Breast cancer is the most common cancer among women globally. While the impact of lifestyle factors like smoking and obesity on breast cancer risk and survival is well documented, the effect of working conditions is not fully understood. Moreover, breast cancer can reduce employability, making it crucial to identify factors that facilitate return to work and improve life satisfaction. Since breast cancer is affected by sleep and lifestyle, which are related to working conditions, understanding how they affect breast cancer outcomes is key. This study aims to explore the relationship between working conditions and breast cancer outcomes, including incidence, mortality and survival within a causal framework. Our specific aims are to understand the relationship between (1) working conditions and occupational groups and breast cancer outcomes, including the extent to which sleep, lifestyle and breast cancer screening uptake explain these relationships and (2) prediagnosis working conditions, sleep and lifestyle and their effect on return to work and life satisfaction among breast cancer survivors.

We will use data from the UK Biobank, a large-scale cohort study with data on 273 825 women between 40 and 69 years old at baseline, followed from 2006 to 2022. The data has been linked with death and cancer registries and includes 8309 incident breast cancer cases. To quantify the effect of working conditions on breast cancer outcomes (aim 1) and their effect on return to work and life satisfaction (aim 2), we will implement g-methods to estimate the average causal effect and employ counterfactual-based mediation analysis to quantify how much mediating factors, such as sleep and lifestyle, explain this effect.

UK Biobank received ethical approval from the North West Multi-Centre Research Ethics Committee. No further ethical approval was required for the proposed research project. In line with the two aims, four original research manuscripts will be published in open-access peer-reviewed journals to disseminate the findings. In addition, findings will be disseminated at international conferences and scientific meetings.

The Quadrivalent human papillomavirus (HPV) Vaccine Evaluation Study with Addition of the Nonavalent Vaccine Study (QUEST-ADVANCE) aims to provide insight into the long-term immunogenicity and effectiveness of one, two and three HPV vaccine doses. Here, we describe the protocol for QUEST-ADVANCE.

QUEST-ADVANCE is an observational cohort study including males and females who are unvaccinated or vaccinated with the quadrivalent or nonavalent HPV vaccine in British Columbia, Canada. Female participants who are unvaccinated or vaccinated with 1–3 doses of the quadrivalent or nonavalent HPV vaccine at 9–14 years of age will be recruited approximately 5 or 12 years postvaccination eligibility. Male participants who are unvaccinated or vaccinated with 1 or 2 doses of the nonavalent HPV vaccine at 9–14 years of age will be recruited at approximately 5 years postvaccination eligibility. The study involves a maximum of four visits over a period of 4–5 years for female participants, and two visits over a 12-month period for male participants. At each visit, self-collected swabs (cervico-vaginal or penile) and questionnaire data will be collected. In each study group, a subset of participants will be invited to participate in a substudy evaluating the long-term humoral immunogenicity of the HPV vaccine. Additional blood samples will be collected from participants who are part of the immunogenicity substudy. The total required sample size is 7180 individuals. The primary objectives are (1) to examine vaccine effectiveness in males and females against prevalent genital HPV infections for one, two and three doses of the HPV vaccine compared with unvaccinated participants and (2) to evaluate if there is non-inferior immunogenicity as indicated by type-specific antibody response of one dose of the HPV vaccine in 20–27-year-old females vaccinated at 9–14 years of age compared with historical data of three doses of the HPV vaccine females vaccinated at 16–26 years of age up to 12 years postvaccination.

QUEST-ADVANCE was approved by the Research Ethics Board of the University of British Columbia/Children’s and Women’s Health Centre of British Columbia (H20-02111). Individual electronic informed consent or assent will be obtained from each participant before any study-specific procedures are undertaken. Results will be published in an international peer-reviewed journal and on the study website.

To analyse global trends in aortic aneurysm mortality from 1990 to 2021 and project future trends through 2036, examining variations across Socio-Demographic Index (SDI) quintiles, regions, nations, age groups and sexes.

We conducted a comprehensive analysis using mortality data from the Global Burden of Disease (GBD) Study 2021.

Data were obtained from the GBD 2021 database, covering 204 countries and territories across 21 GBD regions.

Individuals with aortic aneurysm-related mortality between 1990 and 2021.

Absolute deaths and age-standardised mortality rates (ASMR) per 100 000 from 1990 to 2021, stratified by SDI quintiles, GBD regions and individual nations. Temporal trends were quantified using estimated annual percentage change (EAPC) and net drift, while decomposition analysis assessed contributions of population ageing, growth and epidemiological changes to mortality patterns. Risk factor attribution across regions and SDI levels was examined, alongside projections of ASMR and deaths through 2036 using the Nordic prediction method.

Global aortic aneurysm deaths increased from 88.35 thousand in 1990 to 153.93 thousand in 2021, while ASMR decreased from 2.54 to 1.86 per 100 000 (EAPC: –1.28%). High SDI regions showed significant ASMR declines (EAPC: –1.982%), while low-middle SDI regions experienced increases (EAPC: 1.272%). Marked regional variations were observed, with Australasia showing the largest decrease (EAPC: –4.114%) and Central Asia the highest increase (EAPC: 2.498%). Japan diverged from other developed countries with significant mortality increase. Decomposition analysis revealed that increased mortality was primarily driven by population growth (59.109 million) and ageing (46.385 million), partially offset by epidemiological improvements (–39.92 million). The male-to-female ASMR ratio decreased globally from 2.45 to 2.00. Tobacco remained the leading risk factor globally, while body mass index emerged as an increasing concern. Projections indicate a slight global ASMR decrease by 2036, with concerning increases in regions like high-income Asia Pacific and South Asia.

Despite declining global ASMR, the absolute burden of aortic aneurysm mortality continues to grow with significant regional and sex-based disparities. These findings highlight the need for targeted interventions, particularly in regions facing increasing mortality rates, and emphasise the importance of addressing modifiable risk factors while strengthening healthcare infrastructure in vulnerable areas.

This study examined the patterns and persistence of SARS-CoV-2 seropositivity among college students from March to November 2020. Using data from a sample of students at Indiana University, we assessed (1) the duration and seropositivity following reverse transcription-PCR (RT-PCR)-confirmed SARS-CoV-2 infection and (2) persistence of seropositivity over 10 weeks between two laboratory antibody test visits.

The longitudinal study was conducted at Indiana University from September to November 2020, with two laboratory antibody tests, and included self-reported RT-PCR results before the observational period from as early as 20 March 2020. This 6–9 month period contributes to our understanding of seropositivity dynamics. The study included 172 college students who had previously tested positive for SARS-CoV-2 and measured their seropositivity.

Our results showed a notable decline (66.7%) in antibody positivity over the observed period. Additionally, 12 weeks postinfection, most students with a SARS-CoV-2 infection history (75%) were no longer seropositive.

These findings reveal a nuanced picture of antibody dynamics, highlighting the complex interplay of factors among college students. The study underscores the need for continued research on antibody levels among young adults to better understand the drivers of variations in antibody persistence.

#NCT04620798.

This study aims to examine the prevalence of elevated blood pressure (BP) among adolescents aged 13–17 years in Shiyan city, Hubei province, China. Additionally, it analyses the distribution characteristics and potential factors influencing elevated BP, providing a scientific foundation for the prevention and management of hypertension in adolescents.

Cross-sectional study.

A total of 11 schools in central China.

From October 2023 to January 2024, a cross-sectional study involving 8534 students aged 13–17 years from 11 schools in central China was conducted. Convenience sampling was used to select participants, and data were collected through questionnaires and medical physical examinations.

This study used physiological measurement to assess BP levels, while questionnaire surveys and anthropometric measurements were employed to identify associated factors.

The overall detection rate of elevated BP was 22.7% (20.2% for boys and 25.6% for girls). Increased body mass index (BMI) (OR: 1.026, 95% CI: 1.003 to 1.048), neck circumference (OR: 1.099, 95% CI: 1.073 to 1.126) and chest circumference (OR: 1.015, 95% CI: 1.007 to 1.023) were associated with an increased risk of elevated BP. Conversely, longer screen time was linked to a lower risk of elevated BP (OR: 0.961, 95% CI: 0.942 to 0.98). Girls (OR: 1.592, 95% CI: 1.419 to 1.787) were at higher risk than boys. Additionally, not consuming meat or poultry (OR: 2.029, 95% CI: 1.171 to 3.514) was identified as a risk factor for elevated BP.

The distribution of elevated BP among adolescents exhibited population heterogeneity. Elevated BP was found to be associated with higher BMI, neck circumference and chest circumference, as well as the absence of meat consumption. Additionally, targeted attention to girls is essential for preventing elevated BP.

Different malaria control measures are deployed simultaneously in endemic settings globally, with varying impacts on malaria burden. In sub-Saharan Africa, which bears the greatest burden of malaria, evidence on the impact of implementing various control interventions on malaria immunity remains unknown. This systematic review seeks to collate evidence on the extent of progression from uncomplicated to severe malaria among populations in sub-Saharan Africa settings receiving concurrent deployment of various malaria control measures.

The review will use a priori criteria contained in the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. An experienced librarian (AAK) will independently search for articles from the following databases: PubMed, Web of Science, Embase, Scopus and Google Scholar. Boolean operators ‘AND’ and ‘OR’ will be used in the article search. Identified articles will be managed using EndNote. Article screening for inclusion and data extraction will be done in duplicate by two reviewers (EJO, and BM). Data extraction tools will be developed and customised in Excel. Data will be analysed using both narrative and quantitative synthesis. The level of heterogeneity between study outcomes will be measured using the I² statistic. Subgroup analysis will be conducted to explore heterogeneity and establish the impact of different control interventions on progression from uncomplicated to severe malaria. A full systematic review and meta-analysis is expected to be ready for dissemination by the end of December 2025.

This study did not involve human participants and so ethical approval was not sought. A full review and a meta-analysis will be published in a peer-reviewed journal and presented at national and international conferences.

CRD 42024619945.

Urolithiasis represents a significant global health burden. Comparing incidence trends between countries with distinct socioeconomic profiles, such as the United States and China, is crucial for tailoring public health strategies. This study aimed to characterise and compare the temporal trends of urolithiasis incidence in the United States and China from 1992 to 2021, thereby providing insights for global disease management.

Data on urolithiasis incidence in the United States and China from 1992 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 study. First, we utilised joinpoint regression analysis to quantify the magnitude and identify significant turning points in age-standardised incidence rate trends over the study period. Second, an age-period-cohort model (APC model) was applied to assess the independent influence of age, period and cohort effects on incidence. Finally, the Nordpred model was employed to project the incidence trends for the next decade.

From 1992 to 2021, the overall incidence of urolithiasis in the United States decreased, but has recently shown an increase; in China, there was a significant reduction. According to the APC model, the highest risk was observed among middle-aged and elderly individuals in these countries. The period and cohort effects in China showed a decline. In the United States, the period effect initially declined but has recently shown an increase; cohort effect peaked around 1930, then declined and also increased in recent years. Over the next decade, the incidence of urolithiasis in both countries was expected to increase.

This study analysed the temporal trends in urolithiasis incidence over the past 30 years in the United States and China. Both countries experienced notable advancements in the burden of urolithiasis; however, the risk of an increased incidence remained higher in the United States.

This study employs structural equation modelling to explore the inter-relationships among optimal antenatal care (ANC), health facility delivery and early postnatal care (EPNC) in Ethiopia. By identifying both direct and indirect influencing factors, the study offers valuable insights to support integrated maternal health strategies and guide informed decision-making by policymakers and women alike.

The secondary analysis of the Ethiopian Demographic and Health Survey 2016 was performed to investigate inter-relationships between optimal ANC, health facility delivery and postnatal care (PNC) among women in Ethiopia. Data were analysed with R software V.4.3.2. The study used binary logistic regression to examine differences in optimal ANC, health facility delivery and EPNC, focusing on variables with a p value of 0.1 or less. Selected variables were incorporated into a generalised structural equation model (GSEM) using the LAVAAN package to explore both direct and indirect effects. The GSEM method assessed the impact of exogenous variables on endogenous variables, all binary, using a logistic link and binomial family. Missing data were handled with the multiple imputation by chained equations package, and sampling weights were applied to ensure national and regional representativeness.

The source population comprised all women of reproductive age (15–49 years) who gave birth in the 5 years preceding the survey. From 16 650 interviewed households (98% response rate), we identified 7590 eligible women with recent births. Finally, we included 2415 women who had attended four or more ANC visits.

Media exposure significantly boosts the likelihood of using ANC (OR=1.8, 95% CI (1.04 to 3.23), p=0.04), health facility delivery (OR=1.7, 95% CI (1.23 to 2.45), p=0.05) and PNC (OR=2.0, 95% CI (1.6 to 4.01), p=0.01). Urban residence and secondary education also enhance ANC (OR=1.2, 95% CI (1.01 to 2.88), p=0.022; OR=1.3, 95% CI (1.20 to 3.01), p=0.018), health facility delivery (OR=1.1, 95% CI (1.01 to 3.24), p=0.035; OR=1.5, 95% CI (1.22 to 3.45), p=0.03) and PNC (OR=1.6, 95% CI (1.01 to 4.32), p=0.03). ANC directly affects health facility delivery (OR=1.4, 95% CI (1.28 to 3.09), p=0.01) and PNC (OR=1.6, 95% CI (1.01 to 3.80), p=0.03). Additionally, women aged 20–34 years and those from male-headed households positively impact health facility delivery (OR=1.5, 95% CI (1.20 to 4.80), p=0.01; OR=1.3, 95% CI (1.07 to 3.45), p=0.014) and PNC (OR=1.4, 95% CI (1.10 to 2.90), p=0.01; OR=1.2, 95% CI (1.07 to 3.08), p=0.025).

Optimal ANC is vital for encouraging health facility delivery and EPNC. To enhance maternal and neonatal health, policies should integrate these services. Key predictors include being aged 20–34, having secondary and higher education, media exposure, male-headed households and living in urban areas. Improving education and media exposure can boost maternal healthcare service use.

Despite a high disease burden, care-seeking for mental health symptoms is low in Bangladesh, particularly among women.

To evaluate help-seeking behaviours for anxiety and depression symptoms among Bangladeshi women aged 15–49 and its association with women’s empowerment.

Data from the Bangladesh Demographic and Health Survey 2022 including 2881 women reporting anxiety or depression symptoms were analysed. Help-seeking behaviours, sociodemographics and women’s empowerment using the Survey-based Women’s Empowerment (SWPER) index were assessed. Logistic regression models were used to explore associations.

The mean age of participants was 33.3 years (SD 8.7); two-thirds lived in rural areas. In the SWPER index, 83% of women had high empowerment in the attitude to violence domain, 16% in social independence and 60% in decision-making. Among women with anxiety or depression symptoms, 18.7% sought help, mainly from spouses (43%) or family (52%), and 15% consulted doctors. Women aged >30 years (adjusted OR, aOR 1.25, 95% CI 1.02 to 1.53), from rich households (aOR 1.49, 95% CI 1.09 to 1.89), and with secondary (aOR 1.47, 95% CI 1.08 to 2.01) or higher education (aOR 1.56, 95% CI 1.03 to 2.36) were more likely to seek help. High empowerment in attitude to violence (aOR 0.54, 95% CI 0.37 to 0.81) and decision-making (aOR 0.53, 95% CI 0.41 to 0.68) correlated negatively with help-seeking.

Few Bangladeshi women seek help for mental health symptoms, relying on informal sources. Age, education, wealth and employment predict help-seeking, while high empowerment level in attitude to violence and decision-making domain of SWPER index shows an inverse relationship.

Although lung cancer in never smokers (LCNSs) accounts for an estimated 25% of all lung cancer cases, the temporal trends in LCNS incidence and its broader epidemiological patterns remain poorly understood. Our study examines the temporal trends in LCNS incidence and analyses key epidemiological characteristics, specifically, the trends in mortality rates, survival rates and changes in age at onset to illuminate the reasons for temporal trends in LCNS incidence.

Retrospective population-based cohort study.

Regional electronic health record (EHR) database linked to the cancer registry in eastern China.

A total of 1 080 317 adults who have never smoked were included, among whom 4061 incident lung cancer cases were identified between 1 January 2009 and 31 December 2020.

The temporal trends in LCNS incidence in a large population-based dynamic cohort were estimated, overall and separately by sex, age group and histological types. The broader epidemiological patterns of LCNS, such as trends in mortality rates, survival rates and changes in age at onset, were analysed.

From 2009 through 2020, the incidence of LCNS among men increased significantly from 9.51 to 43.4 per 100 000 (average annual percentage change (AAPC) 10.51%; 95% CI (6.88% to 14.26%)) whereas a sharper increase was observed among women from 3.57 to 51.68 per 100 000 (AAPC 22.39%; 95% CI (18.36% to 26.55%)). The 2-year survival of LCNS improved from 39% in 2010 to 64% in 2018 for men, and from 57% in 2009 to 86% in 2020 for women, while the mortality from LCNS remained stable from 2014 through 2020 (men: AAPC –1.77%; 95% CI (–8.95% to 5.97%); women: AAPC 2.19%; 95% CI (–4.09% to 8.89%)). The increasing trend in LCNS incidence was observed across most of the age groups except the elderly population aged ≥85 years in both sexes and the men aged 45–54 years, but the increase was most evident in the younger population aged

There is a substantial increase in LCNS incidence, especially among women and young populations. However, the reason for these observed trends remains unclear and warrants investigation.

This study uses nationally representative survey data from the USA to estimate the relationship between a history of heart attack or stroke with the prevalence of mental health symptoms.

Cross-sectional.

Data from the 2019 and the 2018 National Health Interview Survey (NHIS) sample adult interview.

30 872 adults from the 2019 NHIS and 24 593 adults from the 2018 NHIS were analysed separately; a history of heart attack or stroke was determined based on participants’ recollection of previous communications with health professionals.

Poisson log-linear regressions with robust SEs were employed to estimate the relative prevalence of mental health symptoms associated with a history of heart attack or stroke. Mental health outcomes included moderate-to-severe depression symptoms according to the Patient Health Questionnaire, moderate-to-severe anxiety symptoms according to the General Anxiety Disorder scale and serious psychological distress according to the Kessler Psychological Distress scale.

The prevalence of moderate-to-severe symptoms of depression, anxiety and serious psychological distress was more than two times as high among individuals with a history of heart attack or stroke compared with those without such a history. After adjusting for potentially confounding socio-demographic and health variables, survivors of heart attack were 33% and 40% more likely and survivors of stroke were 59% and 52% more likely to experience depression and anxiety symptoms, compared with adults without these conditions. Additionally, survivors of stroke were 76% more likely to have serious psychological distress than those without a stroke history.

Findings from this study highlight the increased mental health problems experienced by heart attack or stroke survivors relative to adults without these conditions. They underscore the importance of addressing mental health concerns among adults who have experienced a heart attack or stroke.

Globally, the circulation of influenza and other seasonal respiratory viruses changed dramatically during the COVID-19 pandemic. This study aims to determine the trends of acute respiratory infections (ARIs) caused by SARS-CoV-2, influenza A, influenza B and respiratory syncytial viruses (RSVs) in patients presenting to hospitals in the Lao People’s Democratic Republic (PDR) (Laos).

Prospective surveillance study.

Four provincial hospitals across Laos between March 2021 and July 2023.

Participants of all ages who met our case definition for an ARI (axillary temperature ≥37.5°C or history of fever AND cough or other respiratory symptoms/signs OR loss of smell and/or taste) presenting to the hospital less than 10 days after symptom onset were eligible to be enrolled in the study. Combined nasopharyngeal and throat swabs were tested for SARS-CoV-2, influenza A, influenza B and human RSV (hRSV) using probe-based real-time RT (Reverse transcription)-PCR assays.

The proportion of patients in whom SARS-CoV-2, influenza A, influenza B and hRSV was detected.

There were 4203 patients recruited, of whom 898 (21%) were children aged under 5 years. SARS-CoV-2 was detected in 16.9% of patients, followed by influenza A, influenza B and hRSV (8.4%, 7.2% and 4.7%, respectively). 98 patients (2.3%) were diagnosed with probable co-infection, with at least two viruses detected. After May 2022, the number of cases of influenza A, influenza B and hRSV increased rapidly. Six per cent of patients (263) had a quick Sequential Organ Failure Assessment score of ≥2, and 34 (0.8%) patients died, of whom 11 tested positive for a respiratory virus.

During the COVID-19 pandemic in Laos, few respiratory viruses were detected by passive surveillance until the relaxation of non-pharmaceutical interventions implemented for infection control. After restrictions were lifted, influenza A, influenza B and hRSV emerged rapidly, showing the importance of continuous surveillance.

To systematically compare the effects of various antithrombotic strategies on prespecified outcomes including 28-day all-cause mortality (primary outcome), major thrombotic events and major bleeding events (secondary outcomes) in adult COVID-19 patients.

Systematic review and Bayesian network meta-analysis (NMA).

PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to February 2024.

We included randomised controlled trials (RCTs; published in English) comparing different antithrombotic strategies (eg, anticoagulants, antiplatelet (AP) agents, fibrinolytics or combinations) in adults (aged≥18 years) with laboratory-confirmed SARS-CoV-2 infection. Eligible trials had at least one active antithrombotic arm versus another strategy or standard care.

Two reviewers independently extracted data using a standardised form; disagreements were resolved by consensus or third-party adjudication. Bayesian NMA was performed using Markov chain Monte Carlo methods with random/fixed effects models selected by the deviance information criterion. The risk of bias (RoB) was assessed using the Cochrane Collaboration’s tool. The confidence in NMA framework was used to assess the quality of evidence.

35 RCTs that randomly assigned 39 949 participants were included in the main analysis. Primary outcome: evidence of low to moderate certainty suggested that, compared with standard of care (SoC), both prophylactic-dose anticoagulation (PA) (risk ratio (RR) 0.71, 95% credible interval (CrI) 0.44 to 0.99) and therapeutic-dose anticoagulation (TA; RR 0.65, 95% CrI 0.38 to 0.94) reduced the 28-day all-cause mortality. Secondary outcomes: TA (RR 0.19, 95% CrI 0.09 to 0.31), TA+AP (RR 0.27, 95% CrI 0.05 to 0.95), PA (RR 0.33, 95% CrI 0.18 to 0.53) and AP+PA (RR 0.52, 95% CrI 0.25 to 0.94) were effective in reducing major thrombotic events. AP was associated with an increased risk of major bleeding events (RR 2.27, 95% CrI 1.01 to 5.07). Subgroup analyses by hospitalisation status showed that PA significantly reduced 28-day mortality versus SoC (RR 0.52, 95% CrI 0.26 to 0.90) for non-hospitalised patients, whereas no strategies showed significant benefit in hospitalised patients. Subgroup analysis based on severity of hospitalised patients indicated that TA was more favourable than PA in decreasing the 28-day mortality in non-critically ill patients (fixed-effect model: RR 0.75, 95% CI 0.61 to 0.91; random-effect model: RR 0.71, 95% CI 0.48 to 1.05), but for critically ill patients, all antithrombotic strategies showed no significant difference.

Our NMA indicates that both PA and TA reduced the 28-day all-cause mortality of adult COVID-19 patients. However, subgroup analyses revealed substantial heterogeneity, and the benefit may differ across hospitalisation status and disease severity.

CRD42022355213.

Stress is nearly ubiquitous in everyday life; however, it imposes a tremendous burden worldwide by acting as a risk factor for most physical and mental diseases. The effects of geographic environments on stress are supported by multiple theories acknowledging that natural environments act as a stress buffer and provide deeper and quicker restorative effects than most urban settings. However, little is known about how the temporalities of exposure to complex urban environments (duration, frequency and sequences of exposures) experienced in various locations – as shaped by people’s daily activities – affect daily and chronic stress levels. The potential modifying effect of activity patterns (ie, time, place, activity type and social company) on the environment–stress relationship also remains poorly understood. Moreover, most observational studies relied quasi-exclusively on self-reported stress measurements, which may not accurately reflect the individual physiological embodiment of stress. The FragMent study aims to assess the extent to which the spatial and temporal characteristics of exposures to environments in daily life, along with individuals’ activity patterns, influence physiological and psychological stress.

A sample of 2000 adults aged 18–65 and residing in the country of Luxembourg completed a traditional and a map-based questionnaire to collect data on their perceived built, natural and social environments, regular mobility, activity patterns and chronic stress at baseline. A subsample of 200 participants engaged in a 15-day geographically explicit ecological momentary assessment (GEMA) survey, combining a smartphone-enabled global positioning system (GPS) tracking and the repeated daily assessment of the participants’ momentary stress, activities and environmental perceptions. Participants further complete multiple daily vocal tasks to collect data on vocal biomarkers of stress. Analytical methods will include machine learning models for stress prediction from vocal features, the use of geographic information systems (GIS) to quantify dynamic environmental exposures in space and time, and statistical models to disentangle the environment–stress relationships.

Ethical approval (LISER REC/2021/024.FRAGMENT/4-5-9-10) was granted by the Research Ethics Committee of the Luxembourg Institute of Socio-Economic Research (LISER), Luxembourg. Results will be disseminated via conferences, peer-review journal papers and comic strips. All project outcomes will be made available at https://www.fragmentproject.eu/.

This study aimed to evaluate the predictive value of self-rated health (SRH) on mortality and healthcare use in older adults (aged ≥75 years) at high risk of hospitalisation in comparison to an objective measure of comorbidities, the Charlson Comorbidity Index (CCI).

Prospective cohort study conducted within the research project ‘Proactive Primary Care for Frail Elderly Persons’.

19 primary care practices in south-east Sweden, between January 2018 and December 2019.

In total, 355 adults aged ≥75 years were included in the study. They were among the 11% older adults with the highest predicted risk of hospitalisation, as identified by a statistical prediction model for unplanned hospital admission.

Outcomes were all-cause mortality and healthcare use measured as hospital care days and the number of physician visits in primary and secondary care. These were analysed for different groups of SRH and comorbidities measured using the CCI.

SRH was grouped into Excellent/Very good, Good, Fair and Poor. The overall mortality rate was 26.5%. Compared with the Poor group, the adjusted HRs were significantly lower for Excellent/Very good (HR=0.2; 95% CI: 0.1 to 0.8, p=0.02) and Fair (HR=0.5; 95% CI: 0.3 to 1.0, p=0.04). Compared with the comorbidity group CCI 0–1, CCI 2–3 had an adjusted HR of 2.2 (95% CI: 1.1 to 4.6, p=0.03), CCI 4–5 had an adjusted HR of 2.6 (95% CI: 1.2 to 5.4, p=0.01) and CCI>5 had an HR of 4.9 (95% CI: 2.4 to 10.2, pExcellent/Very good (3.9 days) compared with Poor (10.7 days). All groups of CCI diagnoses (2–3, 4–5 and >5) had significantly more hospital care days than CCI 0–1.

For physician visits in secondary care, both the SRH Excellent/Very good (p=0.004) and Good (p=0.02) groups had significantly fewer visits compared with Poor. In the comorbidity groups, no statistical differences were found between CCI categories.

In a cohort of older adults at high risk of hospitalisation, the predictive value of SRH for risk stratification was limited. Objective health measures appeared to offer greater utility than SRH for guiding healthcare planning and tailoring interventions for vulnerable older adults in this cohort.

Clinical Trials NCT03180606.

Alzheimer’s disease (AD) impacts over 55 million individuals worldwide and remains the leading cause of dementia (60–70% of cases). By 2050, South and Southeast Asia are projected to have an older adult population more than double, bearing a major share of Alzheimer’s disease burden. This will exert a heavy strain on healthcare systems, particularly in resource-limited countries where support and infrastructure are already stretched. Despite this, no review has yet explored the regional epidemiology and associated risk factors in this context. Thus, this study protocol outlines to synthesise prevailing evidence from these densely populated regions, particularly low- and middle-income nations within South and Southeast Asia.

This review will include studies that reported epidemiological characteristics including prevalence, age of onset, mortality, and risk factors of AD and related dementias comprising in South and Southeast Asian regions. Studies published in any language from inception to date will be extracted from PubMed, Scopus, CINAHL, EMBASE and APA PsycNet, following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We will also search grey literature sources and screen the reference lists of the articles selected for full-text review to identify additional relevant studies. Observational studies including case–control, cohort, and cross-sectional designs reporting desired outcomes will be included and appraised for quality assessment with the modified Newcastle-Ottawa Scale (mNOS). The included articles will be appraised by two independent reviewers, with a third resolving any conflicts. Pooled estimates of prevalence, age of onset and mortality will be analysed using random effect meta-analysis (REML) model. Associated risk factors, including modifiable and non-modifiable will be narratively synthesised. Forest plots will be used to visualise the findings, and heterogeneity across the included studies will be assessed using the I² and Cochrane’s Q statistics. Potential publication bias will be assessed using a funnel plot along with the Begg’s and Egger’s tests. Sensitivity and subgroup analyses will also be conducted to assess the robustness of pooled estimates and to explore potential sources of heterogeneity. Statistical analysis will be conducted using Rstudio (v.4.3.2) and GraphPad Prism V.9.0.2.

The systematic review is focused on the analysis of secondary data from published literature; thus, no ethical approval will be needed. The protocol will follow international standard guidelines, findings will be reported in a reputed journal and disseminated through (inter)national conferences, webinars and key stakeholders to inform policy, research and AD management strategies.

CRD 420251047105.

Frailty is recognised as an emerging public health priority. However, there is still a lack of large-sample, well-designed clinical observational studies investigating frailty status among multidistrict community-dwelling older adults in Shanghai. Therefore, this study aims to establish a large-sample prospective cohort in Shanghai, investigate the frailty status of multidistrict community-dwelling older adults, analyse the characteristics of the frail population and explore potential risk factors for frailty in older adults.

The present study was a cross-sectional analysis embedded within an ongoing prospective population-based cohort study.

A total of 2950 residents (≥65 years) from 9 subdistricts were recruited.

We used a stratified cluster random sampling method to obtain a representative sample of older adults in Shanghai. All participants completed paper questionnaires during face-to-face interviews and underwent physical examinations conducted by the investigation team.

Our results showed that the overall age-standardised prevalence of frailty was 9.91% (95% CI 9.50% to 10.31%). Prevalence was 8.30% (95% CI 6.84% to 9.76%) in men and 9.93% (95% CI 8.85% to 11.01%) in women. Advancing age, female sex, lower education level and comorbidities were significantly associated with frailty among community-dwelling older adults.

Clinical and public health efforts to reduce the burden of frailty in China should devote greater attention to older women, particularly those with multiple comorbidities, and prioritise community-based frailty screening and prevention initiatives.

ChiCTR2000039491.

Depression, affecting 350 million people globally, is notably prevalent among medical students, particularly in South Asia, including Bangladesh. Despite several studies, no meta-analysis has systematically examined the prevalence and contributing factors of depression to address the mental health burden. This systematic review and meta-analysis protocol aims to consolidate findings on the regional prevalence and key risk factors among Bangladeshi medical students.

The research team will search the Medline (Pubmed), Scopus, Web of science, Embase, PsycInfo, BanglaJOL and Google Scholar electronic databases following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines for published studies from their inception till 1^St March 2025, using truncated and phrase-searched keywords and relevant Medical Subject Headings (MeSHs). Observational studies, including cross-sectional, cohort and case-control studies published within the timeframe and following any validated depression assessment tools, with no language restriction, reporting bangladeshi medical students, will be included for the review. Review papers, intervention studies, commentaries, preprints, meeting abstracts, protocols, unpublished studies and letters will be excluded. Two independent reviewers (SS, IA) will screen the retrieved papers using Rayyan, a web-based application, while any disagreements between them will be resolved by a third reviewer (ATS). Exposure will refer to different factors associated with depression among Bangladeshi medical students. Prevalence of depression and associated factors will be extracted. Narrative synthesis (Qualitative information) and meta-analysis (Quantitative data) will be conducted to assess the pooled prevalence using the random-effects meta-analysis (REML) model. For enhanced visualisation of the included studies, forest and funnel plots will be constructed. Heterogeneity among the studies will be assessed using the I ² statistic, sensitivity,and subgroup analyses will be conducted, if necessary, based on study heterogeneity. The quality of the included studies will be assessed using the modified Newcastle-Ottawa Scale (mNOS) tool developed for observational study designs. All statistical analyses and visualization will be conducted using the R studio v.4.3.2 with built-in "meta"-packages and GraphPad Prism v.9.0.2.

This review will analyse existing published evidence. Findings will be submitted to a peer-reviewed journal and disseminated through conferences, policy forums and stakeholders to guide future research and interventions.

CRD 420251006480.

The development of mental disorders is multifactorial across the lifespan. The introduction of the exposome concept has enhanced the understanding of life-course environmental factors by encompassing the totality of environmental exposures. While most studies on chronic diseases have applied a single-exposure approach, the exposome approach remains underutilised in mental disorder research. There is a need to better recognise the environmental factors considered in exposome analysis of mental disorders, the methodologies used and the gaps reported. This scoping review aims to map the evidence on the relationship between the exposome and mental disorders across the lifespan, identifying and describing the methodologies used and highlighting the gaps reported.

This scoping review will follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Population-Concept-Context approach. It will include observational and interventional studies involving populations of all ages in the community or healthcare settings. The search strategy will contain indexed terms in MEDLINE and will be adapted for CINAHL (EBSCO), Scopus, Embase and PsycINFO without restrictions on language or date of publication. For the selection of articles, two independent researchers will screen articles by title and abstract, followed by a full-text assessment. Afterwards, the extracted data will be summarised using a narrative and descriptive analysis.

Ethics approval is not required for this scoping review. Dissemination activities will include peer-reviewed publications and academic presentations.

Hospitalisation is one of the most stressful life events for older adults, particularly for those who are pre-frail or frail. Multi-component community-based interventions have the potential to address the complex needs of older adults post-acute care admission. While some available interventions have been developed with end-user engagement, fully involving older people who are pre-frail or frail in the design of interventions has been less common. Multi-component community-based interventions that address the needs of older adults and their care partners with potential implementation barriers informed by healthcare providers, community partners and health system decision makers are needed. This protocol paper describes the planned process of co-designing for older patients discharged into the community, a Post-Acute Care Intervention for Frailty using Information and Communication technology.

The development of a complex multi-component frailty intervention which meets older people’s needs involves several concurrent tasks and methodologies, each informed by co-design and conducted with consideration to eventual implementation. These tasks include: (1) establishing a Research Advisory Board, (2) assessing the feasibility and validity of using hospital administrative data to identify frail or pre-frail older adults and their needs, (3) conducting a needs assessment of patients returning to the community, (4) mapping community assets to identify existing programmes and services to help tailor the intervention, (5) co-designing a multicomponent frailty intervention, (6) selecting study outcome measures and (7) selecting and tailoring a digital health patient portal to support intervention delivery, data capture and communication.

Each task requiring ethics approval will be submitted to the Hamilton Integrated Research Ethics Board at McMaster University. Results will be disseminated through peer-reviewed journal articles, conferences and networks of relevant knowledge users who have the capacity to promote dissemination of the results. A toolkit will be developed to help researchers and healthcare providers replicate the methodology for other populations.