Catholic University of Croatia

Esophageal carcinoma is very rare in young people, particularly during pregnancy. We present a rare fatal case of esophageal adenocarcinoma in a 26.-year old pregnant woman with the full-term delivery of a healthy baby. Alarming symptoms despite being considered hyperemesis gravidarum raised suspicion of the upper digestive system neoplasia, which was confirmed by subsequent diagnostic work-up, including endoscopy, biopsy, and histopathology. Although the deceased's family suspected possible medical negligence, it was not proven, but was evaluated and interpreted as an unintended outcome. Namely, the pregnant woman did not want to undergo a diagnostic examination of the digestive system in the 20th week of pregnancy, but almost towards the end of the pregnancy, when a malignant neoplasm of the esophagus was diagnosed. After delivery of health baby, she died two months later. This unfortunate case underscores the necessity of maintaining a high index of suspicion for malignancy in persistent gastrooesophageal symptoms during pregnancy. The refusal of diagnostic and therapeutic procedures by the patient dictated the dissemination of the disease and the fatal outcome, which could not be influenced by the professional malpractice, and therefore certainly has a forensically and clinically interesting discussion.

Starting from the perspective that the Catholic Church has historically embraced communication technologies in its evangelizing and pastoral mission, and based on Castells' theory of the networked society, as well as the fact that digital media are part of the environment in which religious communities live, this paper explores the presence of Croatian male and female communities of consecrated life in the digital media sphere. Employing content analysis, the study aims to examine the websites of communities of consecrated life in the Croatian-speaking context. In this context, official websites are understood as tools of institutional communication and as channels for transmitting the values and identity of religious life to a digitally-oriented public, where information about faith and spirituality is increasingly accessed online. The underlying assumption is that these communities have recognized the significance of websites as instruments for mediating their religious identity and the charism of the community to the wider public. The research further investigates the number of official websites maintained by communities of consecrated life, the potential differences in online presence between male and female communities, and the types of content employed to communicate their mission and religious identity. The paper concludes by interpreting the findings with particular attention to the informative and formative functions of these websites, as well as to their degree of interactivity.

OBJECTIVES:Few studies have examined sample size and consensus methods in Delphi studies, leaving limited knowledge in the field of biomedicine. We aimed to analyze these methodological aspects in published articles in which the Delphi method was used. STUDY DESIGN AND SETTING:This was a meta-research study. We analyzed open-access full-text articles in English, retrieved from PubMed, that reported results of primary studies that used a Delphi method. The analysis included the number of planned and conducted rounds, the planned sample size and justification for the sample size, the number of invited and included participants in each round, and the methods used to achieve consensus. RESULTS:Analysis included 1875 articles describing 1904 Delphi studies. The description of the study design was provided in most articles (N = 1157; 62%). The word Delphi was mentioned in the title of 636 articles (34%), and the word consensus appeared in the title of 502 articles (27%). Only 19% of studies reported planned sample size, ranging in the overall sample from 5 to 420 participants (median 19-25). The rationale for their size was described in only 16% of the studies. Invited participants were usually reported for the first round, ranging in the overall sample from 3 to 7468 (median 20-37). The number of participants included was also most often stated for the first round, and in the overall sample, it ranged from 3 to 2295 (median 14-27.5). For all other Delphi rounds used in the studies, a decreasing number of participants was reported. Likert point scales were used in most studies (66%), most often as a single five-point scale. A percentage threshold for consensus was used in most studies, with 80% being the most common. Other numerical definitions most often used were the median, mean, and importance ranking. CONCLUSION:Sample sizes and consensus methods vary significantly in studies using the Delphi method. Therefore, consensus guidelines on sample sizes and recommendations for consistent reporting of consensus criteria need to be developed. PLAIN LANGUAGE SUMMARY:Researchers often use the Delphi method to collect and combine opinions from experts, usually through several rounds of questionnaires, to reach agreement on important topics such as clinical guidelines or research priorities. However, there is little clear guidance on how many experts should take part in these studies or how consensus should be defined. In this study, we examined 1904 Delphi studies published in biomedical journals. We looked at how many participants the authors planned to include, how many they actually invited and retained in each round, and how they defined when experts had reached agreement. We found large differences between studies. Only about one in five studies reported how many participants they planned to include, and even fewer explained why they chose that number. The number of participants ranged from just a few to several hundred. Definitions of consensus also varied widely, with thresholds ranging from 50% to 100% agreement, most often 80%. These findings show that Delphi studies are conducted and reported in very different ways. To make Delphi research more transparent, comparable, and reliable, there is a need for consensus-based guidelines on how to plan, conduct, and report Delphi studies, including how to choose the number of participants and how to define consensus.

One persistent issue undermining the integrity of scientific communication is spin - the misleading presentation or interpretation of results to make findings appear more favourable, significant, or impactful than they truly are, thereby leading to bias. This article examines the nature of spin in scientific communication and highlights the pressing need for increased awareness and preventive measures. Spin represents a form of reporting bias that can mislead readers, clinicians, and policymakers. These seemingly small distortions add up and contribute to biased scientific records. In a context where research underpins medical treatments, spin is not merely an academic or inconsequential practice - it can have significant real-world implications. Addressing spin bias is essential for preserving the integrity, credibility, transparency, and utility of research. Spin can be addressed through institutional reforms, enhanced editorial and peer review oversight, and training researchers, reviewers, and editors in transparent and responsible reporting. While the complete elimination of spin may be unrealistic, systematic and sustained efforts to identify, mitigate, and discourage it are essential for preserving the integrity of scientific literature. Fostering a research culture grounded in integrity, rigor, and accountability will ensure that scientific outputs genuinely contribute to knowledge advancement and serve the broader benefit of society.

Introduction Mobile health (mHealth) technologies have become increasingly popular for monitoring mental health symptoms and lifestyle behaviours, and are largely reported to be feasible and acceptable to users. However, to date, the efficacy of such technologies to improve perinatal mental health outcomes has been mixed. Within the perinatal context, much of this work has been done in the context of postpartum depression, stemming from electronic health records as well as cohort studies. There is, however, a dearth of studies focusing on depression in pregnancy, and machine learning-based clinical decision support systems remain underexplored. The HappyMums application has been developed to meet this need, and its use across Europe will be tested in this study.Methods and analysis A total of 1000 pregnant people currently suffering from, or at risk of, antenatal depression will be recruited across six countries. All participants will be between 13 and 28 weeks’ gestation and will be given access to the new purposefully developed HappyMums mobile application, to use from enrolment until 2 months postpartum. The application leverages passively collected data from smartphone sensors relating to physical activity and behaviour, as well as requiring active engagement from the user to complete mental health questionnaires and ‘game-like’ activities. Digital data types will be combined with traditional mental health measurement methods, such as standardised questionnaires and interviews, to develop novel predictive models capable of identifying mental health trajectories in women at risk of developing antenatal depression and to test the app’s utility for use as personalised risk prediction and depression identification tool. The primary outcome of this study is to determine what proportion of users will continue to use the mobile application and engage with its tasks and activities at least weekly, while secondary exploratory outcomes include assessing usability of the app and testing the predictive ability of a novel machine learning-based model. These outcomes will, for the first time, be assessed by integrating active as well as passive data.Ethics and dissemination Ethical approval has been granted by local research ethics committees in each recruiting centre. At King’s College London (leading the clinical study), the study was reviewed by the East of England—Essex Research Ethics Committee and granted favourable opinion (REC reference 24/EE/0129). All other sites collecting participant data have the study approved for local delivery. Findings relating to the primary and secondary outcomes will be submitted for publication in open access, peer-reviewed journals, as well as presentations at conferences as symposia or posters. Findings will be made available to a non-specialist audience through open access digital mental health magazines and promotion on social media.Trial registration number NCT06578845.