To compare clinical radiography training experiences (structure, resources, participation, feedback) and self-perceived competence/practice readiness between public and private radiography centres in Lagos State, Nigeria.

Comparative cross-sectional survey design from August to October 2025 using a validated self-administered questionnaire distributed in person during departmental seminars and clinical debriefings at University of Lagos-affiliated centres.

Centre-based settings at public and private radiodiagnostic centres.

A total of 260 final-year students and recent graduates, 130 each from public and private radiodiagnostic centres. Inclusion criteria included: age ≥18 years, with ≥6 months clinical exposure, from centres affiliated to the University of Lagos. All participants completed the self-administered questionnaire. There were no interventions.

The primary outcome was the self-perceived competence/practice readiness, and the secondary was participation, extent and feedback mechanisms, measured as planned without protocol deviations. All variables were measured using validated items in the questionnaire.

Private centres significantly outperformed public centres in hands-on practice and feedback, with higher self-perceived competence (mean 35.6±5.7 vs 32.8±6.4; p=0.001). There were no significant differences in training structure (p=0.78). Public centres reported higher patient loads (86.2% vs 68.5%; p=0.001) but lower equipment availability (47.7% vs 72.3%; p

Private centres were associated with higher self-perceived competence and readiness, better resources and feedback, while public centres offered greater patient volumes. Hybrid placements and targeted infrastructure investment are recommended to help address disparities in perceived readiness.

Incidental pulmonary nodules (IPNs) are commonly encountered on chest radiographs (CXRs) performed for routine clinical indications and may represent early manifestations of significant pulmonary pathology, including lung cancer. While low-dose CT screening has mortality benefits in selected high-risk populations, its implementation remains limited in many healthcare settings. Artificial intelligence (AI)-assisted CXR interpretation has the potential to enhance pulmonary nodule detection. However, evidence from Malaysian clinical practice is scarce. This study aims to evaluate the diagnostic performance of AI-assisted CXR interpretation for detecting IPNs across healthcare facilities in the Klang Valley, Malaysia.

This prospective, multicentre study will include 2452 CXRs from patients aged ≥35 years over a 6-month period across four Klang Valley healthcare facilities. Each CXR will be independently interpreted by an experienced radiologist (>5 years of experience) and analysed separately using an AI system (qXR-LNMS). An independent thoracic radiologist will determine the final classification for analysis if there is IPN detection discordance. Diagnostic performance metrics (sensitivity, specificity, positive and negative predictive values, and overall accuracy) will be calculated using a 2x2 classification matrix. Agreement between AI-assisted interpretation and radiologist reports will be assessed using Cohen’s kappa statistic. The prevalence of IPNs detected by AI-assisted interpretation and radiologist reporting will be compared using a two-proportion z-test. AI discriminative performance will be evaluated using receiver operating characteristic curve analysis and area under the curve estimation. Statistical analyses will be conducted using Statistical Package for the Social Sciences V.29, with p

Ethical approval has been obtained from the Universiti Kebangsaan Malaysia Research Ethics Committee and the Ministry of Health Malaysia Medical Research and Ethics Committee. Written informed consent will be obtained from all participants. The findings will be disseminated through peer-reviewed publications, scientific conferences and engagement with relevant stakeholders.

This study investigated perinatal depressive symptoms among pregnant and postpartum Filipino women.

Cross-sectional survey.

The Philippines.

Participants were recruited online and face-to-face from maternal care facilities.

Perinatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) score, with prevalence calculated based on ≥13 cut-off, indicating clinically significant symptoms of depression. Patterns of depressive symptoms were examined by demographics, perinatal time period and other obstetric information using adjusted regression coefficients (ab) and risk ratios (aRR).

A total of 856 women participated in the study, comprising 356 pregnant and 500 postpartum women. EPDS scores were, on average, similar between pregnant (14.4) and postpartum women (14.1). Using the locally validated cut-off of ≥13 revealed that 69.1% of pregnant and 62.0% of postpartum women reported clinically significant depressive symptoms. Consistent EPDS scores and prevalence were observed across pregnancy trimesters and within 12 months postpartum and beyond. Women who received adequate prenatal care were less likely to experience antenatal (ab=–1.59, 95% CI –3.13 to –0.05) and postpartum (ab=–1.30, 95% CI –2.48 to –0.12) depressive symptoms. Postpartum EPDS scores and depressive symptom prevalence (EPDS score ≥13) were higher among 18–24-year olds (ab=1.96, 95% CI 0.30 to 3.61; aRR=1.23, 95% CI 1.03 to 1.47) and single mothers (ab=3.46, 95% CI 0.22 to 6.71; aRR=1.42, 95% CI 1.07 to 1.90), compared with older and married mothers, respectively.

At least 60% Filipino mothers experienced clinically significant perinatal depressive symptoms, which exceeds the established global average of 25%. Younger and single postpartum women were at greater risk, while pregnant and postpartum women who attended adequate prenatal visits were less likely to report depressive symptoms. Our study underscores the need for further research to uncover the true burden of poor perinatal mental health and calls for targeted early interventions and integrative public health strategies to support at-risk mothers, particularly those from socially disadvantaged backgrounds.

Malaria remains a major public health challenge in India, with transmission dynamics varying widely across ecological, epidemiological, sociobehavioural and health system contexts. Achieving the national malaria elimination target by 2030 requires integrated, context-specific evidence to design effective interventions. This study aims to generate a comprehensive understanding of malaria transmission and factors surrounding it across diverse eco-epidemiological settings in India by assessing malaria burden, identifying determinants of transmission, evaluating health system performance and equity, characterising vector bionomics and insecticide resistance, and examining the influence of environmental drivers.

This longitudinal, multicentric study will be conducted in collaboration with the national programme in 12 districts spanning 10 states in India, covering a population of around 25 000 individuals representing varied ecological contexts (urban, periurban, rural, forest-foothill and coastal) and malaria endemicity levels. In each district, two clusters (villages) with a population of 1000 individuals will be included. A baseline mass survey will estimate malaria prevalence using bivalent rapid diagnostic tests (RDTs) and blood smear microscopy, with low-density parasitaemia detected by PCR in a subset of RDT-negative samples. Participants will be followed for 1 year, with monthly screening of symptomatic individuals using RDT and microscopy, and testing a subset of asymptomatic individuals to detect subclinical infections. Sociobehavioural data will be collected through structured interviews and household observations, with purposive inclusion of vulnerable groups, pregnant women, migrants, elderly persons, individuals with disabilities and tribal populations to assess equity dimensions through mixed-methods approaches. Health system performance will be evaluated through key informant interviews with programme officials, health workers, patients, private practitioners and traditional healers. Entomological surveillance will document vector species composition, density, infection rates and assessment of susceptibility status and intensity of insecticide resistance to commonly used public health insecticides. Environmental variables, including temperature, rainfall and humidity, will be linked with entomological and epidemiological data to explore spatiotemporal relationships.

The protocol was approved by the Institute Human Ethics Committee of ICMR-Vector Control Research Centre (IHEC 03-0125/N/F). All standard ethical practices will be adhered to. The findings will be shared with stakeholders and published in reputed open-access journals.

There is a high level of older people neglect in Nigeria, especially in the rural setting, and they did not receive much attention in terms of their overall health and well-being. Government social interventions are usually geared towards the children, adolescents, pregnant women and lactating mothers. Evaluating the level of functional decline and social support among these groups and how it affects their overall well-being will enable policy formulations geared towards holistic care for them. This study aimed to determine the level of functional dependence in some basic activities of daily living (ADLs: mobility, dressing, grasp and bathing) and social support in older people to enhance evidence-based advocacy to all stakeholders in older people care.

This was a hospital-based cross-sectional study of 160 (75 males and 85 females) older people aged 65–98 years selected through systematic random sampling. The 2 test, t-test and logistic regression were used for analysis.

The response rate was 100%. The mean age of male respondents was 76.31±8.34 years and that of the female respondents was 76.87±7.47 years. A statistically significant association was found between age >75 years, absence of a spouse, low education level and functional dependence in all ADLs studied. Although age independently predicted dependence in all studied ADLs, except dressing and grasp, marital status predicted dependence in dressing and bathing, and availability of care also predicted dependence in mobility.

Age is an independent risk factor for functional dependence in mobility and bathing, and marital status independently predicted dependence in dressing and bathing. Not receiving care also independently predicted dependence in mobility. Thus, improvements in the biopsychosocial, biomedical and economic well-being of older people will ameliorate the impact of poor care on functional status and ADLs.

The timing of a woman’s first birth is significantly associated with maternal and child health outcomes and socioeconomic opportunities. Delaying the first birth is associated with reduced risks of adolescent pregnancy complications, improved birth outcomes and enhanced interpregnancy intervals, all of which contribute to better maternal and child health. In Somaliland, early childbearing is prevalent, necessitating an understanding of its associated factors. Early childbearing, defined as a first birth before age 20, is prevalent in Somaliland, with 47.02% of women having their first birth by this age, significantly higher than the average for sub-Saharan Africa (approximately 30%) and global figures.

This study aimed to identify the sociodemographic factors associated with age at first birth among married women in Somaliland.

The median duration from marriage to first birth was 3 years, with a median age at first birth of 21 years. Women residing in the Sool (adjusted HR: 1.318, 95% CI 1.138 to 1.527) and Sanaag (adjusted HR: 1.265, 95% CI 1.095 to 1.462) regions had a significantly higher hazard of first birth compared with those in Awdal (reference). Conversely, women in the middle (adjusted HR: 0.821, 95% CI 0.685 to 0.985) and highest (Adjusted HR: 0.799, 95% CI 0.663 to 0.964) wealth quintiles had a significantly lower hazard of first birth compared with the lowest wealth quintile. Age at first marriage was a strong factor associated with the outcome; marrying at age 20 or older (adjusted HR: 0.699, 95% CI 0.644 to 0.759) was associated with a significantly lower hazard of first birth compared with those who married before age 20. After adjustment, other factors including residence, media exposure and husband’s employment status were not significantly associated with the timing of first birth.

Region, wealth quintile and age at first marriage are critical factors associated with first birth timing in Somaliland. Interventions should focus on addressing regional disparities and promoting delayed marriage to improve maternal and child health outcomes. Further research is needed to explore the complex social and cultural drivers of these findings.

Workplace violence (WPV) is a significant occupational hazard in healthcare, negatively impacting healthcare workers’ (HCWs) mental health and quality of care. Psychosocial safety climate (PSC), an organisational factor emphasising psychological well-being, may influence how HCWs perceive, experience and cope with WPV. However, its role in shaping HCWs’ coping strategies remains underexplored. This study aims to examine the relationship between PSC and coping mechanisms among HCWs experiencing WPV in public hospitals.

This explanatory sequential mixed-method study comprises two phases. In Phase 1, a multicentre cross-sectional survey will be conducted among at least 440 HCWs working in Malaysian public hospitals that are selected through multistage random sampling. PSC, WPV exposure and coping mechanisms will be assessed using validated tools, including the Psychosocial Safety Climate (PSC-12) scale and the Brief Coping Orientation to Problems Experienced (Brief COPE) questionnaire. Linear regression will examine the association between PSC and coping mechanisms among HCWs exposed to WPV. In Phase 2, 6–12 HCWs with WPV experience in the past year and employed in high-PSC departments will be selected via criterion sampling with maximum variation for in-depth interviews. A semistructured interview guide based on the Transactional Model of Stress and Coping will be developed and pilot tested. Data will undergo thematic analysis until saturation is reached, identifying key themes on how PSC influences coping. Findings from both phases will be integrated using joint display analysis to inform PSC-driven interventions that promote coping and reduce WPV impacts among HCWs.

The study has been approved by the Ministry of Health Medical Research and Ethics Committees and Universiti Teknologi MARA Research Ethics Committee. Informed, written consent will be obtained from all participants. Findings will be disseminated to the Ministry of Health and through peer-reviewed publications.

Spinal cord injury (SCI) results in debilitating sensory, functional deficits and paralysis requiring neurorehabilitation solutions. In this regard, focal muscle vibration (FMV) is an emerging neuro-rehabilitation tool that uses mechanical vibration on muscles/tendons to stimulate underlying nerves and consequently modulate neural pathways. We conducted a systematic review to understand the exact effectiveness of FMVs on the sensorimotor function and mobility/strength in the SCI population.

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach.

PEDro, Springer, PubMed, Science Direct, Cochrane Library and Google Scholar were searched through 15 February 2025.

We included studies adhering to the following population–intervention–comparison–outcomes (PICO) elements. Population: SCI, intervention: FMV, comparison: unexposed controls, outcome: either of sensorimotor function or mobility and strength.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) scale. Findings were summarised and a narrative synthesis is provided.

25 studies were included. 9 studies used FMV in the upper limb and 14 in the lower limb. The analysis includes 427 patients with SCI, with a focus on male, chronic SCI cases and a prevalence of North American studies.

Our systematic review of 25 studies, with 21 (84%) reporting positive outcomes, suggests that FMV may improve sensory perception, motor function, mobility and strength in individuals with SCIs, with benefits observed in both limbs. However, substantial heterogeneity in FMV parameters, study designs, participant characteristics and the high prevalence of serious/critical risk of bias (13/25 studies, 52%) limit definitive conclusions. Further research with optimised protocols, larger sample sizes and longitudinal designs is needed to confirm efficacy and establish clinical guidelines.

Excessive opioid prescribing after surgery can lead to adverse events and exacerbate the opioid crisis. Patients undergoing outpatient breast surgery are often prescribed opioids to manage pain at home; however, the value of this approach is uncertain. The Postoperative Analgesia Intervention with Non-opioid Alternatives (PAIN Alt) trial will address the following research question: among patients undergoing outpatient breast surgery, does opioid-free analgesia (OFA) result in non-inferior 7-day pain intensity and pain interference in comparison to opioid analgesia (OA)?

This is a parallel, assessor-blind, open-label randomised trial conducted at seven university-affiliated hospitals in Canada. A sample of 540 adult patients (>18 years) undergoing outpatient mastectomy or lumpectomy will be included. Participants are allocated 1:1 to receive OA (around-the-clock non-opioids and opioids for breakthrough pain) or OFA (around-the-clock non-opioids, with adjustment of non-opioid drugs and/or non-pharmacological interventions for breakthrough pain). The co-primary outcomes are 7-day pain intensity and pain interference (measured using the Brief Pain Inventory). Secondary outcomes include adverse drug events, physical and mental health status, satisfaction with pain management, postoperative complications, chronic pain, opioid misuse, persistent opioid use, healthcare utilisation and costs. The primary statistical analyses will follow the intention-to-treat principle and be conducted using mixed-effects modelling.

This trial is coordinated by the McGill University Health Centre (ethics approval MP-37-2024-102530), with ethics approval being sought at all participating sites. Our results will be published in an open-access, peer-reviewed journal, presented at relevant conferences and disseminated to the public through press releases.

NCT06507345.

Uncontrolled type 2 diabetes mellitus (T2DM) causes microvascular and macrovascular issues that hike healthcare costs and threaten global health. Previous studies have suggested meal replacement (MR) therapy for T2DM, but there were inconsistencies in the results. Thus, a randomised controlled trial is proposed to determine the efficacy of a diabetes-specific MR product on weight loss, glycaemic control, satiety, quality of life, metabolic gene expression and cost benefit in overweight and obese patients with T2DM.

164 overweight and obese participants with T2DM will be randomly assigned to either an intervention group (n=82) or a control group (n=82). All participants will receive dietary counselling; however, only the intervention group will receive MR for 12 weeks. Glycaemic control and obesity indicators are the study’s main outcomes. Secondary outcomes include cardiovascular disease risk markers, metabolic risk, metabolic gene profile analysis, dietary data, physical activity, satiety level, quality of life and cost analysis. Baseline data will include sociodemographics, anthropometry, blood pressure, diet, physical activity, satiety level, quality of life, blood profile, metabolic gene expression profile and cost-benefit analysis. A follow-up is planned at intervention weeks 6 and 12. Week 6 will assess only anthropometry, blood pressure, diet, physical activity and satiety level. For compliance assessment, intervention group participants will bring their MR container. Week 12 will measure the same baseline parameter, except sociodemographic data. Individuals who consume less than 80% of the MR will be deemed non-compliant. All parameter modifications will be documented and analysed for comparison. All statistical analyses will be conducted using IBM SPSS V.29.0 software, with a significance level of p

This research protocol was approved by the Ethical Committee of the National University of Malaysia (JEP-2024-695) and registered on International Standard Randomised Controlled Trial Number. Study findings will be disseminated in peer-reviewed journals, conference presentations and social media.

ISRCTN57040303).

Major depressive disorder (MDD) is among the most common psychiatric disorders in children and adolescents. While previous meta-analyses have synthesised evidence on the efficacy and acceptability of newer-generation antidepressants in this population, specific adverse events (AEs) remain poorly characterised. This is of high clinical importance, as AEs are burdensome for patients, can reduce treatment adherence and lead to discontinuation. Here, we present a protocol for a network meta-analysis designed to evaluate the specific AE profile and comparative tolerability of newer-generation antidepressants in children and adolescents with MDD.

The planned study will include double-blind randomised controlled trials that compared one active drug with another and/or placebo for the acute treatment of MDD in children and adolescents. The following antidepressants will be considered: agomelatine, alaproclate, bupropion, citalopram, desvenlafaxine, duloxetine, edivoxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, venlafaxine, vilazodone and vortioxetine. The primary outcomes will include the number of patients experiencing at least one AE, specific non-serious AEs, serious AEs (eg, suicidal ideation) and AEs leading to treatment discontinuation. Published and unpublished studies will be retrieved through a systematic search in the following databases: PubMed, Embase, Cochrane Library (including the Cochrane Central Register of Controlled Trials), Web of Science Core Collection, PsycInfo and regulatory agencies’ registries. Study selection and data extraction will be performed independently by two reviewers. For each outcome, a network meta-analysis will be performed to synthesise all evidence. Consistency will be assessed through local and global methods, and the confidence in the evidence will be evaluated using the Confidence in Network Meta-Analysis web application. All analyses will be conducted in the R software.

The planned review does not require ethical approval. The findings will be published in a peer-reviewed journal and may be presented at international conferences.

CRD420251011399.

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.

Paediatric hospitalisation, encompassing the period from admission to discharge, often involves feelings of pain, fear and anxiety, primarily due to clinical diagnoses and, more significantly, discomfort and stress-inducing procedures. Numerous methodologies and interventions have been investigated and implemented to alleviate these phenomena during paediatric hospitalisation. Virtual reality (VR), for example, has demonstrated efficacy in pain relief for hospitalised children in recent studies. This systematic review, therefore, aims to identify and evaluate the effectiveness of VR in alleviating pain, fear and anxiety in hospitalised children undergoing painful procedures.

This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines. A systematic search will be conducted in March and April 2025 across the following databases, with no restrictions on language or publication year: PubMed, Embase, Scopus, Web of Science, Cumulated Index in Nursing and Allied Health Literature, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. Eligible studies will include randomised and quasi-randomised clinical trials involving children (aged 2–10 years) and adolescents (aged 10–18 years) who received VR interventions during painful procedures. Data will be managed and analysed using Review Manager software (RevMan 5.2.3). In cases of significant heterogeneity (I² > 50%), a random-effects model will be employed to combine studies and calculate the OR with a 95% CI. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias 2.0 tool, and the certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluations framework.

This study will solely review published data; thus, ethical approval is not required. This systematic review is expected to provide subsidies, evidence and insights into the use of VR. It is also anticipated that the results will directly impact the improvement of care for these patients and the qualification of professional care.

CRD42024568297.

Acute pain in the postoperative period of cardiac surgery is mostly treated with opioid analgesics. However, with the risk of adverse reactions and complications, strategies which do not involve opioid analgesics can be considered, such as aromatherapy. This systematic review aims to analyse the effectiveness of aromatherapy in relieving pain in post-cardiac surgery patients.

Two researchers will independently and simultaneously conduct searches and select studies from the following databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature on Health Sciences, Scopus, Web of Science, Cochrane (Library) and clinical trial registries (clinicaltrials.com), with no language or publication date restrictions. Randomised and quasi-randomised clinical trials on the use of aromatherapy for pain relief in postcardiac surgery patients will be included. Then, two researchers will independently examine the studies based on inclusion criteria, extract data from the included studies and assess the risk of bias using the Risk of Bias 2 tool and the Risk of Bias in Non-randomized Studies of Interventions tool from Cochrane. Data will be synthesised using Review Manager software. The strength of the evidence will be evaluated using the Grading of Recommendation Assessment, Development and Evaluation approach. The literature search, study selection, review and meta-analysis stages will be conducted from early October 2025 to April 2026.

This study is based on secondary data, and therefore ethical approval from a research ethics committee was not required. The results will be disseminated through publication in a peer-reviewed scientific journal.

CRD42024568532.

To explore the use, parameters, safety and outcomes of physical rehabilitation for adults with sepsis.

We conducted a scoping review following the Joanna Briggs Institute framework.

Studies were eligible for inclusion in the study if they included: (1) adults 18 and older, (2) with a previous diagnosis of sepsis, (3) using a physical rehabilitation intervention at any point of sepsis management, (4) published in English or French.

We searched seven databases and screened titles and abstracts, reviewed full texts and performed data extraction independently and in duplicate. We summarised findings narratively using the "population, context, concept" framework and used descriptive statistics where appropriate. End-users reviewed and commented on study findings.

We included 58 studies, representing 77 434 participants, with the majority (79%) being published in the last decade. A large proportion (36%) of physical rehabilitation interventions included exercise and were overseen by a physical therapist (41%). The parameters of the interventions varied widely. However, all interventions (100%) were hospital based and the interventions implemented appeared safe. Of the 28 studies evaluating effectiveness of the intervention, function improved in most studies (78%) following physical rehabilitation.

Research addressing physical rehabilitation for patients with sepsis is increasing. Physical rehabilitation appears safe and may improve functional outcomes in those with sepsis. Future research should report details of intervention parameters and evaluate rehabilitation post-hospital discharge to maximise impact on function and quality of life for sepsis survivors.

The protocol was registered on Open Science Framework Registries (Registration DOI: https://doi.org/10.17605/OSF.IO/2EPJ6).

Acute low back pain (LBP) is a prevalent condition with various non-surgical treatment options, yet no comprehensive network meta-analysis has systematically compared their relative efficacy for pain and disability. This study aims to fill that gap by synthesising available evidence on the efficacy of different types of non-surgical interventions for acute LBP, such as various medications, manual therapies and education-based therapies. Our coprimary objectives are to (1) compare each active treatment to an inert reference for measures of LBP and related disability and (2) rank the efficacy of treatments.

We will conduct a systematic search across multiple databases, including grey literature, to identify randomised controlled trials evaluating non-surgical treatments for acute LBP. Eligible studies must report on pain and/or disability outcomes in adults. The risk of bias will be assessed using the Risk of Bias tool, and the certainty of evidence will be graded using CINeMA (Confidence in Network Meta-Analysis). We will use a frequentist network meta-analysis to pool standardised mean differences in pain and disability, employing random-effects models to account for heterogeneity. A qualitative analysis will assess study characteristics and transitivity, while a quantitative analysis will evaluate efficacy and inconsistency. Results will be presented using network geometry, p-scores, forest plots, funnel plots, Egger’s test, Q-statistics and league tables to visualise both direct and indirect evidence and to identify potential biases.

This review protocol does not involve any primary research with human participants, animal subjects or medical record review. Consequently, this work did not require approval from an institutional review board or ethics committee. Results will be submitted to a peer-reviewed journal and presented at conference(s). De-identified data will be made available in a public repository.

It is unclear how mis- and disinformation regarding healthcare policy changes propagate throughout Latino communities via social media. This may lead to chilling effects that dissuade eligible individuals from enrolling in critical safety net programmes such as Medicaid. This study will examine pathways and mechanisms by which sentiment in response to mis- and disinformation regarding healthcare policies on social media differentially impact health disparity populations, thus supporting the design of tailored social media interventions to mitigate this.

We will search social media from X/Twitter, Facebook/Instagram and Reddit for keywords relating to health benefit programmes. Demographic, geographical location and other characteristics of users will be used to stratify social media data. Posts will be classified as fake-news-related or fact-related based on curated lists of fake-news-related websites. The number, temporal dissemination and positive or negative sentiment in reacting to posts and threads will be examined using the Python-based Valence Aware Dictionary and sEntiment Reasoner (VADER). Using a crowd-sourcing methodology, a novel Spanish-language VADER (S-VADER) will be created to rate sentiment to social media among Spanish-speaking Latinos. With the proposed approach, we will explore reactions to the dissemination of fake-news- or fact-related social media tweets and posts and their sources. Analyses of social media posts in response to healthcare-related policies will provide insights into fears faced by Latinos and Spanish speakers, as well as positive or negative perceptions relating to the policy over time among social media users.

Our study protocol was approved by the University of California, Los Angeles IRB (IRB#23–0 01 123). Results from this study will be disseminated in peer-reviewed journals and conference presentations, and S-VADER will be disseminated to public repositories such as GitHub.