To evaluate the impact of video use in out-of-hours primary care (OOH-PC) telephone triage by examining how triage outcomes (ie, ended by telephone, clinic consultation or home visit) changed during a period with video service failure.

Observational register-based study, using periods of video service failure as a randomisation mechanism for a controlled study.

OOH-PC in four of the five Danish regions.

All telephone triage contacts to the OOH-PC call centres between April 2020 and December 2021.

Video service failures resulted in a subset of telephone triage contacts without the option of using video as a triage tool. Video service failures were identified algorithmically based on observed periods without video use.

Proportion of telephone triage contacts with clinic consultations or home visits as triage outcome during a period of video service failure compared with matched reference telephone triage contacts taking place during normal service (1:10), presented as risk ratios (RR) with 95% CI).

The algorithm identified 6605 telephone triage contacts during video service failure. Compared with matched contacts during normal service, these had a 15% higher risk of resulting in a clinic consultation (RR: 1.15, 95% CI 1.09 to 1.20). This effect was primarily isolated to the year 2021 (RR: 1.23, 95% CI 1.16 to 1.31) compared with 2020 (RR: 1.05%, 95% CI 0.97 to 1.13). Video service failure did not significantly affect the risk of a home visit.

Results strongly suggest that the unavailability of the video service is likely to significantly increase the number of clinic consultations in OOH-PC as a triage outcome. Whether this effect is likely to persist in the long term remains unclear.

The McMaster Monitoring My Mobility (MacM3) study aims to understand trajectories of mobility decline in later life using multisensor wearable technology. To our knowledge, MacM3 is the first major cohort to combine accelerometry and a Global Positioning System (GPS) to track real-world mobility in community-dwelling older adults.

Between May 2022 and May 2024, MacM3 recruited 1555 community-dwelling older adults (mean age 73.9 years, SD=5.5) from Hamilton and Toronto, Ontario. Of the cohort, 68.4% were female, 62.4% married/partnered, 75.3% had post-secondary education and 62.9% had≥3 comorbidities. Most were Canadian born (69.4%) and white/Caucasian (88.0%), with greater ethnocultural diversity observed at the Toronto site.

At baseline, 56.7% of participants reported no mobility limitations, 15.9% had preclinical limitations and 27.4% had minor mobility limitations. Mean gait speed for the total sample was 1.23 m/s, with a mean Timed Up and Go time of 9.4 s and a 5x sit-to-stand time of 13.0 s. A total of 1301 participants had valid wrist-worn device data, and 1008 participants who agreed to wear the thigh-worn device had valid data (≥7 days with ≥10 hours of wear per day). Step count data (n=1008) revealed a mean of 8437 steps per day (SD=2943), with 5073 steps in the lowest quartile and 12 303 steps in the highest.

Ongoing work aims to develop predictive models of mobility decline by integrating wearable, clinical and environmental data. Pipeline enhancements will enable GPS/inertial measurement unit fusion to explore mobility-environment interactions and support ageing-in-place tools.

A cancer diagnosis not only profoundly impacts individuals but also the very core of their families, reshaping their lives in many ways. However, there is a lack of focus on the well-being and health of the entire family across adult cancer research. This is concerning given that one-third of the Danish population will get a cancer diagnosis before the age of 75, suggesting that many Danes will become caregivers during their lifetime. In addition, identifying vulnerable families is challenging, and the determinant factors for their vulnerability are unknown.

The principal aim of this study is to investigate family health during cancer treatment. This will be done by gathering information on various parameters such as perceived support, quality of life and self-efficacy in patients with cancer and families across the cancer trajectory. Additionally, the study seeks to pinpoint particularly vulnerable families and investigate contributing factors to their vulnerability.

This mixed-methods study follows a sequential explanatory design, combining patient-reported outcomes in a longitudinal, prospective multicentre survey with interviews conducted with a nested sampling of the participants from the survey. A total of 240 patients diagnosed with prostate-, breast-, gastrointestinal- and lymphoma cancer, and designated adult family caregivers will be recruited from six different sites for the survey. Variables such as family health, needs and perceived support, quality of life, self-efficacy, depression, stress and resilience will be explored. Survey data will be collected at baseline, 3, 6, 12 and 18 months. The interviews (n=12–15) will be conducted twice with patients and caregivers jointly: once during the treatment phase (3 months) and once after completion of treatment (12 months). For the survey part, we estimated a sample size with 90% power and 5% significance to detect a minimal clinically important change in the Family Health Scale. Assuming an SD of 2x22 = 31, based on a cross-sectional SD of 22, 44 patients per group were required; to allow for dropout, 60 per group (240 total) were included. Patient and caregiver characteristics will be summarised descriptively. Longitudinal patient-reported outcomes will be analysed with linear mixed regression, separately for patients and caregivers. Changes will be reported as mean differences with 95% CIs and compared with published minimal clinically important differences or, if unavailable, 0.3xbaseline SD. For the qualitative part, thematic analysis by Braun and Clarke is chosen to extract data, identify patterns and analyse data and themes from the interviews. NVivo will be used for coding interview data.

The study will be conducted in accordance with the Helsinki Declaration. Measures will be taken to ensure confidentiality, data protection and participant safety throughout the study. The results will be published in peer-reviewed journals and conference presentations.

ClinicalTrials.gov: NCT06433349. Protocol version 2.0, June 2024.

Stroke is a leading cause of disability and mortality worldwide, with upper limb dysfunction being among its most common effects. Compression therapy has recently gained growing interest as an adjunct to other rehabilitation interventions for managing upper limb dysfunction among stroke survivors. However, the evidence for its effectiveness remains inconsistent and equivocal. Therefore, this systematic review aims to assess the effectiveness of compression therapy in managing upper limb dysfunction in patients with stroke.

A systematic search of databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, PEDro, OTseeker, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform) will be conducted to identify peer-reviewed studies and relevant grey literature on compression therapy on upper limb dysfunction after stroke. Two reviewers will independently screen, select and extract data, with discrepancies resolved through discussion or involvement of a third reviewer. Outcomes of interest include clinical measures of upper limb function, activity, participation and safety (ie, adverse effects). Risk of bias will be assessed using the Cochrane RoB 2 for randomised studies, the Risk Of Bias In Non-randomised Studies of Interventions for non-randomised studies. The certainty of evidence across types of compression therapy and outcomes will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Data will be narratively synthesised, and a meta-analysis will be performed if feasible. The review will be reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and will be conducted from September 2025 to December 2025.

This systematic review does not require ethical approval as only secondary data will be used. This review will synthesise the body of evidence on the effectiveness of compression therapy in managing poststroke upper limb dysfunction. Results will then be disseminated through a peer-reviewed publication to inform research and clinical practice.

CRD42024625815.

Self-rated health (SRH) is a well-established predictor of all-cause mortality. However, its predictive value in patients with cancer remains unclear. We aimed to elucidate the relationship between prediagnostic SRH and mortality among patients with cancer using data from the Norwegian Women and Health (NOWAC) Study.

A prospective cohort study.

This study included 26 405 women from the NOWAC cohort who were diagnosed with cancer between 1992 and 2020. Subgroup analyses focused on the most common cancer types among Norwegian women: breast (n=8299), colorectal (n=3653) and lung and bronchial (n=2428) cancers.

Prediagnostic SRH was assessed using a single-item measure with four response alternatives and categorised into ‘very good’, ‘good’ and ‘poor’ SRH. We used flexible parametric survival analysis and competing risk regression models to evaluate the association between SRH and all-cause and cancer-specific mortality after adjusting for age, physical activity, Body Mass Index, smoking, alcohol consumption and education.

Poor prediagnostic SRH was associated with increased all-cause mortality among long-term cancer survivors. For specific cancer sites, the adjusted HRs and 95% CI for poor versus very good SRH were 1.29 (95% CI: 1.06 to 1.58) for breast cancer and 1.50 (95% CI: 1.20 to 1.88) for colorectal cancer. These associations were more pronounced among long-term survivors than short-term survivors. No association was observed between prediagnostic SRH and mortality for patients with lung cancer. For cancer-specific mortality, prediagnostic SRH predicted mortality from all cancers, as well as from colorectal cancer.

Prediagnostic SRH is a significant predictor of mortality in patients with cancer, particularly among long-term survivors. These findings indicate the potential of SRH as a predictive tool for mortality, underscoring the importance of integrating SRH assessments into identifying individuals at higher risk of mortality and highlighting the potential benefits of public health interventions aimed at improving overall health, but further studies are required to assess the effect of such interventions on SRH.

To investigate discrepancies in perceptions regarding the accessibility and availability of rest and relaxation (R&R) spaces between hospital doctors in Scotland and NHS Scotland regional health boards (HBs), with the intention of informing best practices for organisational policy on the provision of R&R spaces both now and in the future.

A qualitative study, through an inhabited institutionalism (II) lens, of semi-structured interviews of hospital doctors across the career continuum in Scotland and all NHS regional HBs in Scotland providing written information relating to R&R space provision.

NHS Scotland during the COVID-19 pandemic and beyond.

Hospital doctors (n=30) who had participated in a larger qualitative study and provided specific insights on R&R spaces. All NHS Scotland regional HBs (n=14).

Although HBs reported the provision of R&R spaces, numerous doctors reported R&R spaces had been removed, relocated or were inaccessible. Furthermore, limited awareness of their availability attributed to inadequate communication, compounded the issue. This divergence between institutional reporting and front-line experience can be interpreted through the lens of II, which posits that institutional polices are often interpreted and implemented differently.

This study emphasises how crucial R&R spaces are to promoting doctors’ well-being especially during the time of high stress. HBs must not only guarantee the accessibility and physical availability of R&R spaces but also enhance their communication regarding the provision.

To evaluate staffing conditions, patient outcomes, quality of care, patient safety and nurse job outcomes in British Columbia (BC), Canada hospitals.

Cross-sectional study of 58 hospitals in BC with surveys of nurses and independent measures of patient outcomes.

58 hospitals in BC.

6685 hospital-based nurses working in a direct patient care role.

Hospital-wide and unit-specific patient-to-nurse staffing ratios derived from registered nurse reports of how many patients and how many nurses were on their unit during their last shift worked.

Objective patient outcome measures included the Hospital Standardized Mortality Ratio (HSMR) and 30-day Readmission Rate, from 2022 to 2023 Canadian Institute for Health Information data. Nurses4All@BC provided data from 2024 using validated items on multiple measures (eg, nurse burnout, missed health breaks, intentions to leave, quality and safety measures such as culture of patient safety, quality of nursing care, missed nursing care).

Burnout (59.4%), missed health breaks (41.7%), job dissatisfaction (36.0%), intentions to leave (19.3%) and patient outcomes (HSMR mean 95.4, median 96.0, range 26–180; readmission rate mean 10.0%, median 9.5%, range 7.9%–13.8%) were high and varied across hospitals. 68.3% of nurses reported there were not enough staff, and 77.3% reported their workloads were unsafe for patients. 60.6% of nurses gave their hospital an unfavourable patient safety rating. More patients per nurse were associated with poorer hospital mortality and readmission rates, poorer job outcomes for nurses, more adverse events for patients, less favourable ratings of quality of care and patient safety, more missed nursing care and poorer ratings of staffing adequacy and management.

Given the variability in staffing, quality and patient outcomes across BC hospitals, the implementation of a minimum nurse-to-patient ratio policy has the potential to improve patient care safety and retention of nurses.

Social norms are often implicit informal rules that most people accept and abide by, and can influence how people behave, sometimes based on perceived rewards and/or sanctions. Social norms are propelled by some reference or population groups who exert a considerable amount of influence on behaviour because people value their approval or disapproval. Despite these observations, little research exists on the influence of social norms on diabetes risk-taking behaviours. We explored diet-related social norms and their influence on risk-taking behaviours for type 2 diabetes (T2D).

We conducted a multi-method qualitative study guided by the Social Norms Exploration Toolkit participatory tools. A total of 45 participants were interviewed for this study, including (10) T2D patients, (10) caregivers of T2D patients, (10) healthcare providers, (2) village health teams, (4) diabetes-free community members; (4) community influencers like cultural leaders and (5) family members. The study was conducted in eastern Uganda in the districts of Bugiri and Busia. Data were collected on health workers, caregivers, patients and community members using focus group discussions, in-depth interviews and non-participant observation. Data were manually analysed to identify emerging social norms and other information of interest following a thematic framework approach.

Most participants were aware that frequent consumption of fatty foods and sugary refined foods could increase one’s risk of getting T2D. The study highlights three themes: general awareness of T2D risk factors, common social norms influencing dietary behaviours and behavioural risk factors that are influenced by the social norms. The study highlights significant behavioural and social drivers of T2D, which include consumption of high-fat, high-sugar diets, limited exercise and stress. Gendered and cultural norms strongly influence dietary behaviours, with women preparing unhealthy foods to meet societal expectations, fearing sanctions like divorce or community stigma, while men’s dietary preferences were linked to respect and social status. Norms around staple food preferences and respect linked to weight further perpetuate T2D risk behaviours. Community influencers, family dynamics and cultural traditions reinforce these practices, underscoring the need for gender-transformative, culturally sensitive and community-centred interventions. However, healthcare providers and village health teams are critical for promoting healthier behaviours and reducing T2D prevalence.

Our deep-dive social norms diagnosis has revealed that even when people know the risk factors for T2D, they will still follow the social norm influence regarding lifestyles. Inclusive strategies that actively engage and reshape norms are therefore vital to reduce the prevalence of T2D.