To develop and evaluate a standardised, fully automated assessment procedure for patient treatment preferences suitable for use in randomised controlled trials (RCTs) with remote or digital health interventions.

Multiphase developmental study followed by implementation in a fully randomised preference trial (FRPT).

University and outpatient cancer care settings in Switzerland; implementation in RCTs with a remote digital health intervention.

50 medical students for pilot testing; 11 patients with cancer for qualitative testing; 124 adult patients with cancer experiencing fatigue or sleep problems in an FRPT with a remote digital health intervention.

Primary outcome: feasibility and applicability of a standardised digital preference assessment procedure. Secondary outcomes: distribution and strength of treatment preferences, reasons for preference.

A procedure with three items for assessing treatment preferences was developed and refined based on pilot testing, stakeholder meetings and patient interviews. The stepwise procedure ensured that study participants with an initially unclear preference were finally able to report their preference. The majority of students (91.7%) indicated their preference already in the first assessment step. Similar in the RCT phase, 110 of 124 participants (88.7%) indicated their preference in the first step. Preference drivers included interest, perceived ease and conceptual appeal in addition to expected treatment benefits.

Our fully automated standardised preference assessment with three items appears feasible in trials with digital health interventions. Future trials with two active treatment conditions should consider implementation of such a preference assessment to evaluate non-specific treatment effects driven by the match of patients’ preferences with the respective treatment.

DRKS00035596; DRKS00035541; SNCTP000006209.

Effective treatment for clinical obesity is available but is rarely offered by healthcare systems, which often treat complications without treating the underlying cause. The LightWAY trial will investigate the clinical benefits and harms as well as cost-effectiveness of an intensive weight loss intervention compared with existing weight management programmes for people with clinical obesity.

LightWAY is an investigator-initiated, international, randomised, parallel-group clinical superiority trial with blinded outcome assessment. Six hundred people seeking treatment for clinical obesity (body mass index ≥35 kg/m² with comorbidities) will be recruited in centres in the UK and Denmark and randomised 1:1 to one of two groups. The experimental group will be offered a 2-year intensive weight loss programme providing support and advice to follow a total diet replacement programme, followed by gradual transition to an energy-reduced diet in combination with increased physical activity and if needed, prescription of weight loss medication. The control group will receive usual care, typically comprising brief behavioural support for weight loss and treatment of the complications of obesity or occasionally referral to specialist weight management services. The two co-primary outcomes are cardiometabolic risk, assessed with metabolic syndrome severity Z-score, and body weight assessed at 2 years. The secondary outcomes include the Short Form-36 mental component scale, 4-metre gait speed and proportion of participants achieving ≥20% weight loss. The key adverse effects will be the proportion of participants with at least one serious adverse event, incidence of eating disorders and disproportional loss of bone mass. Incremental cost-effectiveness will be assessed over the trial period and over the lifetime through modelling.

Ethical approval was granted in the UK (August 2024, 24/SC/0211) and Denmark (December 2023, H-23065222). Findings will be disseminated through peer-reviewed journals and scientific conferences and to participants in the trial and clinicians.

NCT06321458.

Perinatal mood and anxiety disorders affect more than one in five pregnant individuals. Despite the large percentage of individuals impacted by mood disorders, they continue to remain underdiagnosed and undertreated. Recent interventions such as risk prediction modelling offer opportunities to predict patients at risk prior to symptom onset. Leveraging technology platforms such as electronic health records allow for timely diagnosis and intervention. To date, there are no established clinical decision support (CDS) tools. We hypothesise that subjects who use a CDS aid will find them acceptable, appropriate and feasible.

We will conduct a pilot randomised clinical trial at three Weill Cornell Medicine clinics with randomisation at the clinician level. Patients in the control arm will receive usual care, while those in the intervention arm will receive CDS. The primary implementation outcomes are the acceptability, appropriateness and feasibility. The effectiveness outcomes are mental health service utilisation, EuroQol 5 Dimensions questionnaire (EQ-5D), Edinburgh Postnatal Depression Scale and social support measured by the perceived support scale. We hypothesise that stakeholders will find the CDS acceptable, and the intervention arm will have lower mental health service needs compared with control.

This study has been approved by the Weill Cornell Medicine Internal Review Board. IRB Protocol# 23-07026254.

NCT06818734.

Anxiety and depression are common and associated with higher use of general healthcare services. The aims of this systematic review were to (1) estimate the prevalence of anxiety and depression in adults who are high or costly users of general healthcare services in comparison to routine users and (2) estimate the magnitude of healthcare costs associated with the presence of anxiety and depression.

Systematic review of the available literature.

MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and Cochrane Library were systematically searched without language restriction from inception to 1 April 2019 and updated on 25 October 2022, 16 October 2024 and 18 February 2026.

Eligible studies described adults aged ≥18 years who were defined as high or costly general healthcare users and where the prevalence and/or associated costs of anxiety and/or depression were quantified.

Three reviewers independently extracted information on study characteristics, exposure and outcomes.

From the 38 412 identified articles, 27 studies from 10 countries (in Europe, North America and Asia) involving 6 145 907 participants met eligibility criteria and were included. There were wide variations in the estimated prevalence of anxiety (3.8–67.2%) and depression (4.7–77.9%) among high healthcare users. The prevalence of both disorders was higher among high healthcare users than routine users in all studies with non-high user comparator groups. Only four studies investigated healthcare costs associated with depression. These uniformly reported that general healthcare costs are higher for those with depression than those without. No studies investigated costs associated with anxiety.

Anxiety and depression are over-represented among high or costly healthcare users, although accurate quantification of the magnitude of difference is precluded by significant methodological heterogeneity and variability in definitions used. Improved identification of covert mental health problems is essential for the provision of effective interventions for patients and healthcare expenditure reduction. Future research should prioritise a standardised approach, with agreed definitions for high and/or costly healthcare use in different contexts.

CRD42018102628.

To identify socio-demographic subgroups of adolescents through cluster analysis and examine the extent to which these clusters are associated with depression.

This cross-sectional study used cluster analysis and logistic regression.

The Indonesian Health Survey 2023 is a nationally representative survey of Indonesia.

A total of 89,866 adolescents aged 15–24 years were included.

Depression was assessed using the Mini International Neuropsychiatric Interview. Logistic regression models were applied to estimate the association between cluster membership and depression risk, adjusting for behavioural factors (smoking and alcohol use), and geographical distribution.

Five discrete socio-demographic clusters were identified in this study. Two clusters showed a significantly elevated risk of depression compared with the socioeconomically disadvantaged rural male cluster (Cluster 1). Cluster 2 (older, poor, rural females) had an OR 1.58 (95% CI 1.18 to 2.12), while Cluster 3 (younger, urban, affluent females) had an OR 2.60 (95% CI 1.92 to 3.52).

Adolescent depression risk factors are shaped by intersecting socio-demographic vulnerabilities, particularly among females in disadvantaged rural and socioeconomically privileged urban settings. Gender-responsive and context-specific mental health interventions are required.

To systematically evaluate associations between comorbidities and differences in treatment decisions, outcomes, health-related quality of life (HRQoL), healthcare resource utilisation and costs, in patients with colon or rectal cancer.

Systematic review.

PubMed (Medline) and Embase databases were searched for studies published from January 2000 until January 2024.

We included articles that compared the presence and absence of comorbidities, evaluated multiple comorbid conditions or used the Charlson Comorbidity Index, or variations such as the Charlson-Deyo Index. Primary and secondary outcome measures included cancer treatments, outcomes (including complications from treatments, survival and mortality rates), HRQoL, healthcare resource use and costs.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Joanna Briggs Institute checklists to ensure the quality of data. Findings were summarised narratively.

After duplicates were removed, 15 394 hits were screened and 31 studies were selected for inclusion in this systematic review. Comorbidities were associated with a lower likelihood of receiving treatment and lower survival rates and HRQoL, alongside a higher likelihood of complications following treatment, higher mortality rates and higher healthcare resource use. There were very limited studies that reported on HRQoL and resource use, and none reporting data directly relating to the impact of comorbidities on costs. These results were consistent across North America, Europe, Australia and New Zealand.

For patients with colon and rectal cancer, comorbidities are associated with a lower likelihood of receiving treatments and poorer health outcomes. With global populations ageing, there is likely to be an increase in patients with colon and rectal cancer with comorbidities. Therefore, further research is necessary, especially to inform decisions regarding patient management and treatment, and to understand the implications on healthcare resource allocation, costs and HRQoL.

Adolescent girls and young women (AGYW) living with HIV in Ghana face multiple intersecting forms of marginalisation. Beyond the clinical management of HIV, little is known about how they construct meaning, navigate identity and imagine their futures within structural contexts shaped by stigma, gender inequity, economic precarity and colonial legacies.

To explore how AGYW living with HIV in Ghana understand and negotiate their social identities in work and school. We then aimed to understand how their lived experiences at school and work are shaped by broader systems of power.

This qualitative study drew on semi-structured interviews with AGYW (ages 11–24, n=24) receiving HIV care in Kumasi, Ghana. Data were coded both inductively and deductively. Themes were interpreted through the Ghanaian context using intersectionality, Critical Disability Studies, spoiled identity theory and African feminist decolonial theory. The analysis was conducted iteratively and reflexively, with attention to positionality, gender and structural power dynamics.

Seven major themes were identified: (1) social support; (2) concrete plans for the future; (3) unattainability of the future; (4) coping via detachment; (5) need for privacy and confidentiality; (6) role as an arbiter of HIV information; and (7) financial stress. Across these themes, AGYW described dynamic processes of identity negotiation, moral and emotional labour and structural constraint. HIV was rarely the sole barrier. Rather, it intersected with gender norms, family dynamics, age hierarchies, economic marginalisation and misinformation to shape participants’ social worlds. Some participants coped through detachment or concealment, while others reclaimed agency through caregiving roles, education or aspirational goals.

AGYW living with HIV in Ghana are not only navigating a chronic illness but also resisting a layered matrix of social and structural injustice. Their stories reveal both vulnerability and strategic agency. Interventions and policy must go beyond biomedical care to address stigma, provide confidential and affirming school and work environments, and offer structural supports for emotional, educational and economic well-being.

To assess access to child-appropriate medicines in Albanian community pharmacies by applying a child-adapted version of sustainable development goal (SDG) indicator 3.b.3.

Cross-sectional survey.

Community pharmacies providing primary care medicines in six urban areas in Albania.

Thirty community pharmacies were surveyed. Two predefined baskets of child-appropriate essential medicines were assessed: 24 medicines for children aged 1–59 months and 25 medicines for children aged 5–12 years. Medicines were selected from these child-adapted SDG 3.b.3 medicine baskets proposed at an international level and then matched to paediatric formulations registered nationally for application to Albania.

Individual facility scores by age group and medicine type (originator brands (OBs) vs lowest-priced generics (LPGs)), as well as sensitivity analyses using alternative affordability thresholds.

The SDG 3.b.3 indicator score was 0%, as no surveyed facility reached the 80% access threshold. Mean facility scores were 42.6% for medicines intended for children aged 1–59 months and 29.6% for those aged 5–12 years, indicating poorer access for older children. Scores for OBs were particularly low (11.8% and 13.6%, respectively), reflecting reliance on LPGs. In younger children, ibuprofen and hydroxycobalamin showed 0% availability, while in school-aged children, paracetamol, propranolol and budesonide were absent across surveyed facilities; benzylpenicillin was absent in both age groups, whereas ceftriaxone was consistently available in both. Although all surveyed medicines were affordable, limited availability remained the primary barrier to access.

Application of the child-adapted SDG indicator 3.b.3 in Albania highlights substantial gaps in access to essential paediatric medicines in private community pharmacies, driven primarily by poor availability rather than affordability. The findings underscore the need for targeted supply-side policies. This study demonstrates the complementary value of composite SDG indicators and medicine-specific availability measures in monitoring progress toward universal health coverage for children.

This study aims to estimate the prevalence of long-lasting severe fatigue and identify possible risk factors in a 2-year follow-up of patients with predominantly mild-to-moderate SARS-CoV-2 infection.

Prospective cohort study.

A community-based cohort from Telemark and Agder Counties, Norway.

A total of 159 PCR-confirmed SARS-CoV-2 positive individuals in the period between 28 February and 17 December 2020 were included at 12 months after SARS-CoV-2 infection, and 93 responded at 24 months follow-up.

Fatigue was assessed using the Fatigue Severity Scale (FSS), and health-related quality of life using the RAND version of health-related quality of life Short Form 36 (SF-36), developed by the RAND Corporation. SARS-CoV-2 antibodies were measured at 12 and 24 months.

Severe fatigue (FSS ≥5) was reported by 36% at 12 months and 31% at 24 months. A higher proportion of women than men reported severe fatigue at 12 months (p=0.08). The number of acute-phase symptoms was associated with severe fatigue. No association was found between severe fatigue and anti-SARS-CoV-2 antibody levels, demographic variables or reinfection status. The severe fatigue group scored significantly lower on all domains of SF-36.

In this cohort, severe fatigue was common, greatly impacted quality of life and persisted for up to 2 years following SARS-CoV-2 infection. Fatigue severity was associated with symptom burden in the acute phase but not with antibody levels or other demographic variables. These findings underscore the need for long-term follow-up and support for affected individuals.

To identify and prioritise research uncertainties regarding the assessment, management and rehabilitation of patients with problematic hip replacements through a national Priority Setting Partnership (PSP).

A national PSP using the James Lind Alliance (JLA) methodology.

UK.

Patients, carers and healthcare professionals (HCPs) involved in the care of patients with problematic hip replacements.

A steering group was established. The James Lind Alliance methodology was followed throughout. A nationwide survey was conducted to collect unanswered questions. These were refined, prioritised through an interim survey and ranked at a final consensus workshop.

The initial survey yielded 201 questions, refined to 32. The interim survey had 191 respondents, leading to 19 questions at the final workshop. The top 10 research priorities were agreed on.

This PSP identified key research priorities for problematic hip replacements, focusing on diagnosis, pain management, perioperative optimisation and infection. These priorities can inform researchers and funders to improve outcomes for affected patients.

Equity, Diversity, Inclusion and Accessibility (EDIA) are recognised as core principles in higher education, yet their practical integration into pharmacy education remains underexplored. This review aims to identify the scope of existing research, highlight knowledge gaps and provide valuable insights for pharmacy educators, researchers and policymakers seeking to enhance EDIA integration within pharmacy education.

This protocol describes the methodology for a scoping review to systematically map the existing peer-reviewed literature on EDIA in pharmacy education, focusing on three critical areas: faculty development, curriculum content and teaching strategies. Using the Population, Concept and Context framework, the review will include studies examining faculty members, students and administrators within formal pharmacy education contexts worldwide. The scoping review will adhere to the Joanna Briggs Institute methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include peer-reviewed academic studies, accessed through databases such as MEDLINE, Embase, CINAHL, APA PsycINFO, ERIC and Web of Science. Backward snowballing will also be employed. Data will be charted using a predefined extraction tool, and findings will be synthesised and presented in tabular and narrative formats. A pilot search took place in March 2025, and the final search, study selection and data extraction will be conducted from May to December 2025. The subsequent analysis, presentation and interpretation of results are planned thereafter.

Ethics approval is not required. We plan to share findings through a variety of means including professional networks, peer-reviewed journal publications, conference presentations, invited workshops and webinars, on the FPD-Include project website and on our research groups’ university websites.

Stress and burnout are pervasive among physicians. Academic physicians who are female and physicians who are under-represented in medicine (URM) face inequities in the workplace and beyond. Understanding their experiences is crucial for workforce sustainability and diversity, especially given the disproportionate effects on these individuals and overall workforce capacity.

To qualitatively explore the perspectives of academic female and URM physicians and identify key themes affecting their careers and well-being.

Semi-structured interviews were conducted with 30 physicians at an urban academic health system. Interviews were audio-recorded, transcribed and thematically analysed using a general inductive approach. Interview guides were informed by prior literature and constructs.

None.

Female and URM physicians from a large, academic medical centre were recruited via email. Participants self-reported demographic information, including sex, race, ethnicity and tenure.

The primary outcomes encompassed the main themes identified through the analysis of interviews with female and URM physicians regarding their perspectives on well-being, mental health and academic medicine.

30 female or URM physicians were interviewed (27 (90%) female; 14 (47%) black, Asian or multi-racial). Thematic analysis revealed four key themes: physician identity (URM, female, family), well-being in the workplace (emotional health, staffing burden, non-clinical responsibilities), barriers to accessing well-being resources (workplace environment, culture, overgeneralisation) and facilitators to well-being (physician camaraderie, leadership support). Physicians discussed how their identities influenced their experiences of well-being. They highlighted emotional health challenges, staffing burdens and administrative tasks contributing to stress. Barriers to accessing resources included workplace culture and broad-based interventions, while supportive leadership and camaraderie were identified as facilitators of access.

Female and URM physicians face systemic challenges impacting their well-being and careers. These findings underscore the need to address systemic changes and specifically design programmes focused on promoting the well-being and inclusivity of female and URM physicians. Tailored interventions to these individuals, supportive leadership structures and collaborative working cultures are crucial for addressing these issues and sustaining a diverse physician workforce.

Traditional encounter-based analyses overlook downstream costs and complications that follow emergency department (ED) care. To enable more comprehensive evaluations, we developed standardised episode of care definitions for five common, high-cost conditions: chest pain, congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD) and suicidality.

A two-round modified Delphi panel study was conducted following a literature review and evidence synthesis. Using structured surveys with anonymous feedback, panellists rated candidate criteria. To be retained in the final episode definitions, criteria were required to meet a predefined validity threshold without panellist disagreement. Data were analysed descriptively, and meeting deliberations were recorded and reviewed thematically.

Virtual, supported by an online survey platform.

A multidisciplinary panel of 11 experts in emergency medicine and relevant clinical specialties with 9 members participating in each round.

Criteria to determine inclusion, exclusion (including pre-trigger, post-trigger and event exclusion) and risk-adjustment standards for constructing ED-based episodes of care.

Candidate criteria were presented to the panel by condition: 30 for chest pain, 54 for CHF, 30 for COPD, 79 for pneumonia and 375 for suicidality. Following deliberations and re-rating, the number of valid criteria was reduced, primarily in the episode exclusion category. Thematic analysis highlighted trade-offs between episode exclusion criteria and the use of risk adjustment to account for heterogeneity.

Operational definitions for ED-based episodes of care for five conditions were established. These may support healthcare administrators, policymakers and researchers in evaluating variation in ED care delivery and its downstream cost and outcomes.

This study aims to evaluate relationships between self-reported fine motor ability and quality of life (assessed by life satisfaction and life problems) from people with spinal cord injury (SCI) at T1 and above.

Observational cohort study (current analysis from a cross section)

279 individuals with SCI at T1 or above

Community members sampled from records from two Midwestern hospitals and a speciality hospital in the Southeast United States

Fine motor ability was assessed via the Spinal Cord Injury Functional Index-Short Form 9A, while two facets of quality of life, life satisfaction and life problems, were assessed by the Life Situation Questionnaire-Revised version (LSQ-R). Pearson correlations and multivariate analysis were utilised to identify cross-sectional relationships between fine motor ability, life satisfaction and life problems.

Fine motor ability was positively correlated with total life satisfaction score (r=0.16; p=0.02) and was negatively correlated with the total life problems score (r=–0.18; p=0.01), health problems factor (r=–0.24; pβ=0.25; p=0.02), fewer life problems (β=–0.40; pβ=–0.11; pβ=–0.10; p

The results identified significant, modest associations between self-reported outcomes, as better fine motor ability was related to less social isolation, fewer health problems and higher life satisfaction. Further investigation into the relationship between fine motor ability, life satisfaction and life problems is warranted.

To assess anaesthesia capacity and practice in Sierra Leone by enumerating the anaesthesia workforce by volume, training level and distribution across urban and rural areas and facility ownership; estimating the prevalence of anaesthesia methods used for common surgical procedures by provider category; and evaluating hospital infrastructure and the availability of essential anaesthesia-related medications and equipment.

A nationwide, cross-sectional, facility-based study combining structured questionnaires administered through face-to-face interviews with facility leads and retrospective review of surgical and anaesthesia logbooks.

Public and private hospitals and clinics in Sierra Leone providing surgical care with general, regional or local anaesthesia within an operating theatre.

69 of 78 eligible surgical facilities nationwide were included. Facilities providing surgical services between September 2022 and August 2023 were eligible; facilities without registries or declining participation were excluded.

Across participating facilities, the anaesthesia workforce comprised 198 full-time positions, predominantly non-physician providers, with only 40.4% (80/198) trained to administer anaesthesia independently. Ketamine-based and spinal anaesthesia were most common, while general anaesthesia with a protected airway accounted for just 5.0% (415/8339) of procedures. Anaesthesia practices varied by provider training level. Essential infrastructure, equipment and medications fell below international minimum standards, with shortages most pronounced in rural facilities.

Severe shortages of certified anaesthesia providers, limited anaesthesia techniques and inadequate material resources remain major barriers to safe anaesthesia and surgical care in Sierra Leone. Targeted investments in workforce development, infrastructure and resource allocation—particularly in rural areas—are required to improve the safety, quality and equity of anaesthesia care nationwide.

The Infant Gut Bacterial Study in Nigeria (INBUGS-NG) investigates how delivery mode, antibiotic exposure, feeding practices and environmental factors shape gut microbiome development and acquisition of antibiotic resistance genes (ARGs) during the first year of life in northern Nigeria.

Between February and July 2024, 90 mother–infant dyads were enrolled at a tertiary hospital in Kano city, Nigeria. This was a prospective longitudinal cohort with follow-ups at 10 scheduled time points: days 0, 1, 3, 5, 7, 14, 28, 90, 180 and 365. We also intensified stool sampling after infant antibiotic administration, enabling dense early-life sampling. To date, the cohort has contributed 480 infant stool samples, 232 maternal rectal swabs, 254 breast milk samples and 806 environmental samples (total 1772). In parallel, socio-demographic, clinical and cultural data were collected using Research Electronic Data Capture (REDCap) and household visit diaries.

Baseline data show that 84/90 mothers (93.3%) received postpartum antibiotics, and 26/90 infants (28.9%) received antibiotics within the first 3 months of life. Only 8% of infants were exclusively breastfed, with early water supplementation common. Caesarean deliveries accounted for 25% of births, and the mean gestational age was 38.5 weeks. Across the cohort, high retention was achieved, and the study has generated a unique long-read metagenomic resource from an African infant population, with analyses ongoing.

Shotgun long-read metagenomic sequencing (Oxford Nanopore) will enable strain-level and plasmid-level profiling of microbial communities and ARGs. Planned analyses include associations between early-life exposures and resistome dynamics, as well as cross-cohort comparisons with a parallel study in Pakistan. Follow-up will continue through 12 months.

Clinical trials have produced inconclusive results regarding the optimal glucose range for a patient with sepsis in the intensive care unit (ICU) receiving insulin treatment.

To investigate the optimal glucose range in patients with sepsis in the ICU independent of confounding covariates.

Targeted trial emulation of glucose ranges using causal inference targeted maximum likelihood estimation and longitudinal mixed-effects models combined with survival models.

Single-centre, academic referral hospital in Boston, Massachusetts, USA.

Adults fulfilling sepsis 3 criteria with at least three glucose readings and insulin treatment from the Medical Information Mart for Intensive Care (MIMIC)-IV database (2008–2019).

Five predefined glucose distributions with means at 100, 130, 160 (baseline), 190 and 220 mg/dL mimicking current guidelines’ recommendations (140–180 mg/dL).

The primary outcome was in-hospital mortality. Modified counterfactual treatment-policy risks across distinct time-weighted glucose ranges were estimated.

Of 73 181 eligible patients, 8002 patients with a median age of 66 years (41% women, 67% white ethnicity, 57% diabetes) were included. There was a U-shaped curve between glucose range and mortality in patients without diabetes, but overall, this association was not significant (mean glucose at 100 mg/dL with 21% mortality and mean glucose at 220 mg/dL with 26% mortality, p-for-trend 0.26). Mortality was lowest at 17%, with mean glucose between 130 and 160 mg/dL. Hypoglycaemic events (

Our data suggest a U-shaped association of glucose and mortality with an optimal average glucose between 160 and 190 mg/dL. These results confirm current guideline recommendations. Together with recent results from randomised controlled trials, intensivists should aim for a liberal glucose range in most patients.

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.

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.

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.

CTRI/2023/12/060758

To assess the association between the maternal continuum of healthcare and child immunisation in East Africa using propensity score matching (PSM).

Cross-sectional study using Demographic and Health Survey data.

This study was conducted in East African countries.

This study included a weighted sample of 13 488 women with children aged 12–23 months.

Child immunisation was the outcome variable of this study.

The PSM estimates indicate that the average treatment effect on the treated for complete child immunisation was 0.0583, meaning that children of mothers who received a complete maternal continuum of care had a 5.83% higher probability of being fully immunised compared with children of mothers with incomplete care. Expressed relative to the treated group’s mean, this corresponds to a 7.48% increase. Additionally, our results indicated that the population average treatment effect was 0.0629. This means that, on average, a complete continuum of maternal healthcare increases the probability of full child immunisation by approximately 6.29% across the entire population.

The study highlights that children whose mothers receive comprehensive maternal healthcare are more likely to complete their childhood immunisations. This finding underscores the need to integrate immunisation services into maternal healthcare programmes to enhance vaccination coverage and promote better child health. To maximise this connection, improving access to maternal healthcare, especially in underserved regions, is crucial, along with ensuring that immunisation is a regular part of maternal care.