accreditation: A scoping review of measurement design and signalling effects.","authors":"Arjavi Patel, Bhavinkumar Parmar, Sankalp Sagar","doi":"10.1177/20503121261484447","DOIUrl":"10.1177/20503121261484447","url":null,"abstract":"<p><strong>Background: </strong>Healthcare accreditation is widely adopted to improve quality and strengthen institutional credibility. Although research has examined its associations with organisational processes and clinical outcomes, the internal structure of accreditation decisions remains poorly understood. Specifically, the scoring, weighting, and aggregation processes that transform standards compliance into certification results have received limited analytical attention. This scoping review maps the extent to which the published literature addresses accreditation scoring architecture, transparency, and signalling functions in hospital and health service accreditation systems.</p><p><strong>Methods: </strong>Scoping review was performed in line with PRISMA-ScR. The searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, and CINAHL using the English-language publications published between January 2000 and March 2026. Sources that were considered eligible were empirical studies, reviews, governance analysis, theoretical papers, and accreditation program documents. The data were obtained through a systematic framework and synthesized in three domains i.e., scoring and weighting mechanisms, transparency and methodological validity as well as market signalling.</p><p><strong>Results: </strong>Of 2,968 records identified, 27 sources met the eligibility criteria. The majority (85%) defined accreditation as a standards-based compliance intervention focused on organisational outcomes. Ninety-three percent acknowledged methodological limitations in causal inference. Among the included sources, no published evidence was identified that directly examined weighting schemes, score aggregation, threshold logic, or composite score construction. Only six studies addressed transparency beyond binary certification status, and three considered equity implications. Despite 70% of sources describing accreditation as a reputational or legitimacy signal, empirical analysis of the underlying measurement architecture was absent across the entire corpus.</p><p><strong>Conclusions: </strong>Accreditation research has emphasised outcome measurement while neglecting the internal scoring and measurement systems that generate certification decisions. Within the published literature reviewed, the weighting and aggregation mechanisms that shape institutional incentives have received limited analytical attention and remain largely undisclosed in publicly accessible sources. Greater transparency in scoring design and weighting logic is essential, particularly as accreditation becomes more deeply embedded in regulatory, reimbursement, and public reporting frameworks.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261484447"},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal effusion as a marker of disease severity in secondary hemophagocytic lymphohistiocytosis: Clinical and immunological insights.","authors":"Yansheng Wang, Lulu Zhang, Huiping Wang, Qian Li, Furun An, Beibei Xie, Shuangwei Ying, Jinxiao Hou, Hui Qin, Zhimin Zhai, Fan Wu","doi":"10.1177/20503121261487052","DOIUrl":"10.1177/20503121261487052","url":null,"abstract":"<p><strong>Objective: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome with cytokine storm-mediated multiorgan damage. Although serous effusions are frequent complications, the prognostic significance of peritoneal effusion in secondary HLH (sHLH) remains undefined. This study aimed to determine the incidence, clinical and immunological correlates, and prognostic value of peritoneal effusion in sHLH patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 107 adult patients diagnosed with sHLH at the Second Affiliated Hospital of Anhui Medical University between March 2013 and March 2023. Peritoneal effusion was diagnosed based on abdominal ultrasound, computed tomography, or positron emission tomography-computed tomography at initial presentation. Clinical characteristics, laboratory parameters, and lymphocyte subset profiles were compared between patients with and without peritoneal effusion. Logistic regression was used to identify risk factors for peritoneal effusion. Overall survival (OS) was estimated using the Kaplan-Meier method, and independent prognostic factors were assessed using multivariate Cox regression analysis.</p><p><strong>Results: </strong>Peritoneal effusion was found in 24/107 (22.4%) sHLH patients and was associated with lower white blood cell, lymphocyte, monocyte, and platelet counts. Lower monocyte counts, higher direct bilirubin, and distinct immune dysregulation (reduced CD4+ T cells, higher NK cell percentages) were identified as risk factors for peritoneal effusion. Peritoneal effusion correlated with concurrent serous effusions (p < 0.05) and markedly shorter median survival (19 vs. 103 days, p = 0.002). Multivariate analysis identified peritoneal effusion as an independent mortality predictor (HR=1.88; 95% CI 1.09-3.24, p = 0.023).</p><p><strong>Conclusions: </strong>Peritoneal effusion is an independent predictor of mortality in sHLH patients and is associated with a distinct immune profile. Its presence should alert clinicians to a higher risk of death and prompt early, aggressive therapeutic intervention.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":"14 ","pages":"20503121261487052"},"PeriodicalIF":2.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}