Community-based, observational, cross-sectional study.

176 villages in the Copan region of Honduras.

Village residents, comprising 25 605 adults surveyed in a census-based study; using data collected between October 2015 and December 2019.

Symptoms of depression and postpartum depression, among men and women.

Across all participants, 34.99% reported depression symptoms (40.50% for women and 27.62% for men). Among recent parents with a new child in the last 6 months, 28.89% reported postpartum depression symptoms (31.29% for women and 24.31% for men). Women with higher social intransitivity (ie, a greater proportion of friend-pairs among their friends that were not themselves connected) had higher odds of depression symptoms (OR=1.27, 95% CI 1.14 to 1.41), an association not found for men nor in postpartum parents. Because this coefficient is estimated on a 0–1 scale, it corresponds to approximately 2.4% higher odds of depression per 10 percentage-point increase in social intransitivity. In a signed-network decomposition that also included adversarial ties, only the proportion of incomplete/no-tie friend-pairs was associated with depression in women (OR=1.03, 95% CI 1.01 to 1.04), corresponding to approximately 3% higher odds of depression per 10 percentage-point increase.

We report that structural social network position and connectedness beyond dyadic ties, including the friendships and adversarial ties of a person’s friends, are associated with depression. These findings highlight the importance of linking psychological health to broader social connections in the context of face-to-face relationships.

This is a multicentre, double-blinded, randomised, placebo-controlled trial with a 1:1 allocation ratio. Patients of both sexes, aged ≥65 years, who are admitted to the emergency department and will undergo hip fracture surgery are eligible for enrolment. Eligible patients who provide their consent will be stratified according to the type of fracture (intracapsular and extracapsular) and whether or not they are suitable for intravenous TXA therapy, and they will then be randomly allocated to receive either TXA or a placebo. The primary outcome is the blood transfusion rate from patient admission to the emergency department until discharge, while the secondary outcomes include: the preoperative, perioperative and postoperative haemoglobin and haematocrit levels; the preoperative and postoperative occult and total blood loss; the mean length of hospital stay; and any adverse events assessed for up to 1 year after patient discharge.

The study was approved by the Basque Country Ethics Committee (Ref.: 2021012) and the Spanish Agency for Medicines and Healthcare Products (Agencia Española de Medicamentos y Productos Sanitarios). All participants will provide their written informed consent prior to study inclusion. The trial’s results, regardless of its outcomes, will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals, and they will be made publicly available through the European Union Clinical Trials Register after the end of the clinical trial.

EudraCT Number 2020-002144-23; EUCT Number 2024-519349-31-00.

Indian Council of Medical Research, New Delhi, is conducting a multi-centre study employing a mixed-method approach. The study involves different levels of healthcare systems, including both government and private healthcare facilities across seven sites in several states of India, including Maharashtra, Rajasthan, Punjab, Bihar, Uttar Pradesh and New Delhi. For the quantitative data, individuals seeking healthcare services related to STIs will be enrolled and assessed using a semi-structured pilot-tested questionnaire. In-depth interviews and focus group discussions will also be conducted with different stakeholders as per the standard guidelines of the qualitative method by the designated trained project staff. Descriptive and inferential statistics will be applied to the quantitative data, while the qualitative data will be analysed using a deductive approach with thematic content analysis.

The study protocol has been approved by the ethics review committees of all the participating sites individually. The findings from this study will be published in peer-reviewed journals and disseminated through scientific conferences and meetings among policy-makers and government agencies. AIIMS/IEC/2024/609; AIIMS/Pat/IEC/2024/1205; F. 7/BIOETHICS/AIIMS-RBL/APPROEM/2021/1; KIMSDU/IEC/11/2022; LHMC/IEC/2024/11; IEC/02/EX/2024; PGI/IEC/2024EIC000373.

A longitudinal qualitative study using semi-structured interviews.

This study was conducted in an orthopaedics department of a tertiary general hospital in China.

Interviews were conducted with 16 patients at 3–5 days postoperatively, 14 patients at 2 weeks postoperatively and 10 patients at 6 weeks postoperatively.

Data were collected between July 2024 and November 2024. A purposive sampling method was used to recruit patients. Data were analysed using directed content analysis, with data collection and analysis performed concurrently.

Three themes and nine subthemes were identified: (1) symptom perception, including perceived complexity of symptoms, self-identity conflict due to functional limitations, activation of negative emotions and psychological adaptation and interaction and amplification effects among symptoms; (2) symptom evaluation, characterised by the dynamic cognitive reframing of symptom meaning, self-blame tendency and internalisation of responsibility and interference from social and medical information; (3) symptom coping, involving dynamic evolution of active coping strategies and self-efficacy reinforcement, temporal characteristics of passive coping patterns and rehabilitation barriers.

The symptom experience of patients who had TKA is complex and dynamic. Healthcare providers should implement tailored interventions based on patients’ symptom experiences at different stages to facilitate symptom management, alleviate distress and negative emotions and improve quality of life.

This is a proof-of-concept, randomised, parallel-group, triple-blind, placebo-controlled clinical trial. 22 adult outpatients diagnosed with TRD and evidence of low-grade inflammation (serum C reactive protein≥3 mg/L) will be randomised (1:1) to receive either one intravenous infusion of tocilizumab (8 mg/kg; maximum 800 mg) or normal saline, administered as an add-on to their ongoing treatment. Psychiatric, cognitive and biomarker assessments will be performed at baseline and at follow-up visits on days 7, 14 and 28 post-infusion. Additionally, 10 healthy controls with no psychiatric history will undergo the same baseline assessments for biomarker comparison.

The study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (Project number: 2025-0245, CAAE: 88904825.7.0000.5327). Findings will be disseminated through peer-reviewed publications, scientific meetings and, on request, lay summaries for participants.

NCT07052058.

The study will be conducted in three phases across seven districts in diverse regions of India. In phase I (formative), the current status, barriers and facilitators of cancer screening, diagnosis and treatment initiation under NP-NCD will be assessed. In phase II (optimisation), a model (package of implementation strategies) will be co-developed and iteratively optimised with multistakeholder engagement at the subdistrict level to improve screening coverage and quality and strengthen the referral system for early diagnosis and treatment initiation. In phase III (scale-up and evaluation), the model will be implemented at the district level and evaluated for improvements in screening, early diagnosis and treatment initiation. A convergent mixed-methods design will be used, incorporating household surveys, facility assessments and stakeholder interviews. Implementation Research Logic Model will guide planning, execution and evaluation in the present study. Determinants of screening coverage and quality, early diagnosis and treatment initiation will be assessed using the Consolidated Framework for Implementation Research. Implementation strategies for the model will be finalised using the Expert Recommendations for Implementing Change framework. Implementation and service outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.

Ethical approval has been obtained from all study sites. The study findings will be disseminated at the state, national and global levels through meetings and conferences and submitted to a peer-reviewed journal for publication.

CTRI/2025/08/092672.

We will conduct a randomised, single-blind, placebo-controlled clinical trial. 56 patients with T2DM-associated stage III/IV periodontitis will be recruited from the Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China. Eligible participants will be randomised into two groups: the experimental group will undergo SRP combined with topically administered MH ointment and the control group will undergo SRP with a matched placebo. The primary outcomes will include probing depth (PD) changes at periodontal pocket sites with a baseline PD ≥6 mm at 6 months post-baseline, with a specific focus on the percentage of such sites with PD reduced to ≤5 mm. The secondary outcomes will comprise PD changes at pocket sites with a baseline PD ≥5 mm at 6 months post-baseline, as well as clinical attachment loss, the plaque index, bleeding index, the levels of IL-1β, IL-17, calprotectin and insulin levels in gingival crevicular fluid and serum, complete blood count, blood biochemistry, including glycated haemoglobin levels, and the composition of subgingival plaques at baseline, and 2 and 6 months post-baseline.

This study was approved by the Ethics Committee of Peking University School and Hospital of Stomatology (PKUSSIRB-2024102139b). Results will be published in a peer-reviewed scientific journal.

ChiCTR2400092305.

V.3.1 (date: 6 January 2026).

Systematic review of qualitative literature using thematic analysis following Cochrane’s qualitative and implementation methods guidance.

PubMed, PsycInfo, Web of Science and the Cochrane Library were searched in February 2025.

The searches included relevant qualitative and mixed-methods studies on the use of digital devices for hypertension management, which described the barriers and facilitators associated with these tools. We included studies published from 2015 to 2025 to capture relevant evidence. Only studies published in English with a qualitative approach were included.

From an initial 10 943 identified publications, 15 met our inclusion criteria, primarily originating from Europe and the USA, exploring diverse racial and ethnic group experiences. Our thematic synthesis revealed 7 analytical and 22 descriptive themes detailing barriers and facilitators encountered by patients with hypertension, healthcare providers (HCPs) and caregivers. These themes covered technology utilisation, design components, linguistic and cultural relevance, healthcare factors, trust and credibility and interpersonal interactions.

Our analysis underscores that factors such as the usability, design and relevance of social support profoundly influence the uptake and acceptance of DHIs in hypertension self-management among patients, caregivers and HCPs.

CRD42023480389.

A sample of 288 patients will be recruited from 12 centres in France. Inclusion criteria are: diagnosis of schizophrenia spectrum disorder (according to the 5th version of the Diagnostic and Statistical Manual of mental disorders, DSM-5), minimum of 3 months remission of psychotic symptoms and in treatment with antipsychotic medication (except clozapine and long-acting antipsychotic injection). First, the psychotic phenotype of the patients (cycloid psychosis vs other psychotic phenotype) will be assessed. Then, patients will be randomised either to the maintenance of treatment (MT) or to the antipsychotics dose reduction (DR) arm. DR will follow a hyperbolic schema according to Horowitz protocol. Patients will be assessed at baseline, and every 2 months until 24 months follow-up regarding social functioning, psychotic and negative symptoms, side effects of antipsychotic medication, cognitive functioning, patient satisfaction, substance and alcohol use, and quality of life. The primary outcome will be a good social functioning after 24 months defined as a score at the Personal and Social Performance Scale >70. Secondary outcome measures will include: psychotic and negative symptoms, hospitalisation for psychotic episode, antipsychotic dose, antipsychotic side effects, withdrawal symptoms, cognitive functioning, patient’s well-being and quality of life. Safety measures will include death, admissions to psychiatric hospital, psychotic relapses and severe self-harm.

The DREAMSPHEN trial aims to better identify patients with psychotic disorders who are most likely to benefit from antipsychotic tapering with an aim to inform future clinical treatment guidelines for antipsychotic treatment. DREAMSPHEN V2.0 of the 14 May 2025 has received ethical approval from Comité de protection des personnes Ile de France IV (N° 2023-509558-80-00) on 17 July 2025.

EU Clinical Trials Register – EudraCT no. 2023-509558-80-00. Clinical trials: NCT07152184. Registered on 9 August 2025.

Cross-sectional study.

1125 individuals (mean age 20.2±2.5 years; 56.7% female).

Students sampled from a single public university.

Participants completed validated self-report instruments: the International Physical Activity Questionnaire-Short Form to assess physical activity (PA), sedentary behaviour (SB) and the Pittsburgh Sleep Quality Index to assess sleep duration. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale, with a score of ≥11 used to classify elevated symptoms. Binary logistic regression models were used to estimate associations between adherence to the 24-hour movement guidelines (meeting all three, two, one or none) and mental health outcomes, adjusting for potential confounders.

Only 15.5% of students met all three components of the 24-hour movement guidelines. Meeting a greater number of components was significantly associated with lower odds of depressive and anxiety symptoms. In fully adjusted analyses, students who met all three guidelines were less likely to report anxiety symptoms (OR=0.26; 95%CI 0.13 to 0.54) and depressive symptoms (OR=0.42; 95%CI 0.22 to 0.79) compared with those who met none. Among individual behaviours, sufficient PA and adequate sleep were independently associated with lower odds of both outcomes, whereas high SB was associated with higher odds of elevated symptoms.

In this cross-sectional study, adherence to a greater number of 24-hour movement guideline components was associated with lower levels of anxiety and depressive symptoms in a graded manner. However, the cross-sectional design precludes inference regarding directionality or causality, and bidirectional associations or residual confounding remain possible. Longitudinal and interventional studies are needed to determine whether integrated daily movement behaviours influence mental health outcomes in young adults, particularly in Latin American populations.

The DICA-FH study is a national, multicentre, randomised, factorial, parallel-group, superiority, placebo-controlled clinical trial with a 1:1:1:1 allocation ratio. Participants aged ≥16 years receiving age-appropriate lipid-lowering therapy will be randomised into four groups: (1) adapted cardioprotective diet (DICA-FH) plus phytosterol placebo and krill oil placebo; (2) DICA-FH plus phytosterol 2 g/day and krill oil placebo; (3) DICA-FH plus phytosterol placebo and krill oil 2 g/day or (4) DICA-FH plus phytosterol 2 g/day and krill oil 2 g/day. All participants will undergo whole-genome sequencing and receive appropriate genetic counselling. Primary outcomes will be means of low-density lipoprotein cholesterol and lipoprotein(a) levels after 120 days. Secondary outcomes will include additional lipid biomarkers, adherence to protocol and adverse events. The planned sample size is 300 participants. Follow-up is expected to conclude in July 2026.

This study was registered under CAAE 65549622.2.1001.0060 and received ethical approval from the Hcor Research Ethics Committee (approval number 5.805.072) and the Brazilian National Research Ethics Commission (CONEP; approval number 6.864.951). Written informed consent will be obtained from all participants prior to enrolment. The study findings will be disseminated through peer-reviewed publications, scientific conferences and channels aimed at the general public.

NCT06331195.

Umbrella review of systematic reviews and meta-analyses.

Any clinical setting involving adult patients requiring peripheral venous access (including hospital, emergency and outpatient care).

A systematic search was performed in PubMed, CINAHL, Cochrane, Scopus and Web of Science in July 2025.

Systematic reviews and meta-analyses published from 2014 to 2025 that addressed DIVA in the adult population were included. Primary studies and protocols were excluded.

Methodological quality was assessed using the Risk Of Bias In Systematic Reviews tool. Data extraction followed the Joanna Briggs Institute methodology for overviews and the Preferred Reporting Items for Overviews of Reviews reporting guideline.

Seven reviews (six systematic reviews and one meta-analysis) were included. Three analytical dimensions emerged: (1) the conceptual and operational definition of DIVA, identifying common elements such as ≥2 failed attempts, lack of visible or palpable veins and a documented history of difficult access; (2) risk factors and clinical assessment, highlighting obesity, chronic diseases, prior chemotherapy, venous invisibility or non-palpability and the limited validation of diagnostic tools and (3) interventions, including organisational strategies (escalation protocols, specialised teams), technological resources (ultrasound guidance) and clinical measures (pain management and technique optimisation).

DIVA is a multifactorial challenge that requires a standardised definition to improve clinical identification. Effective management relies on a combination of specialised training, the use of ultrasound technology and the implementation of escalation protocols to ensure patient safety and efficiency.

CRD420251084947.

A systematic review and meta-analysis will be conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guidance and registered with PROSPERO. MEDLINE (Ovid), Embase (Ovid) and the Cochrane CENTRAL database will be searched from inception to April 2025. Studies evaluating the diagnostic accuracy of referrals made by non-ophthalmologist healthcare professionals in emergency or acute eye care settings will be included. Two reviewers will independently screen studies, extract data and assess risk of bias using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) framework adapted for referral-diagnosis studies. The primary outcome will be diagnostic concordance between referral and final ophthalmologist diagnosis. Where appropriate, pooled concordance proportions will be synthesised using a random-effects meta-analysis. Condition-specific 2x2 diagnostic accuracy analyses will only be undertaken where valid binary target conditions and sufficient denominators are reported. Heterogeneity will be assessed using Cochran’s Q test and the I² statistic with subgroup analyses exploring differences by referring clinician type and anatomical location of ophthalmic pathology.

Ethical approval is not required for this study as it will synthesise data from previously published studies; findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences.

CRD420261352717.

This study aimed to develop and test the psychometric properties of the Good Limb Position Management Scale for Stroke Patients with Hemiplegia by Nurses (GLPMSSPHN).

A quantitative and cross-sectional design.

89 hospitals in 16 cities of China.

A total of 516 participants completed the questionnaire and were finally used for the analyses.

An initial scale was developed based on the Capability, Opportunity and Motivation-Behaviour model combined with a comprehensive literature review, semi-structured interviews, Delphi expert consultations and a pilot test. A field survey was then performed using the initial scale to test the reliability and validity of the scale. Reliability analysis was conducted by calculating Cronbach’s α coefficients and test–retest reliability. The results of exploratory factor analysis and confirmatory factor analysis were used as the validity index to further verify the model structure of the scale and develop a formal scale.

The GLPMSSPHN was formulated with 4 dimensions and 35 items. Exploratory factor analysis extracted four factors, with a cumulative variance contribution rate of 81.842%, and confirmatory factor analysis indicated that the scale had good construct validity. The Cronbach’s α coefficient of the scale was 0.978, and the test–retest reliability was 0.863.

The GLPMSSPHN has ideal reliability and validity and provides a valid and reliable tool for clinical nurses to identify and assess the management level of GLP in patients who have had a stroke with hemiplegia.

A qualitative international substudy was conducted in the Netherlands, Spain, the USA, Canada and the UK (2023–2024).

19 patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) from a randomised clinical trial participated. Interviews, triggered by AWEs and repeated 6 weeks later, were audio-recorded, transcribed and analysed.

Patients varied in identifying bad days, reporting inability to perform physical activities, symptom worsening or the need for add-on treatment. Recognition of AWEs depended on their duration: shorter events (<2 days) often went unnoticed, while longer events were typically recognised. Most patients indicated they would seek healthcare if needed. Barriers included difficulty obtaining timely appointments (external) and a reactive attitude to worsenings (internal).

AWEs significantly impact daily life but vary widely in recognition and thresholds for seeking care. Limited awareness of daily disease variations may contribute to both under-reporting of worsening events to healthcare providers and suboptimal self-management in COPD.

NCT05492877.

Prospective cohort study from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), with longitudinal data collection and cross-sectional analyses at baseline, 3-month and 6-month follow-ups.

Multicentre registry across eight US academic medical centres (Chicago, Dallas, Houston, Los Angeles, New Haven, Philadelphia, San Francisco and Seattle).

Adults aged ≥18 years, fluent in English or Spanish, with self-reported acute COVID-19 symptoms and a confirmed positive SARS-CoV-2 test within 42 days before enrolment (9 December 2020 to 12 August 2022), and access to an internet-connected device. Exclusions included incarceration, inability to provide informed consent, lack of confirmed SARS-CoV-2 infection or no internet access. Of 3791 eligible participants with complete baseline data, 2897 (76.4%) completed the 3-month follow-up and 2666 (70.3%) completed the 6-month follow-up; most were aged 18–49 years (74–75%), female (66–67%), white (86.6–87.5%) and non-Hispanic (86.6–87.5%).

Prespecified primary outcomes were physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS)-29 V.2.1 T-scores for depression, anxiety, fatigue, sleep disturbance, pain interference, physical function and social participation), cognitive function (PROMIS Cognitive Function Short Form 8 T-scores) and missed workdays due to illness (binary: >1 week vs ≤1 week, from a single-item survey). All measures were self-reported and collected at baseline, 3 months and 6 months; no changes from protocol.

LCA identified a 4-class model as optimal (lowest Bayesian Information Criterion (BIC) after evaluating 1–7 class models; significant demographic differences (² p<0.001 for gender, age, race, ethnicity, education and income distributions)). Sensitivity analysis using four age groups (18–29, 30–49, 50–64, ≥65 years) yielded higher BIC (45 430.8) than three groups (18–49, 50–64, ≥65 years; BIC=42 150.9), confirming the primary model. Class 3 (middle-aged, high-income non-Hispanic; n=599 (15.8%)) was the reference group. Compared with Class 3, Class 1 (lower-income, predominantly Hispanic young to middle-aged adults; n=499 (13.2%)) and Class 2 (lower-income, older, predominantly Black non-Hispanic; n=1828 (48.2%)) exhibited significantly worse outcomes across physical and mental health domains (eg, Class 1 3-month anxiety β=4.41 (95% CI 3.25 to 5.56, p<0.001); Class 2 3-month depression β=3.58 (95% CI 2.53 to 4.64, p<0.001)). Classes 1 and 2 also reported significantly worse cognitive function at both time points (eg, Class 1 3-month β=–3.29 (95% CI –4.77 to –1.82, p<0.001)) and Class 2 had significantly higher odds of missed workdays at 6 months (OR=1.853 (95% CI 1.192 to 2.880, p=0.006)). In contrast, Class 4 (young to middle-aged, highly educated, high-income non-Hispanic; n=865 (22.8%)) consistently reported the most favourable outcomes, including better physical function (3-month β=2.04, p<0.001) and lower pain interference compared with the reference group.

In this US prospective cohort, SDOH-based subgroups showed persistent disparities in health outcomes post-SARS-CoV-2 infection. Findings highlight the urgent need for intersectional approaches to address systemic inequities in post-COVID-19 recovery.

NCT04610515.

Women aged between 40 and 65 years were recruited and classified into pre, peri or postmenopausal groups. Body composition measures and blood samples were collected. Sleep and physical activity were objectively measured using activPAL4 and ActiGraph GT9X link accelerometer over 7 days. Participants were also provided with a sleep diary. Physical function was assessed using the Short Physical Performance Battery. Cognitive function was evaluated using Addenbrooke’s Cognitive Examination-III and Cambridge Neuropsychological Test Automated Battery. Participants completed a series of questionnaires: Depression, Anxiety and Stress Scale-21, RuSATED, Berlin Questionnaire, Insomnia Severity Index, Activities-specific Balance Confidence Scale and the Australian Eating Survey.

Ethical approval was received from the relevant University Human Research Ethics Committee (ethics approval number #S221718) prior to the commencement of the research project. Data collection is ongoing and expected to be completed by April 2026. Results are expected to be available from July 2026. Findings will be disseminated in national and international conferences and in peer-reviewed journals and expected to inform how differences in lifestyle behaviours across menopause influence chronic systemic inflammation, visceral adiposity and cognitive function. Understanding and characterising the links between lifestyle behaviours and menopausal symptoms will inform targeted strategies to improve long-term well-being, heart, brain and metabolic health.

A large-scale, retrospective cohort study.

This single-centre study was conducted at a tertiary academic hospital in South China. The association between the TyG index and AMI was assessed using multivariable logistic regression, with progressive adjustment for demographic and clinical covariates. Cox proportional hazards models were used to estimate the HRs for all-cause mortality associated with TyG index. Restricted cubic splines and mediation analysis were employed to examine non-linear relationships and the mediating role of AMI.

A total of 20 125 patients diagnosed with CAD during hospitalisation between January 2020 and February 2025 were initially enrolled. After applying exclusion criteria (insufficient data), 18 245 participants were included in the final analysis.

We examined the association of the TyG index with the risk of AMI, as well as its association with all-cause mortality across different CAD subgroups.

The association between the TyG index and all-cause mortality was significantly modified by AMI status (P for interaction <0.05). In the fully adjusted model, no significant association was observed in the overall CAD cohort. However, subgroup analysis revealed divergent patterns: among patients without AMI, a modest protective effect was observed (Q3 vs Q1: HR 0.77, 95% CI 0.63 to 0.94), whereas in those with AMI, the TyG index exhibited a harmful, dose-response relationship with mortality (per-SD increase: HR 1.18, 95% CI 1.00 to 1.38; Q4 vs Q1: HR 1.60, 95% CI 1.13 to 2.25). Additionally, each SD increment in the TyG index was associated with 12% higher odds of AMI (OR 1.12, 95% CI 1.05 to 1.19). Mediation analysis further demonstrated that AMI mediated 9.51% of the total effect of TyG index on mortality (p<0.001).

An elevated TyG index independently predicts the risk of AMI in patients with CAD. Its prognostic value for mortality, however, is critically dependent on the presence of AMI: while a higher TyG index is associated with increased mortality in patients with AMI, moderately elevated TyG levels (Q2–Q3) are associated with lower mortality, whereas the highest quartile shows no significant association. Mediation analysis further reveals that AMI significantly mediates the association between TyG index and mortality, highlighting the importance of AMI prevention in mitigating the adverse prognostic impact of insulin resistance in the CAD population. These findings warrant validation in prospective studies.

We are presenting a retrospective cohort study.

The study was conducted at a supraregional stroke centre of an urban tertiary care provider.

Consecutive stroke cases treated between January 2023 and December 2023 of patients >18 years of both sexes and any ethnicity were eligible for inclusion. 934 patients (52.7% male) with a mean age of 71.7±13.6 years (25–101 years) were included.

CT angiographies were analysed by a deep learning algorithm for LVO detection of the anterior circulation. AI results were compared with radiology reports and secondary focused evaluation.

Diagnostic accuracies for ICAS detection by the AI were calculated.

Primary reports identified 30 ICAS and nine additional ICAS were detected during secondary evaluation (incidence 4.2%). The sensitivity of radiology reports was 77% (95% CI 0.61 to 0.89), the specificity 99% (95% CI 0.98 to 1.00), negative predictive value (NPV) 99% (95% CI 0.98 to 0.99) and positive predictive value (PPV) 79% (95% CI 0.65 to 0.88). The AI identified 13 of 39 ICAS correctly. 18 false positive cases (neither LVO nor ICAS) were flagged by the AI. The sensitivity of the algorithm was 33% (95% CI 0.19 to 0.50), the specificity 98% (95% CI 0.97 to 0.99), the NPV 97% (95% CI 0.96 to 0.98) and PPV 42% (95% CI 0.28 to 0.58).

Detection of high-grade ICAS by an algorithm trained to identify LVO is per se a false positive finding but occurred in 13 of 39 cases. Dedicated training for ICAS might lead to a beneficial tool during the diagnostic work-up for ischaemic stroke.

German Register for Clinical Trials (DRKS: DRKS00034019 https://drks.de/search/de/trial/DRKS00034019).

A multicentre, randomised, double-blinded, placebo-controlled, clinical trial including patients with PMR/GCA receiving ongoing prednisolone ≤5 mg/day. Eligible patients undergo an adrenocorticotropic hormone (ACTH) test, and 250 patients with a stimulated cortisol<420 nmol/L (biochemical adrenal insufficiency) are randomised 1:1 to supplemental hydrocortisone or placebo during mild to moderate stress (‘sick-days’) for 6 months or until daily prednisolone is stopped. The goal is 200 patients completing ≥3 months intervention period. Patients continue prednisolone tapering according to PMR/GCA guidelines. In the event of severe stress (risk of adrenal crisis), patients receive open-label hydrocortisone treatment. 95 patients with stimulated cortisol ≥420 nmol/L serve as control group. The primary outcome is HRQoL measured as fatigue using ecological momentary assessments (EMA) of the General Fatigue scale from the Multidimensional Fatigue Inventory-20, five times daily in situations of stress (‘sick-days’). EMA will be administered via a smartphone application ‘EMA live’. Differences in mean fatigue scores during sick-days between hydrocortisone and placebo will be analysed using mixed models for repeated measures. Secondary outcomes include daily smartphone-based symptom reporting, additional HRQoL questionnaires, adrenal crises, adverse effects from glucocorticoid excess, serial ACTH tests and biomarkers of adrenal insufficiency.

The study is approved by the Ethics Committee of the Capital Region of Denmark and the Danish Medicines Agency. Recruitment began June 2022. The last patient’s last visit is expected in 2026. Results will be disseminated via peer-reviewed publication and conference presentations.

EudraCT:2021-002528-18, CTIS:2024-518272-30-00, NCT05435781.

A predefined search strategy will be applied to MEDLINE (via PubMed), Embase, African Journals Online and African Index Medicus to incorporate articles relevant to adults diagnosed with osteoarthritis who are residents of sub-Saharan Africa. We will also include grey literature sources such as Google Scholar, Research Square, manuals, books, medical society websites, secondary databases, theses and dissertation repositories and conference proceedings. Study selection will be conducted in two stages by a pair of reviewers who will independently screen titles and abstracts according to the eligibility criteria, followed by a full-text review of the selected studies. The search period was from October 2025 to January 2026. Data extraction will be performed using a standardised charting form developed by the review team.

This scoping review maps evidence on OA-related socioeconomic impacts and healthcare inequities in Sub-Saharan Africa. As a secondary data analysis, ethical approval is not required. Findings will be disseminated via peer-reviewed journals and academic conferences to clinicians and policymakers.

Outpatient Pulmonary Function Tests Laboratory at a Lebanese university medical centre.

All individuals aged 40 years or older who performed spirometry between 2022 and 2024

A retrospective analysis of pulmonary function tests (PFTs) and demographics was performed. Patients were classified based on the spirometry patterns that are consistent with COPD (forced expiratory volume in the first second (FEV₁)/forced vital capacity (FVC)<0.7 post bronchodilator), PRISm (FEV₁/FVC≥0.7 and FEV₁<80% post bronchodilator) and normal PFTs (FEV₁/FVC≥0.7 and FEV₁≥80%). A small number of PFTs did not meet the above criteria and were classified as ‘others’; they were excluded from the main analysis but retained for descriptive estimation of PRISm and COPD prevalence over the past 3 years. The prevalence and associated risk factors of PRISm and COPD were assessed. Descriptive, bivariate and multinomial regression models were performed using IBM’s Statistical Package for the Social Sciences V.29.

A total of 698 PFTs were performed for 639 patients. The prevalence of PRISm and COPD in the centre between 2022 and 2024 was 11% and 17%, respectively. Compared with normal PFTs, subjects with PRISm were older (adjusted OR; aOR (95% CI)=1.03 (1.002 to 1.05); p=0.03) and more likely to be ex-smokers (aOR=2.19 (1.12 to 4.30); p=0.022); patients with COPD were older (aOR 1.09 (1.07 to 1.12); p<0.001), had lower body mass index (aOR 0.95 (0.91 to 0.99); p=0.024) and were more likely to be smokers or ex-smokers.

These findings highlight PRISm as a potentially relevant pattern within chronic airway disease. Within the context of Sustainable Development Goal 3 on non-communicable diseases, they underscore the importance of identifying this subgroup for closer clinical attention. Further longitudinal and multicentre studies are needed to better understand the clinical significance of PRISm and its relationship to chronic airway diseases.

A descriptive qualitative approach was employed, with data analysed using a phenomenological framework.

Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.

Male patients with SCI undergoing rehabilitation and performing IC were included in the study. Although both male and female patients were approached to participate, all eligible female patients declined participation. During the recruitment process, some female patients informally expressed privacy concerns and discomfort related to discussing bladder management issues and genital care, which may have contributed to their decision to decline participation.

10 male participants with SCI were recruited after eligible female patients declined participation. Three main themes, each with associated subthemes, emerged to reflect the participants’ experiences. Theme 1: Frequent use of IC in daily life, comprised four subthemes: (1) frequency of practice, (2) environmental and health-related challenges, (3) privacy during IC and (4) fluid intake and output. Theme 2: Cleanliness and general care included two subthemes: (1) catheter cleaning and (2) incontinence. Theme 3 focused on body image and sexuality. Cultural and social norms, including privacy concerns and sensitivities surrounding intimate care in the local context, played a significant role in shaping participants’ experiences and coping strategies.

IC was associated with challenges affecting multiple aspects of daily life among patients with SCI, including social interactions and body image. Participants described various coping strategies used to manage the physical and psychological demands associated with IC. These experiences appeared to be influenced by cultural considerations, including privacy, modesty and sensitivity surrounding urinary care within the local Saudi context.

This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Bibliographic databases and hand searches will be used to identify relevant studies. Published and grey literature addressing healthcare access will be included while non-English studies will be excluded. Two independent reviewers will perform study selection and data extraction. Quality assessment will be conducted for full-text studies using the Joanna Briggs Institute tools. Findings will be mapped to evidence on healthcare access, service utilisation, treatment patterns, barriers and facilitators and will be presented using tables and geographic mapping.

This scoping review will use publicly available data and therefore does not require ethical approval. The findings will be published in a peer-reviewed journal.

The ADAPT Study, a longitudinal cohort study, followed 2015 non-pregnant participants aged 15–34 years for a year. Those with confirmed incident pregnancies were followed through their pregnancies and for 3 years.

We recruited participants from 23 reproductive and primary care facilities located in five southwestern states with different sociopolitical reproductive health contexts (restrictive, Arizona and West Texas; protective, southeastern California, Nevada and New Mexico).

334 people reported a new pregnancy within 1 year of enrolment; 324 with outcome data are included in this analysis.

Types of pregnancy care sought (‘Have you looked into where or how you could get (prenatal care, abortion care or adoption services)?’) and care-seeking stress (‘How stressful was it to find (prenatal, abortion or adoption) care for this pregnancy?’).

Most participants (83%, 270/324) sought prenatal care; 43% (138/324) sought abortion care; and 5% (17/324) sought adoption services. Overall, 17%, 29% and 23%, respectively, reported that care-seeking was extremely/quite a bit stressful. Abortion care-seeking was associated with significantly more stress than seeking prenatal care in the ordinal (adjusted odds ratio (aOR 1.70, 95% CI 1.10 to 2.62) but not logistic (aOR 1.33, 95% CI 0.74 to 2.38) model. Adoption care-seeking stress did not differ from prenatal care-seeking stress in either model. Participants who experienced any type of abortion care-seeking obstacle and those recruited in a state with a restrictive policy environment (aOR 2.72, 95% CI 1.09 to 6.80) reported more care-seeking stress than their counterparts.

People who seek pregnancy care often experience some care-seeking stress, regardless of the type of care they seek. Findings point to the need to reduce the burden of the pregnancy care-seeking process across all types of pregnancy care.

NCT03888404.

This is a single-centre, randomised, double-blind, controlled clinical trial. Postmenopausal women aged 45–70 years with vaginal pH ≥5.0 and at least one moderate GSM symptom (Visual Analogue Scale ≥4) will be eligible. Exclusion criteria include current systemic or local hormone therapy, previous vaginal energy-based treatment, abnormal cervical cytology and body mass index ≥35 kg/m². All participants will receive vaginal estriol cream (0.5 mg per dose) daily for 14 days, followed by twice-weekly administration for 16 weeks. Participants will be randomised (1:1) to receive either estriol plus sham Er:YAG laser or estriol plus active Er:YAG laser. Three laser sessions will be delivered at approximately 4-week intervals. Assessments will occur at baseline, monthly during treatment and 4 months after the final session. The primary outcome is the Vulvovaginal Health Index, with the primary endpoint defined as the change from baseline to 4 months post-treatment, reflecting sustained effect. Secondary outcomes include GSM symptom severity, vaginal microbiome composition (16S rRNA sequencing), quality of life (Menopause Rating Scale) and sexual function (Female Sexual Function Index). Data will be analysed using repeated-measures analysis of variance or appropriate non-parametric tests, with significance set at p<0.05.

Ethical approval has been obtained from the Human Research Ethics Committee of UNINOVE. Written informed consent will be obtained. Findings will be disseminated via peer-reviewed journals and scientific meetings.

NCT06873971.

Scoping review.

Four electronic databases (PubMed/MEDLINE, Embase, Web of Science and Google Scholar) alongside ‘grey’ and supplementary searches were conducted between December 202–January 2026.

All studies reporting pregnant women’s perceptions or experiences of social media communication for ANC.

Data were extracted independently by two reviewers using a structured charting framework. Extracted data were synthesised using a descriptive and narrative approach, with pregnant women’s perceptions and experiences analysed through reflexive thematic analysis.

Six studies met the inclusion criteria. Across platforms including WhatsApp, Facebook, Instagram and WeChat, pregnant women generally perceived social media communication as acceptable and beneficial, particularly for accessing trustworthy information, reassurance between visits, peer support and flexible engagement. Experiences varied by platform, moderation model and context. Key challenges included limited personalisation, variability in moderators’ capacity and responsiveness, digital literacy barriers, data affordability, privacy concerns and sociocultural influences. Equity-related considerations were recurrent, highlighting the potential for uneven experiences if digital communication is not carefully designed and standardised.

Social media communication is generally experienced positively by pregnant women as a complement to routine ANC, particularly when professionally moderated and responsive to women’s informational needs. However, variability in experiences and equity-related challenges underscore the need for further research and careful implementation. This scoping review provides a preliminary mapping of the evidence and identifies priorities for future qualitative synthesis, primary research and the development of inclusive, person-centred digital ANC communication strategies.

This prospective, monocentric diagnostic study conducted at the Dijon University Hospital ICU will include 100 adult patients ventilated for ≥48 hours. The primary outcome is the presence of SD, defined as a Penetration-Aspiration Scale score >2 during a FEES procedure performed 3 to 24 hours postextubation and independently assessed by an otolaryngologist blinded to index test results. Pre-extubation cervical ultrasound (Index Test) will be performed within 3 hours prior to extubation and measure hyoid bone ascension (primary variable of interest), geniohyoid muscle surface area and digastric muscle cross-sectional area. The diagnostic performance of cervical ultrasonographic parameters will be assessed using their discriminative capacity via a receiver operating characteristic curve. The feasibility of the ultrasound procedure in a critical care setting will also be assessed.

The study received a favourable opinion from the independent ethics committee CPP Ouest III and is registered with the French health authority ANSM (national agency on safety in medicine and health products). It is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Participants or their proxies provide free and informed oral consent. Results will be submitted for publication in peer-reviewed medical journals and presented at international conferences.

RCB 2023-A00461-44 and NCT05922085

Propensity score matching was utilised to form a cohort of individuals with COVID-19 and a non-infected control group using data from the National Claims Database encompassing six prefectures in Japan. The primary outcome measured was the initiation of renal replacement therapy (dialysis or kidney transplantation) after the index month of the study period. Cox proportional hazards models incorporating inverse probability of censoring weighting were employed to estimate HRs for the association between COVID-19 and ESKD.

A total of 3 073 150 pairs were matched in this study. During follow-up, COVID-19 was associated with a significantly increased instantaneous risk of the composite ESKD outcome (HR 2.79, 95% CI 2.56 to 3.04). The risk was increased for haemodialysis initiation (HR 2.77, 95% CI 2.54 to 3.02) and peritoneal dialysis (HR 5.16, 95% CI 1.93 to 13.75), whereas the estimate for kidney transplantation was imprecise (HR 5.20, 95% CI 0.62 to 43.27). Subgroup analyses showed broadly consistent associations across age, sex, hypertension, diabetes and COVID-19 severity.

These findings suggest that COVID-19 may have sustained adverse effects on kidney outcomes, supporting close post-acute renal monitoring and early risk stratification in high-risk patients.

We will conduct a comprehensive search of MEDLINE, EMBASE and the Cochrane Library from inception to 10 February 2026, to identify RCTs comparing prophylactic clips vs no clips in patients undergoing thermal endoscopic resection of non-pedunculated polyps. The primary outcome is DPPB within 30 days, defined as overt bleeding requiring medical intervention or a haemoglobin decrease ≥2 g/dL. Secondary outcomes include DPPB in proximal large (≥20 mm) lesions, perforation, post-polypectomy syndrome and procedure time. Data synthesis will use a random-effects model. Methodological quality will be assessed using the Cochrane Risk of Bias 2 tool. Publication bias will be visualised using funnel plots. We will quantify the effect of potential effect modifiers by meta-regression if appropriate. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework.

This study will not use primary data, and therefore formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.

CRD420251246840.

The study adopted a cross-sectional design. The original questionnaire was translated into Norwegian and adapted for use in the target population. The Norwegian version was pilot tested in a sample of patients and then validated in the target population.

Norway, using a web-based solution to collect data.

A random sample of Norwegian individuals <85 years old with a history of myocardial infarction and no cardiovascular disease before their first myocardial infarction.

Internal consistency was tested using Cronbach’s α and test–retest reliability using intraclass correlation coefficient (ICC). Difficulty and discrimination indices were determined for the Knowledge scale. Confirmatory factor analysis (CFA) was used to assess structural validity of the Risk scale.

Data for 746 participants (mean age, SD: 66.4, 10.3 years), of which 26.9% females were analysed. The Norwegian version showed satisfactory internal consistency (Cronbach’s α 0.73–0.79) but modest test–retest reliability (ICC 0.35–0.64). The Knowledge scale showed moderate difficulty (0.39–0.84) and good discrimination power (0.44–0.60). The one-factor model CFA for each scale achieved acceptable fit, and the four-factor model showed moderate fit (root mean square error of approximation=0.05, standardised root mean squared residual=0.07, Comparative Fit Index=0.91, Tucker-Lewis Index=0.88).

The Norwegian translated ABCD Risk Questionnaire demonstrated satisfactory psychometric properties and can be considered a useful instrument for assessing knowledge and risk perception among individuals with a history of myocardial infarction.

We will systematically search PubMed, Embase, CINAHL, PsycINFO, Web of Science and CENTRAL from inception to the final search date, without language or date restrictions and will also screen trial registries and grey literature. We will include randomised controlled trials evaluating suprapubic temperature stimulation for prevention or treatment of POUR, compared with usual care, sham/no intervention or other non-thermal strategies. Two reviewers will independently screen studies, extract data and assess risk of bias using RoB 2, with arbitration by a third reviewer. Where appropriate, we will pool effects using ORs for dichotomous outcomes and mean differences or standardised mean differences for continuous outcomes, each with 95% CIs. Heterogeneity will be assessed using the ² test and I² statistic, with planned subgroup analyses by thermal modality and timing, and sensitivity analyses based on risk of bias. Certainty of evidence will be appraised using the Grading of Recommendations Assessment, Development and Evaluation.

This review will be based on previously published studies; therefore, ethics approval is not required. Data searching will commence in June 2026 and is expected to be completed in January 2027. The findings will be disseminated through peer-reviewed journal publication and academic conference presentations.

CRD420261325021.

The study was conducted in a secondary care National Health Service (NHS) setting. A cost comparison analysis was performed over a 2 year time horizon (seven procedures per patient). 177 procedures on rectal cancer patients undergoing WAW with digital proctoscopy between August 2023 and November 2024 were included. The control group, that is, flexible sigmoidoscopy was modelled. The base case was flexible sigmoidoscopy without sedation. Scenarios using sedation were also evaluated. Costs were categorised into fixed and variable costs. A one-way sensitivity analysis, probabilistic sensitivity analysis and What-If scenarios were also performed.

The primary outcome was the minimum cost difference between the two procedures. The secondary outcome measure was the robustness of the cost differences. Over 2 years, the total cost per patient was £768.92 (95% CI £656.6 to £900.7) for digital proctoscopy compared with £1,588.15 (95% CI £1458.1 to £1725.2) for flexible sigmoidoscopy without sedation. The absolute minimum cost saving per patient is £820.23 (95% CI £648.7 to £985.1). Cost savings increased to £848.94 (95% CI £677.20 to £1013.83) to £935.62 (95% CI £761.02 to £1103.08) when sedation was used in flexible sigmoidoscopy procedures. Personnel costs during the procedure and recovery phase were the dominant cost drivers for flexible sigmoidoscopy. Probabilistic sensitivity analysis and What-If scenarios confirmed the robustness of the findings, with flexible sigmoidoscopy remaining more costly.

Digital proctoscopy with the LumenEye device is a cost-saving alternative to flexible sigmoidoscopy for patients with rectal cancer on a WAW protocol. Our findings support the integration of digital proctoscopy into WAW pathways as a cost-efficient alternative within resource-constrained healthcare systems. Endoscopy service pressures are also likely to be alleviated.

The SORT study will use UK’s National Cancer Registry to identify individuals diagnosed with urothelial OC-MIBC (T2-4aN0M0) between 1 January 2015 and 31 December 2021 who received either radical radiotherapy or radical cystectomy after NAC. The data will be linked to Hospital Episode Statistics (HES), National Radiotherapy Data Set (RTDS) and Systemic Anti-Cancer Therapy (SACT) data sets to gather information on clinical, tumour and socio-demographic characteristics and receipt of treatment. Using the target trial emulation framework, we will define the eligibility criteria and radical radiotherapy and radical cystectomy receipt. To reduce the risk of confounding, we will use advanced statistical approaches to allow for differences in measured baseline characteristics between the comparison groups.

The primary outcome is 3-year all-cause mortality after radical treatment receipt. Secondary outcomes will include all-cause and bladder-cancer-associated mortality at 3 and 5 years, time to death, incremental costs and incremental cost-effectiveness reported according to net health benefits.

The study was approved by the London School of Hygiene and Tropical Medicine Ethics Committee (Reference number 29717 - 1). Results will be communicated in open-access journals and conferences to clinicians, researchers, patients and policymakers.

The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. A comprehensive search will be conducted across Cochrane, Medline, PEDro, CINAHL, Scopus, Web of Science and BioMed Central databases. Search terms will be developed using the Population, Intervention, Comparison, Outcome and Study design (PICOS) framework, incorporating keywords and Medical Subject Headings related to ‘Major Depressive Disorder’, ‘Aerobic Exercise’, ‘Depression’, and ‘Quality of Life’. Only intervention studies, including randomised controlled trials, quasi-experimental and pre–post intervention studies, will be included involving adults aged 18 years or older diagnosed with MDD according to standardised criteria (eg, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Statistical Classification of Diseases and Related Health Problems -10 (ICD-10)). For included intervention studies, the comparator will be standard care, placebo or no-exercise control groups. The primary outcome is change in depressive symptoms, and secondary outcomes include quality of life, anxiety and stress-related biomarkers. Three independent reviewers will screen studies, extract data using Covidence software (Veritas Health Innovation in partnership with Cochrane) and assess study quality using the updated Cochrane Risk of Bias 2.0 (Rob-2) tool alongside the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. If feasible, a meta-analysis will be conducted using RevMan V.5.4 (Cochrane's Review Manager), with effect sizes determined by mean differences, standardised mean differences or ORs, depending on the outcome type. This study is currently at the proposal stage, with article searches expected to begin in November 2025 and data extraction anticipated to be completed by January 2026.

No ethical approval is required as this review uses existing published data. Findings will be disseminated through a peer-reviewed journal and presented at academic conferences.

CRD420251151897.

Cross-sectional study.

Outpatient endocrinology and gynaecology services in the Oran region, western Algeria.

A total of 313 women aged 16–45 years diagnosed with PCOS according to the Rotterdam 2004 criteria.

Prevalence of metabolic syndrome and differences in anthropometric (body mass index (BMI)), metabolic (fasting glucose and lipid profile), hormonal (gonadotropins, androgens, anti-Müllerian hormone (AMH), progesterone, vitamin D) and clinical features (hyperandrogenism, menstrual irregularity, infertility) between women with and without metabolic syndrome.

Of the 313 participants, 181 (57.9%) met the criteria for metabolic syndrome. These women had significantly higher BMI (26.70±5.93 vs 25.06±6.47 kg/m²; p=0.004), elevated fasting glucose (133.43±28.52 vs 105.41±28.54 mg/dL; p<0.0001) and triglycerides (p<0.0001), but lower high-density lipoprotein (HDL)-C (p<0.0001). They also exhibited elevated luteinising hormone (LH), LH/follicle-stimulating hormone ratio, total testosterone and AMH levels, and reduced progesterone and vitamin D concentrations (all p<0.0001). Clinical hyperandrogenism, menstrual irregularity and secondary infertility were significantly more prevalent in this group.

More than half of women with PCOS exhibited metabolic syndrome, characterised by obesity, dyslipidaemia, insulin resistance and vitamin D deficiency. These findings highlight the need for early metabolic screening and holistic management in women with PCOS to reduce long-term cardiovascular and reproductive risks.

The review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) checklist. Peer-reviewed studies will be identified through comprehensive searches in PubMed, Scopus, Web of Science, CINAHL and Google Scholar. Two independent reviewers will screen titles, abstracts and full texts and extract data using the JBI Extraction Form. Data will be charted and mapped according to the six dimensions of the Digital Health Data Quality Dimension and Outcome (DQ-DO) framework—accuracy, completeness, consistency, contextual validity, currency and accessibility—and analysed across professional groups and hospital contexts.

Ethical approval is not required for this scoping review as it is based on publicly available data. The findings will be disseminated through peer-reviewed publication and presentations at relevant academic and clinical conferences.

The protocol has been registered in the Open Science Framework: https://doi.org/10.17605/OSF.IO/YQ2DX

This non-randomised clinical trial was performed in the ICU. There are two distinct groups (194 patients)—a control group that receives usual care and an intervention group that receives both usual care and a set of targeted interventions based on the seven components of the Humanising Intensive Care (HU-CI) model (‘open-door ICU’, ‘communication’, ‘patient well-being’, ‘caring for professionals’, ‘post-ICU syndrome’, ‘end-of-life care’ and ‘humanised infrastructure’) for three main groups including healthcare personnel, patients and their families. The primary outcome is delirium (Confusion Assessment Method for the Intensive Care Unit tool), and secondary outcomes are family satisfaction (Family Satisfaction in the Intensive Care Units Questionnaire) and human dignity (Patient Dignity Inventory). Finally, the data will be analysed through STATA V.18 software using the statistical methods of independent t-test or its non-parametrical equivalent, ² or Fisher’s exact tests, Mann-Whitney or Kruskal-Wallis tests, multivariate binary logistic regression models or analysis of covariance, and non-linear mixed models.

The study protocol has been approved by the Ethics Committee of the Tehran University of Medical Sciences (Ethical code: IR.TUMS.FNM.REC.1404.086). Informed consent will be obtained from all participants. The data will be shared on reasonable request to the corresponding author.

IRCT registration number: IRCT20250727066651N1. Registration date: 30 July 2025.

Systematic review.

From September to November 2025, with an updated search in March to April 2026 using the same eligibility criteria, we systematically searched Ovid MEDLINE and Ovid Embase supplemented by reviewing reference lists of relevant articles and opportunistic searches of the Centers for Disease Control and Prevention publications.

We included English-language US-based cross-sectional, cohort and case–control studies and systematic reviews containing US-based data published between 1 January 2018 and 31 December 2025 relevant to one of the defined DR cascade stages: (1) diagnosis of diabetes, (2) adherence to DR screening, (3) diagnosis of DR, (4) adherence to DR care and (5) DR-related blindness. We included systematic reviews only to inform DR-related blindness, where primary data were limited and excluded them from other stages to avoid double-counting. Exclusion criteria included studies not relevant to one of the defined DR cascade stages and editorial, perspective or commentary pieces.

Two reviewers independently screened studies, extracted data and assessed risk-of-bias using the Newcastle-Ottawa Scale and Risk of Bias in Systematic Reviews tool. We synthesised data narratively and organised via the DR treatment cascade framework.

Of 14 893 studies screened, 46 met the inclusion criteria. Cascade analysis revealed substantial losses in patient engagement at three stages: (1) only 15.5%–78.7% (median 59.4%, IQR 33.9%–74.0%) of individuals with diabetes obtain biennial DR screening; (2) a substantial 54.9%–88.5% (median 70.1%, IQR 62.5%–79.3%) of individuals with DR are unaware of their diagnosis; (3) only 30.9%–62.7% (median 52.0%, IQR 40.9%–59.1%) of individuals diagnosed with DR are initially linked to care and 55.3%–77.8% (median 70.3%, IQR 59.2%–77.7%) have a lapse in DR follow-up.

This review identifies major gaps in the DR care continuum, particularly in diagnosis awareness, linkage to care and follow-up adherence. The cascade framework highlights key points of disengagement and provides a basis for prioritising future research.

This single-blinded, parallel-group RCT will recruit 100 adults aged 55–80 years diagnosed with asthma and/or COPD and/or OSA in the Northern Savo region of Finland. Participants will be randomly allocated to either an intervention group or a control group.

The intervention group will participate in a 12-week supervised exercise programme consisting of progressive NW sessions twice per week and resistance, balance and mobility training once per week. The primary outcome is a change in cardiorespiratory endurance. Secondary outcomes include functional capacity, physical activity level, spirometry parameters and quality of life. The control group will continue their usual physical activity and receive physical activity guidance after 12 weeks. Measurements were conducted at baseline, three and 9 months. Data will be analysed according to the intention-to-treat principle. Group differences over time will be examined using appropriate parametric or non-parametric methods depending on data distribution.

Ethical approval was obtained from the Regional Medical Research Ethics Committee of Eastern Finland Collaborative Area (892/13.00/2023). Findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.

The trial is registered at ISRCTN12097135, registration date: 7 June 2024.

This scoping review will follow Joanna Briggs Institute guidance and will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PRISMA Protocols (PRISMA-P) items are addressed where applicable. The review will be conducted from 1 May 2026 to 31 October 2026. Searches will identify sources published from 1 January 2000 to the planned final search date of 31 July 2026. MEDLINE, Embase, CENTRAL, Global Index Medicus, Google Scholar, citation searching and selected registry, professional, governmental and conference sources will be searched. No language restriction will be applied at the search stage. Eligible evidence will include peer-reviewed studies, registry or professional reports, governmental or institutional reports and conference abstracts or posters with extractable PD outcome data. Non-English sources will be screened using machine translation and extracted using targeted translation of relevant sections when feasible. Outcomes of interest include patient survival, technique survival and transition to haemodialysis, peritonitis and other infectious complications, hospitalisation and health service utilisation, cardiovascular outcomes, catheter-related complications and patient-reported outcomes when reported as clinical endpoints. Findings will be summarised descriptively and mapped by outcome domain and by region, with contextual factors noted when reported.

Ethics approval is not required because this review will synthesise published literature only. Findings will be disseminated through peer-reviewed publication and conference presentations, and the extracted dataset and search strategies will be shared in supplementary materials or an online repository, subject to journal policy.

This protocol is registered on the Open Science Framework (OSF): https://osf.io/3dkvx/.

This mixed-methods study comprises three sub-studies. The first will recruit 175 pregnant women (75 with T1D and 100 with T2D) who will complete three 7-day monitoring periods, one per trimester. PA will be assessed using wrist-worn accelerometers and exercise diaries, dietary intake via remote food photography, and corresponding continuous glucose monitor and diabetes-related well-being data will be collected.

The second involves a subsample of ~16 women participating in focus groups to explore experiences of being physically active during pregnancy.

The third invites ~100 HCPs involved in diabetes in pregnancy care to complete an online survey, ~10 HCPS will take part in an optional interview about their experiences of providing PA guidance.

The primary outcome is the change in PA across pregnancy. Secondary outcomes include associations between PA, glucose metrics, diet and diabetes-related well-being, and qualitative themes relating to experiences of women and HCP. Quantitative data will be analysed using multilevel modelling and regression analysis, and qualitative data using reflexive thematic analysis.

Ethical approval was granted by the East Midlands Nottingham 1 Research Ethics Committee (25/EM/0190) and University of Exeter Public Health and Sport Sciences ethics committee. Findings will be disseminated through peer-reviewed publications and conference presentations.

LIMITS is a pragmatic, open-label, UK-based, multicentre randomised controlled trial, with an internal pilot phase and integrated economic evaluation. A total of 140 children receiving kidney transplants will be randomised to receive either conservative postoperative fluid administration (maximum of 150 mL/m²/hour for no longer than 18 hours, followed by a fixed daily target of maximum 1.5 L/m²/day thereafter) versus the comparator of liberal postoperative fluid administration (fluid volume administered to replace urine output and insensible losses for at least 48 hours with target urine output >2 mL/kg/hour). The primary outcome is mean days at home in the first 30 days after kidney transplant. The primary outcome will be analysed using a mixed linear regression model adjusted for donor type (living vs deceased donor) and participant weight (<20 kg and ≥20 kg pretransplant) as fixed effects and transplant centre as a random effect. Cost-effectiveness will also be evaluated.

The trial received Health Research Authority approval on 20 August 2025 (REC reference: 25/EE/0161, IRAS project ID: 354370). Findings will be presented to academic groups via national and international conferences and peer-reviewed journals. The patient and public involvement group will play an important part in disseminating the study findings to the public domain.

ISRCTN21516608.

Cross-sectional study.

Data were collected through face-to-face interviews conducted in all 26 Brazilian state capitals and the Federal District between 2022 and 2023, using a sequential sampling approach.

A total of 1392 individuals aged 18 years or older experiencing homelessness for at least 6 months were included.

The primary outcome was the completeness of the COVID-19 vaccination schedule (complete vs incomplete), based on self-reported vaccination status. Secondary analyses examined sociodemographic, institutional and behavioural factors associated with vaccine uptake using binary logistic regression.

Completion of the vaccination schedule was positively associated with receiving government aid (OR: 1.58; 95% CI 1.09 to 2.30), visits from street clinic health agents (OR: 3.19; 95% CI 1.95 to 5.36), prior COVID-19 diagnosis (OR: 5.77; 95% CI 3.17 to 11.15), support for mandatory vaccination (OR: 3.76; 95% CI 2.48 to 5.76), trust in vaccine efficacy (OR: 3.92; 95% CI 2.63 to 5.89), seeking information from community sources (OR: 1.91; 95% CI 1.01 to 3.88) and trust in federal authorities (OR: 1.57; 95% CI 1.06 to 2.31).

This study identified structural, social and individual factors associated with complete COVID-19 vaccination among people experiencing homelessness in Brazil. Although overall coverage was substantial, gaps in vaccination completeness persisted. Social support, healthcare outreach and trust in vaccines were associated with higher uptake, highlighting important barriers and facilitators to vaccination in socially vulnerable populations.

This study is a prospective, pragmatic randomised controlled trial comparing the effectiveness of online parent coaching plus Family Focus (Coaching+FF) to Family Focus alone (FF) for primary carers of children experiencing developmental regression. A sample of 56 families will be randomised in a 1:1 ratio. Outcomes are assessed at baseline, post-intervention and 12-month post-randomisation. The primary outcome is parental stress symptoms at post-intervention. Secondary outcomes include parental depressive and anxiety symptoms, parental engagement in health-promoting activities, family empowerment, family quality of life and child global health outcomes. The study will also examine the uptake and acceptability of specific coaching and FF components and explore the facilitators and barriers to their delivery and implementation.

Ethics approvals were obtained from the participating organisations (Monash Health HREC/107806). Informed consent is obtained from parents/guardians of children prior to study enrolment. Study findings will be disseminated through peer-reviewed publications, conference presentations and lived experience agencies.

ISRCTN25513446.

This qualitative study aimed to explore the contributing factors to irrational antibiotic prescribing, understand healthcare professionals’ perceptions, identify barriers to rational use and gather suggestions for improving rational antibiotic use.

A qualitative study using semi-structured interviews was conducted with participants. A total of 60 healthcare professionals (20 physicians, 20 pharmacists and 20 nurses) participated after providing verbal consent.

Semi-structured interviews were conducted with healthcare professionals across various clinical settings in Pakistan until data saturation was reached. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure transparent reporting. An inductive thematic analysis approach was employed and themes and subthemes were developed from the data.

The findings revealed a generally good understanding of irrational prescribing. Contributing factors included prescriber-related issues, patient expectations, weak regulatory oversight and underutilisation of pharmacists. Key barriers identified were financial constraints, lack of awareness and insufficient resources. Suggestions for improvement included regular audits, public awareness campaigns, an integrated healthcare system, interprofessional collaboration, drug utilisation reviews, adverse drug reaction reporting, standardising hospital policies and strengthening regulatory frameworks.

This study highlights critical factors and barriers contributing to irrational antibiotic prescribing and presents practical suggestions to improve rational use. Implementing evidence-based approaches, updating clinical guidelines, and promoting awareness among healthcare professionals are essential steps toward improving prescribing practices and combating AMR.

We will include randomised controlled trials evaluating active interventions for depressive disorders in children and adolescents. Seven electronic databases (PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO, Scopus and ClinicalTrials.gov) were searched from inception to 2 July 2024 and updated on 2 November 2025. Two of four investigators will independently screen studies, extract data from eligible articles and assess the risk of bias using the Cochrane Risk of Bias 2.0 tool. The primary outcome will be the change in depressive symptoms. Secondary outcomes will include acceptability (all-cause discontinuation), response rate, remission rate and overall functioning. Pairwise and Bayesian NMA will be conducted. Small-study effects and publication bias will be assessed. The certainty of the evidence will be evaluated according to the Confidence in Network Meta-Analysis approach.

As this review involves secondary analysis of previously published studies, ethical approval is not required. The findings will be disseminated through publication in peer-reviewed journals.

PROSPERO-ID CRD42024557384.

This protocol outlines a scoping review guided by the Joanna Briggs Institute methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We will systematically search EBSCOhost, Scopus and Web of Science for peer-reviewed empirical studies published from 1 January 2000 to the planned end date of 5 November 2025. Two reviewers will independently screen records, with a third resolving discrepancies. Data extraction will be conducted using a customised tool, and results will be synthesised narratively and visually, structured around bibliometric characteristics, the Population, Concept, Context framework and a Stimulus-Organism-Response model. Subgroup analyses will be conducted across populations, disciplines and regions.

As this study is based on secondary analysis of published data, ethical approval is not required. Findings will be disseminated through peer-reviewed journals and academic conferences.

Family linkage study, using two cross-sectional population-based health studies, the Young-HUNT study and the HUNT study. Registry-based data from Statistics Norway (SSB).

Northern part of Trøndelag County, Norway.

Adolescent (aged 13–19 years) participating in The Young-HUNT3 Survey (2006–2008, n=8199) and The Young-HUNT4 Survey (2017–2019, n=8066) and their parents participating in The HUNT3 Survey (2006–2008, n=50 800) and the HUNT4 Survey (2017–2019, n=56 042).

Adolescent anxiety and depression symptoms were assessed by a short version of the Hopkins Symptom Checklist (HSCL), the five-item HSCL-5. Self-reported family financial stress was measured using a single-item question. Parental anxiety and depression were assessed by the 14-item Hospital Anxiety and Depression Rating Scale (total HADS score). Parental income and parental education were obtained from SSB. We use a multilevel mixed-effects generalised linear model.

Adolescents who perceived their family financial stress as worse than others reported a higher SCL-5 total score compared with those with self-perceived average financial stress. The relative differences ranged from 1.16 (95% CI 1.09 to 1.23) in boys to 1.24 (95% CI 1.17 to 1.31) in girls. In contrast, little or no association was found between parental registry-based income or educational level and adolescents’ mean SCL-5 total scores. Adjusting for parental HADS scores did not alter the estimates. With a few exceptions for girls, there was no evidence for a secular change in these associations.

Self-perceived family financial stress, but not registry-based parental income and education, was associated with elevated anxiety and depression symptom levels in adolescents, and findings were essentially the same in Young-HUNT3 and Young-HUNT4. These findings underscore the importance of incorporating multiple measures of socioeconomic status when investigating socioeconomic inequalities in adolescent mental health.

A mixed-methods implementation research approach will be adopted for this study, comprising three phases: formative, pilot and implementation and evaluation.

A mixed-methods study at the district level will be conducted to capture diverse perspectives and characterise inequalities in oral healthcare access and literacy levels across urban, rural and tribal areas. Oral health literacy surveys, facility preparedness checklists and in-depth interviews will be conducted. With a consultative approach involving stakeholders, we ensure their input in the design and pilot the integrated interventions to build a replicable model for integrating dental health services into primary healthcare.

Through this structured approach, the study seeks to improve overall oral health outcomes and achieve sustainable improvements in oral health at both community and system levels.

This study has been approved by the Institutional Ethics Committee at the Institute of Public Health Bengaluru (IPH/23-24/E/374). Findings will be disseminated through workshops, presentations and publications in peer-reviewed journals.

This is a prospective, multicentre, non-interventional cohort study in two HSX-member healthcare organisations (HCOs) in southeastern Pennsylvania. At the onset of the study, all adult T2D patients are scored by the algorithm analysing HIE data on relevant predictors found in the 24-month lookback period. Patients meeting a prespecified score threshold estimated in retrospective testing to yield 10% recall will be presented to designated endocrinology or primary care providers for structured chart review, attribution confirmation and guideline-concordant follow-up (including autoantibody testing where appropriate). The primary endpoint is positive predictive value for confirmed adult-onset T1D among flagged patients. Secondary endpoints characterise operational cascade metrics (attribution, provider recommendation, test ordering/results and diagnosis updates) along with 95% CIs. Exploratory endpoints will assess provider adoption, interpretability and workflow integration via structured provider interviews.

This study was reviewed and approved by Advarra Institutional Review Board (protocol Pro00075945). The Institutional Review Board waived patient informed consent and granted a full waiver of HIPAA authorisation for patient records, while providers were required to provide written informed consent. HSX data were accessed and shared under its member-defined use cases. Findings will be disseminated via peer-reviewed publications and conference presentations. Reporting will follow Strengthening the Reporting of Observational Studies in Epidemiology guidance for cohort studies.

A retrospective analysis was conducted on 500 psychiatric consultations provided by the University Facility of Psychiatry. Additional analysis was performed in a subgroup of patients with a diagnosis of delirium (143 subjects). The Delirium Rating Scale-Revised-98 (DRS-R-98) was administered at the time of consultation (T0) and 1 week later (T1). Descriptive statistics were performed on the whole sample. In the subgroup of patients with delirium, linear regression for continuous variables and one-way analysis of variance for categorical variables were conducted. Stepwise multiple regression was performed with DRS-R-98 (difference of DRS-R-98 score between T0 and T1) as the dependent variable.

The majority of requests for consultation came from the internal medicine department or from orthopaedic and trauma units and concerned male patients with a positive history of psychiatric disorders. Although psychiatric re-evaluations were frequently required, transfers to the psychiatric ward were rare (9.8%), and there were no compulsory psychiatric admissions in our sample. In addition to delirium, the most frequent reason for requesting CLP evaluation was depressive disorder. Among the 143 cases of delirium, the mean age and prevalence of males were higher than in the whole sample. Mortality was also higher (28%) than in the whole sample (17.6%). In the stepwise multiple regression analysis, variables significantly and independently associated with DRS-R-98 included: age (t=–4.074; p<0.001), treatment with benzodiazepines (BDZ) (t=–5.737; p<0.001) and treatment with atypical antipsychotics (t=3.104; p=0.002).

CLP interventions in our high-complexity general university hospital were mainly requested for patients with mood disorders and delirium. CLP service provides an important opportunity to identify unknown psychiatric disorders or symptoms below the diagnostic threshold. Predictors of improvement of delirium-related symptoms are young age and the use of atypical antipsychotics, while BDZ treatment can be considered a negative predictor of outcome in patients with delirium. Further research on this topic is recommended to better understand the relevance of CLP, particularly the effects of this type of intervention in the management of delirium.

This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant studies. Major databases will be searched using a structured search strategy developed by the research team. The review will include randomised controlled trials (RCTs) that assess the impact of interventions conducted in school or community settings to prevent psychological distress—specifically depression, anxiety and stress. To minimise bias, two reviewers will independently select studies and extract data at various stages. The quality of included studies will be assessed. A meta-analysis will be conducted to compare intervention outcomes between children from underserved/minority communities and other children. Pooled prevalence rates and subgroup analyses will be used to explore differences in effectiveness. Heterogeneity among studies and publication bias will also be assessed. Meta-analyses of proportions, ORs and relative risks will be conducted using a random-effects model to estimate effect sizes from multivariate analyses.

Ethical approval was not required, as this study involved secondary analysis of published literature and did not involve human participants. To date, no systematic review has comprehensively compared school-based and community-based interventions in terms of their effectiveness in addressing anxiety, depression and stress among school-aged children. This review aims to fill that gap by providing clinical insights into the comparative effectiveness of various intervention types and settings.

CRD42023479389.

In total, 140 women will be randomised in a 1:1 ratio to the intervention or waitlist control group. The intervention programme consists of two times a week 1-hour supervised Hatha or (easy) Vinyasa yoga classes at a yoga or sports centre for 18 weeks and once per week a half-hour at home using videos. The waitlist control group is asked to maintain their habitual lifestyle during the first 18 weeks and will participate in a similar yoga programme to the intervention group for the following 18 weeks. The control group yoga programme is offered live-remote. The primary outcome (musculoskeletal complaints) is assessed with the Brief Pain Inventory questionnaire at baseline and 18 weeks (primary comparison) and additionally at 36 weeks. Secondary outcomes include lower and upper extremity joint complaints, menopausal symptoms, fatigue, sleep, quality of life, anxiety and depression, cognitive complaints and habitual physical activity (all patient-reported), vital signs and anthropometrics, physical fitness, blood biomarkers, medication use, safety data and patient and teacher experiences. At baseline and 18 weeks, cognitive complaints are also assessed with an online neuropsychological test battery.

The COBRA study was approved by the Medical Ethical Committee of the University Medical Center Utrecht. The study started on 8 October 2024, and 65 participants have been included (20 January 2026). Results will be submitted to an international peer-reviewed journal.

NCT06480513.

The continuation of first-line therapy with radiotherapy for oligoprogression versus early switch to second-line therapy in oligoprogressive hepatocellular carcinoma trial is a prospective, multicentre, randomised phase III study that will enrol 132 patients with advanced HCC who experience their first oligoprogression during FLST. Oligoprogression is defined as one to five progressive lesions involving no more than one to three organs. Participants will be randomised (1:1) to either continuation of FLST combined with RT to all oligoprogressive lesions or discontinuation of FLST followed by initiation of SLST. RT will be delivered with a biologically effective dose (linear–quadratic model, α/β=10) of at least 60 Gy whenever feasible. The primary endpoint is PFS. Secondary endpoints include overall survival, objective response rate, disease control rate, duration of response and quality of life. Predefined exploratory analyses include circulating tumour DNA profiling, optional paired tumour biopsies, functional imaging with fibroblast activation protein inhibitor positron emission tomography-CT and longitudinal immune profiling.

This study has been approved by the Ethics Committee of the Affiliated Cancer Hospital of Shandong First Medical University (number: SDZLEC2025-025-02) and has been registered in ClinicalTrials. gov (NCT06841172). Final study results will be disseminated through peer-reviewed journals.

NCT06841172.

We will conduct a randomised pilot trial in KwaZulu-Natal (KZN) Province, South Africa among postpartum women and their male partners. The study will pilot a combination intervention consisting of cognitive behavioural strategies (including communication skills training, motivational interviewing and problem-solving) to promote HIV self-testing (HIVST) for Partners and PrEP uptake for HIV-uninfected Postpartum Women, the ‘H4P’ intervention. The study aims to determine the feasibility, acceptability and preliminary effectiveness of the H4P intervention. We will enrol 60 HIV-uninfected women, aged 18 years and older, in their third trimester of pregnancy and reporting a partner whose HIV-serostatus is unknown. Sixty male partners will also be eligible to enrol. Enrolled women will receive three oral HIVST kits to distribute to their male partners and standard of care information on HIVST and PrEP. Women randomised to the intervention arm will receive additional counselling and reproductive health-centred HIVST information for the male partner, including information about why HIV testing is important during their partners’ postpartum period. To evaluate feasibility, we will calculate screening-to-enrolment ratios for women and men, the number of women who distribute HIVST kits to their male partners and the number of men who test. Acceptability will be evaluated using the Client Satisfaction Questionnaire and qualitative interviews. Effectiveness will be assessed at 3 months by measuring the proportion of women initiating PrEP via self-report and urine tenofovir measurements or receipt of injectable PrEP and the proportion of men who test positive who link to HIV care. Qualitative interviews will explore perceptions of the intervention.

Ethics approval for this study was obtained from the Human Research Ethics Committee at The University of the Witwatersrand, Johannesburg, South Africa (Reference number: 250612) and the Institutional Review Boards at Massachusetts General Brigham (2025P002271, Boston, Massachusetts, USA) and the University of Alabama at Birmingham (300015167, Birmingham, Alabama, USA) in the USA. Site support and approvals were obtained from the health facility and the KwaZulu-Natal Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations.

NCT07194902.

Retrospective, multicentre, non-interventional observational cohort study.

Region-wide public healthcare system data (primary and secondary care) from Andalusia (Spain), 2016–2022.

All adult patients meeting inclusion criteria with a recorded diagnosis of hypercholesterolaemia between 1 January 2016 and 31 December 2022 (n=557 034; 227 834 men and 329 200 women).

None.

Primary outcomes were age- and sex-stratified patterns of hypercholesterolaemia diagnosis and comorbidity burden before and after age 50 years (proxy for post-menopausal age). Secondary outcomes included comorbidity-specific comparisons between sexes across age strata and trajectory-based analyses (OR trajectories and incidence-ratio summaries).

Women were diagnosed later than men (mean age 59.1 vs 56.0 years; mean difference 3.1 years, 95% CI 3.03 to 3.17). Hypercholesterolaemia diagnoses in women rose sharply around ages 50–55 and remained higher than in men at older ages. Comorbidity patterns differed by sex across age strata: compared with men, women aged ≥50 years had higher frequencies of osteoporosis (42 255 vs 2623), anxiety disorder (94 916 vs 31 374) and hypertension (147 538 vs 91 532), with statistically significant differences for these comparisons (p<0.001).

Menopause age is a pivotal period associated with a shift towards higher hypercholesterolaemia diagnosis rates and a greater burden of specific comorbidities in women. These findings support sex-specific prevention and management strategies, particularly targeting the menopausal transition and early post-menopause.

The trial of Transcutaneous Auricular vagus nerve Stimulation for moderate to severe Chronic Prostatitis/CPPS is a prospective, randomised, sham-controlled trial with a 1:1 allocation ratio. Participants will be assigned randomly to either the taVNS group or the sham-taVNS group. The intervention period will consist of a 4-week treatment (a total of 40 sessions), followed by an 8-week follow-up period. The primary outcome is the change from baseline in the National Institutes of Health Chronic Prostatitis Symptom Score Index total score at week 4. Secondary outcomes include the International Prostate Symptom Score Scale, European Quality of Life 5-Dimensions-5-Levels questionnaire, Self-Rating Anxiety Scale and Self-Rating Depression Scale. Safety assessments will be conducted throughout the entire study period.

This study protocol and informed consent documents were reviewed and approved by the Institutional Review Board of Guang’anmen Hospital, China Academy of Chinese Medical Sciences (approval number: 2023-250 KY). Written informed consent will be obtained from all participants and/or their legal guardians prior to trial participation. The findings will be disseminated through publication in a peer-reviewed journal and presentations at scientific conferences. The research data will be made available on reasonable request.

NCT06287970.

Participants self-administered an online-survey in a cross-sectional study design. The survey consisted of 14 questions on current practices of SLPs with their patients with PD, self-perceived competence when assessing and managing PD and perceived barriers for catering to patients with PD. Inferential statistics were run on self-perceived competence across domains and their relationship with demographic/current practice factors. Descriptive statistics were used to analyse perceived barriers.

The survey was administered in English through Google Forms.

54 Malaysian SLPs with at least one active case of PD in their caseload were invited via email and WhatsApp Messenger. These contacts were obtained from the Speech-Language Therapists Association of Malaysia (SPEAK), and snowball sampling was encouraged to recruit additional SLPs through other social networks.

To quantify Malaysian SLPs’ self-perceived competence levels (assessed on 5-point Likert scales) in assessing and managing five key domains in patients with PD: speech, language, oro-motor skills, cognition and swallowing; and to identify the frequency and types of barriers encountered in clinical practice with patients with PD through structured multiple-choice questions. Secondary outcomes included quantifying current service delivery patterns (frequency of PD referrals, stage at referral, caseload size), multidisciplinary consultation patterns and confidence levels in managing rehabilitation risks associated with PD, all measured through structured survey items with categorical or ordinal response options.

Most participants had 1–5 patients with PD in their active caseload, referred at a middle or advanced stage of the disease. The majority of participants felt competent in assessing and managing motor speech and language in patients with PD. Conversely, most of them did not feel competent in assessing and managing cognition in these patients, regardless of demographic factors or current practices. This difference was significant. Most participants also reported facing barriers such as health conditions or comorbidities, family expectations on the therapy outcome and the unavailability of a multidisciplinary approach.

The study reveals that SLPs working in Malaysia feel competent in working with motor speech and language in individuals with PD. However, it highlights a need for additional training to address cognitive assessment and management as a crucial tool to boost functional communication in people with PD. The study also reveals a need for promoting a multidisciplinary approach.

Cross-sectional survey.

Bangladeshi youths aged 18–35 years across the eight divisions who participated in the national Gender Norms Attitude Study in 2022.

Of the 2790 participants, 2016 (mean age 28.27, SD 5.11) were included in this study as they were either married or in a committed relationship.

The primary outcome measures were IPV perpetration, assessed using the Hurt, Insult, Threaten, Scream scale. The primary exposures were two dimensions of childhood adversity (ACE): threat and deprivation, derived from the nine items commonly used in public health research.

Overall, 59.88% of men and 41.53% of women reported having perpetrated IPV. Both threat (adjusted OR (aOR)=2.57; 95% CI 2.03 to 3.23) and deprivation (aOR=1.75; 95% CI 1.39 to 2.20) ACEs significantly associated higher odds of IPV perpetration. Women had lower odds of perpetration than men (aOR=0.41; 95% CI 0.32 to 0.52), as did those with higher socioeconomic status (aOR=0.83), whereas the odds varied by region (eg, highest in Barisal, aOR=4.40).

Conclusions

The findings highlight the importance of adopting a dimensional approach to ACEs and considering regional and socioeconomic factors in IPV prevention efforts. By integrating these findings into public health interventions and policy frameworks, Bangladesh and other low- and middle-income countries can develop more effective, culturally sensitive strategies to reduce IPV and its devastating consequences.

This study focuses on predicting ICU length of stay (LoS), hospital discharge outcomes and discharge location for ICU-admitted viral hepatitis patients using a comparative assessment of machine learning (ML) models. Leveraging data from the Medical Information Mart for Intensive Care-IV database, which includes around 94 500 ICU patient records, this study uses sociodemographic details, clinical characteristics and resource utilisation metrics to develop predictive models such as Random Forest, Logistic Regression, Gradient Boosting Machines and Generalised Additive Model with Negative Binomial Regression.

Among 3875 ICU-admitted hepatitis patients, Random Forest classification outperformed Logistic Regression in predicting discharge outcomes, achieving higher accuracy (0.87 vs 0.82) and greater discriminative ability (area under the receiver operating characteristic curve 0.95 vs 0.89). For ICU LoS prediction, Random Forest regression applied to log-transformed LoS demonstrated strong performance (R² up to 0.82), while the generalised additive model with negative binomial distribution explained approximately 76% of LoS variance. Prediction of discharge location yielded moderate performance across Gradient Boosting and multinomial logistic regression models (accuracy 0.55 and 0.56), reflecting challenges associated with multi-class imbalance. Variable importance analyses across ML models consistently identified medication counts, procedure counts, comorbidity burden, age, race and total LoS as the most influential predictors of discharge outcomes and discharge location.

This study demonstrates the value of ML models for predicting clinical outcomes for hepatitis patients, including ICU LOS and hospital discharge status. The results underscore the influence of factors like race and age, revealing disparities that must be addressed in predictive care strategies. While the models show promise, challenges such as variability in prolonged stays and limited multiclass prediction accuracy point to the need for ongoing refinement and research.

We will conduct a mixed-methods, non-randomised, single-arm feasibility study, designed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) framework and checklist for feasibility and pilot studies, including best practice guidance for non-randomised feasibility studies. The study will be conducted in two rural sites: Kilifi, Kenya and Kiang West, The Gambia. The intervention was codesigned with stakeholders and includes community-based hypertension screening by CHWs, risk stratification and hypertension-mediated organ damage assessment at primary healthcare facilities, followed by treatment initiation using single-pill combination (SPC) antihypertensive therapy for eligible individuals. Training will be provided to all healthcare providers involved in the study. We will screen 500 participants aged 30–80 years at their residence (250 from each country), and we expect that about 45% will be referred for additional assessments and of these 25% (or 10% of the total sample) will be prescribed treatment with SPC. Data collection to evaluate the intervention and its implementation will involve quantitative measures of feasibility and clinical outcomes; observations to assess fidelity and costing measures; and qualitative interviews and focus group discussions with patients, healthcare providers and policymakers to understand the acceptability and contextual influences on intervention implementation.

Ethics approval was obtained from the Kenyan National Committee for Science, Technology and Innovation (ref: 415561), the Gambia Government/Medical Research Council Joint Ethics Committee (ref: 31372) and the London School of Hygiene and Tropical Medicine Ethics Committee (ref: 31372). Study findings will be disseminated through peer-reviewed publications, conferences, policy briefs, community engagement forums and accessible summaries shared via the Improving Hypertension Control in Rural sub-Saharan Africa and partner newsletters.

This study is registered with the ISRCTN- The UK’s Clinical Study Registry (ISRCTN81228019), and Pan African Clinical Trials Registry (PACTR202504839027548).

A cross-sectional two-stage multi-cluster sampling survey.

In 2016–2019, a violent conflict in the Greater Kasai region of the DRC led to widespread atrocities and massive displacement. The population not only has to cope with the aftermath of interpersonal violence, loss of loved ones and displacement but also faces severe food shortages and livelihood crises.

Data were collected in 2022 from 4069 randomly selected heads of households (displaced and non-displaced) within 126 randomly selected localities in 27 health zones in the Greater Kasai. The study collected data from households with different displacement experiences: internally displaced people (IDPs), returned IDPs, repatriated refugees and members of the host community (those without a displacement history).

The primary outcomes are mental health disorders. Anxiety, depression and PTSD were measured with the Generalised Anxiety Disorder-7, the Patient Health Questionnaire-9 and the Primary Care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

The prevalence of anxiety, depression and PTSD was 8.3%, 18.3% and 37.8%, respectively. Anxiety affected 10% of non-displaced respondents, with a similar prevalence among IDPs (9%) and returned IDPs (8%), compared with a substantially lower prevalence among repatriated refugees (4%). About 17% of non-displaced respondents have symptoms of depression; this number is considerably higher for IDPs (22%) and returned IDPs (22%) but lower for repatriated refugees (11%). Around 40% of the non-displaced individuals, IDPs and repatriated refugees are characterised by PTSD, while this share is lower for returned IDPs (31%). Overall, a one unit increase in food insecurity (on a 0–7 scale) is associated with higher levels of anxiety (0.33 on a 0–21 scale, p<0.001), depression (0.60 on a 0–27 scale, p<0.001) and PTSD (0.07 on a 0–5 scale, p<0.05); these associations exist for those with and without a displacement history.

Food insecurity is associated with poor mental health in Greater Kasai. Further research needs to explore how to develop synergistic interventions to improve both mental health and livelihoods in conflict-affected populations.

This is a descriptive cross-sectional survey.

All 12 regions in Morocco.

Perceived priority drivers of mental health and well-being among youth.

A total of 1182 participants were included (mean age 20.5 years, 68.2% female, 85.7% from urban settings). Regarding health and nutrition, 46.3% valued sleep, 59.7% emphasised physical health, 53.1% highlighted access to quality healthcare and 56.5% prioritised clean air. In terms of connectedness and contribution, 75.7% rated family relationships as critical to their well-being, while 42.5% emphasised positive peer relationships. Regarding safety and supportive environments, 64.7% considered personal safety essential, 70% prioritised the fulfilment of basic needs and 63.7% valued personal information protection. For education and competence, 54.4% emphasised learning opportunities and 62.2% identified self-confidence as key drivers. Regarding agency and resilience, 59.4% valued independence, 68.5% stressed having a sense of purpose and 55% identified hope and optimism as key to their well-being. In digital well-being, 37.7% believed social media helped maintain connections, 38% viewed it as a learning tool while 31.6% reported it as a source of stress and anxiety

This study provides valuable insights into priority drivers of youth mental health in Morocco from the perspective of Moroccan youth which should be the target for future interventions aiming to promote youth well-being. The findings contribute to the limited data on youth mental health in low and middle-income countries, highlighting the urgency for comprehensive mental health services and further research on subjective well-being.

Cross-sectional household survey using a standardised KAP questionnaire. Ontologies were classified using latent class analysis. Associations between ontology classes and outcomes were assessed using multivariable logistic regression models.

Urban, rural and protected areas in biodiversity-rich regions of Bolivia, Brazil, Chile and Guatemala.

A total of 2903 individuals aged ≥10 years were recruited through random household sampling (response rate 85%).

Primary outcomes were defined according to the KAP framework. Knowledge outcomes comprised combined knowledge of zoonotic disease transmission from wildlife to humans and knowledge of zoonotic risks associated with wildlife trade. Perceived training needs related to zoonotic disease prevention were analysed as a secondary knowledge outcome measure. Attitudes were measured through risk perception, operationalised as concern about zoonotic disease transmission. Practices included self-reported hunting and slaughtering of wildlife.

The analysis identified three distinct ontology classes: Relational environmentalism (52% of the population), characterised by strong spiritual connections to animals and a tendency to protect wildlife; Dualistic environmentalism (28%), with a weaker spiritual connection to animals but a commitment to wildlife conservation; and Neutral (20%), demonstrating little spiritual connection to animals and a neutral attitude towards wildlife conservation. In the logistic regression analyses, both environmentalism groups exhibited greater knowledge of zoonotic transmission and concern about outbreaks, with members of the Relational class demonstrating higher levels of these attributes. Furthermore, members of the Dualistic environmentalism class were less likely to have close contact with animals.

In Latin America’s biodiversity-rich regions, individuals whose ontology aligns with environmentalism appear to demonstrate a heightened awareness of zoonoses, particularly those who adhere to a Relational environmentalism perspective. Consequently, the integration of IPLC cultural knowledge holds potential to enhance wildlife conservation measures and contribute to the mitigation of disease transmission. Further research is needed to explore causal pathways and the integration of culturally grounded approaches into public health interventions.

Prospective cohort study.

The American Cancer Society Cancer Prevention Study-3, a nationwide US cohort with follow-up every 3 years beginning in 2015.

Adults who in 2015 had already quit smoking (n=3112) or were smoking (n=1018) and who in 2018 reported past or current exclusive use of ENDS or NRT and provided smoking status.

Relapse to cigarette smoking in 2018 among people who were already quit in 2015, and abstinence from cigarettes in 2018 among people who were smoking in 2015.

Among respondents who had already quit in 2015, the unadjusted risk of relapse in 2018 was approximately three times greater for those who reported past exclusive ENDS versus past exclusive NRT use (11.2% vs 3.9%; relative risk (RR)=2.90, 95% CI 2.12 to 3.98). This association remained significant in a multivariable-adjusted model (RR=2.09, 95% CI 1.49 to 2.92). Among those smoking in 2015, the unadjusted likelihood of abstinence in 2018 was higher for those who reported current ENDS versus NRT use (RR=1.35, 95% CI 1.01 to 1.80), but the multivariable model adjusted for smoking frequency indicated no difference in abstinence (RR=1.38; 95% CI 0.93 to 2.05).

ENDS use was associated with greater relapse risk than NRT among people who had already quit. Although ENDS may support shorter-term cessation, further long-term observational research is needed to clarify relapse risks associated with ENDS relative to NRT.

The methodology for this scoping review will follow the guidelines outlined in the Joanna Briggs Institute Methodology Manual. Using the keywords, UGT1A1 polymorphism, HIV and TB coinfection, treatment outcomes and SSA, we will search for articles on PubMed/Medline, Cochrane Library, Embase, Web of Science and Scopus to obtain relevant articles published from January 2010 to April 2026. Two independent reviewers will screen and assess quality of titles and abstracts against the predefined inclusion and exclusion criteria and manage the data using Microsoft Excel. Conflicts will be resolved through discussion and where necessary a third reviewer will be consulted. Findings will be narratively synthesised across polymorphisms and treatment outcomes. The reviewers will meet and discuss the themes that will arise as well as the interpretation of the themes to minimise bias in the findings.

The scoping review relies on publicly available published resources, exempting it from ethical review board oversight. The review findings will be shared in a peer-reviewed journal.

Cross-sectional study design.

Sub-Saharan Africa (SSA) region. 24 SSA countries were included in this study.

Demographic and Health Survey (DHS), 2016–2024.

82 397 women who were pregnant in the last 2 years preceding the survey.

HIV test non-uptake, which is a legacy indicator of HIV test among pregnant women.

The HIV test non-uptake among ANC attending pregnant women was 39.6% (95% CI 39.27% to 39.93%). The spatial autocorrelation test revealed that HIV testing non-uptake among pregnant women was clustered. The global Moran’s I value was 0.48 with a p value <0.01. Hotspot areas were those with high rates of HIV testing non-uptake. These hotspot areas were located in most parts of Mali, Mauritania, Madagascar, Guinea, Senegal, central parts of Angola, eastern part of Senegal and northern parts of Ethiopia. The Multiscale Geographical Weighted Regression (MGWR) model explained 91% of the spatial variation of HIV test non-uptake among pregnant women, who were in the age group 15–19 years, had no formal education and no health insurance, and less than four antenatal care contacts were significantly associated with HIV test non-uptake.

There was a significant geographical variation in HIV test non-uptake among pregnant women attending antenatal care (ANC) in sub-Saharan Africa. Prioritising hotspot areas with high rates of HIV test non-uptake for spatially targeted interventions is essential. Policymakers, health professionals, and other stakeholders should focus on improving women’s formal education, expanding health insurance coverage, and increasing ANC contacts to ensure that each visit includes HIV screening. Moreover, special attention should be given to younger women to enhance HIV testing uptake among those attending ANC in sub-Saharan Africa.

An observational study, using a mixed-methods convergent design triangulating data from (1) semistructured interviews or focus groups and/or a self-completed survey, (2) routine service utilisation data, (3) local grey literature and (4) expert consultation.

The study was conducted in Chile, Ethiopia, Georgia, Nigeria, South Africa and Sri Lanka.

121 key informants.

We found clear evidence in all sites that the pandemic exacerbated pre-existing disadvantages experienced by people with MHCs and led to a deterioration in the availability and quality of care, especially psychosocial care. Alongside increased vulnerability to COVID-19, people with MHCs faced additional barriers to accessing prevention and treatment interventions compared with the general population. To varying extents, sites showed accelerated implementation of digital technologies, but with evidence of worsening inequities in access. In sites where primary care-based mental healthcare was more developed or prioritised, systems seemed more resilient and adaptive.

Our findings have the following implications. First, these mental health service reductions are clear examples of ‘structural stigma’, namely policy level decisions in healthcare which place a low priority upon services for people with MHCs. Second, integration of mental healthcare into all general healthcare settings is key to ensuring accessibility and parity of physical and mental healthcare. Third, digital innovations should be designed to strengthen and not fragment health systems. We discuss these findings in terms of anticipating such challenges for future pandemics and preparing layers of resilience.

Nationwide cross-sectional study based on an online self-administered questionnaire. Multivariate logistic regression models were used to identify factors associated with financial precarity.

All 34 French health universities.

A total of 12 565 health students participated, including medical (56%), paramedical (21%), midwifery, odontology, pharmacy or physiotherapy students (12%) and first-year health students (11%).

Financial precarity was defined as an indicator combining financial insecurity, frequent overdrafts and foregoing essential purchases. Primary outcomes included depressive symptoms, anxiety and emotional exhaustion. Secondary outcomes included healthcare avoidance and academic outcomes.

Among 12,565 respondents, 56% were medical students, 21% were paramedical, 12% midwifery, odontology, pharmacy or physiotherapy and 11% first-year health students. Financial precarity varies by academic fields of health, ranging from 4.6% in first-year health students to 12% in paramedical students. Adjusted analyses showed lower odds of precarity among medical (aOR=0.69; 95% CI 0.52 to 0.83), midwifery, odontology, pharmacy or physiotherapy (aOR=0.55; 95% CI 0.43 to 0.72) and first-year health students (aOR=0.54; 95% CI 0.38 to 0.77) than paramedical students. Risk factors included very low parental socio-economic status (aOR=2.96; 95% CI 2.33 to 3.89) and student loans (aOR=2.78; 95% CI 2.33 to 3.32). Financial precarity was strongly associated with depressive symptoms (aOR=4.90; 95% CI 4.13 to 5.80), anxiety (aOR=3.84; 95% CI 3.13 to 4.52), emotional exhaustion (aOR=8.49; 95% CI 5.98 to 12.06), renouncing healthcare (aOR=6.21; 95% CI 5.01 to 7.70) and repeating a year (aOR=1.80; 95% CI 1.54 to 2.10).

Financial precarity among health students is shaped by economic and academic factors, with family support protective of and low socio-economic background increasing vulnerability, and is associated with poorer mental health, reduced healthcare access and academic difficulties.

Secondary analysis of data from the TransformUs cluster randomised controlled trial with cross-sectional and 12-month follow-up analyses.

Primary schools in metropolitan and regional areas of Victoria, Australia.

Children aged 7–11 years with valid accelerometer at baseline, regardless of demographic, adiposity and HRQoL data available (n=792), were included in the analytical sample for the latent profile analysis.

Sedentary time, light-intensity physical activity (LPA) and moderate- to vigorous-intensity physical activity (MVPA) along with their respective mean bout lengths were derived from raw acceleration data. Latent profile analysis used these measures (total times, as isometric log ratios and mean bout lengths) as input variables to classify distinct profiles for us as a categorical exposure variable in regression models. Primary outcomes were age- and sex-standardised body mass index, waist circumference and parent-reported HRQoL at baseline. Secondary outcomes were the same measures assessed at 12-month follow-up.

Four distinct profiles were identified. The high MVPA-short sedentary bout profile (n=184) was characterised by the highest levels of MVPA, moderate sedentary time and the shortest mean sedentary bout duration. The low sedentary-high LPA profile (n=54) had the lowest sedentary time, the highest LPA and the longest mean LPA bout duration. Two profiles were characterised by high sedentary time: the high sedentary-long sedentary bout profile (n=149), which had the longest mean sedentary bout durations, and the high sedentary-shorter bouts profile (n=405), which also had high sedentary time but shorter bout durations for all intensities. While the omnibus Wald test for differences across profiles indicated uncertainty in the overall profile effect, the high MVPA-short sedentary bout profile had favourable adiposity levels cross-sectionally compared with the high sedentary-long sedentary bout reference profile in pairwise comparisons. No longitudinal associations were detected.

Four distinct movement profiles were identified. Few pairwise differences between health outcomes were observed. While MVPA remains a key factor for promoting healthy body weight, our findings suggest that a variety of movement patterns - including those characterised by lower sedentary time and higher LPA - may also support health in children.

This study is a secondary analysis of the TransformUs effectiveness-implementation trial, registered with the Australian Clinical Trials Registry (ACTRN12617000204347; 1 April 2017).

We aimed to investigate the association between hypertension and tinnitus in detail using a large, population-based dataset from a rural setting.

Design

Observational cross-sectional study.

Setting

Sheshdeh, Fasa, Iran.

We analysed data from 9775 individuals in the general population, aged 35–70 years, excluding those with a history of cancer, pregnancy or medical conditions known to cause tinnitus, such as stroke, seizures or multiple sclerosis. Additionally, although the study design aimed to exclude participants using aminoglycosides because of their significant ototoxic effects, no such users were identified during the study period.

Hypertension was defined as a systolic blood pressure (SBP) of ≥140 mm Hg or a diastolic blood pressure (DBP) of ≥90 mm Hg on at least two separate measurements or as current use of antihypertensive medications following a prior diagnosis. These medications included ACE inhibitors, angiotensin receptor blockers, diuretics, aldosterone antagonists and atenolol. Stage I hypertension was classified as an SBP of 140–159 mm Hg or a DBP of 90–99 mm Hg, while stage II was defined as an SBP of ≥160 mm Hg or a DBP of ≥100 mm Hg. Controlled blood pressure was defined as values below these thresholds. Tinnitus, assessed by a self-reported questionnaire, was defined as a continuous wheezing sound in the ear persisting for more than 1 week.

Among participants (4446 males, 5309 females; mean age 48.55 (SD 9.53) years), the prevalence of tinnitus and hypertension was 7.4% and 19.3%, respectively. Hypertension was significantly associated with higher odds of tinnitus (adjusted OR=1.34; 95% CI 1.10 to 1.62). Notably, even participants with controlled hypertension had a 27% increased odds (OR=1.27; 95% CI 1.02 to 1.59) compared with normotensive individuals. The odds were highest in those with uncontrolled grade II hypertension (OR=2.08; 95% CI 1.25 to 3.47), demonstrating a dose-response relationship.

Our findings suggest a positive association between hypertension and tinnitus, with odds increasing alongside the severity and poor control of hypertension. Importantly, even controlled hypertension was associated with elevated odds, indicating that tinnitus screening may be warranted in all hypertensive patients, regardless of control status. These results underscore the need for heightened clinical awareness and further research into the pathophysiological mechanisms linking vascular health and auditory symptoms.

Systematic review with best-fit framework synthesis

MEDLINE, EMBASE, Web of Science, CINAHL and Scopus from inception to 14 November 2025.

Studies with any design, in any clinical and geographical setting, reporting on adult (18+) current or past smokers with a diagnosis of schizophrenia, bipolar or mood disorder, including major depressive disorder or post-traumatic stress disorder. We selected all quantitative and qualitative findings regarding patients’ values and preferences, including beliefs, attitudes, behaviours and perceived barriers and facilitators, in relation to smoking cessation interventions.

Two reviewers independently screened studies. After a pilot to increase accuracy, data were extracted by one reviewer and verified by another. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used the best-fit framework synthesis methodology to synthesise the data.

Of 14 970 identified articles, 65 were included. Most studies were of moderate to high quality. Financial costs posed a significant barrier, while education and social support emerged as important facilitators. Patients preferred personal interactions with healthcare providers. Their motivation for cessation varied and was influenced by habits and perceived nicotine dependence. Health concerns and financial savings were primary drivers for reflective motivation. Beliefs regarding treatment varied. Although commonly used, scepticism about nicotine replacement therapy and concerns about the long-term safety of electronic delivery systems were reported. Overall, patients preferred personalised, flexible programmes and emphasised the need for tailored approaches. Digital interventions, especially mobile apps, that provide support, motivational content and relevant information, were perceived as appealing and helpful when sufficiently considering accessibility and usability aspects. Patients commonly perceived smoking as a coping mechanism for negative emotions. Developing new coping strategies and creating smoke-free environments were deemed to contribute to successful cessation.

Patient-centred care for people with severe mental illness should leverage behavioural and pharmacological strategies for smoking cessation. Flexibility, accessibility and ongoing support appeared important for addressing stress, withdrawal symptom interpretation and relapse vulnerability in this population.

CRD42022337933.

A systematic review and narrative synthesis.

Medline, Embase, PubMed, Cochrane via Ovid and CINAHL were searched from 1990 to 2025.

Any study design investigating the impact of PHMRs in isolation or in combination with other interventions on medication discrepancies and other DRPs was included.

Quality of studies was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was undertaken. One reviewer screened the titles and abstracts, assessed full texts and extracted data from all papers with three additional reviewers collectively reviewing 10% at each stage.

A total of 31 studies were included: 13 reported data related to the impact of PHMRs on medication discrepancies, 10 on other DRPs and eight on both. 12 studies explored use of PHMRs integrated into routine clinical flows, with 10 showing that they contributed to the detection and resolution of discrepancies. Seven studies explored use of PHMRs enabling patients to independently complete reconciliation at home (eg, via patient portals). Five of these showed favourable findings in detecting and resolving discrepancies. The remaining two compared their use against standard medication reconciliation: one showed their non-inferiority, while the other favoured the standard process but noted similarities between them. 18 studies reported on other DRPs where PHMRs contributed to detecting and improving problems such as non-adherence (n=7), adverse drug events (ADEs) (n=4), therapeutic duplications or drug-interactions (n=3) and indication without medications (n=2). Two studies evaluating the rate of ADE (per patient) did not find significant findings.

PHMRs can engage patients in their medication safety and contribute to improving medication management. Further large-scale studies are needed to better understand their effectiveness as well as their unintended consequences.

PROSPERO registration number

(CRD42022309343) - An amendment was made to update the search end date.

This study systematic analysis of the burden of maternal haemorrhage sourced data from the Global Burden of Disease (GBD) 2021 study. We estimated the incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) due to maternal haemorrhage. Changes in the burden from 2000 to 2021 were computed using AAPC. To detect statistically notable changes in the trends of maternal haemorrhage metrics between 2000 and 2021, Joinpoint regression analysis using the Joinpoint Regression Programme was conducted. We also projected mortality rates, YLDs and YLLs through to 2050 using maps and trends generated by the GBD Foresight visualisation tool.

Globally, the incidence of maternal haemorrhage among women aged 15–49 years declined from 881.98 per 100 000 reproductive aged women (95% uncertainty interval (UI) 687.01 to –1150.23) in 2000 to 714.00 (95% UI 556.97 o t908.54) in 2021, with an average annual percentage change (AAPC) of –0.91 (–1.37 to –0.49). Similar downward trends were observed for maternal deaths, DALYs, YLDs and YLLs attributable to maternal haemorrhage, with AAPCs of –3.78 (–4.39 to –3.18), –4.68 (–4.83 to –4.55), –1.21 (–1.54 to –0.89) and –4.80 (–5.10 to –4.52), respectively. Sub-Saharan Africa, particularly Western Sub-Saharan Africa, recorded the highest burden in 2021, which is almost 300 times higher than in Western Europe. Elevated rates of mortality, DALYs and YLDs were also evident in Sierra Leone, Chad, Niger, Mali, Nigeria, Burkina Faso, Central African Republic, Somalia and South Sudan in 2021 and projections for 2050. However, the high-income Asia Pacific region had the lowest incidence, DALYs and YLDs at 151.32 (109.63–203.68), 2.21 (1.72–2.86) and 0.87 (0.46–1.38) per 1 00 000 women, respectively. Australasia recorded the lowest maternal death count and YLLs attributed to maternal haemorrhage at 0.69 (0.50–0.90) and 0.56 (0.41–0.74) per 1 00 000 women, respectively.

While the global burden of maternal haemorrhage has declined over time, significant regional and national inequities persist. Even though the 2050 projections show improvement in the burden of maternal haemorrhage, there is also regional and national variation in the rate of decrease in maternal haemorrhage burden. Targeted, context-specific interventions are urgently needed to reduce maternal haemorrhage-related mortality and morbidity.

This study is a scoping review.

We included articles from Medline (via Ovid), Embase and Psychinfo and articles found manually, with no limitations in terms of publication date or location.

Inclusion criteria were all physicians and medical students and articles focusing on one or more dimensions of EC (based on the model of Mikolajczak et al) and of CR (based on the framework of Young et al). We excluded non-research articles and articles concerning other health professionals, physicians’ psychiatric disorders or the impact of emotions on well-being, instrument-handling skills or students’ academic learning.

Data were extracted by two independent reviewers. Results were summarised using descriptive analyses and a narrative synthesis.

After removing duplicates, we identified 12 046 articles. Following a review of their titles and abstracts, we assessed 268 articles for eligibility and included 98 in the scoping review. Most studies examined the effects of emotional regulation strategies, empathy and global EC scores on clinical performance. Positive effects of EC on uncertainty management and intuitive reasoning have been well documented, as have its effects on diagnostic and therapeutic performance and the development of CR in the context of life-threatening situations. A smaller number of studies suggest a favourable impact on clinical performance in the surgical context and on the quality of prescriptions. The impact of EC on diagnostic and therapeutic performance outside emergency and intraoperative contexts and on patient outcomes remains uncertain. The effects of EC on CR were most evident under conditions of high acute stress, likely due to the increased cognitive load associated with such conditions.

EC has been found to have a positive impact on CR mainly when dealing with uncertainty and life-threatening emergencies. Stress regulation and the resulting reduction in cognitive load appear to be a key modulator of EC’s impact on CR. Further research should focus on the impact of EC on diagnostic and therapeutic performance outside emergency conditions and on patient outcomes.

A longitudinal small area-level analysis exploring the association between a proxy for population mental health and economic prosperity across 6789 small areas in England from 2011 to 2019 (NxT=61 101). We apply linear regression models with fixed effects at the area level. Mental health in each area is proxied by a standardised index constructed from administrative data on the use of services related to mental health.

National study of geographical areas in England.

Small areas of England.

Economic prosperity is measured by gross disposable household income (GDHI) per capita at the small area level.

A one SD increase in the index is linked to a 1.9% (95% CI 1.4% to 2.5%) rise in GDHI. The association varies depending on the region, with the strongest association in the North East.

There is evidence of a positive association between proxies for better population mental health and subsequent household income per capita, varying by region. While we cannot infer causality, these findings are consistent with the view that improving mental health may support local economic prosperity.

A descriptive qualitative study with thematic analysis with codes derived inductively from the transcriptions and a structured framework analysis using the six building blocks of the WHO Health Systems Framework exploring barriers and enablers to PoCT implementation.

Healthcare settings in Australia.

Healthcare workers with patient care responsibilities and healthcare administrators with oversight or regulatory responsibility for a service. 18 participants were interviewed with four from hospitals, four from primary care, three from community care, three from pathology laboratories, two from emergency care and two from pharmacy settings.

Healthcare professionals’ perspectives on PoCT implementation were grouped into three main themes: (1) community-centric pathology testing, (2) connectivity and continuity of care and (3) quality and governance. Participants identified insufficient health system financing and health information systems as significant barriers to PoCT implementation. Improved practical guidance for workforce training and health service delivery to interpret the current regulation outside of laboratory settings was viewed as a potential enabler to establishing PoCT within healthcare services.

Participants reflected that Australia has several examples of successful PoCT programmes providing patient-centred pathology to improve healthcare equity. However, the lack of information systems, funding, workforce training and diagnostic strategies prohibits the implementation of PoCT at-scale. It was recommended that adequately financing PoCT to encompass costs for testing, quality management and workforce training would incentivise services to obtain accreditation and ensure quality healthcare delivery. Despite the potential of PoCT to improve equitable healthcare access and patient outcomes, health system strengthening is required to integrate PoCT effectively across Australian healthcare services.

Qualitative, critical ethnographic study conducted from November 2023 to April 2025. We conducted an interpretive, thematic analysis, triangulating fieldnotes (40 hours observations at public events), semistructured in-depth interview transcripts (n=48 interviews with 52 participants) and documents (ie, policies, media, reports).

This study examined direct experiences with manufacturer PSPs across Canada. PSPs have proliferated in Canada as the universal public health insurance scheme does not cover outpatient prescription drugs or infusion services.

A purposive sample of 52 participants with direct experience of pharmaceutical industry PSPs, including patients prescribed specialty medicines, clinicians, pharmaceutical industry and PSP provider employees, payers and policymakers.

Manufacturer PSPs are the default pathway for people to afford and access high-cost specialty and biologic prescription medicines in Canada. Though they are the only care pathway available, participants experienced support as variably helpful, stressful and superfluous; variable over time and across patients’ experiences; and available at the discretion of the PSP. Across participants, four core themes were identified: (1) patients are required to engage with PSPs in exchange for access; (2) outsourcing supports for access to medicines gives rise to a parallel, private health system, generating additional health system complexity; (3) programs are inherently designed for physicians, thus adoption is prioritised over access; and (4) this results in calculated policy trade-offs and health system and patient risks when depending on manufacturer PSPs for affordable access to medicines.

Patients and health systems are precariously dependent on manufacturers to afford and access high-cost, specialty medicines. As a parallel, private care system, there remains little transparency nor patient accountability, with access at the discretion of manufacturers through physician intermediaries. Thus, reliance on pharmaceutical industry resources for affordable access to medicines may incur greater costs for patients and health systems in the longer term. Policymakers need to consider how to design patient-centred, equitable, accountable systems that ensure affordable access to important medicines.

We will conduct a pragmatic, three-arm randomized controlled trial in Texas and South Carolina, enrolling 693 adults with CMP (231 per group). Participants will be randomized to: (1) APA-SM with remote training, (2) APA-SM with in-person training or (3) education control. The primary outcome is pain impact measured by the PEG (composite score of pain intensity, interference on enjoyment of life, and general activity) scale at immediate post-intervention (4 weeks), with follow-up at 1, 3 and 6 months. Secondary outcomes include National Institutes of Health Helping to End Addiction Long-Term Clinical Pain Core common data elements (eg, psychological functioning, disability, sleep, quality of life), opioid use and patient-reported adherence and satisfaction. Implementation outcomes will be assessed at both the patient and provider levels, guided by the RE-AIM framework. Cost-effectiveness will be estimated using implementation costs and incremental cost-effectiveness ratios, and predictive factors for APA-SM treatment response will be identified using statistical machine learning approaches and historical electronic health record data. The target sample size (231 per group) provides 90% power to detect a moderate effect size (Cohen’s d=0.35), accounting for 25% attrition. Randomization occurs at the participant level to reflect real-world delivery and minimize contamination.

This study, sponsored under grant number 4UH3AT012728, has single Institutional Review Board (IRB) approval at UTHealth Houston, Texas, USA (HSC-SN-25-0443). A Data Safety Monitoring Board will oversee adverse event reporting and trial conduct. Dissemination will occur through peer-reviewed publications, conference presentations, stakeholder workshops and community-based reports tailored for rural health systems and policymakers.

This trial will provide the first large-scale evaluation of APA-SM in rural U.S. populations, integrating digital health tools and implementation science methods to help address disparities in pain management. By assessing clinical effectiveness, implementation outcomes, cost-effectiveness and predictive response factors, study results will inform scalable strategies for integrating APA-SM further into rural communities and healthcare systems. If successful, APA-SM has the potential to improve pain care access, reduce opioid reliance and provide a sustainable, patient-centered model for chronic pain management.

NCT07179016.

This systematic review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and the protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline. MEDLINE, Embase, Emcare and CENTRAL will be searched for studies published from inception to 2026, involving adult patients with ILD requiring invasive mechanical ventilation (IMV), with or without comparison to non-invasive respiratory support such as high-flow oxygen, non-invasive ventilation (NIV), continuous positive airway pressure or bilevel positive airway pressure. Eligible studies will include randomised controlled trials and observational studies (cohort and case–control) in adults with ILD and acute respiratory failure requiring IMV in the intensive care setting. Case series with fewer than 10 patients, non-human or in vitro studies and studies involving perioperative lung transplant or lung cancer as the primary diagnosis will be excluded. The primary outcomes assessed will be in-hospital and 1-year mortality, and secondary outcomes will include ventilator-free days, ICU and hospital length of stay, NIV failure, reintubation and postdischarge respiratory outcomes where available. Where feasible, meta-analysis will be conducted using a random-effects model. Heterogeneity will be assessed using the I² statistic. Prespecified subgroup analyses will be performed, including ILD subtype (eg, idiopathic pulmonary fibrosis (IPF) vs non-IPF), presence of pulmonary hypertension, timing of IMV initiation (early vs late), baseline lung function (forced vital capacity ≥50% vs <50%), ventilation strategy (lung protective vs non-specified) and geographical region (eg, Europe, North America, Asia). Sensitivity analyses will be conducted to evaluate robustness of results. Risk of bias will be assessed using the Cochrane Risk of Bias 2 tool (RoB 2) for randomised studies and the Newcastle-Ottawa Scale for non-randomised studies. The quality of evidence will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation approach.

This systematic review will be based on published data, and as such, no ethical approval is required. Findings from this study will be disseminated through peer-reviewed publications as well as presentations in healthcare-based settings.

CRD420251265836.

A retrospective observational study.

A tertiary care hospital in Zhejiang Province, China.

This study included 1030 inpatient fall incidents that occurred between January 2015 and March 2025, drawn from the nursing adverse event reporting system.

Based on the fall-related injury outcomes recorded in the nursing adverse event reporting system. Descriptive statistics were employed to analyse the current status of fall-related injuries. Univariable and multivariable analyses were conducted to explore factors associated with the severity categories of fall-related injuries.

The incidence of fall-related injuries in this study was 60.6% and the incidence of serious fall injuries was 12.1%. Logistic regression analysis identified factors associated with the severity categories of fall-related injuries. The analysis revealed that patients aged ≥65 years (minor injuries OR=1.82; serious injuries OR=1.76), women (OR=1.59; 1.90), tripping falls (OR=3.94; 4.48), impact to the knee (OR=4.00) or trunk (OR=4.28; 5.34) and ambulatory status prior to the fall (OR=1.71; 1.97) were all associated with more severe fall injuries.

These findings underscore the need to strengthen fall and fall-related injury prevention efforts among inpatients, particularly among patients aged ≥65 years and women. Clinical professionals should prioritise protecting high-risk populations through fall prevention and control to reduce the risk of fall-related injuries.

Feasibility randomised controlled trial (RCT).

Study recruitment and intervention delivery took place within four community mental health teams in the UK and Ireland.

Eligible participants had a diagnosis of a SMI and no contraindications to participating in physical activity. Fifty-four participants (25 male, 29 female; mean age 51.6 years) were recruited.

Participants were randomised to the 13-week WORtH intervention, comprising education, activity tracking and health coaching or an education-only control.

Feasibility outcomes included recruitment, retention, adherence and acceptability. Clinical outcomes included device-measured (Axivity AX3) and self-reported PA and SB, body anthropometry, physical function and mental well-being.

This feasibility study met 90% target recruitment and 94% of participants provided follow-up data. Adherence to allocated intervention and engagement with all core intervention components was >80%. Qualitative feedback indicated high levels of satisfaction. Valid device-measured moderate-vigorous PA (MVPA), the intended primary outcome for a definitive trial, was obtained from 90% of participants at baseline and 75% of participants at post-intervention. Point estimates indicated a mean increase of 8.6 min/day of MVPA in the intervention group (baseline 54.7 min/day (95% CI 39.5 to 70.0); follow-up 63.3 min/day (95% CI 50.1 to 76.4)) and of 1.0 min/day in the control group (baseline 42.1 min/day (95% CI 24.6 to 59.6); follow-up 43.1 min/day (95% CI 29.6 to 56.5)).

The results of this study support the feasibility of the WORtH intervention in adults with SMI, and findings will be used to optimise the design of a definitive RCT.

NCT04134871.

Cross-sectional analysis of baseline data from the Fasa Prospective Epidemiological Research Studies in Iran Cohort Study.

Sheshdeh, a rural district in southern Iran.

10 143 adults aged 35–70 years enrolled between 2017 and 2019.

Prevalence of self-reported medicinal herb use during the past year and its associations with demographic variables and non-communicable diseases (NCDs).

Overall, 84.7% of participants (95% CI 83.9% to 85.5%) reported herb use. In multivariable logistic regression, higher educational attainment was positively associated with herb use (university education vs. illiterate: adjusted OR 1.41, 95% CI 1.11 to 1.88). No significant adjusted associations were observed between herb use and major NCDs including diabetes, hypertension, ischaemic heart disease or depression. The most frequently used herbs were Zataria multiflora, Echium amoenum and Matricaria chamomilla, most commonly for anxiety/neurasthenia (81.6%), gastric pain (59.6%) and common cold (49.8%).

Medicinal herb use is highly prevalent among adults in southern Iran. Educational level, but not chronic disease status, was associated with herb use. These findings highlight the need for integrated public health strategies regarding safe and evidence-based use of medicinal herbs.

ElucidatiNg Immunosuppressant pharmacokinetic variabilities by investigating Gut Microbiome modulations After kidney transplantation (ENIGMA) is a prospective, low-interventional, naturalistic longitudinal trial designed to identify biomarkers of TAC and MMF PK variability by examining gut microbiome changes and modulations after kidney transplantation and their link with TAC and MMF PK. Biological samples from 50 patients will be collected at nine specific timepoints pre- and post-transplantation using a rich PK and biological sampling strategy. This approach will enable the derivation of PK parameters for the investigated drugs and the creation of a biobank for future hypothesis testing.

The ENIGMA trial has received ethical approval from the European Medicines Agency (EMA). The reference number of our project is R&D/1325226 and is registered on the Clinical Trial Information System (CTIS) platform with European Union Clinical Trial number 2023–5 08 335-31-00. Results of the trial will be published in scientific journals and presented at different (inter)national conferences.

2023–5 08 335-31-00 EMA.

A systematic review and meta-analysis will be conducted adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE and PubMed Central (via PubMed), Scopus, Embase (via Ovid), the Web of Science Core Collection as well as websites of public health agencies (PHA) will be searched until 1 July 2026. All journal articles and sources from PHAs reporting any primary data on the prevalence of HA-COVID-19 will be included. Methodological quality will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The primary outcome will be the global prevalence of HA-COVID-19. Data synthesis will include random-effects proportional meta-analysis. Estimates will be presented with two-sided 95% CIs and heterogeneity assessed using the I² statistic.

Ethical approval is not needed as no original data will be generated. This review will be published in an international, peer-reviewed journal.

CRD420251136884.

In this prospective multicentre observational study, 230 preterm infants will be recruited after birth. This study will include preterm infants born between 27⁺⁰ and 31⁺⁶ weeks of gestation who require respiratory support within the first 48 hours after birth. NIV-NAVA will be initiated as primary respiratory support either immediately after birth or during the early NICU stay, with settings adjusted according to each infant’s clinical condition. Discontinuation of NIV-NAVA or transition to continuous positive airway pressure or high-flow nasal cannula will be performed based on clinical stability. A less invasive surfactant administration method will be used for infants with respiratory distress syndrome to avoid intubation whenever possible. Infants intubated at birth will be extubated to NIV-NAVA as early as is clinically feasible. Invasive ventilation may be applied if clinical deterioration occurs. The rate of NIV-NAVA failure, duration of non-invasive and invasive ventilation, rate of bronchopulmonary dysplasia and clinical outcomes, such as air leak, patent ductus arteriosus, intraventricular haemorrhage and retinopathy of prematurity, will be measured. The neurodevelopmental outcomes of infants will be assessed for up to 3 years.

The Institutional Review Board (IRB) of Korea University Anam Hospital (2024AN0554) and Seoul National University Bundang Hospital (IRB No. B-2507-984-304) approved this study. The results will be disseminated through scientific conferences and publications.

NCT06786039 registered on 14 January 2025.

This was a retrospective observational study using population-level data from the National Statistics Office of Georgia (Geostat) and the Georgian Birth Registry (GBR). Temporal trends were analysed using Prais-Winsten regression models and annual percentage changes (APCs) and future projections were generated using autoregressive integrated moving average (ARIMA) models.

The study included data on 543 662 live births retrieved from the Geostat for the period 2014–2024. Additionally, maternal characteristics were analysed for 366 684 births recorded in the GBR for the period 2017–2024. Selection criteria included all live births during the study period, with no specific exclusion criteria applied.

Primary outcome measures were trends in the total fertility rate (TFR) and crude birth rate (CBR) over the study period (2014–2024) and their projections for 2025–2034. Secondary outcome measures were concurrent changes in maternal characteristics, including maternal age, nationality, place of residence, region of residence and parity.

Between 2014 and 2024, Georgia’s TFR declined from 2.30 to 1.68 children per woman (APC=3.12%, 95% CI –3.65 to –2.59), and the CBR dropped from 16.3 to 10.7 births per 1000 population per year (APC=4.39%, 95% CI –4.63 to –4.15). Fertility rates decreased most significantly among women aged <20 (APC=–9.93%, 95% CI –10.72 to –9.13) and 20–24 years (APC=–6.41%, 95% CI –7.70 to –5.10). Advanced maternal age increased in both nulliparous (APC=3.65%, 95% CI 1.83 to 5.51) and multiparous women (APC=1.67%, 95% CI 1.12 to 2.22). ARIMA forecast based on current trends showed a continued decline in the TFR to 1.09 (95% CI 0.91 to 1.27) children per woman and the CBR to 7.07 (95% CI 5.97 to 8.16) births per 1000 population by 2034.

Georgia is undergoing a demographic transition characterised by declining fertility rates and delayed childbearing. Assuming the mechanisms underlying 2014–2024 data remain unchanged, projections indicate a continued decline in fertility and birth rates by 2034, which may pose significant social and economic challenges for the country. Further research is needed to explore the underlying factors driving these trends and to develop strategies to address the potential implications of this demographic shift.

We will conduct a randomised effectiveness trial of 350 low-income adults (≥ 55 years) within 3 months of ischaemic or haemorrhagic stroke and with subthreshold depression (Patient Health Questionnaire-9 score <9 and 24-item Hamilton Depression Rating Scale (HDRS) score <15). Eligible and consented adults will be randomly assigned to Tele-BA-S or treatment-as-usual. Tele-BA-S will be comprised of an orientation session, 5 weekly BA sessions and 2 follow-up monthly booster calls delivered by trained community health workers. We will conduct assessments at 1 month, 2 months, 4 months, 6 months and 9 months after baseline. The primary outcome (PSD) will be measured by the 24-item HDRS. Secondary outcomes will include anxiety (Generalised Anxiety Disorder-7 Scale), psychological well-being (Ryff Scale of Psychological Well-being), QOL (Stroke Specific QOL Scale), medication adherence (Medication Adherence Report Scale-5), rehabilitation adherence (Rehabilitation Adherence Inventory), number of emergency department visits and hospitalisations, functional outcome (Barthel Index) and degree of disability (Modified Rankin Scale). Mediating variables will include self-efficacy (Stroke Self-Efficacy Questionnaire), motivation (Motivation in Stroke Patients for Rehabilitation Scale) and activity engagement (Neuro-QOL Participation in Roles and Activities). Exploratory implementation measures will also be collected. Primary analysis will follow the intention-to-treat principle and evaluate intervention effects over time using mixed-effects models.

Ethical approval was obtained by the University of Texas Health Science Center at Houston’s (UTHealth Houston) Committee for the Protection of Human Subjects Institutional Review Board. The trial protocol, statistical analysis plan and code, and deidentified participant data will be made available via the National Institute of Mental Health Data Archive. The results will be presented at academic conferences and submitted for publication. The authors declare that they have no conflicts of interest relevant to the content of this manuscript.

NCT06864715.

Cross-sectional study.

SENS study at the University Medical Center Groningen, the Netherlands, December 2021–May 2023.

KTR, participating in the ongoing TransplantLines Biobank and Cohort Study, ≥12 months post-transplantation.

Participants underwent a structured neurological assessment including history taking, neurological examination, quantitative sensory testing and nerve conduction studies. An expert panel classified participants into no/possible, probable/definite large fibre polyneuropathy or small fibre neuropathy. Large-fibre subtypes included axonal or demyelinating, pure sensory, pure motor and sensorimotor. To assess potential associations with clinical characteristics, logistic regression analysis was conducted.

We included 160 KTRs with a mean age of 59.8±11.6 years at a median of 6.1 (95% CI 3.9 to 13.1) years post-transplantation, with 16 KTRs (10%) diagnosed with polyneuropathy before study inclusion. In total, 84 KTRs (53%) were identified with large fibre polyneuropathy and 7 KTRs (4%) with small fibre neuropathy. KTRs with large fibre polyneuropathy presented with either sensor-predominant polyneuropathy (40 KTR (48%)) or sensorimotor polyneuropathy (44 KTR (52%)). We found no neurophysiological characteristics of demyelination. Overall, 18% (95% CI 11% to 27%) of KTRs with large fibre polyneuropathy were asymptomatic. Higher age (OR=1.04 (1.01 to 1.08), p=0.01), male sex (OR=2.55 (1.19 to 5.60), p=0.02), diabetes (OR=5.58 (1.36 to 38.14), p=0.03) and elevated urea levels (OR=1.12 (1.04 to 1.23), p=0.01) were significantly associated with polyneuropathy in KTR.

In contrast with previous studies, axonal sensory or sensorimotor polyneuropathy is highly prevalent and often underdiagnosed in KTR. Next to higher age and male sex, it was independently associated with diabetes and higher urea levels. Further research is needed to reveal the aetiology and course of polyneuropathy in KTRs.

NCT04664426.

Systematic review and meta-analysis.

MEDLINE, EMBASE and Cumulative Index to Nursing and Allied Health Literature from inception to October 2023.

Non-randomised studies reporting on harms of selected interventional procedures administered to adults living with chronic axial or radicular non-cancer spine pain with ≥4 weeks of follow-up.

A parallel guideline panel provided input on the scope, design and interpretation of this systematic review, including selection of adverse events for consideration. Systematic literature screening, data abstraction and risk of bias appraisal were conducted independently and in duplicate by pairs of reviewers. We used random-effects models for all meta-analyses and the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the certainty of evidence.

We included 60 longitudinal studies (56 non-comparative, 4 comparative) that enrolled 4966 patients with chronic non-cancer spine-related pain. 31 studies investigated radiofrequency ablation or denervation, 22 epidural injections and 11 joint injections or nerve blocks. Low certainty evidence suggests that joint targeted steroid injection and epidural steroid injection for chronic spine pain may result in temporary altered level of consciousness (incidence: 2.1%; 95% CI 1.1% to 4.0%), joint radiofrequency nerve ablation, joint targeted steroid injection and epidural injection of local anaesthetic and steroids may result in deep infection (incidence: 0.7%; 95% CI 0.3% to 2.0%), epidural steroid injection, joint radiofrequency nerve ablation and joint targeted injection of local anaesthetic and steroids may result in dural puncture (incidence: 1.4%; 95% CI 0.5% to 4.3%), and dorsal root ganglion radiofrequency and joint radiofrequency nerve ablation with or without joint-targeted injection of steroids may result in prolonged pain or stiffness (incidence: 8.6%; 95% CI 6.3% to 11.6%). Several interventional procedures may result in metabolic complications and prolonged sensory deficits, but the supporting evidence was only very low certainty. Most complications resolved spontaneously or with conservative management.

Low certainty evidence suggests that several common interventional procedures for chronic spine pain show risk of deep infection, dural puncture, temporary altered level of consciousness and prolonged pain or stiffness. Other harms are uncertain due to very low certainty evidence, and catastrophic outcomes were not reported in the small studies that contributed to our analyses.

A scoping review of studies was conducted using Web of Science, PubMed, Embase and PsycINFO databases from their inception to 18 November 2025, without any restrictions on geographical location. We included only observational studies with full-text, peer-reviewed English articles reporting any suicides, suicide attempts and suicidal ideation of children and young people aged 0–24 years exposed to war. The quality of the included articles was assessed using the Quality Assessment with Diverse Studies. The protocol of the review was registered with the Open Science Framework on 29 March 2022 (https://osf.io/7kszh/).

Of the 3229 articles retrieved, 37 studies were eligible for review, providing data from 24 countries and covering a period of almost a hundred years (1921–2025). Most studies (>20) focused on conflicts ongoing during or until the 2000s, whereas only three focused on World War II. The reported outcomes were suicides (n=9), suicide attempts (n=15) and suicidal ideation (n=21). Included studies spanned six continents, from Latin America (n=5, Colombia only) to Europe (n=10). We assessed the suicide rates during and after wars. There was some evidence of a decrease in suicide rates during war, but no clear trend in suicide rates post-war was observed. The prevalence rates of suicide attempts and suicidal ideation varied widely, without uniformity in the definitions used. War-related trauma, mental health problems, substance abuse and exposure to suicide or suicide attempts were identified as risk factors, while protective factors included family and social support.

There is a need for more methodologically consistent and rigorous research on suicidal thoughts and behaviours in children and young people exposed to war or armed conflicts. Future research should identify mediator/moderating factors influencing suicidal behaviours and their links to mental health.

A qualitative approach was utilised with females purposively sampled for one-on-one semi-structured interviews in the Maputo female prison setting. Data were analysed using Interpretive Phenomenological Analysis (IPA).

Nine females over the age of 18 convicted and incarcerated for perpetrating IPV against their violent partners.

The analysis revealed three themes: Theme 1: Childhood exposure to violence, with subthemes: direct violence in childhood, witnessing violence in the family and the role of alcohol consumption in violence within the family. Theme 2: Living in a violent intimate relationship with subthemes: psychological violence, coping strategies as victims of IPV and use of self-defence during violent episodes. Theme 3: Consequences of IPV perpetration, with subthemes incarceration experience, mistrust of prison psychology services, disintegration of their families and plans for the future.

Mozambican women incarcerated for IPV described their lived experiences marked by family violence growing up and IPV in their relationships and how this may have shaped their coping strategies, risk appraisal and responses to threat. These factors were central to understanding the circumstances that preceded their offence. The women identified a current need for psychosocial services independent of prison staff. Sustained investment in IPV prevention and victim protection services is warranted to potentially reduce both prolonged victimisation and the risk of subsequent lethal violence.

A comprehensive scoping review was conducted. Multiple sources were reviewed and articles screened based on inclusion criteria and exclusion criteria.

Searches performed across multiple sources including PubMed, Embase, the Cochrane Library, WHO International Clinical Trials Registry Platform, Orphanet, EU Clinical Trials Register, King’s College London Library and charity organisation webpages.

The included studies were required to focus on KS patients with reported data from an active registry that routinely collects data on KS patients.

Basic information about registries identified in included articles was extracted. Registries identified were contacted with a standardised set of questions to collect additional contextual information. Findings are presented in tables.

The scoping review included 18 articles. From those, 10 registries storing KS patient data were identified. Only one of those registries was KS-specific. Only three out of 10 registries collected data that encompassed genetic, clinical and social variables. Most data included in registries were collected exclusively from medical records, although some registries included data from patient surveys. Registries that received government funding had more KS participants than those that did not.

With only one KS-specific registry existing worldwide and none within the UK, this review has identified a need for the development of further KS-specific registries. Data collected could be used to develop an accurate KS phenotype and therefore lead to increased diagnosis of the disorder, improving the lives of people with KS.

A phase 2 double-blind randomised controlled trial will be conducted using a parallel group design with four arms, namely: (1) standard therapy with oral probiotics and topical secretome (placebo), (2) standard therapy with oral probiotics (placebo) and topical secretome, (3) standard therapy with oral probiotics and topical secretome and (4) standard therapy with oral probiotics (placebo) and topical secretome (placebo). Sixty-four patients with mild to moderate acne vulgaris will be randomly allocated to these groups. Interventions will be administered over a period of 8 weeks, with outcomes to be measured at baseline and post-therapy. This study will be conducted at the Dermatology and Venereology Department of Bali Mandara General Hospital (RSBM). The primary outcome will be the reduction of comedones and inflammatory lesions, assessed using the Yolov8 method. Secondary outcomes will include gut and skin health parameters, such as tryptophan metabolites, collagen, pH, moisture, sebum levels and IL-6, to explore the relationship between microbiome balance, skin condition and inflammation in acne.

This study will be conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and the International Conference on Harmonisation–Good Clinical Practice guidelines. Ethical approval has been granted by the Health Research Ethics Committee of Bali Mandara Regional Hospital (Approval Reference Number: 060/EA/KEPK.RSBM.DINKES/2024). All participants will provide written informed consent prior to enrolment. Data confidentiality and participant safety will be upheld throughout the trial. The results of this study will be disseminated through journals, scientific conferences and relevant academic platforms to ensure wide accessibility and to support further research and clinical application in the field of dermatology, particularly in addressing antibiotic resistance and microbiome-based acne therapies.

NCT06925386.

To understand the current key needs, barriers and challenges of POCT developers for effective development and implementation of POCTs across diverse settings particularly in the domain of cancer, nutrition and infections.

A qualitative semi-structured focus group discussion (FGDs) was employed. The FGDs were guided by the needs assessment process and the Phase Gate Framework. The qualitative data were coded and analysed in NVivo and refined into various themes.

The study was conducted in person at Cornell Tech Campus in May 2024, New York, USA.

24 participants were purposively sampled from the PORTENT (Point-of-Care Technologies for Nutrition, Infection and Cancer) network. Participants included technical developers (eg, engineers, scientists, startup leads) and expert stakeholders (eg, funders, policy advisors, clinicians and academic partners) involved in POCT development, evaluation and implementation.

A total of 24 participants participated in the in-person FGDs in New York (n=24). Key themes identified included gaps in stakeholder engagement, limited regulatory preparedness, insufficient market analysis, challenges in scaling and manufacturing and the need for context-specific adaptation in low- and middle-income country (LMIC) settings. Participants emphasised the importance of user-centred and context-responsive design, strategic partnerships and early planning for regulatory and implementation pathways.

Technical developers and expert stakeholders in the POCT landscape face various barriers to efficient and effective development and implementation of POCTs. It is important to consider their needs when adapting POCTs in LMICs and diverse settings.

To explore the use of eHTA in the development of stem cell-related technologies, a scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review Extension guidelines. Systematic searches were conducted across scientific databases (MEDLINE, International HTA database, EconLit, PAIS Index and EconPapers), grey literature sources (Overton) and through hand-searching to identify eligible articles published from inception to 14 April 2026. No limits were imposed on language. Reviewers will independently record data from eligible studies using a standard data abstraction form. The gathered information will be synthesised both quantitatively and narratively.

Formal ethical approval is not required, as this study does not involve the collection of primary data. The findings will be shared through professional stem cell networks, published in national and international health technology assessment conference proceedings and submitted for open-access, peer-reviewed publication.

A scoping review of studies published in English between 2012 and 2025 was conducted using PubMed and Web of Science. The search combined ‘HIV’ with terms related to area-based SES measures. Eligible studies included PLWH, were based in Canada or the USA, used area-based SES measures and assessed health outcomes.

We screened 3470 studies: 56 met inclusion criteria. Most were US-based (n=53) and focused solely on PLWH (n=46). Area-based SES was measured using composite (n=34), single (n=16) or both types of indicators (n=6), all drawn from census data. The most common SES domain was income/poverty (n=56), the most common geographic unit was census tract (n=19) and the most common health outcome assessed was viral load/suppression (n=29). Most studies linked lower area-based SES with poorer health outcomes among PLWH (n=46).

Our findings highlight the utility of area-based SES as an individual-level SES proxy and tool for capturing broader social determinants of health when assessing a range of health outcomes across studies including PLWH. This review contributes to strengthening methodological approaches and supports future work focused on addressing social determinants and advancing health equity for PLWH.

This study is a multicentre, parallel-group, randomised controlled trial that will be conducted at ten sites in China. A total of 158 adult patients with undiagnosed exudative pleural effusions will be enrolled and randomly allocated (1:1) to undergo either a conventional pleural biopsy (control group) or a pCLE-guided pleural biopsy (intervention group) via semirigid thoracoscopy. In the intervention group, a pCLE system will be applied during thoracoscopy to identify suspicious pleural areas for targeted biopsy. The primary outcome is the diagnostic yield of the procedure in patients with unknown causes of pleural effusion. Secondary outcomes include negative likelihood ratio, diagnostic sensitivity in specific diseases, procedural time, rate of adequate specimens for achieving molecular diagnosis and complications.

Ethics approval was obtained from the China-Japan Friendship Hospital Ethics Committee (2025-KY-018). Written informed consent will be obtained from all the participants. The findings will be disseminated through journal publications and conference presentations.

NCT06741839.

This is a cross-sectional analysis from a Leeds (UK) cohort of anti-cyclic citrullinated peptide (anti-CCP) positive individuals with new musculoskeletal complaints and no clinical arthritis. Assessments included physical examination, a mannequin where participants ticked joints that were painful and ultrasound scans of wrists, metacarpo-phalangeal joints 1–5 (MCPs1-5), proximal interphalangeal joints 1–5 (PIPs1-5), elbows, knees, ankles, metatarso-phalangeal joints 1–5 (MTPs1-5), finger flexor tendons (2-5) and extensor carpi ulnaris. Grey scale (GS), power Doppler (PD), tenosynovitis and erosions were assessed. A generalised estimating equations model was used to evaluate potential associations between tenderness/PRJP and ultrasound findings at the joint-level, adjusting for age and sex. Positive and negative predictive values for ultrasound changes were calculated.

323 participants were analysed. Joint tenderness was associated with ultrasound abnormalities, predominantly PD in wrists, MCPs, PIPs, elbows, knees and MTPs. GS and erosions were also associated with tenderness, but to a lesser degree. Association of PRJP with ultrasound abnormalities was more inconsistent and mostly for GS in the feet (all p≤0.05). Absence of symptoms and signs had a negative predictive value between 97% and 100% in all joints, except in wrists; which was slightly lower.

In anti-CCP positive individuals at risk of RA, tenderness, predominantly in the small joints, was associated with local inflammatory changes on ultrasound. The association of PRJP and ultrasound was limited. In the absence of tenderness, the presence of PD, tenosynovitis or erosions was uncommon. These findings may inform future studies evaluating symptom/sign-guided ultrasound assessment approaches in at-risk populations.

NCT02012764.

SOCRATES is a prospective, population-based cohort study conducted in all linguistic regions of Switzerland. Eligible participants include women aged 14 and above who gave birth to a live or stillborn infant (≥22⁺⁰ weeks’ gestation and ≥500 g) and their cohabiting co-parents, provided they speak German, French, Italian or English. Recruitment was conducted in 81 of the 112 Swiss maternity units, birth centres and organisations of midwives over 6 weeks in spring 2025. Clinical data on pregnancy, childbirth and the early postpartum period are extracted from medical records. Postpartum hospitalisation data are obtained through linkage with national medico-administrative databases. Participants complete online questionnaires shortly after birth and at 2, 6 and 12 months post partum, including sociodemographic characteristics and patient-reported outcomes. The primary outcome is the prevalence of childbirth-related post-traumatic stress disorder at 2 months, assessed using the City Birth Trauma Scale. Secondary outcomes include depression, physical recovery, sexual health, quality of life, healthcare use, perceived care quality and overall well-being. A weighting procedure will be used to ensure representativeness and to account for attrition.

Ethical approval was granted by all seven Swiss ethics committees (number 2024-02262). All participants provided informed consent. Findings will be disseminated through national and international conferences, peer-reviewed publications, policy briefs, social media and stakeholder engagement activities.

NCT06886841.

A systematic review and meta-analysis of observational studies.

A comprehensive search was conducted in PubMed/MEDLINE, Web of Science, Scopus, ScienceDirect and major Iranian databases from inception to 30 November 2024.

We included observational studies published in peer-reviewed journals that assessed CAM use among pregnant women in Iran and reported prevalence estimates or relevant associated factors.

Data extraction and quality assessment were performed independently by two reviewers using a standardised form and the Quality Assessment Tool. Meta-analyses of proportions were performed using the DerSimonian and Laird random effects model. The between-study heterogeneity was assessed using the I-squared (I²) statistic. Subgroup analysis, 95% prediction intervals (95% PrIs) and sensitivity analysis were conducted to explore the sources of heterogeneity and to evaluate the robustness of the overall effects, respectively. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO.

20 studies with a total of 8106 participants were included. The pooled prevalence of CAM use was 49% (95% CI 39% to 59%). The between-study heterogeneity was very high (I²=94.69%) with a wide 95% PrIs range of 3%–94%. The very high between-study heterogeneity and the wide range of PrI for the pooled prevalence were not explained by the quality of the studies, geographical regions of Iran or the methods of data collection. Mentha longifolia, Zataria multiflora and Boswellia thurifera were the most commonly used herbs. Across the included studies, the first trimester of pregnancy was most frequently reported as the period of CAM use, with socioeconomic factors identified as significant predictors. Family and friends were the primary sources of information regarding CAM. The most common reasons for CAM use included gastrointestinal issues, respiratory problems such as colds and coughs, and the desire to improve general health. Only 31% of participants disclosed their use of CAM to their healthcare provider.

Nearly half of pregnant women in Iran use CAM, yet disclosure to healthcare providers is low. An actionable implication is the critical need to integrate routine enquiry about CAM use into standard antenatal care to ensure safe practice. Further research is recommended to evaluate the effectiveness, safety and outcomes of CAM use among pregnant women.

CRD42024618490

Ghana, nationwide sample of males and females aged ≥15 years.

This was a cross-sectional secondary analysis of the 2022 GDHS.

A representative sample of 22 058 individuals (females, 15 014 aged 15–49; males, 7044 aged 15–59)

Current tobacco smoking, smokeless tobacco use and dual use.

Prevalence for smoking, smokeless tobacco and dual use was 4.7 (4.1–5.4), 1.6 (1.3–2.0) and 0.6 (0.4–0.9) among males and 1.0 (0.8–1.3), 0.08 (0.05–0.1) and 0.1 (0.05–0.1) among females, respectively. Among males, smoking was associated with higher age (30–44 years: AOR: 2.3, 95% CI 1.7 to 3.1; 45–59 years: AOR: 2.6, 95% CI 1.8 to 3.7). Higher education was protective for both sexes [(males: AOR: 0.4, 95% CI 0.2 to 0.8) and (females: AOR: 0.4, 95% CI 0.2 to 0.8)] compared with their counterparts who had no education. Males in the Coastal zone had higher odds of use (AOR: 1.8, 95% CI 1.3 to 2.3) compared with males in the Middle zone, while females in the Northern/Savanna zone had lower odds of tobacco use (AOR: 0.5, 95% CI 0.3 to 0.8) compared with the Middle zone. Being Christian was associated with lower odds of smoking among males (AOR: 0.3, 95% CI 0.2 to 0.5) compared with others, while being Mole-Dagbani ethnic is associated with higher odds of smoking among females (AOR: 3.0, 95% CI 1.7 to 5.4).

The study provides the first national analysis across Ghana’s 16 regions and investigates patterns of smoking, smokeless tobacco and dual tobacco use. While tobacco use in Ghana remains predominantly smoked and male-driven, the divergent patterns of use across educational, regional and ethnic groups, especially the emerging risk among females, represent a significant public health shift that demands focused gender-sensitive tobacco control interventions.

A literature review was initially conducted to identify five reference diseases of interest (lung cancer, stomach/colon cancer, breast cancer and kidney insufficiency) and previously reported VOC profiles associated with these diseases. In this trial, the project team from the MITERA Hospital will select patients, and the hospital staff will conduct personal interviews with these subjects. Each participant will also complete a questionnaire for the acquisition of demographic and medical history data, after being informed in detail about the purposes of the questionnaire and signing a consent form. The study protocol consists of two phases. Phase 1 is a baseline study designed to detect and identify breath biomarkers for the early diagnosis of the diseases mentioned above using gas chromatography-mass spectrometry (GC-MS) and secondary electrospray ionisation high-resolution mass spectrometry (SESI-HR-MS). Prescreening will select 120 healthy controls and 175 patients for the baseline phase of the clinical trial, for which breath samples will be collected in 1 L Supel-Inert Multi-Layer Foil gas sampling bags. New biomarkers and VOC profiles will be extracted from these data, and further statistical analysis will allow for artificial intelligence (AI) models to be produced and tested. For phase 2 (validation phase), 120 healthy controls and 100 patients will be selected. Breath samples will again be collected in 1 L gas sampling bags for analyses with GC-MS and SESI-HR-MS. The VOCORDER device will also be used, and its functioning with the newly developed AI models will be evaluated.

This clinical study has been approved by the scientific council at the MITERA hospital in Athens, Greece (#513/2024). The outcomes will be disseminated through peer-reviewed journal publications and presentations at scientific conferences.

NCT06711939.

This systematic review will include primary clinical research studies reporting on diurnal variations, defined as an afternoon/evening (PM) minus a morning (AM) value, within a timeframe of 12±4 hours, for predefined proinflammatory markers, in individuals with diabetes (type 1 or type 2) compared with healthy controls. A search of online databases (Cochrane CENTRAL, Ovid MEDLINE and Ovid Embase) will be performed. Grey literature searches will be performed in clinical trial registries. Two review authors will independently screen retrieved citation records at the title/abstract and full-text levels. Study quality will be assessed using an appropriate National Institute of Health quality assessment tool. A meta-analysis will be performed if more than one study reports equivalent data for any outcome. Statistical heterogeneity will be assessed using the ² test. Where a meta-analysis is not possible or unlikely to be meaningful, a narrative synthesis of the findings will be provided.

Ethics approval is not required for this systematic review as no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations.

CRD420251115780.

A scoping review was conducted with a preregistered protocol. Comprehensive searches of PubMed, Embase and Cumulative Index of Nursing and Allied Health Literature were conducted in April 2025. Reports published between 2016 and 2025 that explored the effects of the CDC guideline were included. No restrictions on language or country of study origin were applied, though all retrieved reports were published in the USA and in English. Two authors independently screened titles, abstracts and full-text reports. Data were extracted by healthcare setting, study aims and design, sample size, study population, participant characteristics and study findings and outcomes. Reports were characterised as empirical studies that evaluated guideline effects or implementation studies that assessed uptake. Study findings were presented descriptively and by evidence maps.

Ninety-four studies met the inclusion criteria: 75 empirical studies and 19 implementation studies. Eighty-eight per cent measured changes in opioid prescribing; all but one found significant reductions in at least one prescribing measure, often among people receiving ≥50–90 morphine mg equivalents per day. Effects occurred across specialties and populations, including groups not targeted by the guideline. Studies found increased rates of tapering, with mixed findings on opioid-benzodiazepine coprescription. Legal analyses showed widespread policy adoption at the state level. Implementation studies described expanded risk-mitigation strategies, sometimes beyond guideline text. Few studies reported patient-centred outcomes, participant race or ethnicity or equity measures.

This voluntary federal guideline had significant intended and unintended effects. The guideline was associated with reductions in opioid prescribing among groups targeted and not targeted by its design, with limited evidence on patient outcomes. Future work should prioritise equity-focused patient outcomes to inform implementation of the 2022 CDC guideline.

Secondary analytical study based on sex-specific PAF estimation combining Moroccan exposure prevalence from a Moroccan population-based survey conducted in 2010–2011, pooled relative risks from an international meta-analysis, national disease frequency estimates (for COPD, two prevalence sources were used: 2010–2011 observed Moroccan data and 2019 modelling-based estimates), 2019 burden indicators and direct medical costs.

Morocco.

Adults aged 40 years and older included in the Burden of Obstructive Lung Disease (BOLD I) survey in Fez, Morocco.

Sex-specific PAFs, attributable COPD and lung cancer cases, disability-adjusted life years (DALYs) and annual direct medical costs attributable to HAP.

In Morocco, HAP accounted for 14.4% (95% CI 8.4% to 21.6%) of COPD cases in men and 25.3% (95% CI 17.0% to 34.0%) in women, and for 14.2% (95% CI 7.9% to 21.8%) of lung cancer cases in men and 25.0% (95% CI 16.1% to 34.2%) in women. The estimated number of COPD cases attributable to HAP ranged from 661 717 (95% CI 411 046 to 948 444) using modelling-based prevalence estimates to 815 368 (95% CI 509 160 to 1 163 973) using Moroccan BOLD I prevalence estimates, while 1356 (95% CI 775 to 2041) lung cancer cases were attributable to HAP. Total attributable DALYs were estimated at 62 561.2 (95% CI 37 588.4 to 91 439.2). Total annual direct medical costs attributable to HAP ranged from US$529.9 million (95% CI US$328.9 million to US$760.0 million) to US$651.6 million (95% CI US$406.6 million to US$930.6 million), depending on the COPD prevalence source used.

HAP contributes substantially to the respiratory and economic burden in Morocco. These estimates should be interpreted considering the regional source of exposure data and the application of pooled international relative risks to the Moroccan context.

This is a multicentre, prospective, longitudinal study involving four clinical centres in Italy and one self-financing partner. Participants aged 3–50 years will be enrolled and stratified into four intervention cohorts: newly diagnosed drug-naïve epilepsy scheduled to start anti-seizure medications, focal drug-resistant epilepsy (DRE) undergoing epilepsy surgery, DRE receiving VNS, and DRE initiating KD. Clinical assessments (including body mass index calculation, self-reported monthly seizure count, dietary evaluation, quality of life scale and gastrointestinal symptoms scale), electroencephalography, MRI and biological sample collection (stool and blood) will be obtained at baseline and longitudinally at two or three timepoints over a 12-month observation period. Gut microbiota changes over time will be assessed via metagenomics (using 16S ribosomal RNA sequencing) and metaproteomics; the associated host DNA methylation profiles will be obtained from blood using Illumina EPIC arrays. Primary endpoints include identification of microbial or host methylation changes predictive of therapeutic response (ie, reduction from baseline in monthly seizure count) to the intervention. Data will be analysed using multivariate models and mixed-effect regression. Further, omics data and corresponding metadata will be integrated using multi-omics approaches to identify molecular signatures biomarkers predictive of treatment response and prognosis in PWE.

The study received ethical approval from the Research Ethic Board (Comitato Etico Territoriale Lombardia 3, ID 4896 – parere numero 4896_17.07.2024_N_bis). All participants or their legal guardians will provide written informed consent. Results will be disseminated through peer-reviewed publications, conference presentations or lay summaries targeting patient organisations.

ClinicalTrials.gov Identifier NCT07010445, registered on 2 May 2025.

The aim of this study was to explore (1) the benefits and challenges experienced by PxP steering committee members in a patient-led event and (2) how to better support patient leadership.

We conducted a qualitative descriptive study of semi-structured virtual interviews with PxP conference steering committee members. Thematic analysis was used to identify core themes that were salient to the data.

The Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis in Vancouver, Canada, and an international virtual setting via Zoom from January 2025 to April 2025.

Purposive sampling was used to conduct interviews with thirteen PxP patient partner steering committee members.

Four core themes were identified in the data: (1) institutional support: how institutions can support patient leadership, (2) steering committee environmental characteristics: what characteristics are conducive to patient leadership, (3) personal growth: how patient leadership promotes growth among patient partners and (4) new possibilities: how patient-led events foster future expansion and opportunities. Power dynamics, intersectionality, and accessibility were also identified as central to supporting patient leadership and building safe and supportive environments.

Patient partners are capable of leading events which promote interpersonal relationships and advance patient engagement practices and governance. Important facilitators include institutional support and governance that considers power dynamics, accessibility and intersectionality.

Following the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, a comprehensive search will be conducted across Medline (PubMed), CINAHL, Embase, Web of Science, The Cochrane Library and MedRxiv from database inception to 10 September 2025. Studies published in English, French, Dutch or German, involving AI-powered chatbots in any healthcare context reporting on clinical outcomes and/or patient satisfaction and/or operational efficiency will be included. Studies without full-text availability, protocols, trial registrations, reviews and studies conducted solely in educational settings will be excluded. Title and abstract screening will be supported by ASReview LAB, an AI-based active learning tool to enhance efficiency. Screening and data extraction will be conducted independently by two reviewers with disagreements resolved by a third reviewer. Findings will be synthesised narratively and presented using structured evidence tables categorised by chatbot type, clinical healthcare context and reported outcomes.

Ethical approval is not required, as this study involves the analysis of published data only. The results of this scoping review will be disseminated through publication in a peer-reviewed journal, presentations at academic conferences and established professional networks.

Open Science Framework (OSF), https://doi.org/10.17605/OSF.IO/8UE3B.

This exploratory qualitative case study aims to capture contextual experiences using semi-structured interviews to gain thematic insights. The estimated sample size for this study is 20 informants and will be selected purposively. Data will be collected through individual interviews using an interview guide with predetermined questions followed by probing questions. Each interview session will last for about 30–60 min. Data analysis will begin during the data collection period using the six-phase thematic analysis approach by Braun and Clarke.

Ethical approval has been provided by the Muhimbili University of Health and Allied Sciences Senate of Research and Ethical Committees with reference number DA.282/298/01.C/2630. In accordance with the Declaration of Helsinki (1964) and its later amendments, all respondents will provide verbal and written informed consent and will be free to participate voluntarily with no incentives. The findings will be shared with participating healthcare facilities, district and regional health authorities and relevant stakeholders through presentations and summary reports. Findings will also be presented at national and international scientific conferences and submitted for publication in peer-reviewed journals.

Systematic review and thematic synthesis.

A comprehensive systematic search across nine databases (MEDLINE, CINAHL, APA PsycINFO, Web of Science (all databases), EMBASE, CENTRAL, LENS.org, British Nursing Index and Health Management Information Consortium) was conducted in June 2025. Grey literature was identified through website searching, contact with topic experts and a national Call for Evidence.

Qualitative and mixed-methods studies exploring motivations, experiences and preferences for peer support after miscarriage were included.

Two independent reviewers used standardised methods to search, screen, extract and code included studies. Suitable studies were evaluated using the Critical Appraisal Skills Programme Qualitative Research Checklist. Findings were extracted and subjected to a thematic synthesis.

Across nine studies included in the review, three overarching themes were developed, with seven subthemes, capturing both barriers and facilitators. ‘Engaging in relational recognition’ reflects the validation and connection that arise through experiential resonance, often heightened by the context of exclusion from broader social or clinical support. ‘Mechanisms of Communality’ describe how communality is enacted through dynamic peer interactions, including modelling and facilitating grief, benchmarking physical change and mattering through reciprocity, highlighting mutual support and shared coping. ‘Dynamics of Access’ consider factors which shape engagement, including changing needs of individuals across time and modalities of support and their effects.

These findings form the first synthesis of peer support after miscarriage and bring a nuanced service user perspective of barriers and facilitators by examining evidence from diverse studies. Peer support after miscarriage was seen to be a dynamic, relational process shaped by shared experience, mutual exchange and context-specific factors. Findings underscore key policy and practice considerations, including the use of trauma-informed, loss-sensitive approaches and consideration of intersectionality, that should be reflected when offering peer support services, with and for, those who have experienced miscarriage.

CRD42024518248.

Qualitative interview study.

UK National Health Service (NHS) breast screening and diagnostic pathways.

Purposively sampled stakeholders.

Semistructured interviews with key professional stakeholders explored potential MBI pathways and routes to adoption, including barriers and facilitators. Data were analysed thematically.

22 participants were recruited between January 2020 and October 2021. Barriers to MBI adoption were identified at three levels: scan-related, system-level, and cultural within the screening programme. Overcoming these is likely necessary for implementation. A further theme highlighted the potential for MBI to improve screening in selected patient groups, contingent on addressing these barriers. Specifically, adoption would require advances in next-generation MBI systems, particularly reductions in radiation dose and scan time, alongside prospective clinical studies in UK populations to assess diagnostic accuracy.

Once identified barriers are overcome, participants perceived that MBI could improve screening pathways, particularly for women with dense breast tissue.

This multisite randomised clinical trial is a multisite double-blind, double-dummy, randomised clinical trial enrolling 360 emergency department patients with moderate-to-severe OUD. Enrolled patients will be randomised to one of two study arms: standard-dose induction or high-dose induction, both provided in the ED. This study will engage, train and provide resources to five EDs throughout the US to recruit patients with untreated OUD into a randomised clinical trial. The primary aim is to evaluate the effects of the standard-dose induction and high-dose induction on rates of OUD treatment participation within 10 days post-randomisation. The secondary aims are to evaluate differences between standard-dose induction and high-dose induction on the outcomes of opioid craving, opioid withdrawal symptoms and illicit drug use assessed during 10 days post randomisation and evaluate the effects between treatment arms on rates of OUD treatment participation within 30 days post randomisation.

This study is funded by the National Institute on Drug Abuse and has been approved by the WCG Instutitional Review Board. It has been registered at clinicaltrials.gov. This study will inform the strategy for treatment initiation with buprenorphine among diverse ED settings and will provide ongoing evidence to support the safety and efficacy of initiating treatment for OUD in the ED.

NCT06494904.

A total of 14 324 participants (average age: 53.48, 34.8% females) were recruited for the baseline survey from July 2022 to November 2023. All participants underwent routine medical examination, including anthropometric (height, weight and blood pressure), ECG, colour Doppler ultrasound (thyroid, carotid artery, heart, abdominal and reproductive system), chest imaging measurements (X-ray or computerised tomographic scanning), and plasma, urine and faeces sample test and a standardised questionnaire, including demographic information, lifestyle factors (smoking, alcohol consumption, diet, sleep factors, physical activity, cognitive activity and social activity) and self-reported history of common chronic diseases. Participants older than 60 were also invited to perform cognitive function tests using the Montreal Cognitive Assessment scale. Follow-ups were tracked annually through routine medical examinations and standardised questionnaires to detect their health status.

Key baseline findings revealed sex disparities in disease prevalence and clinical characteristics, with males showing higher rates of hypertension (46.60% vs 34.23%), type 2 diabetes (17.39% vs 9.54%) and gout (33.47% vs 15.59%), while females had higher prevalence of hyperlipidaemia (15.47% vs 18.26%), insomnia (5.42% vs 10.00%) and cancer (1.75% vs 3.23%) (all p<0.05). Females demonstrated higher cognitive scores but lower scores in naming/abstraction compared with males. Furthermore, based on the baseline data, we also found that the combined elevation of fasting glucose and serum uric acid levels significantly correlates with non-alcoholic fatty liver disease, especially in individuals without self-reported diabetes status.

THCDS is an ongoing prospective cohort with long-term follow-up (at least 15 years). Ongoing follow-ups will be used to investigate longitudinal trajectories of risk factors and chronic diseases and to identify modifiable determinants to inform NCD prevention strategies.

ChiCTR2400083075; pre-result.

We conducted a retrospective cohort study with multilevel, multivariate modelling of civil legal cases against physicians licensed to practise in Canada.

We used the Canadian Medical Protective Association’s national repository of medicolegal case data.

We extracted data on physicians’ demographic characteristics, geographical characteristics and undergraduate medical education.

Outcomes included physician medicolegal case rates (the number of civil legal actions a physician is involved in per year) and case outcomes (when a case proceeds and is either dismissed, settled or proceeds to trial). Our multilevel models examined associations between physician factors and the rate of civil legal actions and the distribution of civil legal outcomes.

The case rate model included 433 038 physician-year observations from 98 960 physicians (2015–2019), with 7657 civil legal cases (mean case rate per physician-year 0.0221; 98% had no cases). Case rates did not differ significantly between IMGs and Canadian/US graduates (p=0.0516). The case outcome model included 8046 cases (2016–2023). Unadjusted, cases favoured the plaintiff slightly more often for IMGs (39.1% vs 36.6%, ² (2, N=8046)=14.03, p<0.001, Cramér’s V=0.04), but IMG status was not associated with case outcomes after adjustment (OR 1.135, 95% CI 0.977 to 1.319).

Our study suggests that where physicians receive their medical degree has no effect on their level of medicolegal risk in civil legal actions in Canada.

Searches will be performed in four electronic databases (PubMed, Cochrane Library, Web of Science and SPORTDiscus) for published trials. Eligible studies will be randomised controlled trials of exercise interventions, including older adults with frailty aged ≥60 years, with frailty identified using a validated method. Five reviewers and three referees, all with expertise in exercise interventions, will be assigned to three independent review teams to ensure efficient screening. Reviewers will independently screen titles, abstracts and full texts using Rayyan, and then extract trial and adverse event data into an Excel spreadsheet. The risk of bias in eligible trials will be assessed using the Cochrane Risk of Bias 2 (RoB-2) tool. The referees will resolve any disagreements between the two reviewers throughout the screening, data extraction and risk-of-bias assessment processes. The primary outcome is adverse events, defined as any unfavourable, unintended signs, symptoms or disease that occurred during the study period. An independent biostatistician will perform a random-effects meta-analysis using a generalised linear mixed model with a binomial likelihood and a logit link to estimate the pooled risk ratios (RRs) for adverse events in the intervention group relative to the control group. Publication bias will be evaluated using funnel plots and Egger’s regression test. Depending on the number of available studies, subgroup analyses will be conducted to examine differences in RRs according to the study quality, duration of intervention, exercise frequency, setting and supervision.

Ethical approval was not required because we did not use specific patient data. The findings of the systematic review and meta-analysis will be disseminated through publication in a peer-reviewed journal and presentation at appropriate conferences.

CRD420251180645.

This is a multicentre, open-label, parallel-group randomised controlled trial conducted in three centres in China. Infertile women aged 35–42 years undergoing their first intracytoplasmic sperm injection cycle and having ≥2 good-quality days 5–6 blastocysts (Gardner grade ≥4BC,defined as an expansion grade of at least 4, with an inner cell mass grade of B or better and a trophectoderm grade of C or better) will be randomised 1:1 to ni-PGT-guided embryo selection or conventional morphology-based selection. Randomisation will be stratified by study centre using variable permuted block sizes of 4 and 6 and implemented through a unified centralised randomisation system. After a multicentre set-up period for investigator training and harmonisation of spent culture-medium sampling procedures, during which no participant was enrolled or randomised, recruitment and randomisation commenced on 14 February 2025 at the lead site; additional sites started recruitment after local ethics approval and site initiation. A freeze-all strategy will be applied; frozen-thawed single blastocyst transfer will start from the second menstrual cycle after oocyte retrieval.

For the primary endpoint, embryo transfers using embryos from the index retrieval cycle that occur within 12 months after randomisation and within the first three frozen-thawed single embryo transfer attempts will contribute to the cumulative outcome, whichever occurs first. Clinical care will not be restricted beyond this prespecified analysis range. The primary outcome is the cumulative ongoing pregnancy rate within 12 months after randomisation, defined as the proportion of participants achieving at least one ongoing pregnancy (clinical pregnancy continuing to ≥12 weeks’ gestation) following a qualifying embryo transfer within the prespecified analysis range. Key secondary outcomes include early miscarriage rate (<12 weeks) in the first transfer cycle, biochemical and clinical pregnancy, time to live birth, number of transfers to live birth, pregnancy/perinatal complications, neonatal birth weight and congenital anomalies. The primary analysis will follow the intention-to-treat principle, comparing groups using relative risks with 95% CIs. A total of 354 participants (177 per group) will be recruited.

The trial will be conducted according to the Declaration of Helsinki. Ethics approval has been obtained from all participating centres before participant recruitment at each site. Written informed consent will be obtained from all participants. Results will be disseminated through peer-reviewed publication and conference presentations.

ChiCTR2400088283

Observational study.

A single-centre retrospective observational study in Okayama, Japan.

We retrospectively analysed consecutive patients who underwent AF ablation under deep propofol sedation with adaptive servo-ventilation. A total of 686 patients were included. Patients were managed using a standardised sedation protocol with or without low-dose pentazocine. Patients treated with conventional manual compression for haemostasis (n=383) were compared with those treated using a venous access-site closure device (n=303).

Postprocedural bed rest duration and the incidence and timing of PONV were compared between groups. Associations between closure device use and PONV were evaluated using logistic regression analysis.

The primary outcome was the occurrence of PONV following AF ablation.

All procedures were completed under propofol sedation without conversion to general anaesthesia. The duration of postprocedural bed rest was shorter in the device group than in the conventional-compression group (mean difference –14.7 hours, 95% CI –15.2 to –14.0).

PONV occurred in 6/303 patients (2.0%) in the device group and 20/383 patients (5.2%) in the conventional-compression group, corresponding to a relative risk of 0.38 (95% CI 0.15 to 0.93), an OR 0.25 (95% CI 0.10 to 0.62) and a risk difference of –3.2% (95% CI –6.0% to –0.5%).

In multivariable analysis, use of a venous closure device was associated with a lower likelihood of PONV.

In this single-centre observational study, use of a venous access-site closure device was associated with a lower occurrence of PONV after AF ablation under propofol sedation. These findings suggest that postprocedural management strategies enabling earlier mobilisation may be associated with improved patient comfort; however, causal inference is limited by the observational design.

A mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone.

Primary care.

Fifteen semistructured interviews were conducted with participants in the COPESS trial; eight were randomised to the intervention arm, and seven were randomised to the treatment-as-usual arm. Interviews lasted 30–60 min.

COPESS is a brief, relational psychotherapy delivered over 4 weekly sessions plus a follow-up, focusing on understanding difficult emotional states and their links to self-harm through here-and-now relational and emotional processes.

Thematic analysis allowed exploration of themes important to participants in their experiences in the COPESS trial and their experiences of care for self-harm more generally.

Five themes were identified as associated with the acceptability of the COPESS intervention and trial: self-harm as a primary problem, what I needed when I needed it, being heard and understood, online delivery of the intervention and lasting impacts. Participants generally expressed positive views about the intervention, citing a need for services that specifically target self-harm and an appreciation of the rapid access to help. Strong relationships with the therapist were highly valued and not diminished by online delivery of the intervention. Positive impacts continued post therapy sessions.

These results support the acceptability of the COPESS intervention, the need for self-harm specific services and support moving forward to a full trial.

Pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.

This single-centre, randomised controlled, evaluator-blinded clinical trial will assess the rehabilitative efficacy of VR-based cognitive training in patients with PSCI. A total of 60 patients who had a stroke will be enrolled and randomised to either a conventional rehabilitation group or a VR intervention group. The intervention will last 2 weeks, with five sessions of 60 min each training session per week. During the 60-minute training session, both groups will receive 30 min of conventional rehabilitation training. For the remaining 30 min, the control group will undergo traditional cognitive rehabilitation while the experimental group will be subjected to VR-based cognitive rehabilitation training. The primary outcome measure is the Montreal Cognitive Assessment; secondary outcomes include the Mini-Mental State Examination, Trail Making Test and Stroop Test. Assessments will be conducted at three time points: baseline (T0), immediately postintervention (T1) and 4 weeks after completing the intervention (T2). This study aims to evaluate the preliminary effectiveness of a VR-based intervention in improving multidimensional cognitive function, while incorporating exploratory neuroimaging outcomes to generate hypothesis-forming insights into potential neural correlates.

The trial was approved by the Ethics Committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (2025–1933-273-02).

The results will be submitted to a peer review journal or at a conference.

ChiCTR2600116040.

We will include any qualitative study in which patient or practitioner experiences of empathy with AI-assisted healthcare are explored. Secondary studies, quantitative studies and those exploring other stakeholders’ experiences will be excluded. The search will include records from database inception in any language. The search strategy is based on the Population, Phenomenon of Interest, Context framework, built around the keywords: artificial intelligence, empathy, healthcare professionals and patients. The following databases will be searched: MEDLINE, Scopus, APA PsycINFO and CINAHL. Additionally, grey literature searches in BASE and OpenAIRE. Forward and backward citation chasing will also be conducted. Records will be screened by two independent reviewers, data extraction will be conducted by one reviewer and checked by another. The risk of bias assessment will be conducted in duplicate using the Joanna Briggs Institute appraisal tool for qualitative studies. The results will be synthesised using thematic synthesis. The number of records identified from the search and the exclusions to reach the total number of included records will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The included studies will be listed, along with summaries of relevant study characteristics and risk of bias assessments. Confidence in the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative research framework.

The systematic review will include only previously anonymised data from primary studies. For this reason, ethical approval is not required for this study. Dissemination of the findings of the final systematic review will occur through publishing in a peer-reviewed journal.

CRD420261301427.

Mixed-methods study using interviews and a cross-sectional survey.

Imperial College Healthcare Trust for interviews and nationally across the UK for the survey.

19 interviewees and 329 survey respondents, all clinical staff working in UK operating theatres.

Barriers and facilitators to unnecessary non-sterile glove use in operating theatres.

The findings highlight a combination of key drivers leading to the unnecessary use of non-sterile gloves: (1) lack of prioritisation of sustainability, (2) fears around negative patient outcomes, (3) strong social influences such as norms to use gloves, (4) the absence of clear guidelines and limited training on glove use, (5) availability of alternatives and quality of gloves and (6) beliefs about personal safety and habitual glove use. Respondents also suggested potential intervention strategies.

67% of participants reported using gloves unnecessarily. Our findings highlight the role of habitual behaviour, social influences and unclear guidelines in driving this practice. Interventions should address these factors, for example, by clearly communicating when gloves should and should not be worn, encouraging changes to local social norms towards waste reduction, improving access to hand gel and supporting habit change to reduce unnecessary glove use and associated environmental impact.

A sequential mixed-methods approach was used, comprising a quantitative survey followed by an exploratory qualitative phase using nominal group technique (NGT) discussions with people with DKD.

Patients were recruited from 45 primary care clinics in Peninsular Malaysia from March to May 2024.

Survey data were collected from 131 adults with an estimated glomerular filtration rate between 30 and 89 mL/min/1.73 m² and with suboptimal glycaemia and blood pressure outcomes. Exploratory NGT discussions were conducted with seven participants.

The online survey used the WHO definition of unmet healthcare need as the ‘failure to seek healthcare when needed during the past twelve months’ to assess the prevalence and associated factors. Qualitative data and ranking of other perceived unmet needs of these people with DKD and suboptimal clinical outcomes were collected through NGT discussions.

The prevalence of reported unmet healthcare needs per the WHO definition was 13%, with history of diabetic foot ulcer (adjusted OR (AOR) 6.67, 95% CI 1.22 to 37.25) and urban residence (AOR 3.70, 95% CI 1.26 to 12.89) reported as associated factors. NGT identified three patient-prioritised unmet needs: ‘dietary support’, ‘better medication’ and ‘mental health support’. Female participants prioritised obtaining medication and kidney health information, whereas male participants emphasised self-monitoring support.

The low prevalence of WHO-defined unmet need, alongside patient-prioritised concerns extending beyond standard measures, suggests that current operational definitions may not fully capture patient-perceived unmet healthcare needs in DKD.

A population-based cross-sectional study using secondary data from the 2021 Madagascar Demographic and Health Survey. Spatial statistical methods were used to assess geographic clustering and hotspot areas of anaemia.

The study was conducted across community and household levels throughout Madagascar, covering both rural and urban populations within the primary and secondary healthcare delivery contexts.

A weighted sample of 10 683 children aged 6–59 months was included. Sampling followed demographic health survey procedures, and only children with complete haemoglobin data were analysed.

No interventions were applied.

The primary outcome was anaemia, defined as haemoglobin <11 g/dL. Spatial autocorrelation and hotspot analyses identified geographical clustering patterns.

The overall point prevalence of anaemia was 47% (95% CI 45.60 to 48.36), showing significant spatial clustering (Global Moran’s I=0.136, p<0.001), with hotspots mainly in the central and southeastern regions. Differences in anaemia prevalence were observed across population subgroups, including child age, maternal education, household wealth, place of residence and nutritional status.

Anaemia among Malagasy children remains a major public health concern and shows clear geographic variation. The findings describe important differences in prevalence across regions and population subgroups, providing useful evidence for public health planning and for generating hypotheses for future analytical research.

This is an ambispective observational cohort study conducted in a tertiary hospital in Chongqing, China. A total of 2800 pregnant women will be enrolled. After hospital admission and providing written informed consent, participants will complete a demographic questionnaire. Data collection will include maternal baseline characteristics, haemodynamic parameters at multiple stages of labour and maternal and newborn outcomes. These data will allow comprehensive analysis of haemodynamic changes during labour in women undergoing vaginal delivery.

This study has been approved by the Research Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (ethics approval number: 2024–406-01). Participation is voluntary and initiated only after obtaining written informed consent. The findings will be disseminated through presentations at national and international conferences and through publications in peer-reviewed scientific journals.

ChiCTR2500097643.

A qualitative, descriptive phenomenological design was employed, involving in-depth interviews with 12 research coordinators across 12 healthcare facilities in Nigeria. Participants were purposively selected from the Nigeria Implementation Science Alliance–Model Innovation and Research Centres. Data were analysed using Colaizzi’s phenomenological method, with thematic analysis to identify key patterns.

Field researchers described both rewarding experiences and significant obstacles. While they found value in contributing to impactful research, they faced emotional strain from engaging with sensitive narratives. Key barriers included low health literacy, cultural and religious constraints, hesitation to engage in the study and logistical constraints such as unreliable infrastructure. Facilitators included prefield training, trust-building and support systems. Recommendations emphasised ethical adherence, continuous skill development, context-appropriate incentives and streamlined data collection tools.

The study underscores the need for systemic support for data collectors, including mental health resources, adaptive methodologies and institutional policies that address logistical and emotional issues. These findings advocate for participant-centred, ethically sound research practices to enhance data quality and collector well-being in long-term illness studies.

Future research needs to evaluate interventions to optimise data collection processes in LMICs.

HiPress is a two-centre, two-arm randomised clinical trial with blinding of both patients and outcome assessors. A total of 70 adult patients undergoing CRS-HIPEC will be included. Patients will be randomised to receive either continuous low-dose argipressin or continuous low-dose norepinephrine. Both groups will receive standardised GDFT during the procedure. The primary endpoint is cumulative intraoperative fluid administration (mL). Secondary endpoints include direct fluid-related outcomes (eg, cumulative intraoperative fluid (ml/kg/hour), postoperative fluid balance until day five and ultrasound-assessed pulmonary oedema and venous congestion) and indirect fluid-associated outcomes (eg, quality of recovery, surgical and abdominal complications, acute kidney injury (AKI), pulmonary complications, length of ICU and hospital stay and 30-day mortality).

The study is enrolling patients since February 2025. The trial is approved by the Medical Research Ethics Committee (hereinafter: MREC) NedMec, The Netherlands (Ref: D-25-500202). Results of the trial will be published in an international peer-reviewed journal and announced at national and international scientific meetings.

Clinical Trials Information System (CTIS): European Union clinical trials register (EUCT) number: 2024–5 13 598-33-00

This prospective observational study (Apr 2022-Sep 2023) enrolled women presenting for delivery at two regional referral hospitals in Uganda. Data were collected during admission and 6 weeks after delivery by phone.

Overall, 7131 women delivered 7359 newborns, of whom 7129 (99%) women and 6968 (94%) newborns were discharged alive. The newborn mortality rate was 2.7% and 32% of deaths occurred post-discharge. Following discharge, 230 (3%) women and 287 (4%) newborns were readmitted. Suspected sepsis and infections were the most common reasons for readmission among mothers (62.2%) and newborns (89.9%). Caesarean delivery (OR:2·26 (1·75-2·93)) and perinatal death (OR:3·18 (2·09-4·69)) were associated with post-discharge maternal readmission. Both maternal and newborn readmission were associated with household food insecurity during pregnancy (maternal OR:1·56 (1·15-2·08); newborn OR: 1·73 (1·31-2·25)). Newborn resuscitation with oxygen was associated with maternal readmission (OR:2.24 (1.24–3·78)), newborn readmission (OR: 2·74 (1·54-4·56)) and newborn death (OR: 4·01 (1·73-8·21)). Although >99% of women had ≥1 antenatal care visit, only 511 (7%) had ≥1 routine postnatal care visit. There were no routine postnatal care visits among 211 (91·7%) readmitted mothers, 276 (96·2%) newborns and 57 (91·9%) newborns who died.

Post-discharge complications occur in a context of low routine postnatal care use. Risk-informed discharge planning, postnatal care and health education strategies may improve outcomes in mothers, newborns and their families.

The convergent parallel design process evaluation will follow the UK Medical Research Council guidance. We will interview: staff involved in CHARMER implementation, geriatricians and pharmacists who receive the intervention and research delivery staff involved in patient/carer recruitment and data collection. We will also interview patients/carers and primary care practitioners. Interviews will be supplemented with recordings of implementation activities and completed implementation manuals. Questionnaires will capture the extent to which the four proactive deprescribing steps are enacted by intervention recipients, measure the behavioural mechanisms by which the CHARMER intervention operates and capture the patient experience of proactive deprescribing. Qualitative data will be analysed thematically and then mapped to Normalisation Process Theory to explore implementation and the Theoretical Domains Framework to explore behaviour change. Most quantitative data will be analysed descriptively; however, changes in staff questionnaire responses preintervention and postintervention will be analysed using a Mann-Whitney test. We will triangulate qualitative and quantitative findings to explain intervention effects.

Ethical and governance approvals have been obtained by the Wales 2 Research Ethics Committee and the Health Research Authority, respectively. The dissemination strategy will be underpinned by the evidence-based Guide to Disseminating Research (GuiDiR) targeting healthcare practitioners, policy makers and patient-facing organisations.

ISRCTN13248281.

This sequential exploratory mixed-methods protocol consists of three phases. Phase 1 fieldwork (semi-structured interviews with 15 participants, 3 participant observations and field notes) has been completed. Qualitative data are currently being analysed using conventional content analysis. The scoping review component of Phase 1 is planned but has not yet been conducted. Phase 2 (instrument development) is planned to include item generation from qualitative results followed by expert panel review. Phase 3 (psychometric evaluation), scheduled for late 2026, will employ a cross-sectional study to assess face, content and construct validity; reliability; interpretability; and feasibility. This phase features pilot testing (n=30–50), face and content validity assessment (n=10 each), test-retest reliability (n=15) and exploratory and confirmatory factor analyses (n=300–400).

Ethical approval was obtained from the Ethics Committee of Iran University of Medical Sciences. All participants will provide written informed consent. Confidentiality, voluntary participation and withdrawal rights are guaranteed. Findings will be published in peer-reviewed journals, presented at conferences and shared with participating home healthcare centres, policymakers and stakeholders.

This systematic review protocol has been prepared following robust methods, and it is reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will conduct searches through relevant databases, including PubMed, CINAHL, LILACS, HINARI, African Journals Online, Google Scholar, Scopus, Web of Science, Trip Pro and TOXNET from 2007 to 30 June 2026, without language restriction for studies that evaluated digital premium payment systems and reported health insurance enrolment or retention rates. The search terms and concepts include: ‘national health insurance’, ‘health insurance coverage’, ‘insurance enrolment’, ‘digital premium’, ‘e-payment’, ‘online payment’, ‘electronic payment’, ‘mobile payment’, ‘telepayment’ and ‘cashless payment’, together with their alternate terms and synonyms, singular and plural forms as well as British and American spelling. The names of the countries in SSA will be included as search terms. Grey literature including dissertation repositories, national health insurance databases and conference proceedings will be searched. Reference list of retrieved articles will be reviewed, and where necessary, experts working in the field of national health insurance will be contacted for knowledge about completed studies not captured by our searches. Two reviewers will independently screen studies, extract data (using pretested data extraction form developed from Microsoft Excel) and assess risk of bias in the included studies using the quality assessment tool for Risk Of Bias In Non-randomized Studies - of Exposures. Any disagreements will be resolved through discussion between the reviewers. Heterogeneity will be explored graphically for overlapping CIs and statistically using the -statistic. We will combine dichotomous outcomes using risk ratio and for continuous data mean difference employing random-effects meta-analysis and presenting weighted effect estimates with their 95% (CIs). Subgroup analysis will be performed to assess the impact of heterogeneity and sensitivity analyses to test the robustness of the pooled effect estimates. The overall level or certainty of evidence will be assessed using Grading of Recommendations, Assessment, Development, and Evaluation.

This systematic review will collate empirical data on publicly available published and unpublished primary studies and no ethical approval is required. However, an eligible study with serious ethical issues will be excluded from the analysis and the reasons for exclusion documented. The review findings will be shared with key stakeholders and health authorities, agencies involved in digital premium health insurance and policymakers. The review results will be presented at scientific conferences and symposia, and a manuscript will be submitted for publication in a high impact factor journal.

CRD42024576134.

This is a single-centre, randomised, triple-blind, placebo-controlled trial aiming to enrol 792 infertile women aged 20–40 years with a history of at least one previous embryo implantation failure and abnormal uterine contractions prior to single blastocyst-stage embryo transfer. Eligible participants will be randomly assigned in a 1:1 ratio to receive either intravenous atosiban or a placebo before embryo transfer. The primary outcome is live birth rate, with secondary outcomes encompassing various pregnancy and perinatal parameters. Randomisation will be stratified by age and transfer type. Intention-to-treat analysis will be performed using generalised linear models. The trial will be monitored by an independent data and safety monitoring committee, including one interim analysis.

This study has been approved by the Institutional Ethics Committee of Northwest Women’s and Children’s Hospital (No. 2025-058-02). Written informed consent will be obtained from all participants. The study results will be disseminated at scientific conferences and published in peer-reviewed journals.

NCT07185230.

This stepped-wedge cluster randomised trial is being conducted from 11 March 2024 in 43 centres across Europe. All centres begin in the selective stimulation (control) arm, where stimulation is applied only when breathing effort is judged inadequate by treating clinicians. Every fortnight, one centre switches to the repeated stimulation (intervention) arm, where stimulation is provided for 10 s, alternated with 10-second pauses for at least the first 5 min after birth. Once centres switch, they continue in the repeated stimulation arm until study completion. The order of switching is prospectively and randomly assigned, with the last switch occurring on 24 November 2025. The primary outcome is achievement of a pre-ductal oxygen saturation ≥80% at 5 min after birth. Analyses will use generalised linear mixed models to compare outcomes between groups at the individual level.

Ethical approval was obtained at all participating centres. The study adheres to the Declaration of Helsinki, the principles of Good Clinical Practice and the General Data Protection Regulation. Results will be shared with investigators, published in a peer-reviewed journal and presented at national and international conferences.

NCT05942924.

This study is a retrospective observational cohort including all patients admitted with acute ICH to the Department of Neurology, University Hospital of Southern Denmark, Aabenraa between January 2014 and December 2024 (estimated approximately n=610). Medical records and initial non-enhanced CT scans will be reviewed. Two neurologists and two radiologists, blinded to final diagnosis, will independently extract clinical presentation, topographical and volumetric haemorrhage characteristics, and classify each case using the abovementioned ICH-classification systems. Primary analyses will assess associations between clinical and radiological features and underlying neoplastic vs non-neoplastic aetiology. Secondary analyses will compare diagnostic performance of classification systems using sensitivity, specificity and receiver operating characteristic curves. Multivariate logistic regression models will be applied with Holm correction for multiple comparisons.

The study has been submitted to the National Danish Research Ethics Committee and the Danish Data Protection Agency. As data derive from completed disease courses, no patient contact is expected. Results will be disseminated through peer-reviewed journals, conferences and scientific presentations.

The TTAP study is a multicentre, prospective observational cohort study. Study participants are pregnant women with asthma attending antenatal clinics at 10 metropolitan and regional hospitals (public and private) in NSW and Victoria, Australia. Assessment of traits from the pulmonary, extrapulmonary and behavioural domains as well as asthma outcomes is conducted at three gestational timepoints: 12–16 weeks, 22–26 weeks and 32–36 weeks of pregnancy. A follow-up assessment of asthma outcomes is conducted at 2–4 weeks postpartum. The outcomes assessed are asthma exacerbations requiring medical intervention (primary outcome), asthma symptom control and asthma-related quality of life. Traits and outcomes will be assessed using questionnaires, direct questioning, measurement of biomarkers, physical measurements and assessment of routinely collected data from medical records.

The Hunter New England Human Ethics Committee (2024/ETH01289) has approved the TTAP study protocol. Outcomes will be published in peer-reviewed journals, presented at scientific conferences and disseminated online to participants, clinicians and other pregnant women with asthma and their families via the Asthma in Pregnancy Toolkit website https://asthmapregnancytoolkit.org.au/.

This is a phase Ib/II, single-arm clinical trial designed to evaluate the safety and efficacy of adjuvant Atezo+Bev following C-ion RT in patients with HCC. Eligible patients will be enrolled in the first registration phase. C-ion RT (60 Gy) will be administered over four consecutive treatment days ideally within one calendar week. Patients will receive a combination of atezolizumab (1200 mg) and bevacizumab (15 mg/kg) administered intravenously every 21 days for one treatment cycle. The primary endpoint of the phase Ib part is the proportion of patients with dose-limiting toxicity (DLT). DLT is defined as prespecified toxicities associated with the investigational drug among the adverse events that occurred from the start date of the investigational drug (Day 1) to Day 21. If there is one or fewer cases of DLT out of six cases, the trial will proceed to the phase II part. The primary endpoint of the phase II part is the 1-year recurrence-free survival rate.

This study was approved by the ethics committee of two participating institutions (Chiba University Hospital (approval No. 2024021) and National Institute for Quantum and Radiological Science and Technology, QST Hospital (approval No. C24-001)). Trial results will be reported in a peer-reviewed journal publication.

jRCT2031240284.

A cross-sectional study.

3 tertiary public hospitals in Hunan Province, China.

242 primary caregivers were invited, and 211 completed the study (87.2% response rate). Convenience sampling was used. Eligible participants were unpaid adult caregivers (aged ≥18 years) of children (aged <18 years) with cSLE, providing care for >1 month. Exclusion criteria included inability to complete questionnaires independently, cognitive impairment due to major physical or mental disorders and current participation in other psychological interventions.

Primary outcomes (depression, anxiety and stress) were measured using the Depression Anxiety and Stress Scale-21. Correlates included threat/challenge appraisal, coping style and perceived social support.

Among 211 caregivers (mean age 40.55±8.22 years; 77.3% female), 31.8% reported depression, 27.0% anxiety and 24.2% stress. Higher threat appraisal was consistently associated with depression (regression coefficients (B) =1.012, p<0.001), anxiety (B=0.514, p<0.001) and stress (B=1.091, p<0.001). A higher number of hospitalisations was associated with higher depression (B=0.118, p=0.005) and anxiety (B=0.099, p=0.012). Anxiety and stress were also associated with younger child age (anxiety: B=–0.339, p=0.028; stress: B=–0.393, p=0.024), lower challenge appraisal (anxiety: B=–0.252, p=0.044; stress: B=–0.421, p=0.002) and negative coping (anxiety: B=0.492, p<0.001; stress: B=0.311, p=0.019).

Caregivers of children with cSLE face substantial psychological distress, with threat perception and negative coping as key modifiable correlates. Interventions to reshape cognitive appraisal and promote adaptive coping, alongside expanded health insurance coverage and optimised caregiving role distribution, are needed to alleviate caregiver burden.

This scoping review will be guided by the work of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Search terms will be identified through an iterative process using the PICOT method and Boolean logic. Four databases—Scopus, PubMed, Web of Science and Google Scholar—with the addition of grey literature from UN agencies and non-governmental organisations focused on water-related issues will be searched. Two independent reviewers will apply a priori eligibility criteria to select studies. Conflicts will be resolved through discussion and a third independent reviewer absent agreement between the first two reviewers. Cohen’s kappa statistic will be calculated to assess inter-rater reliability. Data extraction will be guided by predefined data points, and the Consolidated Framework for Implementation Research will guide evidence synthesis through a solution-based approach.

Institutional research ethics review is not required because no human subjects are involved. Findings will be disseminated through a peer-reviewed publication, a policy brief, conference presentations and infographics for use by organisations serving flood disaster impacted communities.

Cross-sectional study.

A single tertiary hospital in China.

A total of 120 healthy Han Chinese adults (aged 25–45 years, both sexes) were enrolled using stratified random sampling by age and categorised into three groups: obstetricians, clinical support staff and administrative personnel. Of these, 105 (87.5%) completed the study and entered the final analysis (obstetricians n=40; clinical support staff n=33; administrative personnel n=32); 15 were excluded due to incomplete questionnaire data. Key exclusion criteria were chronic medical conditions, medication use, acute illness, a clinical shift within 24 hours before measurement, pregnancy or lactation, body mass index extremes (≤18.5 or ≥ 28 kg/m²) and major life events within the past 6 months. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey; workload, lifestyle and family history were collected via questionnaire.

Advanced haemodynamics were assessed via Ultrasonic Cardiac Output Monitor. The primary outcome was cardiac power output (CPO). Secondary outcomes included other non-invasive haemodynamic parameters, such as cardiac index (CI), systemic vascular resistance index, Smith–Madigan inotropy index and corrected flow time.

Severe burnout was associated with reduced CPO and CI (–0.152 W and –0.403 L/min/m², respectively; both p<0.05). Increased weekly exercise independently predicted higher CPO and CI (B=0.046 W and 0.155 L/min/m², respectively; both p<0.001). This protective association remained significant in obstetricians and clinical support staff, and was stronger for CI in obstetricians (interaction p=0.03). The severe burnout–haemodynamics association was consistent across all groups.

In high-stress populations, advanced haemodynamic patterns may serve as an early-warning biomarker for burnout, guiding personalised exercise advice. Longitudinal studies are needed to confirm their predictive value.

To assess the association between completing at least eight antenatal care (ANC) contacts and maternal anaemia in Ghana and to explore heterogeneity in this association using causal machine learning.

An institution-based cross-sectional study was conducted using a retrospective review of medical records and causal machine learning analysis.

Juaben Government Hospital.

Of 2326 women who delivered at the hospital, 2114 with complete data on the main exposure and outcome variables were included in the analysis.

Completion of at least eight ANC contacts. ANC contact was defined as the in-person visit to the clinic with a healthcare professional for routine ANC services and follow-up.

Maternal anaemia, defined as a haemoglobin level below 11 g/dL in the last ANC before delivery.

A causal forest model was used to estimate the association between completing at least eight ANC contacts and maternal anaemia. Conditional average treatment effects were used to explore individual-level variation in these associations, providing policy-relevant insights.

Completing ≥8 ANC contacts was associated with a 6 percentage-point lower probability of maternal anaemia compared with having fewer visits (average treatment effect: -0.06, 95% CI –0.11 to –0.02). Predicted individual-level effects ranged from –0.21 to 0.09. Participants’ age, malaria prophylaxis, marital status, parity and educational level were the five most important contributors to the observed heterogeneity.

This study demonstrated that completing ≥8 ANC contacts is associated with a lower probability of maternal anaemia, with heterogeneity across subgroups. We recommend differentiated, context-specific ANC interventions that focus on high-impact subgroups while strengthening the effectiveness and quality of care delivered at each visit.

This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Randomised and non-randomised controlled studies will be systematically identified from major electronic databases. Balance-related outcomes will be categorised using a predefined construct-based framework (eg, static postural control, dynamic balance, limits of stability, functional mobility and gait performance). Meta-analyses will be conducted only within conceptually homogeneous constructs; otherwise, findings will be synthesised narratively. Risk of bias will be assessed using Cochrane Risk of Bias 2 and Risk of Bias in Non-randomised Studies of Interventions. Random-effects models will be applied where appropriate, and meta-regression analyses will be exploratory.

Ethical approval is not required because this study will use only previously published data and will not involve individual-level human participant data. The findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences.

CRD420251110102.

Qualitative methods were used in this study.

Participants were invited to participate in face-to-face interviews in one district in Sierra Leone.

Six pregnant or postnatal adolescents living with disability, alongside four caregivers and five stakeholders from various organisations participated in semi-structured interviews employing thematic analysis.

We identified four key themes: (1) discrimination and financial barriers within the healthcare system, despite laws ensuring free healthcare for persons living with disabilities, (2) societal stigma manifested through abandonment by families and inadequate support, (3) lack of understanding of disability issues, particularly of those with intellectual impairments, leading to stigmatisation and exclusion, and (4) infrastructural limitations which hinder accessibility to essential services, with many facilities remaining non-compliant with disability regulations.

Adolescent girls living with disability during pregnancy and after birth in Sierra Leone face barriers to accessing healthcare, including caregiver ignorance, lack of autonomy, disabling services, social stigma and ineffective policy implementation, despite existing supportive laws. These findings keep those women who are arguably the most vulnerable, adolescent and living with a disability, from accessing perinatal healthcare, exacerbating their risk and that of their babies. Solutions include the need to enforce disability-inclusive policies and infrastructure adaptations, awareness and training for healthcare providers and community advocacy to break down social stigma.

Qualitative study exploring the experience of survivors and emergency responders (armed and unarmed police, paramedics, doctors and fire officers) present in the hot (unsafe) zone of five major terror attacks in the UK since 2000. We used reflexive thematic data analysis to build qualitative case studies, comparing similarities and tensions between perspectives of different participant groups.

In our analysis of over 2000 min of interview data from 26 participants, we found a common view that the priority during a terror-related mass casualty event was to save lives. However, responder groups maintained distinct mental models that shaped their operational priorities regarding treatment for those injured within the hot zone. All responders expressed willingness to take self-assessed risks to save lives, but better interagency communication was noted to be required to achieve this safely. All responders felt it was vital to have experienced health professionals present to triage and facilitate urgent treatment and extraction decisions. Armed police commanders had dual responsibilities to achieve rapid care delivery while preventing further terrorist-inflicted injuries. Operationally, this was perceived as leading to a lack of shared mental models between responders regarding what is ‘unsafe’ due to zoning, rather than communication of risk, potentially delaying vital care delivery. There were mixed survivor perspectives regarding the risks that responders should be exposed to, but broad agreement that there was a notable absence of health professionals present in the hot zone during the immediate aftermath of attacks.

There is strong professional and public support for improving care delivery, including potential hot zone working, to minimise the therapeutic vacuum in active terrorist attacks. Better risk communication and better shared mental models are necessary to balance responder risk with care delivery to maximise lives saved as safely as possible.

We conducted an artificial intelligence (AI)-assisted evidence map of research records on global farmer health published from 2015 to 2024. We searched bibliographic databases and screened titles/abstracts using SWIFT-Active Screener, a collaborative review platform that uses machine-learning prioritisation to rank records for human review. We retrieved 32 006 records. After manually screening 8533 records and stopping when the tool estimated ≥94% recall of relevant records, we included 1684 studies. We mapped research output by health topic category (non-communicable diseases (NCDs), communicable diseases, injuries and mental health) country income groups and alignment with SDG 3 targets.

Despite 98% of the agricultural workforce living in low- and middle-income countries (LMICs), 52% of studies originate from high-income countries (HICs). Research focuses on NCDs (29%) and injuries (26%), with LMICs focusing on pesticide poisoning and HIC on accidents. Mental health emerges as a key topic in HICs, with the proportion of publications nearly doubling from 2021 to 2024 but remains underexplored in LMICs. Key gaps with high relevance to farming populations and climate change, such as heat-related illnesses, occupational injuries and musculoskeletal conditions, are not well represented in SDG 3 indicators.

Our findings highlight urgent needs for a more equitable and comprehensive global research agenda that integrates agricultural worker health into sustainability frameworks beyond the SDG era, ensuring the resilience and well-being of food producers worldwide.

Evaluate the efficacy and optimal timing of hyperbaric oxygen therapy as an adjunct to standard care for fibromyalgia.

This single-centre, randomised, cross-over group, assessor-blinded clinical trial was conducted in the Department of Rheumatology at the University Hospital of the Federal University of Juiz de Fora, Juiz de Fora, Brazil, and adhered to Consolidated Standards of Reporting Trials (CONSORT) guidelines. Women (18–70 years) with a diagnosis of fibromyalgia for ≥2 years were randomised 1:1 to early hyperbaric oxygen therapy plus standard care or standard care alone (delayed group). Intention-to-treat (ITT) analysis was conducted with all 56 participants (mean age: 51.0±9.8 years; mean body mass index: 30.5±5.1 kg/m²).

Standardised care (education, exercise and pharmacotherapy) plus hyperbaric oxygen therapy was delivered at 2.3 atmospheres absolute for 90 min, five times per week, over 8 weeks (total 32–40 sessions). The early group received hyperbaric oxygen therapy during weeks 0–8, while the delayed group received it during weeks 8–16, following the same protocol.

Primary endpoints included the Fibromyalgia Impact Questionnaire-Brazilian Portuguese (FIQR-Br), the pain visual analogue scale (VAS) and the Symptoms Assessment Scale-40 (EAS-40) for psychopathology. Secondary endpoints included the 12-Item Short-Form Health Survey (SF-12) physical and mental components and adverse effects. Assessments were conducted at baseline, 8 weeks and 16 weeks, and analysed using a mixed-design 2x3 analysis of variance (group: early vs delayed; time: baseline, 8 weeks and 16 weeks) with Greenhouse-Geisser corrections as needed, followed by Bonferroni post hoc tests. Missing data were assessed using Little’s missing completely at random (MCAR), and considering the ITT analysis, the means imputed for missing data were estimated through expectation maximisation. Effect sizes were reported as partial ² and Cohen’s d with α=0.05.

44 participants completed the study, and the overall withdrawal rate was 21.4% with no baseline between-group differences. Significant time effects were observed for all primary outcomes and the SF-12 outcome (p<0.001; ²=0.23–0.60). Groupxtime interactions were significant for FIQR-Br, VAS, EAS-40 and SF-12 physical and mental (p≤0.02; interaction ² up to 0.23), indicating improvements during active hyperbaric oxygen therapy exposure. Compared with standard care alone over 8 weeks, combined treatment achieved greater gains: FIQR-Br, –31.1% vs –14.4%; VAS, –54.0% vs –33.5%; EAS-40, –28.4% vs –3.7%; SF-12 physical, +39.1% vs +14.8%; SF-12 mental, +57.4% vs +31.9%. Large within-group effect sizes were observed (eg, VAS d=2.5–2.7; FIQR-Br d=1.4–1.7). Efficacy was equivalent regardless of time started, and the benefits converged by the end of each hyperbaric oxygen therapy phase. After stopping hyperbaric oxygen therapy, the FIQR-Br and SF-12 mental component scores regressed towards standard care levels, whereas residual improvements persisted for up to 8 weeks in VAS, EAS-40 and SF-12 physical component scores. Adverse events were infrequent; one case of otalgia required extended management. Withdrawals were primarily due to non-compliance or intolerance to chamber confinement. No serious or unexpected safety concerns were reported.

Hyperbaric oxygen therapy, delivered under a standardised protocol, is an effective and well-tolerated adjunct to multimodal fibromyalgia care. Timing can be individualised: early initiation for rapid relief or stepped introduction after optimised usual care, with comparable overall efficacy. The durability of the benefit appears to be exposure dependent, and maintenance or booster schedules merit further evaluation.

RBR-6prps8g.

Pawson’s realist review approach will be used. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards will also be followed. The review will follow five steps: (1) Development of the initial programme theory; (2) evidence search; (3) selection and appraisal of data; (4) extraction and organisation of data and (5) data synthesis and analysis. The search will be conducted in MEDLINE (Ovid); Embase; PsycINFO; Web of Science and Cochrane Library and supplemented with citation tracking, grey literature, relevant organisational websites, programme evaluation reports and through consultation with stakeholders. The realist review will be an iterative process, and the initial realist programme theory will be tested (confirmed, refuted or refined) in response to the data searches and stakeholder discussions. Patient and public involvement and engagement will be embedded throughout the review. Patients, carers and health and care stakeholders will contribute to refining the initial programme theory, interpreting emerging programme theory and co-developing dissemination outputs to ensure findings remain grounded in lived realities.

Ethical approval is not required for this review as it involves secondary analysis of published literature. The review will be conducted in accordance with principles of research integrity, transparency and responsible stakeholder involvement. Findings will inform the co-design of future digital discharge interventions and contribute to national priorities around digital transformation, safety and equity in transitional care. Dissemination will include conference presentations, a peer-reviewed journal article and accessible summaries co-developed with stakeholders to support equitable implementation and impact.

The OPTIGO study is a multicentre, prospective, randomised, open-label, non-inferiority trial conducted in three French centres. A total of 610 adult patients scheduled for endoscopic procedures of the pharynx, larynx and oesophagus will be randomised in a 1:1 ratio to receive either HFNO or standard oxygenation via a nasopharyngeal oxygen catheter.

The primary outcome is the occurrence of intraoperative oxygen desaturation, defined as a peripheral oxygen saturation ≤85% at any time from induction to the end of the procedure.

Secondary outcomes include intraoperative complications, postoperative laryngeal pain, surgeon comfort, duration of the procedure, anaesthetic drug consumption, and perioperative gas exchange.

This study has been approved by the independent ethics committee CPP Est 1 (10 April 2025; EudraCT 2025-A00278-41). The trial will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice Guidelines.

Results will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.

CPP Est 1 EudraCT 2025-A00278-41 (Clinical trial NCT07004699).

This project applies a community-based participatory research approach to develop and refine the WeCARE (Women’s Engagement for Cancer Awareness, Resources and Education) intervention for women aged 50–74 years who have either never undergone breast cancer screening or have not received screening in the past 5 years and who reside in rural areas or belong to low SES groups. The intervention consists of two components. Component 1 is a single-day, in-person community forum that includes (a) an educational seminar led by an oncologist to address breast cancer risk and screening guidelines, (b) survivor storytelling to enhance emotional engagement and cultural resonance and (c) facilitated navigation to breast cancer screening and future research participation. Component 2 involves structured post-forum follow-up through multiple touchpoints (phone calls and mailed boosters) to reinforce knowledge, address barriers and support screening completion and research enrolment. Quantitative data (eg, screening completion, satisfaction and follow-up engagement) will be summarised using descriptive statistics to assess feasibility and reach on 50 participants. Qualitative feedback from participants will undergo thematic analysis to identify barriers, facilitators and perceived cultural relevance. Integrated mixed-method interpretation will inform iterative refinement of the WeCARE intervention and guide design of subsequent larger trials.

Approved by the Mayo Clinic Institutional Review Board (IRB #25–008934). All participants will provide informed consent. Procedures ensure confidentiality, cultural sensitivity and participant safety. Data will be stored in REDCap and disseminated through publications, conferences, local town halls and community reports.

Prospective cohort study.

Canada.

41 302 adults, aged 45–85 at baseline, participating in the Canadian Longitudinal Study on Aging.

BMI and BMI-defined obesity were measured at baseline, follow-up 1 and follow-up 2 (FUP2), with 33% of FUP2 data (n=13 444) gathered after 16 March 2020, when COVID-19 restrictions began. Correction factors were applied for self-reported BMI and weighted generalised estimating equations assessed BMI changes before and during the pandemic.

We found a significant interaction between follow-up time and timing of FUP2 data collection (before or during the pandemic). Participants measured during the pandemic had an excess BMI increase of 0.21 kg/m² (95% CI 0.15 to 0.28) and 1.06 times higher odds of obesity (95% CI 1.03 to 1.09) compared with prepandemic trends. Increases were more pronounced among females, middle-aged adults and those without diabetes.

The COVID-19 pandemic was associated with a modest increase in BMI and obesity among Canadian adults. Ongoing research is needed to assess long-term trends.

We will conduct a scoping review guided by Arksey and O’Malley’s framework, refined by Levac et al, and report according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and PRISMA-Equity guidelines. Eligible studies will include original research evaluating Epic MyChart or Epic Healthy Planet programmes, reporting outcomes related to patient-reported measures, clinical effectiveness, engagement, safety, efficiency or equity. Searches will cover MEDLINE, CINAHL, PsycINFO, EMBASE, Cochrane CENTRAL, Scopus, trial registries and grey literature. Two reviewers will independently screen records and extract data on study characteristics, outcomes, equity factors and implementation determinants. Quantitative findings will be synthesised narratively using synthesis without meta-analysis guidance; qualitative data will undergo thematic synthesis. Stakeholder consultations with health informatics experts, clinicians, data scientists and health system managers, alongside a patient and public involvement workshop, will support interpretation of findings. A logic model will illustrate relationships between portal features, implementation factors and outcomes. Although focused on Epic MyChart, the review will offer insights relevant to other patient portals, as many implementation and equity considerations are shared across digital health systems.

Ethical approval is not required as the review uses published data. Findings will be disseminated through peer-reviewed publication, conferences and stakeholder engagement to inform implementation of patient portals internationally.

The protocol is registered on the Open Science Framework (https://osf.io/5azdh/overview).

This will be a cross-sectional study based on surveys of care recipients, their unpaid carers as well as formal care providers. In the first half of 2026, we will survey 1850 people accessing domiciliary care either through a homecare agency, a housing with care scheme or by directly employing personal assistants and 400 unpaid carers, all based in England. We will conduct a cost-effectiveness analysis taking a ‘production function’ approach and use quality of life as measured by the Adult Social Care Outcomes Toolkit as the main outcome of interest.

The study received ethical approval from the School of Social Sciences Staff Review Committee at the University of Kent on 20 May 2025 (reference 1195) and the Health Research Authority, London—Camberwell St Giles Research Ethics Committee on 28 October 2025 (reference 25/LO/0652). Implications around consent, data protection and confidentiality, risk and participant payment are discussed. In addition to academic outputs (eg, academic articles, conference presentations), we aim to coproduce news items and blogs with people with lived experience of accessing long-term care and jointly present findings at events aimed at the care sector. Moreover, we will offer participating care providers benchmarking briefs based on our findings.

This quasi-experimental matched-control study will be conducted in Atahualpa (intervention site) and the neighbouring villages of El Tambo and Prosperidad (control sites). Eligible participants are adults aged ≥60 years without disability, dementia or major psychiatric illness. Intervention participants will be matched to controls using variable-ratio propensity score methods. The 12-month SCIP includes monthly community educational activities, peer-support group sessions and individualised coaching (two times per month) focused on skill-building, goal-setting and cognitive-behavioural strategies. Participants in the control villages will receive usual community and primary care services without exposure to SCIP activities. Baseline and 12-month assessments will measure social isolation, loneliness, cardiovascular health, sleep quality, cognitive performance, depressive symptoms and quality of life. Incident stroke, cardiovascular disease and mortality will be monitored quarterly. Analyses will use mixed-effects models for continuous and categorical outcomes and Cox proportional hazards models for incident events, adjusting for relevant confounders.

The protocol was approved by the Ethics Committee of Hospital-Clinica Kennedy, Guayaquil. All participants will provide written informed consent. Findings will be disseminated through peer-reviewed publications, conference presentations and community reports. Results may inform scalable strategies to enhance psychosocial well-being and reduce cardiovascular and cognitive risk in underserved rural populations.

NCT07319663.

Community-based cross-sectional study.

Tigray regional state, Ethiopia.

A sample of married pregnant women (n=1477) whose gestational age was at least 8 weeks were the study participants.

The primary outcome of the study was women’s empowerment status, assessed using 24 indicators across five key domains: decision-making power, social independence, attitudes towards violence against women, social networking and household asset ownership. Equal weight was assigned to all domains and the weight assigned to each domain was distributed equally to the indicators within the corresponding domain. Women who scored at least 80% (ie, met 4 out of 5 domains) were considered as empowered.

In total, only 8.2% (95% CI 6.9 to 9.78) of women were empowered. Intrafamilial factors: husband’s education with primary (adjusted OR (AOR): 2.66 (1.30 to 5.43), secondary AOR: 4.69 (2.23 to 9.84) and tertiary AOR: 3.60 (1.20 to 10.83)) levels, being from model households (AOR: 4.38 (1.33 to 14.47)), households with middle (AOR: 3.50 (1.13 to 8.37)) or high (AOR: 3.10 (1.25 to 7.67)) wealth index, enrolment in productive safety net programmes (AOR: 2.37 (1.25 to 4.50)) and age at first pregnancy (AOR: 1.16 (1.08 to 1.24)) were positively associated with women’s empowerment. From the community-level characteristics, dowry (AOR: 1.82 (1.10 to 5.30)) and perceived good availability of justice for women and girls (AOR: 3.00 (1.05 to 8.60)) were positively associated with women’s empowerment. Conversely, the history of an adverse pregnancy outcome was negatively associated with women’s empowerment (AOR: 0.51 (0.26 to 0.99)).

The overall status of women’s empowerment in Tigray was very low. Husband’s education, being model household, wealth index, enrolment in productive safety net programmes, dowry practice, perceived good availability of justice for women and girls and age at first pregnancy were found to be significant factors associated with women’s empowerment. In view of these empirical insights, several policy recommendations are proposed. First, interventions should focus on the identified associated factors, particularly in areas with lower empowerment scores such as partner’s education, improving access to justice for women, addressing harmful community practices such as dowry and strengthening household economic status through social protection and livelihood programmes. Second, the promotion of gender-balanced household dynamics through awareness campaigns and policy incentives could make a substantial contribution to women’s empowerment in the study area.

A cross-sectional study.

Xinjiang, China.

50 778 community-dwelling older adults residing at varying altitudes across Xinjiang.

A multistage stratified sampling method was used to conduct an epidemiological survey from January 2019 to December 2019 among 50 778 community-dwelling older adults aged ≥60 years who were long-term residents of Kashgar (1289 m), Hami (738 m) and Turpan (35 m), Xinjiang. Logistic regression analysis was conducted to evaluate the association between altitude and hypertension risk.

Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) showed significant variations (both p<0.001) across Kashgar, Hami and Turpan at different altitudes: Kashgar (SBP: 133.15±19.644 mm Hg, DBP: 76.6±11.363 mm Hg), Hami (SBP: 136.68±19.617 mm Hg, DBP: 77.25±11.808 mm Hg) and Turpan (SBP: 135.44±21.101 mm Hg, DBP: 74.87±12.785 mm Hg). Statistically significant differences in the distributions of both SBP and DBP were observed across different altitudes for both males and females (all p<0.001). The differences in the distributions of SBP and DBP at different altitudes were statistically significant in all age groups, except for ≥90 years (all p<0.001). Moreover, the differences in SBP and DBP in older individuals living at the three altitudes were statistically significant (all p<0.001) regardless of smoking status, alcohol consumption, diabetes, education level or body mass index. The hypertension prevalence rates were 40.5%, 49.5% and 54.5% in Kashgar, Hami and Turpan, respectively (p<0.001). After adjustment for sex, age group, education level, smoking, alcohol consumption, BMI, diabetes, HR, SCr, blood urea nitrogen and dyslipidaemia, the risk of hypertension was increased in Hami (OR = 1.55, 95% CI 1.45 to 1.66, p<0.001) and Turpan (OR=1.80, 95% CI 1.71 to 1.88, p<0.001) compared with that in Kashgar.

In community-dwelling older adults residing in lowland to mid-elevation zones (35–1289 m) of Xinjiang, the prevalence and risk of hypertension were found to be inversely associated with residential altitude. These findings may reflect an environmental gradient effect specific to mid-to-low altitude settings, and their generalisability may be limited to populations at higher altitudes (>1500 m) or regions with distinct ethnic, genetic or healthcare backgrounds. Furthermore, it should be emphasised that this association likely reflects altitude-related environmental factors rather than direct physiological effects of hypoxia. Additional studies are warranted to further elucidate these complex relationships.