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☐ ☆ ✇ PLOS ONE Medicine&Health

Integrated versus standalone home-based records for reproductive, maternal, newborn, and child health in Nepal: A comparative qualitative study with descriptive quantitative profiling

by Sudim Sharma, Anjali Neupane, Dikshya Kandel, Pratibha Chalisay, Sabina Marasini, Budhi Setiawan, Deepak Chandra Bajracharya, Shyam Raj Upreti, Leela Khanal, Haruko Yokote, Chahana Singh, Kshitij Karki

Background

Home-Based Records (HBRs) are personal health documents intended to improve continuity of care and caregiver engagement across reproductive, maternal, newborn, and child health (RMNCH) services. In Nepal, both standalone (sHBR) and integrated (iHBR) models are implemented, yet comparative evidence on their utilization and implementation challenges is limited. This study examined utilization patterns and system-level barriers associated with sHBR in Madhesh Province and iHBR in Koshi Province.

Methods

We conducted a comparative qualitative study with descriptive quantitative profiling between May 17 and August 27, 2024. A total of 100 semi-structured in-depth interviews were completed with caregivers, health workers, Female Community Health Volunteers, and program managers across two provinces. The study applied “kuragraphy,” an ethnographic approach integrating interviews and field observations to construct contextual case narratives. Socio-demographic data were analyzed descriptively using the statistical package for the social Sciences (SPSS). Informed by the Human Centered Design (HCD) approach, the qualitative data were thematically analyzed in Excel using the Journey to Health and Immunization (JTHI) framework.

Results

Caregivers widely perceived HBRs as essential documents, primarily for immunization tracking and future service access. The iHBR was viewed as more comprehensive and user-friendly, particularly due to its illustrations, which improved comprehension among low-literacy users. However, understanding remained limited among illiterate and marginalized populations. Family involvement in record management was minimal and largely confined to mothers. Implementation barriers included inadequate training – particularly for iHBR use, limited decision-making authority among frontline health workers, incomplete documentation of non-immunization components, poor material quality of sHBR, and concerns regarding the sustainability of donor-supported iHBR initiatives.

Conclusion

HBR utilization in Nepal is shaped by caregiver literacy, gender dynamics, and health-system readiness. Strengthening training, supportive supervision, user-centered design, and sustainable supply mechanisms will be essential to optimize HBR effectiveness and support equitable RMNCH service delivery.

☐ ☆ ✇ PLOS ONE Medicine&Health

Effect of partner support on antenatal care visits among married adolescents in rural northwestern Uganda: A quasi-experimental study

Por: Saidi Appeli · Christine Chandia · Jonathan Izudi — Abril 2nd 2026 at 16:00

by Saidi Appeli, Christine Chandia, Jonathan Izudi

Background

Adolescent pregnancy is associated with several challenges, and partner support is crucial. However, the causal effect of partner support on the use of maternal health services among pregnant adolescents has not been rigorously examined. We assessed the causal effect of partner support on the frequency of antenatal care (ANC) visits among married adolescents in rural Uganda.

Methods

We conducted a quasi-experimental study using observational data from a cross-sectional study that involved married adolescents aged 10–19 years in rural northwestern Uganda. The primary exposure was partner support, measured as a binary variable. Adolescents were considered to have received support if their spouse encouraged ANC attendance, accompanied them to visits, or provided financial or emotional support during ANC; otherwise, they were classified as having not received support. The primary outcome was the number of ANC visits, while the secondary outcome was attending four or more ANC visits. Propensity score weighting was used to ensure covariate comparability between the partner support groups (yes vs. no). Poisson regression was used to estimate the causal effect of partner support on the number of antenatal care (ANC) visits (primary outcome), while the modified Poisson regression was used to estimate the causal effect on attending four or more visits (secondary outcome).

Results

Of 281 participants, 205 (72.9%) received partner support. Among participants with partner support compared to those without partner support, the frequency of ANC visits (Risk Ratio 1.15, 95% CI: 1.00–1.32) and four or more ANC visits (Risk Ratio 1.25, 95% CI: 1.01–1.52) improved.

Conclusion

The study showed that partner support was associated with improvements in ANC visit frequency and attendance of four or more ANC visits, among married adolescents in northwestern Uganda. Interventions aimed at improving ANC utilization should consider engaging and educating partners, as their support positively influences ANC utilization.

☐ ☆ ✇ BMJ Open

Association of eating disorders and/or insulin omission with impaired glycaemic control in persons living with type 1 diabetes: cross-sectional analysis of the French SFDT1 study

Por: Ritz · P.-J. · Aguayo · G. A. · Cosson · E. · Canha · D. · Renard · E. · Merwin · R. M. · Amouyal · C. · Arnault · G. · Bilariki · K. · Borot · S. · Chevalier · N. · Lemoine · A. · Franc · S. · Fremy · B. · Gouet · D. · Julla · J.-B. · Marchand · L. · Pinto · S. · Rigalleau · V. · Sonnet · E. — Marzo 19th 2026 at 11:26
Objective

To address whether eating disorders (ED) or insulin omission (IOM) in adult persons living with type 1 diabetes (pwT1D) are associated with impaired glycaemic control.

Design

Cross-sectional analysis.

Settings

The French-Speaking Diabetes Society—Type 1 Diabetes Cohort (SFDT1) is an ongoing epidemiological cohort study that includes pwT1D in France who attend hospitals or private ambulatory diabetes centres.

Participants

Adult participants from the SFDT1 study, with data on ED and IOM. The current analysis was performed on data collected during the baseline visit in participants enrolled between December 2020 and March 2024.

Main outcome measures

Using the SCOFF, a self-reported questionnaire to screen for ED, and a single question on IOM to screen for IOM, we described four categories of pwT1D: no ED & no IOM, ED & no IOM, no ED & IOM and ED & IOM. We performed unadjusted and adjusted (for age, sex, diabetes duration, social vulnerability, smoking, alcohol status and insulin treatment) multinomial logistic regression models with the four categories as the outcome and glycaemic variables as explanatory variables, including continuous glucose monitoring (CGM) variables and HbA1c. No ED & no IOM was the reference outcome for all comparisons. We stratified each model by sex and fear of hypoglycaemia.

Results

We included 1113 participants, 51% males, median (IQR) age 38 (29–50) years, diabetes duration 21 (12–32) years. Prevalences were as follows: no ED & no IOM: 68% (n=758), ED & no IOM: 11% (n=124), no ED & IOM: 16% (n=177) and ED & IOM: 5% (n=54). With the fully adjusted model, and compared with the group no ED & no IOM, time in range (OR (95% CI) 0.5 (0.4 to 0.7)) and time below range (0.5 (0.3 to 0.8)) were inversely associated with ED & IOM. Moreover, time in range (0.4 (0.4 to 0.5)) was associated with IOM & no ED. Time above range (2.2 (1.6 to 2.9)), Glycaemic Risk Index (1.8 (1.3 to 2.5)), glucose monitoring indicator (2.2 (1.7 to 2.9)) and HbA1c (2.0 (1.5 to 2.5)) were directly associated with ED & IOM. We did not observe associations between CGM variables and ED & no IOM. Most associations were valid in both men and women. The associations were stronger in participants with a fear of hypoglycaemia. However, the associations remained even in people with a fear of hypoglycaemia.

Conclusions

Both ED and IOM are frequent in pwT1D, and IOM seems to be associated with impaired glycaemic control. As our analysis was cross-sectional, we cannot infer causality and cannot know whether IOM was a result of glycaemic control or the inverse (reverse causality). Our results suggest that IOM should be systematically screened in clinical practice. Further research is needed to better identify and care for EDs, with or without IOM, in T1D.

Trial registration number

NCT04657783.

☐ ☆ ✇ BMJ Open

Adolescents perspectives on spectacle wear and adherence following a school-based outreach programme in Indonesia: a qualitative study

Por: Rahayu · T. · Barliana · J. D. · Lestari · Y. · Chandra · A. P. · Nadira · D. — Marzo 18th 2026 at 21:31
Objective

The aim of this study is to explore in depth adolescents’ insights regarding experiences of spectacle lens wear and its correlation with self-perception, quality of life, social interactions, adherence and barriers.

Design

Qualitative design through individual interviews and thematic analysis.

Setting

Middle school students in five regions of Jakarta Province.

Participants

31 middle school adolescents who participated and received free spectacle wear by the Indonesian Ophthalmologist Association.

Methods

A set of semistructured questionnaires exploring adolescents’ perception regarding spectacle lens wear, adapted from the PedEyeQ. Interviews were conducted on site or through Zoom and were then transcribed.

Findings

Thematic analysis identified three themes, as follows: (1) experience with eyeglasses, (2) motivation and encouragement and (3) barriers to usage. This study found that more than half of adolescents received their first spectacles during the outreach programme, with most reporting improved vision and academic performance after spectacle wear. However, adherence varied, as some participants—particularly those with moderate to high myopia and astigmatism—did not use their new glasses due to discomfort, poor fit or dissatisfaction with visual clarity. While initial adaptation often involved dizziness or soreness, most adjusted within a week. The majority recognised the importance of spectacle wear, describing clearer vision, reduced eye strain and improved confidence, though a minority viewed it as unnecessary. Parents played a central role in influencing health-seeking behaviour, and limited prior access to eye examinations and geographic challenges restricted care for several adolescents. Financial concerns were reported by a small proportion, while psychological barriers such as fear of teasing or negative self-perception were the major barrier. Overall, adolescents highlighted both the benefits and challenges of spectacle wear, with motivation shaped by personal experience, parental influence and accessibility of eye care services.

Conclusions

Findings showed insight that adolescent understanding regarding eye health is imperative to support adherence. However, psychological barriers act as a major factor that impedes lens wear. Involving parents and teachers in understanding urgency and severity of eye health in adolescents, specifically refractive error and its long-term negative impact, as well as the prominent psychological barriers, may improve adolescent perception and adherence.

☐ ☆ ✇ BMJ Open

Identifying common mental disorders among perinatal and non-perinatal women in northern India: a cross-sectional validation study of the diagnostic accuracy of six self-report measures

Por: Fellmeth · G. · Sharma · D. · Kanwar · P. · Chawla · K. · Gupta · V. · Thakur · A. · Harrison · S. · Quigley · M. A. · Bharti · O. · Chandra · P. S. · Desai · G. · Thippeswamy · H. · Singh · S. · Nair · M. · Kishore · M. T. · Alderdice · F. · Verma · A. · Perinatal Mental Health Study (P — Marzo 18th 2026 at 21:31
Objectives

To translate and culturally adapt six self-report measures for depression, anxiety, post-traumatic stress disorder (PTSD) and somatic symptom disorder into Hindi and determine their diagnostic accuracy against a diagnostic clinical interview.

Design

Cross-sectional validation study.

Setting

Rural Kangra, Himachal Pradesh, northern India.

Participants

480 perinatal (pregnant or within 12 months postpartum) and non-perinatal (not currently pregnant and not given birth within 12 months) women at one tertiary hospital and district-level Anganwadi (community health) centres.

Primary and secondary outcome measures

Symptom endorsement; and discriminant validity, sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve (AUROC) of the Kessler Scale of Psychological Distress (K10), Patient Health Questionnaire (PHQ9), Edinburgh Postnatal Depression Scale (EPDS), Generalised Anxiety Disorder Scale (GAD7), Perinatal Anxiety Screening Scale (PASS), PTSD Checklist (PCL-5) and Scale for the Assessment of Somatic Symptoms (SASS).

Results

Complete data were available for 443 participants. Tiredness and body weakness were the most commonly endorsed symptoms among participants with common mental disorders. Among perinatal participants, the AUROC was highest for the GAD7 (0.88, 95% CI 0.79 to 0.96) and SASS (0.84, 95% CI 0.71 to 0.96). Among non-perinatal participants, the AUROC was highest for the SASS (0.92, 95% CI 0.88 to 0.97) and PHQ9 (0.91, 95% CI 0.86 to 0.96).

Conclusions

Measures which assess for fatigue, tiredness and somatic symptoms may help to identify women experiencing common mental disorders in this setting. Small numbers of participants with clinically diagnosed mental disorders in our sample mean results must be interpreted cautiously.

Trial registration number

NCT05485701.

☐ ☆ ✇ BMJ Open

Co-STARS: a feasibility evaluation of a co-produced mental health literacy training package to reduce mental health inequities for Black young people in underserved communities - study protocol for a randomised controlled trial with an external pilot, pro

Por: Kumarendran · B. · Cherrington · E. · Bandyopadhyay · S. · Crowe · F. · Machaczek · K. K. · Brown · L. · Campbell · N. · Jordan · G. · Pope · M. A. · Antonovic · M. · Taylor · M. · W · N. · Mahamud · A. · Chandan · J. S. · Griffiths · S. L. · on behalf of the Co-STARS youth co-produc — Marzo 18th 2026 at 21:31
Introduction

Severe mental illness such as psychosis is among the most disabling illnesses worldwide, disproportionately affecting minoritised ethnic groups and those in socioeconomic disadvantage. In the UK, people from Black ethnic backgrounds are more likely to experience a first episode of psychosis and to be detained under the Mental Health Act than White British people. There is a clear need for mental health services to improve cultural awareness and understanding of the broader social needs of minoritised groups, as well as the need to improve mental health literacy (MHL) within Black communities to empower individuals to seek timely mental health support. This protocol describes our programme of work which aims to assess the feasibility, acceptability and cost-effectiveness of Co-STARS, which is a co-produced, culturally appropriate tiered training package.

Methods and analysis

We co-produced a culturally appropriate, place-based, tiered MHL training package (Co-STARS) to deliver within underserved Black communities and via an e-learning package implemented among staff within mental health trusts. The training will be evaluated in stages. First, a pilot cluster randomised controlled trial will assess the feasibility and acceptability (defined as participants’ perceptions of the training’s relevance, usefulness and delivery) of a lived experience-led MHL training package delivered by Black young people with experience of mental ill health, to underserved communities in Birmingham, UK. Acceptability will be quantified through participation and completion rates and explored qualitatively via focus groups and interviews. Second, a stepped-wedge cluster randomised trial will evaluate the feasibility of an e-learning training programme for mental health professionals. We will embed a process evaluation to explore change mechanisms and identify barriers and enablers for future implementation. Third, we will use realist-informed participatory systems mapping and novel epidemiological analyses to explore downstream effects (ie, improved care access for Black ethno-racial groups within the intervention areas). Last, a cost-effectiveness framework will be developed to assess whether the intervention is good value for money in future efficacy trials. In the cluster trial, eight clusters will be randomised to the intervention arm (face-to-face training in the community) and control arm (display of MHL materials) with pre- and post-assessments in 120 participants from 8 clusters, 3 weeks apart. In the stepped wedge trial, six clusters (clinical teams within NHS mental health trusts) including 120 NHS staff in total, will move from control phase to intervention phase in a stepped wedge manner, with pre-assessments and post-assessments.

Ethics and dissemination

This proposal was reviewed by the Research Governance of the University of Birmingham and UK Research and Innovation (UKRI) grant reviewers. Ethics approval was granted by East of Scotland Research Ethics Service. The findings will be communicated in research conferences, stakeholder meetings, via social media, through publication in peer-reviewed journals and as a policy document.

Trial registration number

ISRCTN10517405.

☐ ☆ ✇ BMJ Open

Promoting CHANGE cluster randomised controlled trial to improve food outlet healthiness in Australian sport and recreation facilities: protocol

Por: Lalchandani · N. · Romaniuk · H. · Cameron · A. · Orellana · L. · Ananthapavan · J. · Peeters · A. · Backman · B. · Adam · M. · Allender · S. · Nguyen · P. · Sacks · G. · Brimblecombe · J. K. · McMahon · E. · Blake · M. — Marzo 11th 2026 at 15:50
Introduction

Food retail outlets in sports and recreation facilities often fail to support healthy eating, despite aligning with healthy lifestyles and goals of local governments (LGs) that often own or manage them. LGs face barriers to implementing facility changes including inadequate staffing, training and incentives. The Promoting CHANGE initiative was co-designed to support LGs in improving and sustaining healthier food and drink offerings in these settings.

Methods and analysis

A 3-year, type 2 effectiveness-implementation hybrid cluster randomised controlled trial will evaluate the Promoting CHANGE capacity-building and support package in three Intervention and four Control LGs in Victoria, Australia (August 2023–July 2026). The co-designed initiative includes human resource support, training, tools, technical assistance, community-of-practice groups, feedback based on food outlet audit and sales data and small grant incentives. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework, the trial’s co-primary outcomes are the percentage of least healthiest food and drinks (1) displayed (implementation) and (2) sold weekly (effectiveness). Key secondary outcomes are effectiveness (sales and revenue); facility-level adoption, implementation, maintenance of healthy changes; cost-effectiveness (within-trial modelled economic evaluation). Findings will provide evidence of the initiative’s effectiveness and scalability, informing recommendations for advancing healthier food environments in over 6000 community-based food outlets across 500 Australian LGs, with implications globally.

Ethics and dissemination

This study has received approval from the Deakin University Human Research Ethics Committee (reference number HEAG-H 92_2023). The results will be published in scientific peer-reviewed journals along with plain language summaries for participants.

Trial registration number

ACTRN12621001120864.

☐ ☆ ✇ BMJ Open

Prevalence of ABO and Rh blood groups among individuals attending a tertiary care hospital in Nepal: a retrospective cross-sectional study

Por: Chand · A. B. · Sen · B. · Khadka · J. · Pandey · S. · Nepal · B. — Marzo 10th 2026 at 14:36
Objective

Understanding the regional blood group distribution is essential for safe transfusion practice and efficient blood bank inventory management, as local variations in the ABO and Rh blood group systems guide donor recruitment and minimise shortages and transfusion incompatibilities. This study aimed to determine the prevalence and distribution of ABO and Rh blood groups among individuals attending a tertiary care hospital in Lalitpur, Nepal.

Design

Retrospective cross-sectional study.

Setting

Department of Transfusion Medicine and Blood Bank of KIST Medical College and Teaching Hospital.

Participants

All individuals attending a tertiary care hospital between 17 July 2018 and 31 July 2023 who underwent ABO and Rh blood group testing were included in this study. Individuals younger than 4 months of age and those with discrepant blood group results were excluded.

Outcome measures

Frequency and distribution of ABO and Rh blood groups among different categories.

Methods

A retrospective cross-sectional study was conducted among individuals attending a tertiary care hospital after obtaining ethical approval from the Institutional Review Committee (reference number: 2080/81/91) of KIST Medical College and Teaching Hospital. The blood grouping and sociodemographic data of individuals were analysed using SPSS V.17.0, and statistical significance was established at p

Results

Out of 20 966 individuals, 12 956 (61.80% (95% CI 61.14% to 62.45%)) were female, and 8010 (38.20% (95% CI 37.55% to 38.86%)) were male. The most common blood group was A+ 6629 (31.62% (95% CI 30.99% to 32.25%)), while AB– was the least common blood group 49 (0.23% (95% CI 0.17% to 0.30%)). The RhD+ cases were 20 432 (97.45% (95% CI 97.24% to 97.67%)) and the RhD– cases were 534 (2.55% (95% CI 2.33% to 2.76%)). O+ blood (OR 1.25 (95% CI 1.18 to 1.32), p

Conclusions

Of the two major blood group systems, the ABO and RhD systems, A+ and RhD+ blood groups were the most prevalent among individuals attending a tertiary care hospital. Understanding the regional distribution of blood groups supports effective blood bank management and transfusion services, ultimately improving patient care.

☐ ☆ ✇ BMJ Open

Delivering hospital care at home in a Dutch Tertiary University Hospital: protocol for a prospective feasibility cohort study evaluating a Virtual Ward for early discharge of inpatients

Por: van Herwerden · M. C. · Scholte · N. T. B. · Mkrtchjan · A. · Feyz · L. · Mol · A. P. · Aitken · J. · de Boer · R. A. · Chandoesing · P. P. · Gommers · D. A. M. P. J. · De Haan · B. · Den Hoed · C. M. · van den Hoogen · M. W. F. · Peeters · R. P. · Wlazlo · N. · Van Der Boon · R. M. — Febrero 24th 2026 at 16:52
Introduction

Virtual Wards (VWs) facilitate hospital-level monitoring, diagnostics and treatment within patients’ homes, while the hospital team retains responsibility for care. International research indicates that VWs decrease hospital length of stay without increasing readmissions; however, the feasibility and key operational determinants within Dutch care remain uncertain. This protocol outlines the VW for Early Discharge in Patients Receiving Inpatient Care (VIP Care) study.

Methods and analysis

The VIP Care study is a single-centre prospective feasibility cohort study conducted at Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands. The study encompasses seven predefined subcohorts with n=51 eligible patients per subcohort: (1) bacterial, fungal or parasitic infections; (2) viral respiratory infections; (3) dehydration; (4) decompensated heart failure; (5) high-dose corticosteroid treatment; (6) post-transsphenoidal pituitary surgery follow-up and (7) severe inflammatory skin disease with or without bacterial or viral superinfection. Adults who require hospital-level monitoring and/or therapy may qualify for early discharge to the VW.

The VW integrates scheduled, patient-performed measurements using (European Conformity) CE-marked devices with structured symptom assessment submitted via a patient application, and data review in an electronic health record-integrated clinician cockpit. Submissions are evaluated by VW tele-nurses using prespecified Early Warning Score based thresholds and an escalation protocol. Patients receive a daily physician telephone review. Diagnostics and treatments are administered at home to hospital standards through established home-care services.

The primary outcome (feasibility) is adherence to transfer, defined as the proportion of eligible inpatients who provide written informed consent and are subsequently successfully transferred to the VW. The prespecified feasibility threshold is 30%. Secondary outcomes include reach (eligibility, invitation and consent rates among admitted patients), operational performance during the VW episode (alert frequency and handling, contact volumes and actions), length of stay on the ward and in the VW, emergency department reassessments and 30-day readmissions. Qualitative interviews will be conducted to identify implementation determinants.

Ethics and dissemination

The study received approval from the Erasmus MC Medical Ethics Committee (MEC-2024–0060; amendment MEC-2024–0060 A0001). Incremental risk is considered minimal. Written informed consent is obtained. Findings will be disseminated through peer-reviewed publications, conference presentations and an accessible lay summary.

Trial registration number

ClinicalTrials.gov NCT06936891; CCMO NL85516.078.24. Recruitment began in May 2025 and is ongoing.

☐ ☆ ✇ BMJ Open

Knowledge, attitudes and practices toward skin cancer prevention among Malaysian adults: a cross-sectional online survey

Por: Mohammed · A. H. · Hassan · B. A. R. · Wong · Y. J. · Ying · L. H. · Hong · M. L. B. · Nee · A. W. S. · Ying · L. S. · Ramachandram · D. S. · Hassan · H. S. · Jia · L. J. · Dujaili · J. · Blebil · A. — Febrero 22nd 2026 at 18:08
Objectives

To assess the levels of knowledge, attitudes and practices (KAP) toward skin cancer prevention among Malaysian adults and to examine differences in KAP across socio-demographic groups.

Design

Cross-sectional online survey.

Setting

Community-based study conducted in Malaysia using social media recruitment.

Participants

A total of 386 adults aged ≥18 years residing in Malaysia. Most participants were young adults (86.3%), female (55.4%) and of Chinese ethnicity (65.5%). Healthcare professionals were excluded.

Primary and secondary outcome measures

Primary outcomes were levels of knowledge, attitude and preventive practices toward skin cancer, measured using the validated KAP-SC-Q (Knowledge, Attitude and Practice of Skin Cancer Questionnaire) and categorised as poor, moderate or good. Secondary outcomes included differences in KAP across socio-demographic and clinical characteristics, analysed using independent t-tests and 2 tests.

Results

Over half of participants demonstrated poor knowledge of skin cancer (56.0%) and the vast majority showed inadequate preventive practices (84.2%), while attitudes toward skin cancer were predominantly positive (62.4%). Significant differences in mean KAP scores and categorical levels were observed across several socio-demographic variables. Participants with tertiary education had higher knowledge (14.32 vs 12.61) and attitude scores (20.01 vs 15.95; p

Conclusions

Malaysian adults exhibited limited knowledge and very poor preventive practices toward skin cancer despite generally positive attitudes. These findings highlight substantial gaps between awareness and behaviour and support the need for targeted public health interventions to correct misconceptions, improve risk perception especially in high-risk groups and promote effective ultraviolet protection behaviours.

☐ ☆ ✇ International Wound Journal

Wound Healing Property of a Novel Thermo‐Reversible Wound Gel With Lasting Antimicrobial and Antibiofilm Activity

ABSTRACT

This study investigated the efficacy and safety of a novel thermo-reversible antimicrobial wound gel (TRG, revyve Antimicrobial Wound Gel) designed to combat biofilm-related infections in wounds. The TRG was evaluated for its ability to disrupt biofilms, sustain antimicrobial activity and promote wound healing. The gel exhibited thermo-reversible properties, transitioning from a less viscous liquid ≤ 18°C to a highly viscous solid gel at wound temperature which would facilitate easy application and removal. Antimicrobial testing demonstrated that TRG effectively inactivated a broad range of wound-related pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa, with a 99.99%–99.9999% reduction in bacterial counts within 30 min. The TRG also maintained its antimicrobial efficacy after multiple inoculations with high microbial load (107 CFU/mL) over 7 days. In vitro biofilm assays showed effectiveness against biofilm bacteria with a reduction of ≥ 99.99% bacterial counts with one application over the course of 7 days. Biocompatibility testing confirmed that TRG was safe, with no signs of tissue necrosis or signs of tissue damage and no impact on wound healing in a porcine wound model. TRG's ability to reduce both planktonic and biofilm-based bacteria without compromising wound healing makes it a promising candidate for treating both chronic and acute wounds.

☐ ☆ ✇ BMJ Open

Suicidal thoughts and behaviours in pre-adolescent children: a population-based study in Olmsted County, Minnesota

Por: Ramachandran · N. · Firwana · M. · Murad · S. T. · Kabbara Allababidi · A. · Wang · Z. · Murad · M. H. · Sim · L. A. — Febrero 9th 2026 at 15:19
Objectives

To describe the incidence, presentation and long-term health outcomes of suicidal thoughts and behaviours (STBs) in children aged 12 years or under.

Methods

This population-based study included children identified through the Rochester Epidemiology Project who presented between 2005 and 2023 with STBs across primary, secondary and tertiary care centres in Olmsted County, Minnesota, USA. Information related to the patient and family characteristics, presentation, prior history and outcomes was manually extracted by two independent researchers. Patients were excluded if the index visit note could not be located, the patient had no suicidal ideation, attempts, intent or plan, was older than 12 years 11 months at the index date, less than 2 years old or was a duplicate entry.

Results

The average annual population was 28,035 children, of which 637 presented with STBs (mean (SD) age, 10.6 (1.7) years; 51.2% girls, 76.3% White, average follow-up 7 years). The majority of the cases presented to the emergency department (ED) 491 (77.1%). The annual incidence per 100,000 person-years tripled from 68.8 in 2005 to 208.6 in 2023. Overall, 105 patients (16.5%) presented with a suicidal attempt. There were no cases of death by suicide. A prior psychiatric diagnosis was present in 454 (71.3%). STB events were preceded by a precipitating event in 471 (73.9%), the most common of which was an argument with a parent, followed by a bullying event and family distress. A specific suicide plan was reported by 328 (51.5%) with laceration reported most frequently, followed by hanging and overdose. Significant predictors of a suicide attempt were previous use of mood stabilisers (OR 3.21; 95% CI 1.24 to 7.97) and having a specific plan (OR 2.73; 95% CI 1.72 to 4.41). Children who had suicidal attempts had more subsequent ED visits (3.50 vs 2.58; p=0.009) and hospitalisations for psychiatric reasons (1.90 vs 1.30; p=0.003) and psychiatric hospitalisation days (12.70 vs 9.04; p=0.048). Subsequent suicide attempts occurred in 31% of the cohort during follow-up.

Conclusion

STBs in preadolescent children are rare but are increasing in incidence. Such children have significant psychological diagnoses, use of mental health services, and subsequent suicide attempts. Novel age-appropriate interventions are needed.

☐ ☆ ✇ BMJ Open

Multicentre international observational study on airway management for anaesthesia: the STARGATE study protocol

Por: Russotto · V. · Sansovini · C. · Muraccini · M. · Collino · F. · Myatra · S. N. · Higgs · A. · Brewster · D. · Curic Radivojevic · R. · Parotto · M. · Karamchandani · K. · Landoni · G. · Sorbello · M. · Monfroglio · M. · Rovescala · G. · Martinelli · P. · Tinelli · O. · Meessen · J. · Be — Febrero 6th 2026 at 14:29
Introduction

More than 300 million major surgical procedures are carried out under general anaesthesia each year worldwide, and advanced airway management remains one of the leading daily challenges for clinicians. Data from large international prospective cohort studies on adverse events such as cardiovascular collapse, cardiac arrest and severe hypoxaemia during advanced airway management to facilitate anaesthesia are lacking.

Methods and analysis

The International obServational sTudy on AiRway manaGement in operAting room and non-operaTing room anaEsthesia (STARGATE) study will be an international prospective observational cohort study describing the incidence of major adverse events associated with advanced airway management (tracheal intubation or supraglottic airway device placement) for general anaesthesia in the operating and non-operating room for surgery and medical procedures. The secondary aim will be to describe the practice of airway management in a large international cohort. Critically ill patients will be excluded from this study. Data on patients’ characteristics, type of procedure and the adopted airway management strategy, post-procedure adverse events, operator characteristics and in-hospital mortality will be prospectively collected. The study aims to enrol 10 500 patients.

Ethics and dissemination

The study has been approved by the Ethics Committee of the coordinating centre (Comitato Etico Interaziendale AOU San Luigi Gonzaga, N° 25/2023). Each of the participating centres will then seek approval of their local Ethics Committee before enrolment. Data will be disseminated to the scientific community by original articles submitted to international peer-reviewed journals.

Trial registration number

NCT05759299.

☐ ☆ ✇ BMJ Open

Understanding the impact of temporary childbirth migration on maternal and child health: study protocol of a community-based prospective cohort study in India

Por: Patil · R. · El Ayadi · A. M. · Tonde · K. · Choudhari · B. · Bhujbal · S. · Murro · R. · Agarwal · D. · Charlebois · E. · Bansal · P. · Nitnaware · N. · Kalantri · A. · Mundra · A. · Goyal · N. · Raut · A. · Rongsen-Chandola · T. · Juvekar · S. K. · Diamond-Smith · N. — Febrero 5th 2026 at 13:02
Introduction

Temporary childbirth migration (TCM), where women return to their natal homes for pregnancy, delivery or postpartum for a limited duration, is a long-standing sociocultural practice in India. While often motivated by familial support and traditional norms, its implications for maternal and child health and health system engagement remain poorly understood. This study aims to quantify the impact of TCM on maternal and newborn outcomes and to explore how continuity of perinatal care and social support mediate these relationships.

Methods and analysis

We are conducting a three-site, community-based, prospective cohort study across the Health and Demographic Surveillance System sites of Vadu (Maharashtra), Sevagram (Maharashtra) and DEESHA (Delhi). A total of 3000 pregnant women will be enrolled in pregnancy (

Ethics and dissemination

This study has been approved by the Ethics committees at the KEM Hospital Research Centre Pune (KEMHRC/RVM/EC/1931), Society for Applied Studies (SAS/ERC/TCM Study/2024), Mahatma Gandhi Institute of Medical Sciences (MGIMS/lEC/COMMED/8412023) and University of California San Francisco (22-36484). All research activities are conducted in accordance with Indian Council of Medical Research Guidelines for biomedical research and the Declaration of Helsinki. On study completion, findings will be disseminated to diverse local, national and global stakeholders and published in academic journals.

Trial registration number

CTRI/2024/02/062881.

☐ ☆ ✇ BMJ Open

Safety and efficacy of the Atalante exoskeleton in the rehabilitation of French patients with amyotrophic lateral sclerosis: a prospective, monocentric, open, uncontrolled, interventional protocol, EXALS

Por: Trad · G. · Lenglet · T. · Ledoux · I. · Querin · G. · Blancho · S. · Marchand-Pauvert · V. · Hogrel · J.-Y. · Pradat · P.-F. — Enero 16th 2026 at 18:44
Introduction

Robotic rehabilitation on locomotion is a new approach in amyotrophic lateral sclerosis (ALS) and previous studies showed its feasibility. In this study, we aim to evaluate safety, patient’s experience and efficacy of a gait training programme with the Atalante exoskeleton, compared with usual care, on walking ability, functional capacity and other symptoms associated with ALS.

Methods and analysis

EXALS is a monocentric, prospective, interventional, open trial. 20 slowly progressing patients with gait deficits will be recruited. The study is conducted in three phases, each lasting 6 weeks, following the ABA procedure. Phase B represents the intervention phase, during which patients practise their gait training at a rhythm of three sessions/week, as an add-on to usual care. In the two phases A, patients receive usual care with no additional treatment. An evaluation is planned before, in the middle and at the end of each phase. The primary outcome of the study is safety and tolerability of the Atalante exoskeleton. Secondary outcomes include: participants’ subjective impact and experience, attitude and motivation, efficacy and interactivity of the exoskeleton, walking ability, functional capacity, spasticity, balance, postural stability, lower limb muscle strength, quality of life, pain, fatigue, anxiety and depression. Statistical analyses will include descriptive methods for all variables and adverse events. Quantitative outcomes are analysed using repeated-measures ANOVA (analysis of variance) across the seven visits, with post hoc tests applied when appropriate. Nominal outcomes are evaluated using Cochran’s Q test with McNemar pairwise comparisons when significant. Associations between variables are examined using Spearman correlation coefficients. Missing data will be replaced using linear interpolation, and sensitivity analyses will be planned. Qualitative interview data are analysed using thematic analysis.

Ethics and dissemination

This study was approved by the French ethics committee CPP Nord-Ouest I (no. 23.02378.000201). Participant data are anonymised and securely stored in the laboratory’s database, accessible only to the research team. Results will be disseminated through peer-reviewed journals and conferences.

NCT06199284.

☐ ☆ ✇ PLOS ONE Medicine&Health

Custom foot orthoses for chronic metatarsalgia: Study protocol for a participant- and assessor-blinded superiority randomized controlled trial

by Eléna Payen Schalkens, Maxime Acien, Andrée-Anne Marchand, Pier-Luc Isabelle, Jacques Abboud, Gabriel Moisan

Background

Chronic metatarsalgia (CM) causes significant pain and disability, affecting quality of life. Foot orthoses (FOs) including medially wedged designs with a metatarsal pad decrease excessive plantar pressure under the metatarsal heads, which is a suggested risk factor for developing CM. This FOs model may be effective in diminishing pain and improving function in these individuals. Thus, the objective of this trial will be to compare the effects of medially wedged FOs with a metatarsal pad and sham FOs on pain and foot function in individuals with CM.

Methods/design

This participant- and assessor-blinded superiority randomized controlled trial (RCT) with two parallel groups will be conducted in Trois-Rivières, Canada. Sixty-four participants with CM will be recruited from the Université du Québec à Trois-Rivières outpatient podiatry clinic and via social media invitations. They will be randomized into intervention (customized FOs) or control (sham FOs) groups and will be evaluated at baseline and after 6 and 12 weeks. The primary outcome will be: (1) mean pain during walking for the most painful foot during the past week. The secondary outcomes will be: (1) Foot Function Index, (2) Global rating of change and (3) the 5-level EQ-5D.

Discussion

Medially wedged FOs with a metatarsal pad are expected to provide a greater reduction in pain and improvement in foot function compared to sham FOs. This trial will help guide FOs prescription recommendations for managing foot pain in individuals with CM in the future.

Trial registration

ClinicalTrials.gov NCT06962475

☐ ☆ ✇ BMJ Open

Exploring the mechanisms of yoga-based cardiac rehabilitation in heart failure via assessment of endothelial function, genomics and arterial health (Yoga-EndOmics): a study protocol

Por: Shetty · V. V. · Patil · L. R. · Patil · S. G. · Aithal · K. · Oli · A. K. · Yenagi · V. A. · Kaulgud · R. S. · Dharne · M. · Chandra Sekaran · A. M. · Prabhakaran · D. — Enero 13th 2026 at 15:20
Introduction

Heart failure (HF) remains a major global health challenge, particularly in low-resource settings where access to comprehensive cardiac rehabilitation (CR) is limited. Yoga, a culturally contextualised mind-body intervention, holds promise as an adjunctive therapy in CR. The Yoga-EndOmics study aims to evaluate the effects of Yoga-based cardiac rehabilitation (Yoga-CaRe) on gene expression, endothelial function, vascular biomarkers and clinical outcomes in systolic HF, providing mechanistic insights into its potential integration into conventional cardiac rehabilitation.

Methods and analysis

This is a prospective, randomised, open-label, blinded-endpoint (PROBE) mechanistic trial enrolling 78 patients with HF with reduced ejection fraction (HFrEF). Participants will be randomised in a 1:1 ratio to receive either a structured Yoga-CaRe intervention or enhanced standard care for 3 months. The Yoga-CaRe group will attend 20 supervised sessions with guided home practice involving tailored asanas, pranayama and meditation. Primary outcomes are changes in endothelial-dependent flow-mediated dilation (FMD) and functional exercise capacity at 3 months. Secondary outcomes include changes in arterial compliance and stiffness, circulating biomarkers of endothelial dysfunction, oxidative stress and inflammation, and immediate changes in global gene expression profiles in peripheral blood mononuclear cells following the Yoga-CaRe intervention. Data will be analysed using analysis of covariance (ANCOVA) for between-group comparisons and significant analysis of microarray (SAM) for global gene expression profiles.

Ethics and dissemination

The study has received ethical clearance from the Institutional Ethics Committee of the SDM College of Medical Sciences and Hospital, India (SDMIEC/2025/1072) and is registered with the Clinical Trials Registry of India. Findings will be disseminated through peer-reviewed journals, scientific conferences and stakeholder engagement platforms to inform future integrative strategies in HF management.

Trial registration number

CTRI/2023/12/060758

☐ ☆ ✇ BMJ Open

Associations between oral health behaviours, oral health, salivary biomarkers and clinical phenotype in individuals with alcohol use disorder: protocol for a longitudinal observational study

Por: Maki · K. A. · Xu · S. · Wallen · G. R. · Gerrard · C. · Sung · C. · Papneja · S. · Tuason · R. T. S. · Ramchandani · V. A. · Diazgranados · N. · Barb · J. J. — Diciembre 17th 2025 at 11:54
Introduction

Binge drinking in the previous month was reported in 23.5% of US adults, and 28.1 million adults met criteria for Alcohol Use Disorder (AUD) in 2023. Individuals with AUD face increased risks of oral health problems, including caries, periodontal disease and mucosal lesions. Poor oral hygiene, nutrition and dental care all contribute to these conditions, but individuals with AUD are often under-represented in oral health surveys. Understanding relationships between oral health behaviours, attitudes and general health is crucial for designing future interventions. This pilot aims to explore the relationship between oral and systemic health in subjects with AUD, focusing on oral health behaviours, salivary biomarkers and clinical phenotype, including systemic biomarkers of inflammation, to inform future research on oral–systemic interactions in AUD.

Methods and analysis

This protocol has two parts. Part 1 involves cognitive interviews to assess the content validity and interpretability of the Oral Health Behaviours Assessment (OHBA) questionnaire. Part 2 will collect biological and behavioural data from treatment-seeking patients with AUD and matched controls (age, sex and smoking status), including saliva, blood, dental exams, and health behaviour and symptom measures. Inpatients with AUD will provide biospecimens and answer symptom severity questionnaires at admission and again at the dental exam visit (7–12 days later), while controls will provide a single set of measures at their dental exam visit. Oral health will be assessed through structured dental and periodontal examinations, radiographs and validated questionnaires (including the OHBA). Additional data will include alcohol use history, psychiatric and medical history assessments, dietary recall, and measures of stress, sleep and mood to capture potential moderators of oral–systemic relationships. Biomarkers of inflammation and stress will be quantified from saliva and blood using immunoassays. Primary outcomes will compare oral health, salivary biomarkers and clinical measures between AUD and controls, while secondary outcomes will evaluate within-subject changes in patients with AUD during inpatient treatment and early abstinence.

Ethics and dissemination

This clinical protocol was approved by the National Institutes of Health Institutional Review Board (IRB #002005). Prior to enrolling, participants will be informed of the study purpose, risks and benefits, and study procedures, and evaluated for understanding prior to signing consent. Part 1 of the protocol is currently active and recruiting participants for cognitive interviews. The study findings will be disseminated through journals and conferences related to addiction medicine, psychology, immunology, neuroscience and dentistry. We expect the results of the pilot study will inform future research on oral health and salivary bioscience while also providing treatment-seeking patients with AUD targeted information on the importance of oral health behaviours for maintaining oral and systemic health.

Trial registration number

NCT06684483; preresults.

☐ ☆ ✇ PLOS ONE Medicine&Health

Investigating organizational resilience in a medicine and health sciences university in United Arab Emirates

Por: Tamara Muir · Chandra Sharma Poudyal · Romana De Lima · Farah Otaki — Diciembre 17th 2025 at 15:00

by Tamara Muir, Chandra Sharma Poudyal, Romana De Lima, Farah Otaki

Introduction

COVID-19 pandemic emerged in late 2019, leading to global disruption and forcing people to adapt to a new reality. The intensity of the pandemic affected many organisations’ preparedness, response, and recovery efforts, causing numerous businesses to struggle. Although no single theory fully explains why some businesses thrived during this time, the concept of organisational resilience stands out. Organisations with a resilient culture seemed better equipped to address risks, adapt effectively, and seize opportunities for innovation. Therefore, the purpose of the current study is to critically examine the response to COVID-19 of a medicine and health sciences university in Dubai, United Arab Emirates.

Methods

The study relied on a convergent mixed methods approach to research. A tailor-made questionnaire was used to collect quantitative data using two 5-point Likert-type scales: ‘Opinions about Organizational Response’ and ‘Conducive Organizational Response Behaviours’ (where 110 current employees who were tenured during COVID-19 were selected, using purposive, non-probability sampling, and in turn invited to participate). Semi-structured interviews were conducted to collect qualitative data [where seven respondents who had completed the questionnaire and agreed to participate in follow-up interviews were selected (i.e., convenience, nonprobability sampling) and in turn invited to participate]. The quantitative data were descriptively and inferentially analysed. Qualitative data was analysed using an inductive six-step thematic approach. The quantitative findings were mapped onto the output of qualitative analysis using the iterative joint display analysis process.

Results

A total of 70 employees completed the questionnaire (63.64%), and six out of seven invitees participated in the semi-structured interviews. The percentage of the total extent of agreement of ‘Opinions about Organizational Response’ score was 90.94%. As for the percentage of the total frequency of observation of ‘Conducive Organizational Response Behaviours’ score, it was 95.08%. The qualitative analysis generated a conceptual model, namely: ‘Enablers of Organizational Resilience’, with five interlinked themes namely: Preparedness and planning for uncertainty, Adaptation and agility, Team cohesion, Social responsibility, and Learning organisation. Four meta-inferences emerged from integrating the data findings: Response characteristics, Behaviour specificities, Consistency of opinions, and the Fundamental role of organizational culture.

Conclusion

The findings reveal that organizations, in the intersect between higher education and public health, should continue on innovatively investing in agile leadership, strategic partnerships, and a robust continuous learning and development culture to better navigate future disruptions.

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