Cardiac rehabilitation (CR) is a recommended treatment for patients with cardiovascular disease (CVDs), given the rising number of cardiac incidents due to ageing population and modern lifestyles.1 To improve accessibility and follow-up support for optimal health, e-platforms are increasingly being used. Virtual CR uses technology-based methods such...

The purpose of this article is to present the Gothenland Millennium Cohort, describe the data collection process, present key measures used and summarise some of the key findings to date in order to stimulate collaboration and use of the cohort data. This research programme was originally established to study pathways to alcohol and drug use, behavioural problems, mental health issues, and the factors that promote or prevent these outcomes. The Cohort aims to support scientific research and doctoral education through a longitudinal study that tracks individuals from early adolescence through adulthood. This programme is multidisciplinary (social work, psychology, disability research) with the goal of producing high-quality research that deepens our understanding of how early-life vulnerabilities, risks and protective factors influence long-term wellbeing, including health and welfare, in diverse populations.

In 2013, all school-registered adolescents, in grades 6 and 7 (aged 12 and 13), in four municipalities in Gothenland region (ie, southern Sweden) born in year 2000 or 2001, were invited to participate. Of 2150 invited adolescents, 1885 (88%) accepted participation in the programme and 1760 (93.4%) participated in at least one of the annual data collection waves up to grade 9 (Wave 4), with participation rates ranging from 70% to 85% per wave. Wave 5 questionnaires were collected during the second year of upper secondary school (grade 11). In Wave 5, half (50.4 %; n = 949) of the adolescents participated. In Wave 6, interviews were conducted with a selection of participants in their last year of upper secondary school (grade 12). Parents were surveyed in Waves 1 and 2 by self-report questionnaires (response rate = 32%; 41%). Data were also gathered from teachers (attrition

Over 240 publications have been produced as of September 2025 in the areas of disability and everyday functioning, child-parent relationships, child welfare, substance use and criminal behaviour, mental health, trauma, harassment, and sexuality.

These include continued investigation of wellbeing and its related indicators during adolescence as well as in emerging adulthood, continued efforts to secure funding and an age 25 expansion of the cohort data.

International migrants comprise 3.6% of the global population and face systemic barriers to accessing sexual and reproductive health (SRH) services, such as contraception, safe abortion care and sexual function support. In high-income countries, policy frameworks vary widely, with migration status significantly influencing entitlement and access to host countries. This protocol outlines a planned study to systematically analyse SRH policies in high-income countries with strong migrant integration frameworks, aiming to identify policy gaps, assess inclusivity and inform recommendations to strengthen Australia’s SRH policy landscape.

This study employs a systematic policy analysis using the Joanna Briggs Institute scoping review methodology. Countries with ≥10% migrant populations and a Migrant Integration Policy Index health score ≥70 will be included. 13 countries meet these criteria, including Australia, Canada and Sweden. A comprehensive search of academic databases (PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ProQuest Public Health) and grey literature from governmental and non-governmental sources will be conducted. Data extraction will follow Bacchi’s ‘What’s the Problem Represented to Be?’ approach. Thematic analysis will combine deductive and inductive methods to examine the extent to which SRH policies address migrant and refugee needs, including sexual function, safe abortion care and fertility care. A comparative policy matrix will identify strengths, limitations and best practices.

As this study analyses publicly available policy documents, ethics approval is not required. Findings will be disseminated through peer-reviewed publications and policy briefs targeting stakeholders involved in SRH policy and migrant health.

This protocol is registered with the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/AYZ6P

To conduct a systematic review and narrative synthesis to identify barriers, facilitators and pre-existing interventions and describe the current status of initiatives/interventions aimed at improving access to quality trauma healthcare after injury in Pakistan.

Systematic review and narrative synthesis

MEDLINE (Ovid), Embase (Ovid), Web of Science (Clarivate Analytics), Cochrane (Wiley), Scopus and ProQuest, as well as grey literature.

Full-text peer-reviewed publications, including cross-sectional studies, cohort studies, case-control studies, randomised controlled trials and qualitative studies published in English from January 2013 to December 2023.

Two independent reviewers used a standardised tool to extract data variables to Excel. The quality of the included studies was evaluated using the CASP checklist. The barriers, facilitators and pre-existing interventions were mapped using the four delays framework, the Institute of Medicine (IOM) quality domains and the WHO health systems building blocks. The data were synthesised narratively to improve access to quality trauma care in Pakistan. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.

The review included 20 studies. 19 studies reported 58 barriers to access to quality care. Six studies reported 20 facilitators, and eight studies described initiatives or interventions aimed at improving access to quality trauma healthcare after injury. According to the four delays framework, the receiving care stage of access to care was primarily studied in 16 studies, which identified 37 barriers and 13 facilitators across 5 studies. Regarding the quality of care according to IOM domains, the effectiveness of quality trauma care after an injury was studied in 15 studies, which identified 19 barriers and 10 facilitators across four studies. According to the WHO health system building blocks, most studies (n=15) described challenges in healthcare service delivery, with these 15 studies identifying 23 barriers and 3 studies identifying 4 facilitators.

Our findings highlighted the scarcity of available literature, identified barriers and facilitators and pre-existing interventions, which informed the need to develop feasible, sustainable and contextually relevant interventions to improve access to quality trauma care after injury in Pakistan.

CRD42024545786

Gram negative bloodstream infections (GN BSI) are a leading cause of mortality worldwide, and antibiotic treatment approaches remain understudied. BALANCE+ is a perpetual Bayesian adaptive platform trial to test multiple treatment questions for hospitalised patients with GN BSI. The vanguard phase objective was to test the feasibility of the main trial.

Adaptive platform trial with five initial domains of investigation, each with open label 1:1 randomisation.

Ten hospitals across four Canadian provinces.

Individuals admitted to hospital with blood cultures yielding Gram negative bacteria.

The five initial domains of investigation included: antibiotic de-escalation versus no de-escalation; oral transition to beta-lactam versus non-beta-lactam treatment; routine versus no routine follow-up blood cultures (FUBCs); central vascular catheter replacement versus retention; and, ceftriaxone versus carbapenem treatment for low risk AmpC organisms.

Domain-specific recruitment rates and protocol adherence.

During the vanguard phase, 719 patients were screened, of whom 563 (78.3%) were eligible, with 179 (31.8%) enrolled into the platform. The platform recruitment rate was 1.37 patients/site-week. Recruitment varied by domain: routine versus no FUBC domain 1.23 patients/site-week; oral beta-lactam versus non-beta-lactam domain 0.48; de-escalation versus no de-escalation domain 0.28; low risk AmpC domain 0.02; catheter replacement versus retention domain 0.01. Domain specific protocol adherence rates were 145/158 (91.8%) for routine versus no routine FUBC, 53/60 (88.3%) for oral beta-lactam versus non-beta-lactam, 26/33 (78.8%) for de-escalation versus no de-escalation, 3/3 (100%) for low risk AmpC, and 0/1 (0%) for line replacement versus retention. There was complete ascertainment of all study outcomes in hospital 170/170 (100%) and near complete ascertainment at 90 days 162/170 (95.3%).

The vanguard phase demonstrated overall trial feasibility by recruitment rate and protocol adherence, with differences across interventions, leading to a transition to the main BALANCE+ platform trial with minimal protocol modifications.

NCT05893147.

Substance use among adolescent expectant mothers is a significant public health concern due to its adverse effects on both maternal and fetal health. Despite this, there is limited evidence regarding the patterns and factors influencing substance use among pregnant adolescents in Ghana.

This study aimed to explore the psycho-social and cultural factors that influence substance use among adolescent expectant mothers attending the antenatal clinic at the Upper East Regional Hospital in the Bolgatanga municipality.

A qualitative, descriptive exploratory design was employed. 17 adolescent expectant mothers were purposively recruited and interviewed using a researcher-developed semistructured guide. Interviews were audio-recorded, transcribed verbatim and analysed using a six-step thematic analysis guided by a deductive approach. The study was underpinned by the socioecological model, which allowed for the exploration of knowledge, social and cultural factors influencing substance use during pregnancy.

The study was conducted at the antenatal clinic of the Upper East Regional Hospital in Bolgatanga and involved adolescent expectant mothers attending the clinic.

Analysis revealed three major themes: knowledge of substance use, social factors and cultural factors influencing substance use. Participants demonstrated understanding of substance use, including its definition, causes and potential consequences. Social influences, particularly peer pressure and family dynamics, were reported as motivating factors for substance use. Cultural factors, including local beliefs, practices and community attitudes, also played a significant role in shaping substance use behaviours among these adolescents.

The findings indicate that while adolescent expectant mothers possess knowledge about the risks and consequences of substance use during pregnancy, many continue to engage in such behaviours. Peer and family influences, alongside cultural beliefs and community attitudes, were identified as key drivers of substance use. These results highlight the need for targeted, culturally sensitive substance use education and intervention programmes within antenatal clinics and the broader community to support adolescent mothers in reducing substance use during pregnancy.

Neurodegenerative disorders (NDDs) represent an unprecedented public health burden. These disorders are clinically heterogeneous and therapeutically challenging, but advances in discovery science and trial methodology offer hope for translation to new treatments. Against this background, there is an urgent unmet need for biomarkers to aid with early and accurate diagnosis, prognosis and monitoring throughout the care pathway and in clinical trials.

Investigations routinely used in clinical care and trials are often invasive, expensive, time-consuming, subjective and ordinal. Speech data represent a potentially scalable, non-invasive, objective and quantifiable digital biomarker that can be acquired remotely and cost-efficiently using mobile devices, and analysed using state-of-the-art speech signal processing and machine learning approaches. This prospective case–control observational study of multiple NDDs aims to deliver a deeply clinically phenotyped longitudinal speech dataset to facilitate development and evaluation of speech biomarkers.

People living with dementia, motor neuron disease, multiple sclerosis and Parkinson’s disease are eligible to participate. Healthy individuals (including relatives or carers of participants with neurological disease) are also eligible to participate as controls. Participants complete a study app with standardised speech recording tasks (including reading, free speech, picture description and verbal fluency tasks) and patient-reported outcome measures of quality of life and mood (EuroQol-5 Dimension-5 Level, Patient Health Questionnaire 2) every 2 months at home or in clinic. Participants also complete disease severity scales, cognitive screening tests and provide optional samples for blood-based biomarkers at baseline and then 6-monthly. Follow-up is scheduled for up to 24 months. Initially, 30 participants will be recruited to each group. Speech recordings and contemporaneous clinical data will be used to create a dataset for development and evaluation of novel speech-based diagnosis and monitoring algorithms.

Digital App for Speech and Health Monitoring Study was approved by the South Central—Hampshire B Ethics Committee (REC ref. 24/SC/0067), NHS Lothian (R&D ref. 2024/0034) and NHS Forth Valley (R&D ref. FV1494). Results of the study will be submitted for publication in peer-reviewed journals and conferences. Data from the study will be shared with other researchers and used to facilitate speech processing challenges for neurological disorders. Regular updates will be provided on the Anne Rowling Regenerative Neurology Clinic web page and social media platforms.

ClinicalTrials.gov NCT06450418 (pre-results).

To examine demographic, behavioural and clinical determinants of self-rated health (SRH) among Iranian adults with hypertension (HTN), with a particular focus on the association between blood pressure (BP) control and perceived health.

National cross-sectional analysis of 15 predictors spanning demographic, lifestyle and clinical domains.

2021 Iranian STEPwise Approach to Non-communicable Disease Risk Factor Surveillance, a nationally representative survey.

A total of 8812 adults with HTN (mean age 56.97 years; 57% female). Controlled HTN was defined as systolic blood pressure

The primary outcome was SRH, measured on a standard EuroQol-Visual Analogue Scale (0–100).

Controlled HTN was independently associated with higher SRH scores (β=1.31, 95% CI 0.07 to 2.54). Positive predictors of SRH included male gender (β=4.34, 95% CI 3.38 to 5.31), higher wealth (richest vs poorest: β=5.52, 95% CI 4.06 to 6.97), sufficient physical activity (β=4.38, 95% CI 3.48 to 5.28), healthier diet (β=3.06, 95% CI 1.99 to 4.14) and complementary insurance coverage (β=2.50, 95% CI 0.63 to 4.37). Significant negative predictors included diabetes mellitus (β=–4.23, 95% CI –5.59 to –3.26), dyslipidaemia (β=–3.61, 95% CI –4.62 to –2.59), people who smoke (β=–4.21, 95% CI –5.64 to –2.78) and older age. Notably, antihypertensive medication use showed one of the strongest negative associations with SRH (monotherapy: β=–4.83; combination therapy: β=–5.28), likely reflecting underlying disease severity and treatment burden.

Better SRH among hypertensive adults was associated with controlled BP, healthier lifestyle patterns and higher socioeconomic status. Conversely, comorbidities, smoking, older age and antihypertensive treatment were linked to poorer perceived health. Integrating SRH screening into HTN management may help identify vulnerable individuals and inform targeted interventions addressing behavioural and socioeconomic determinants of health.

Forming secure attachment relationships provides children with the best possible start to life. Children from families with high psychosocial vulnerability and complex mental health needs (eg, caregivers with lived experience of trauma, experiencing mental illness or substance abuse, current or past domestic violence, and/or current or a history of child protection issues) are at the greatest risk of experiencing attachment disturbances. Nurturing Connections is a new early intervention service launched by the New South Wales State Ministry of Health targeting both caregiver adversity and the caregiver-child attachment relationships in families with high psychosocial vulnerability and complex mental health needs. This paper outlines the evaluation protocol of the Nurturing Connections Programme.

A mixed-methods design will be used to undertake an implementation and outcomes evaluation. The study will draw on both qualitative and quantitative data, including routinely collected service data, surveys, participant observations, and semi-structured interview and yarning circle data. Appropriate descriptive and inferential techniques will be used to analyse quantitative data while thematic analysis will be drawn on to analyse qualitative data.

This research was approved by the South Eastern Sydney Local Health District Research Ethics Committee (2024/ETH01715). The Mid North Coast Local Health District also received ethics approval from the Aboriginal Health and Medical Research Council of New South Wales (2380/25). Evaluation findings will be shared via published manuscripts, conference presentations, as well as a final report to funding bodies.

This study aimed to understand the knowledge possessed by informal medicine vendors regarding antibiotics and antibiotic resistance, identify the perceptions held by informal medicine vendors about antibiotics and their uses and examine the practices employed by informal medicine vendors in the sale and distribution of antibiotics.

Exploratory qualitative study using semi-structured interviews and direct observations.

Markets and shops across 11 villages in the Nanoro health district, Burkina Faso.

23 informal medicine vendors, aged between 25 and 55 years and with 8–30 years of experience, were recruited through snowball sampling in the Nanoro health district of Burkina Faso.

Informal medicine vendors exhibited a limited understanding of antibiotics, often confusing them with other treatments and referring to them using local terminologies based on perceived use and effectiveness. Antibiotics were perceived as universal remedies, supported by therapeutic belief, empirical reasoning and community solidarity, with empirical diagnosis, approximate dosing and informal preparation techniques passed on through imitation. These findings emerged across themes including perceptions, symbolic attributes and sales practices.

Informal medicine vendors in rural Burkina Faso demonstrated limited understanding of antibiotics and antimicrobial resistance, with practices shaped by local beliefs and empirical experience. These findings underscore the need for context-sensitive interventions that include tailored education and regulatory engagement to improve antibiotic stewardship and mitigate the spread of resistance.

Many pregnant women have a history of trauma, such as abuse or violence, which can significantly impact their mental and physical health. Discussing these experiences in maternity care presents an opportunity to support women, reduce stigma and connect them with resources. However, concerns persist about stigmatisation, re-traumatisation and unwarranted safeguarding referrals.

The objective of this study was to explore how trauma discussions should be approached in maternity care, drawing on the perspectives of women with lived experience, voluntary sector representatives and healthcare providers in the UK. Findings aim to inform the development of a future intervention.

Semistructured interviews were conducted with women with trauma histories (experts by experience; n=4), representatives of voluntary sector organisations (n=7) and healthcare providers (n=12). Reflexive thematic analysis was used to analyse the data. A qualitative content analysis approach was employed, supported by a Patient and Public Involvement and Engagement group (named as the ‘Research Collective’ for this study) comprising experts by experience, maternity care professionals and voluntary sector practitioners. The group contributed to both study design and data analysis.

Five descriptive categories emerged: (1) Rationale for discussions—whether and why trauma should be addressed; (2) Professionals and settings—who should lead discussions and in what environment; (3) Timing considerations—when discussions should occur; (4) Communicating about trauma—strategies to sensitively explore prior trauma; and (5) Supporting care providers—training and emotional support needs. Participants highlighted both the benefits of trauma discussions and the practical, emotional and systemic challenges involved.

Trauma discussions in maternity care are complex but essential. Findings provide practical, UK-specific insights into timing, communication and staff support considerations, highlighting the need for culturally sensitive, co-designed approaches to facilitate safe and effective trauma-informed care.

For ovarian cancer patients undergoing preoperative Neoadjuvant Chemotherapy (NACT), the toxicity of chemotherapeutic agents may cause hepatic and renal function impairment, altered sensitivity of the central nervous system or abnormal pain perception thresholds. These changes can further affect the metabolism and efficacy of intraoperative anaesthetics. However, the optimal intraoperative opioid dosage regimen for this specific patient population remains unclear. Currently, nociceptive stimulation monitoring technology has achieved certain progress in guiding intraoperative opioid administration. Among this technology, the index of consciousness 2 (IOC2), as a representative monitoring indicator in this field, provides important references for optimising opioid dosage regimens. This trial will investigate the opioid requirements and patient outcomes in the anaesthetic management of ovarian cancer patients undergoing preoperative NACT guided by IOC2.

This prospective, single-blind, single-centre randomised controlled trial will randomly recruit 90 patients undergoing open ovarian cancer cytoreductive surgery under general anaesthesia, with equal numbers assigned to the control and experimental groups. The experimental group will adjust the remifentanil plasma target concentration based on the IOC2 value, while the control group will adjust according to the patients’ mean arterial pressure. The primary outcome will be intraoperative opioid use (calculated in morphine equivalents per hour). Secondary outcomes include the average intraoperative propofol dose, post-anaesthesia care unit (PACU)-related metrics (including extubation time, time to spontaneous eye opening and morphine consumption in PACU), pain levels at 4, 24 and 48 hours postoperatively, as well as the use of analgesics and antiemetics. Postoperative recovery quality will also be assessed, including time to first flatus, time to ambulation, length of hospital stay and the 24-hour Quality of Recovery-15 (QoR-15) score.

This study involves human participants and was approved by the Ethics Committee of the Jiangsu Cancer Hospital (ethics no: XJS-2024-017). Patients gave informed consent to participate in the study before taking part. The study results will be published in peer-reviewed journals and presented at relevant academic conferences.

ChiCTR2400091897.