This study aimed to determine the associations between adherence to the 24-hour movement guidelines and symptoms of anxiety and depression among Colombian university students.

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.

Australian studies investigating parental factors often lack meaningful inclusion of Aboriginal and Torres Strait Islander families, limiting our understanding of current influences on positive developmental trajectories within communities. There is growing recognition of the need for culturally safe and responsive longitudinal research that is co-designed and co-led by the community for the community. An Indigenous-led birth cohort study of Aboriginal and Torres Strait Islander families in Queensland, Australia, has therefore been developed to better understand health across generations.

The Strong Families Study is a co-designed prospective longitudinal birth cohort study that will follow 400 Indigenous families in Queensland from pregnancy until the child reaches 5 years of age. Eligible participants include pregnant individuals (

This study was approved by the Mater Misericordiae Ltd Human Research Ethics Committee (HREC/MML/105191) and ratified by the University of Queensland Human Research Ethics Committee (2025/HE001924). Endorsement letters were secured from partner services at each study site. Findings will be shared with partnering hospitals and funding bodies at conferences and through reports and peer-reviewed publications.

Although the association between obesity and health-related quality of life (HRQoL) is well-documented, studies on the association between weight trajectories and HRQoL among spouses are limited. This longitudinal study aimed to characterise distinct body mass index (BMI) trajectories and their association with HRQoL at individual and spousal levels.

The total sample of 773 couples was followed for an average of 15 years. Univariate group–based trajectory models and multi-trajectory group–based models were used to identify latent classes of individual and couple BMI trajectories, respectively. Linear regression analyses were applied to investigate the associations between identified BMI trajectories and HRQoL at the individual level and at the spousal level, where spousal HRQoL refers to the association between both partners’ BMI trajectories and each individual’s HRQoL.

Based on BMI changes over the life course, four trajectories were identified in wives and husbands at both individual and couple levels, ranging from stable healthy weight to progressively increasing overweight and obesity, with all trajectories showing an overall rise in BMI with age. In the fully adjusted model, compared with wives in the mild progressive overweight group, the mean score of physical HRQoL in women in the progressive obesity group (β=–2.14, p=0.02) and severe progressive obesity group (β=–2.55, p=0.03) was significantly lower. Moreover, compared with husbands with stable healthy weight status, those in the progressive obesity group had lower physical HRQoL (β=–2.67, p=0.02). At the spousal level, lower physical HRQoL was observed in individuals whose BMI trajectories, together with their partner’s trajectory, indicated higher risk (eg, wives with severe progressive obesity and husbands with stable overweight) compared with couples with both partners in lower-risk BMI trajectories (β=–3.61, p=0.01). A similar effect was observed only in severe progressive obese women whose husbands were of stable healthy weight during their lifespan. None of the BMI trajectories at either individual or spousal levels affected mental HRQoL.

Our findings indicate a significant effect of individuals’ BMI patterns on the physical domain of HRQoL. Spousal HRQoL associations reflect how both partners’ BMI trajectories are jointly associated with individual HRQoL. Clinically, these results highlight the potential importance of early weight management, particularly in women, in relation to long-term physical HRQoL and possible benefits for both partners. Further investigation is required to assess the role of potential confounders in BMI–HRQoL associations.

Primary healthcare (PHC) emergency services are critical as the first line of defence against life-threatening conditions, significantly reducing mortality and morbidity. Globally, life-threatening emergencies (LTEs) such as acute myocardial infarction, stroke, severe trauma and respiratory failure frequently present first at PHC centres, particularly in low- and middle-income countries. However, inadequate emergency preparedness at the primary care level contributes to substantial avoidable mortality and long-term disability. Many PHC centres, especially in underserved and rural areas, face substantial challenges including inadequate equipment, insufficient training and poor referral systems which compromise emergency care quality and outcomes. Despite the recognised importance of PHC in emergency care, there is currently no synthesised evidence comprehensively mapping the barriers and facilitators that influence LTE management at this level. This systematic review aims to synthesise evidence on barriers and facilitators in managing LTEs at PHC centres to inform effective interventions and policy development.

This systematic review will comprehensively search PubMed/MEDLINE, Scopus and Web of Science for relevant literature published up to 31 May 2026. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent researchers will conduct a three-stage screening process: initial title/abstract evaluation, full-text assessment and manual review of reference lists. Any disagreements between reviewers will be adjudicated by the lead investigator. The eligibility criteria and research question will be established using the SPIDER framework, which examines Sample, Phenomenon of Interest, Design, Evaluation and Research Type components. Methodological quality will be appraised using the Mixed Methods Appraisal Tool (2018). Extracted data will be systematically collected using a standardised form. A ‘best fit’ framework synthesis approach, complemented by thematic analysis, will be employed to integrate qualitative evidence.

The protocol for this systematic review has received ethical approval from the Research Ethics Committee of Tabriz University of Medical Sciences (approval number: IR.TBZMED.VCR.REC.1404.061). The committee confirmed that the study objectives do not involve direct patient contact or clinical interventions, and therefore, the review meets ethical standards for research based exclusively on published literature. Findings will be disseminated through peer-reviewed publication, conference presentations and policy briefs.

Registration number PROSPERO CRD420251071584.

To evaluate the effectiveness of a web-based secondary prevention programme for postpartum depression, delivered with or without telephone support, compared with usual care.

We first conducted a randomised controlled superiority trial to test whether the web-based Parents and Babies programme (Toi, Moi, Bébé; TMB) delivered with motivational telephone support (ie, coaching) was superior to the fully automated programme (ie, self-help). TMB incorporated classic and third-wave cognitive–behavioural therapy components and psychoeducation. Then, we tested whether TMB (both treatment modalities combined) was superior to usual care. The usual care comparison group was drawn from the CONCEPTION prospective pan-Canadian perinatal cohort (N=592).

A remote study based at Sainte-Justine Hospital Centre, Quebec, Canada.

Web-based intervention programme participants were women aged ≥14 years at 12–25 weeks’ gestation, with subclinical to moderate clinical Edinburgh Postnatal Depression Scale (EPDS) scores: 9–16. Exclusion criteria were psychosis and self-reported substance abuse. The usual care comparison group was pregnant women ≥18 years old. All participants were living in Canada at study inception.

The primary outcome was EPDS scores at 3 months post partum, accounting for baseline EPDS scores and depression events defined as EPDS ≥13 at 3 months post partum. The secondary outcomes were EPDS scores at 6 months post partum, depression events (EPDS≥13) at 6 months post partum, anxiety symptoms (Generalised Anxiety Disorder 7-item Scale, GAD-7) at 3 and 6 months post partum, accounting for baseline scores for the continuous outcomes; as well as the number of completed intervention modules and well-being scores (WHO 5-Item Well-being Index) at 3 months post partum.

We randomised 510 participants to TMB self-help (n=255) or TMB with coaching (n=255); 211 and 214 participants, respectively, were included in the complete-case intention-to-treat analyses. At baseline, 91% lived with a partner, 71% were university graduates and 42% self-reported GAD-7≥10. Randomisation was successful. First, TMB with coaching was not superior to TMB self-help: at 3 months post partum, EPDS scores were TMB self-help (mean 8.0±4.3) vs TMB with coaching (mean 8.6±4.5); effect size was 0.01 (95% CI 0.00 to 0.03; p=0.16). Second, TMB (regardless of intervention arm) was superior to usual care: in adjusted regression models, EPDS scores were 6.2 units lower (per SD, 95% CI –8.2 to –4.3) in TMB (both treatment modalities combined) than in usual care; and proportions of depression events were 4.7 units lower (per SD on the logit scale, 95% CI –6.6 to –2.7) in TMB (combined) than in usual care. No other group differences were observed.

Our findings suggest that, in women with subclinical to moderate clinical antenatal depressive symptoms, receiving a web-based cognitive–behavioural therapy-based programme in addition to usual care can reduce depression postnatally.

NCT05110456.

The COVID-19 pandemic threatened global HIV Test and Treat Efforts. We assessed whether it affected (1) the number of antiretroviral therapy (ART) initiations and (2) the proportion of timely ART initiations in people living with HIV (PLWH) globally.

Quasi-experimental, regression discontinuity design using routinely collected data from HIV clinics.

360 HIV care clinics across primary and secondary levels of care, participating in the International epidemiology Databases to Evaluate AIDS consortium, in 31 countries in Asia, Africa and the Americas.

177 391 PLWH (≥18 years old) who initiated ART 2 years before and 1 year after the onset of the COVID-19 pandemic in their country.

The primary outcome was the number of ART initiations per week; the secondary outcome was the proportion of timely ART initiations (ie, ART initiated within 7 days of enrolment). We assessed changes in these outcomes in the 52 weeks after compared to the 104 weeks before the pandemic onset, defined using each country’s peak Oxford Stringency Index score between January and June 2020.

Among 177 391 newly enrolled PLWH, 129 743 initiated during the pre-pandemic and 47 648 post-pandemic onset. 72.5% of ART initiations were timely pre-pandemic whereas 82.3% were during the pandemic. Absolute number of ART initiations remained stable during the pandemic period in 25 of 31 countries but decreased significantly in six countries: India (–5.0 p, 95% CI –9.2 to –0.7), Rwanda (–10.0 p, –18.6 to –1.4), Malawi (–33.4 p, –54.1 to –12.3), South Africa (–130.8 p, –188.6 to –73.1), Zimbabwe (–12.9 p, –20.0 to –5.8) and Togo (–19.6 p, –39.1 to –0.1). The proportion of timely initiations was stable in all countries except in Kenya (+4.2 pp, 95% CI +0.3 to +8.1) and in Mozambique (+2.7 pp, +0.5 to +4.9), where it increased significantly.

A deeper understanding of the factors that contributed to sustaining ART initiations, particularly in settings with stringent public health and social measures, is needed. These insights should inform preparedness strategies, resource allocation and policy development to ensure continuity of HIV services during future health emergencies, in line with World Health Organisation recommendations.

Global ageing populations require accessible, non-invasive tools for early detection and monitoring of neurological chronic and neurodegenerative diseases. Current diagnostic methods face limitations including invasiveness, high costs and infrequent clinical assessments. The human voice has emerged as a promising digital biomarker, with vocal characteristics reflecting physiological and cognitive changes associated with conditions like dementia and Parkinson’s disease. While artificial intelligence (AI) and machine learning have enabled sophisticated vocal analysis, the literature remains fragmented without comprehensive synthesis. This scoping review protocol delineates a systematic approach to collate and synthesise existing research on the application of AI-driven audio biomarkers for the detection and management of neurological diseases (eg, cognitive decline, Parkinson’s disease, Alzheimer’s, dementia and depression) in older adults aged 65 years and above.

This scoping review will be conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and the methodological framework proposed by Arksey and O’Malley, incorporating recent methodological advancements. The eligibility criteria for study selection will be formulated using the PCC (Population, Concept, Context) framework. A comprehensive literature search will be performed across several electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, IEEE Xplore, Embase, Compendex, CINAHL, Scientific Information Database (SID), Magiran, IranMedex and Barakat Knowledge Network System (BKNS). The search will encompass peer-reviewed articles published in Persian and English from 1 January 2012 to 31 March 2026. Two independent reviewers will screen titles, abstracts and full texts and extract data according to the predefined PCC-based eligibility criteria. Discrepancies will be resolved through discussion or, if necessary, by consultation with a third reviewer. The results will be synthesised and presented narratively, accompanied by summary tables, charts and figures to address each research question.

The Research Ethics Committee of Tabriz University of Medical Sciences approved the protocol for this scoping review (approval number: IR.TBZMED.VCR.REC.1404.223). They concluded that since the review involves only analysis of existing literature without direct patient involvement or clinical procedures, it meets the relevant ethical standards. Results from the review will be shared through peer-reviewed journals and conference presentations to provide valuable insights for researchers, clinicians and policymakers on the use of audio-based biomarkers in older adults.

Not registered.

International guidelines on breast cancer (BC) screening have differing recommendations leading to uncertainty on best practices for primary care providers. The purpose of this study was to create a Canadian best practices document on BC health and screening for primary healthcare providers through multidisciplinary consensus using Nominal Group Technique and Delphi method.

A 9-member multidisciplinary expert group and a patient advocate participated in the consensus methods and voting. Experts included those involved in BC management and two primary care physicians. Twenty-nine experts across BC disciplines participated in external review.

Two study objectives included (1) building consensus on key ‘best practice’ behaviours related to BC-related health and screening and (2) building consensus on specific definitions related to BC screening.

The final consensus document consists of 65 statements grouped in five categories with companion resources to support uptake of all best practices. Categories include identification and work-up for diagnostic imaging, risk factors and identifying individuals eligible for high-risk screening, shared decision-making, decisions and referrals for BC screening and screening outcomes. Special areas of focus were shared decision-making, age to initiate screening, and BC screening in special populations.

We created a comprehensive consensus document distilling the latest evidence to provide practical Canadian consensus-based advice on specific ‘best practice behaviours’ related to BC health and screening to serve as a resource for providers.

Human papillomavirus (HPV) is one of the most common sexually transmitted diseases and affects the quality of life (QoL) of individuals, necessitating interventions beyond physical treatments. The aim of this study is to determine the effectiveness of individual supportive counselling on the QoL in women with high-risk HPV.

This randomised clinical trial will include 80 women with HPV who will be selected from 2025 to 2026 in Babol, Iran. Following selection based on inclusion criteria, samples will be randomly allocated to intervention and control groups. Then, they will complete demographic–social questionnaires, QoL in HPV patients and general health questionnaires. Individuals in the intervention group will receive 4 weekly online supportive counselling sessions in addition to routine care. The control group will receive routine care. Both groups will complete the questionnaires again at 6 weeks and 4 months postbaseline. Data will be analysed using SPSS V.26 software and statistical tests including ², t-test and repeated measures analysis of variance, and regression models if necessary. A significance level of 5% will be used for the tests.

This study was approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.HRI.REC.1404.082). The trial will adhere to the ethical principles of the Declaration of Helsinki. Findings will be disseminated through publication in peer-reviewed journals and presentation at scientific conferences.

IRCT20180218038783N11, 14 September 2025.

Solidarity in global health is often invoked as an ethical imperative to guide responses to global health challenges. Its meanings and practices across diverse contexts, however, remain under-explored. Deepening an understanding of how solidarity is conceptualised, enacted and perceived by a diverse array of actors within the global health ecosystem is crucial to advancing meaningful and measurable application of this commitment in global health.

This qualitative study uses interpretive research methodology to explore perspectives on solidarity among key global health stakeholders: community-level leaders in civil society organisations working on global health issues; research institute directors in the Global South; and individuals with experience of funding decision-making with major global health funding and agenda setting organisations (‘global health influencers’). Data will be gathered through semi-structured interviews and analysed using inductive and deductive reflexive thematic analysis, to identify patterns and differences in how these global health stakeholders recognise and define solidarity or its absence in their day-to-day work, while remaining attentive to conceptual tensions, participant interpretations of solidarity that may be unfamiliar to our team, and our role as researchers in shaping what we register and emphasise as significant in our reporting of findings.

Ethics approval was obtained from the Western University Health Sciences Research Ethics Board (HSREB) in Ontario, Canada # 2024-123965-87873 and the Ethics Committee for the Humanities, University of Ghana # ECH 163/23–24 and University of Oxford, Oxford Tropical Research Ethics Committee (OxTREC) waiver dated 10 April 2024. Study results will be submitted for peer-reviewed publication. Results will also be summarised in an open access report and presented at various stakeholder meetings and in online webinars.

The final protocol was registered with Open Science Framework on 28 October 2023. View only link: https://osf.io/gryp5/?view_only=8baff435a35847f09a342408d38ee35b.

This study aims to explore the impact of financial toxicity (FT) faced by cancer patients in Bahawalpur, Pakistan, identify their coping strategies and provide patient-driven recommendations to mitigate the FT.

A qualitative study design was used, and thematic analysis was employed to analyse the data.

Patients were selected from two tertiary care hospitals located in Bahawalpur, Pakistan.

Thirty patients were selected using a purposive and convenience sampling method. Data were collected between April and June 2024. Patients who provided consent, were 18 years or older and were receiving cancer treatment were included in the study.

Most participants were between 40 and 60 years old, and 66.6% were male. The study highlights severe FT, characterised by financial instability, psychological distress and family lifestyle disruptions. Patients employed various strategies, such as adjusting healthcare decisions, mobilising financial resources and seeking financial aid to cover treatment costs. Novel insights revealed the inadequacy of existing government health card programmes, which focus on direct medical expenses but fail to cover indirect costs, further exacerbating FT. Patients reported significant challenges in accessing government aid programmes due to administrative barriers. Participants highlighted the need for additional support mechanisms to address these gaps effectively, including enhanced accessibility, broadening financial assistance and integrated financial counselling.

This study is the first to explore FT in Pakistan’s healthcare system. It reveals gaps in support mechanisms and highlights the need for comprehensive policy interventions. Addressing these challenges holistically can improve patient outcomes and quality of life.

Kerato-lenticule extraction (KLEx) is a refractive surgery technique that, in contrast with femtosecond laser-assisted in situ keratomileusis (FS-LASIK), does not require the creation of a flap to correct refractive defects. The potential advantages of this technique are related to the absence of a flap and its complications. On the other hand, FS-LASIK is the most widely practised refractive surgery worldwide, as it offers excellent visual outcomes and is currently the gold standard of refractive surgery. The objective of this study is to compare the effectiveness and safety of KLEx versus FS-LASIK as a treatment option in patients with myopia or myopic astigmatism.

This double-masked, parallel-group, single-centre randomised clinical trial will enrol 80 eyes from adults with myopia or compound myopic astigmatism within the ranges sphere –0.50 to –12.00 D and cylinder –0.50 to –6.00 D, recruited at the Instituto de Oftalmología Conde de Valenciana, Mexico City, Mexico. Participants will be allocated to KLEx or FS-LASIK and assessed at baseline and 1 day, 1 week, 1, 3, 6 and 12 months postoperatively. The primary outcome is uncorrected visual acuity at all postoperative visits. Secondary outcomes include postoperative spherical equivalent, best-corrected visual acuity (BCVA), loss of ≥2 BCVA lines, the proportion of eyes within ±0.50 D of the refractive target, corneal aberrations over a 5 mm pupil, epithelial changes and adverse events. Participants and outcome assessors will be masked to the assigned surgical technique.

Participant confidentiality will be maintained with the publication of results. This study was approved by the research and ethics committee of the Instituto de Oftalmología Fundación de Asistencia Privada Conde Valenciana (CI-017-2024). The study results will be disseminated in scientific articles published in peer-reviewed journals and presented through research posters at national and international conferences.

ClinicalTrials.gov registry (NCT06477081).

The objective of this study was to generate evidence for strengthening the local food system to contribute to improved dietary diversity among children in Ethiopia.

A community-based cross-sectional survey.

The study was conducted in the Amhara, Oromia and Somali regions of Ethiopia.

A total of 1475 children aged 6–23 months were included. Children requiring special care or not permanently residing in the study areas were excluded.

The primary outcome measure was the adequate Minimum Dietary Diversity, defined as the consumption of at least five of the eight defined food groups in the previous 24 hours.

Only 25.6% of children met the adequate minimum dietary diversity requirement. Children from households with backyard gardening (Adjusted odds ratio (AOR)=1.43, 95% CI 1.08 to 1.88), access to communication devices (AOR=1.99, 95% CI 1.51 to 2.64), attendance at cooking demonstrations (AOR=1.99, 95% CI 1.44 to 2.74), use of labour-saving and time-saving technologies (AOR=1.55, 95% CI 1.15 to 2.09) and irrigation use for crop production (AOR=1.78, 95% CI 1.26 to 2.52) had higher odds of meeting adequate minimum dietary diversity. Residence was strongly associated with dietary outcomes: children in Amhara had more than seven times the odds of achieving adequate minimum dietary diversity of children compared with Somali (AOR=7.56, 95% CI 4.92 to 11.62), while those in Oromia had nearly twice the odds (AOR=1.74, 95% CI 1.17 to 2.60).

Dietary diversity among children was low in the study areas. Strengthening local food systems through promotion of backyard gardening, cooking demonstrations, irrigation use, communication access and appropriate technologies could improve children’s dietary diversity. Regional disparities highlight the need for context-specific strategies, particularly to address the low dietary diversity in children.

A successful extubation process is critical for the future health outcomes of paediatric patients, as it tests the functioning of the respiratory system without the support of mechanical ventilation. However, extubation can cause stress, pain, anxiety or discomfort in patients, which may sometimes lead to an increased likelihood of reintubation. Music-based interventions and therapies have been shown to be effective in reducing anxiety and stress levels in ventilated patients in the paediatric intensive care unit (PICU), but studies evaluating the effect of music therapy during the extubation process in the PICU are scarce.

This is a pragmatic multicentre randomised clinical trial with two parallel arms. The intervention group will receive standard care + music therapy during the extubation process, and the control group will receive standard care alone. The main outcome measure is heart rate, which will be measured every minute for 5 min pre-extubation, during the extubation process and up to 10 min postextubation. Secondary outcome measures are: oxygen saturation, respiratory rate, blood pressure and heart rate variability. A total of 82 patients will be randomised.

This study was approved by the Research Ethics Committee of the Fundación Universitaria Sanitas (CEIFUS 1356-24, date of approval: 3 May 2024). All parents or legal guardians of patients will sign a written informed consent, and if applicable, assent from participants will be sought. The results will be disseminated through publications in peer-reviewed journals, conferences and presentations at the hospitals’ clinical committees.

Version 1.0, 18 December 2024.

NCT06591533, trial registration date: 10 September 2024.

Overuse of CT scans is associated with multiple harms, such as an increased risk of cancer development, particularly in children. However, the rate of CT scan use is high and unwarranted worldwide.

This study aimed to identify the patterns and reported indications for head CT scans ordered for non-traumatic paediatric cases in Palestine.

This was a retrospective, cross-sectional study based on a desk review.

The study was carried out from June 2024 to September 2024 in five hospitals located in five major Palestinian governorates in the West Bank.

The study included records of children aged 14 or younger, presenting with non-traumatic complaints and having undergone head CT between January 2020 and September 2024. A total of 3715 patient records were explored, of which 2977 were included in the final analysis; 1764 (59.3%) males and 1213 (40.7%) females.

A pilot review of 100 records was conducted, and the data collection spreadsheet included demographic and clinical characteristics, presentations, reported reasons for CT requests, CT results, and information on lumbar puncture (LP) performance.

The mean age of patients was 4.3 years (SD±3.3), with 59.3% aged 3 to 11 years, and 47.7% presenting to hospitals in northern governorates. The most commonly reported presentation was fever and convulsion (8.2%), followed by convulsions (7.7%), and a combination of fever, headache and vomiting (6.5%). Only 12.9% of the CT scans yielded positive findings, including dilated ventricles (19.3%), sinusitis (18.8%), brain oedema (12.9%), and brain mass (11.1%). Most CT scans were requested to check for contraindications to LP, with only 4.1% having a positive CT finding indicating a contraindication. At the multivariate level, a positive CT result was associated with being a neonate, having a past medical condition, ordering CT to check for contraindication to LP and presenting with convulsions.

CT scans were found to be overused without justification, particularly for ruling out contraindications to LP. The development of clear and specific national guidelines is recommended. This process can be supported through training, decision support tools, alternative management pathways and specialist consultations to ensure compliance. Additionally, enhancing reporting quality and using health information systems are vital for monitoring and improving radiological safety.

Dementia is a chronic and progressive neurological condition characterised by cognitive and functional impairment. It is often associated with multimorbidity and imposes a significant economic burden on healthcare systems and families, especially in low-income and middle-income countries. In Peru, where dementia cases are increasing rapidly, timely detection and referral for diagnosis is crucial. This protocol is part of the IMPACT Salud project in Peru. Here, we focus on a specific component aimed at validating an mHealth tool for the detection of cognitive and functional impairment and assessing its cost-effectiveness. We will also assess changes in cognitive and functional impairment as well as health economic outcomes over 1 year.

This observational study will be conducted in four geographically diverse regions of Peru. Community health workers are expected to contact approximately 32 000 participants (≥60 years) to apply an mHealth-enabled tool that includes cognitive and functional instruments: Ascertain Dementia 8, Peruvian version of Rowland Universal Dementia Assessment Scale and Pfeffer Functional Activities Questionnaire. From this large sample, we aim to find 3600 participants and their study partners to enrol and interview at baseline regarding sociodemographic characteristics, lifestyles, comorbidities and health economic data including resource use, costs and health-related quality of life (HR-QoL). Psychologists, blind to previous results, will assess dementia stage of the participants using an abbreviated Clinical Dementia Rating (CDR) scale. At 6-month follow-up, participants will complete a brief health economics questionnaire on resource use, costs and HR-QoL. To validate the accuracy of the detection tool, a subsample of 600 participants who completed the baseline will undergo a gold-standard clinical neuropsychological assessment. This subsample will participate in a 12-month follow-up, including health economics, cognitive and functional impairment tests and the CDR scale. Results will be analysed and presented by cognitive status, site, sex and multimorbidity profile. Finally, data from all stages and external sources will inform a decision model to implement a cost-effectiveness analysis of the detection tool at the national level.

The study received ethics approval in Peru (Universidad Peruana Cayetano Heredia: CONSTANCIA-CIEI-378-33-23) and in the UK (Imperial College London: ICREC/SETREC reference number 6647445). Informed consent will be obtained from participants and their study partners, considering the participant’s capacity to consent. For illiterate participants, consent will be obtained through a witnessed procedure involving study partners, with a fingerprint obtained instead of a signature. The results will be disseminated through conferences, published articles, public presentations (particularly to those involved in dementia care) and presentations or meetings with local health authorities.

Programmes based on early childhood development (ECD) services play a vital role in improving child health and developmental outcomes. Across many countries, these programmes target children under 5 years of age—including those who are healthy, at risk or with developmental disorders—and are implemented in governmental and non-governmental organisations in both the health and non-health sectors globally. This protocol outlines a scoping review designed to systematically map and synthesise existing evidence on the components, implementation strategies and delivery mechanisms of ECD services worldwide. The review aims to inform the development of optimised and comprehensive interventions that support holistic child development.

This review will be conducted by Arksey and O’Malley’s framework and its recent advances. Several databases, including PubMed/MEDLINE, Scopus, Science Direct and Web of Science, Scientific Information Database, Magiran, IranMedex and Barakat knowledge network system, will be initially searched for studies up to December 2024. All searches will be done for published or unpublished articles/reports without time and language restrictions. Two researchers will independently carry out screening of the included studies and extraction of data. Any discrepancies will be resolved by consensus. In case no initial consensus is reached, a third researcher will be consulted to make a decision. The findings will be synthesised through the content-analysis method.

The findings of this review may offer a novel perspective for developing a comprehensive package of ECD services within the Iranian health system. Furthermore, it provides a detailed roadmap for researchers and stakeholders aiming to enhance child health and prevent developmental disorders. This study received ethical approval from Tabriz University of Medical Sciences (ID: IR.TBZMED.REC.1404.139), with no ethical concerns as it involves no patient participation or interventions.

Vitamin D deficiency during pregnancy is a global health concern, contributing to adverse maternal and fetal outcomes. Despite its importance, limited data exist on vitamin D status and its determinants among pregnant women in Ethiopia. This study aimed to assess the prevalence and determinants of vitamin D deficiency among pregnant women in their first and second trimesters in Gondar Town, Ethiopia, 2024.

A facility-based cross-sectional study was conducted at the antenatal care unit of University of Gondar Comprehensive Specialized Hospital from January to March 2024.

Eligible participants were selected using a simple random sampling technique. Sociodemographic, behavioural and clinical data were collected through structured questionnaires and medical record reviews. Serum levels of vitamin D, calcium and alkaline phosphatase were analysed using the Beckman Coulter clinical chemistry analyser. Statistical comparisons between pregnant women in the first and second trimesters were performed using the independent t-test. Determinants of vitamin D deficiency were identified using multivariate logistic regression analysis.

384 pregnant women in their first or second trimester.

The prevalence of vitamin D deficiency (90 mm Hg) (AOR 0.28, 95% CI 0.11 to 0.70), lower dietary diversity (AOR 3.17, 95% CI 1.13 to 8.89), lower fish and fish oil consumption habit (AOR 3.01, 95% CI 1.03 to 8.77; AOR 12.27, 95% CI 1.50 to 100.42) were the key predictors associated with serum vitamin D defiency.

Nearly half of the pregnant women in Gondar Town exhibit vitamin D deficiency, showing a challenging public health concern. Thus, targeted interventions, such as dietary supplementation and lifestyle modifications, are urgently needed to address the problem and improve maternal and neonatal health outcomes.

This study aims to investigate the relationship between waterpipe smoking, polycythaemia and cardiac risk factors, including blood pressure and obesity.

Cross-sectional Study conducted in 2022.

An-Najah National University (ANNU) in the West Bank, Palestine.

A total of 954 university students participated in the study.

A questionnaire used to assess smoking behaviours and other substance practices and patterns. Anthropometric and clinical measurements were measured and recorded, and complete blood counts (CBC) were obtained using an automated haematology analyser. Descriptive statistics were used to characterise the sample. Logistic regression models were applied to assess associations between smoking and polycythaemia. Also, there is a link between polycythaemia and high systolic and diastolic blood pressure.

Out of 954 participants, 60% were females, 18.5% smoked cigarettes (57.1% daily), 31.1% smoked waterpipes (20.5% daily), 6.5% smoked e-cigarettes (18.2% daily), 18.8% had polycythaemia and 17.6% were obese. After adjusting for gender, obesity and other confounders, waterpipe smoking was associated with polycythaemia (OR=1.70, p=0.023), male gender (OR=87.89, p

The study findings indicated significant associations between high blood pressure and polycythaemia, tobacco smoking, obesity and male gender. These findings underscore the importance of addressing tobacco hazards and their potential impact on cardiometabolic health, particularly among young adults.

There are many barriers to mental health services, including cost and stigma. Even when individuals receive professional care, assessments are intermittent and may be limited in part by the cyclical nature of psychiatric symptoms. The human voice might have the potential to serve as a valuable biomarker in the identification, early diagnosis or monitoring of psychiatric conditions. Therefore, this protocol presents a proposed scoping review with the aim of synthesising existing knowledge on the application of artificial intelligence (AI) or machine learning (ML) in the management of individuals at risk of/suffering from schizophrenia through audio samples as a biomarker.

Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and Arksey & O’Malley’s scoping review framework (with recent advancements), we systematically mapped the literature on the application of voice-based biomarkers in schizophrenia. Several databases (PubMed/MEDLINE, Scopus, Web of Science, IEEE Xplore, Embase, Compendex, CINAHL, Scientific Information Database, Magiran, IranMedex and Barakat knowledge network system) will be systematically searched for relevant studies through 2025. All searches will be conducted for peer-reviewed articles/studies published in Persian and English between 1 January 2012 and 1 September 2025. Two researchers will independently carry out screening of the included studies and extraction of data. Any discrepancies will be resolved by consensus. In case no initial consensus is reached, a third researcher will be consulted to make a decision. Findings will be presented narratively in the form of text, summary tables, charts and figures for each research question.

This proposed scoping review is based on publicly available information and is also a review of primary studies, so ethics and publication ethics approval are not required because all data from this study have been previously published. The findings of this review will be published in a peer-reviewed journal and presented at national or international congresses and conferences. Importantly, the initial results from this review will serve as a basis for the design and validation of an intelligent clinical decision support system based on acoustic biomarkers for patients with schizophrenia, using AI or ML techniques.

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