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.

The ‘time-limited trial’ for patients with critical illness is a collaborative plan made by clinicians, patients and families to use life-sustaining therapies for a defined duration. After this period, the patient’s response to therapy informs decisions about continuing recovery-focused care or transitioning to comfort-focused care. The promise of time-limited trials to help navigate the uncertain limits and benefits of life-sustaining therapies has been extensively discussed in the palliative and critical care literature, leading to their dissemination into clinical practice. However, we have little evidence to guide clinicians in how to conduct time-limited trials, leading to substantial variation in how and why they are currently used. The overall purpose of this study is to characterise the features of an optimal time-limited trial through a rich understanding of how they are currently shaping critical care delivery.

We are conducting an observational, multicentre, focused ethnography of time-limited trials in patients with acute respiratory failure receiving invasive mechanical ventilation in six intensive care units (ICUs) within five hospitals across the US. Study participants include patients, their surrogate decision makers and ICU clinicians. We are pursuing two complementary analyses of this rich data set using the open-ended, inductive approach of constructivist grounded theory and, in parallel, the structured, deductive methods of systems engineering. This cross-disciplinary, tailored approach intentionally preserves the tension between time-limited trials’ conceptual formulation and their heterogeneous, real-world use.

This study has been reviewed and approved by the University of Wisconsin Institutional Review Board (IRB) as the single IRB (ID: 2022-1681; initial approval date 23 January 2023). Our findings will be disseminated through peer-reviewed publication, conference presentations, and summaries for the public.

NCT06042621.

The main objective of the Health Survey of São Paulo or Inquérito de Saúde de São Paulo (ISA) in Portuguese, is to generate health indicators to support research and policy planning. The ISA-Physical Activity and Environment Longitudinal Study has the primary objective of examining built and social environmental determinants of leisure-time physical activity and active transportation.

The baseline (2014–2015) study included 4042 participants aged 12 years and older, men and women, living across the five regions of São Paulo city. Data were collected through household interviews. The second wave (2020–2021) used telephone interviews and included 1434 participants aged 18 or older, 58.6% female and representing 35% of the baseline sample. The third wave (2023–2024) included 1583 participants through household or telephone interviews, 58.6% of female and represented 39% of the original cohort.

The study has collected extensive individual-level data, including physical activity behaviours, health status and related behaviours, self-report of diseases and sociodemographic characteristics; built environment features such as public open spaces, transport infrastructure, schools and healthcare facilities, walkability index, sidewalks, traffic control and social environment features, such as crime occurrence and socioeconomic index. Analyses have identified changes in the built environment and their associations with physical activity and obesity. Infrastructure improvements, such as the increase of bike paths and outdoor gyms, have been more frequent in wealthier areas, reinforcing spatial inequalities. Increased availability of public open spaces has been associated with increased leisure-time walking. Obesity has shown a growing trend, particularly among specific sociodemographic groups, while physical activity has demonstrated protective effects against obesity. Cycling for transportation has remained stable over time, with disparities by gender and physical activity status.

The plan is to conduct the fourth wave in 2026 and 2027 and the fifth wave in 2029 and 2030.

To assess the comparative effectiveness of educational interventions in neurological disease for healthcare workers and students.

Systematic review.

Medline, Embase and Cochrane through to 1 June 2025.

Studies evaluating neurological disease educational interventions with a comparator group (observational cohort/randomised controlled trial (RCT)) were included.

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted (PROSPERO: CRD42023461838). Knowledge acquisition and educational methodologies were collected from each study. Study outcomes were classified using the Kirkpatrick and Kirkpatrick four-level model (learner reaction, knowledge acquisition, behavioural change, clinical outcome).¹ Risk of bias was assessed using the Newcastle-Ottawa scale for non-randomised studies and the Cochrane Risk of Bias tool for RCTs.^{2 3}

A total of 67 studies involving 4728 participants were included. Of these, 36 were RCTs, and 31 were observational studies. Virtual interventions were the most common (67.2%, n=45 studies), primarily targeting either medical students (46.3%, n=31 studies) or specialists (40.3%, n=27 studies). Overall, 70.1% (n=47) of studies demonstrated outcomes in favour of the intervention. However, few studies used K&K level 3/4 outcomes, with two studies evaluating behaviour change (level 3) and three assessing clinical outcomes (level 4 combined with other levels). No study exclusively assessed level 4 outcomes. Meta-analysis of 22 RCTs with calculable standardised mean differences (SMDs) (n=1748) showed a significant benefit of interventions (SMD 0.75, 95% CI 0.22 to 1.27, p=0.0056).

This review highlights a growing body of research particularly focusing on virtual techniques, specialist audiences and treatment-oriented content. Few studies assessed changes in practice or patient care. Non-specialists remain underrepresented. Future studies should prioritise assessing the clinical impact of educational interventions within non-specialist audiences.

The global prevalence of osteoarthritis (OA) is expected to rise as the population ages, leading to increased physical impairments that often reduce physical activity. Knee OA, in particular, is a leading cause of chronic pain and disability in people over 40. OA progression varies among individuals, with factors such as higher age and body mass index contributing to a more rapid progression. However, research suggests that engaging in physical activity such as hiking and running may help alleviate pain and slow OA progression. However, current literature on the relationship between physical activity and knee OA is largely retrospective, lacks comparative analyses across different physical activity types and rarely considers the intensity of physical activity. To address these gaps, the LoaD study was designed as a prospective cohort study aimed at examining how different physical activity types (ie, hiking, running, cycling and tennis) and their intensities relate to knee OA progression over 24 months in physically active individuals with early signs of the condition.

This prospective cohort study will include 300 participants (75 per physical activity group), who will be followed for 24 months. Eligible participants are aged 45–65, meet the National Institute for Health and Care Excellence (NICE) criteria for clinical knee OA and engage in a minimum weekly activity level for either running (60 min), cycling (120 min), playing tennis (60 min) or hiking (1 hike of 10 km). Baseline and follow-up assessments will include MRI, physical examination (eg, biometrics, lower extremity strength) and blood sampling for molecular biomarker assessment (eg, genetics, inflammatory biomarkers). Participants will receive monthly online questionnaires (eg, demographics, lifestyle, general health, history of knee injuries) and their physical activities will be tracked continuously by global positioning system data from wearable devices. The study’s primary outcomes focus on knee OA progression and symptom changes. These will be assessed through (1) structural progression of knee OA, measured using the MRI Osteoarthritis Knee Score (MOAKS) and (2) clinical symptom progression evaluated by (a) the Knee Injury and Osteoarthritis Outcome Score sport and recreation function subscale and (b) Visual Analogue Scale for pain during an activity nominated by the participant to be the most aggravating for knee pain in the past month (VASNA, 0–10). Differences between groups on the primary outcomes will be analysed using mixed-effects models to determine the impact of activity type and intensity on knee OA progression.

The study is approved by the Erasmus MC Medical Research and Ethics Committee (MREC) (MEC-2022-0420). The results of this study will be made publicly available through peer-reviewed international open-access scientific journals and national and international conferences. Participants will be informed about the results as soon as they are published.

Preventable hospital patient harm events disproportionally affect certain patient populations. For some, harm extends beyond physical injury to include cultural, emotional or spiritual impacts. While these disparities are linked to socio-demographics (eg, race, education), they are driven by structural factors (eg, procedures and policies). Patient safety monitoring systems (eg, incident reporting, patient concerns) were not originally designed to identify equity-related harms and may inadvertently obscure or reinforce the injustices they should address. This study will examine how equity is currently considered within hospital incident reporting and patient concerns systems across Canada and will identify opportunities to strengthen these systems’ responsiveness to inequities in patient safety.

This 3-year exploratory sequential mixed-method study began in September 2024. Phase one involves qualitative interviews with patient safety and equity leads, patients/families/caregivers and leaders of innovative initiatives to explore current practices, gaps and innovations in how equity-related factors are identified and addressed within incident reporting and patient concerns systems. Findings will inform Phase 2, a modified Delphi process with patient safety and equity experts and persons with lived experience of equity-related harm events to refine and reach consensus on key equity-promoting features, considerations and recommendations for these systems. In Phase 3, consensus items will be used to develop a national cross-sectional survey assessing the extent to which equity is integrated into hospital incident reporting and patient concerns systems in Canada. A patient advisory committee will inform data collection, interpretation of findings and dissemination.

Ethics approval has been received for Phase 1, with subsequent approvals to be sought for later phases. Dissemination plans include peer-reviewed publications, presentations at international conferences and knowledge exchange activities to inform patient engagement, the design of incident reporting and patient concerns systems and policy development.

An estimated 262 million people lived with asthma globally in 2019. Similarly, in 2021, chronic obstructive pulmonary disease (COPD) was responsible for 3.5% million global deaths. They are usually distinct disorders, but the Global Initiative Chronic Obstructive Lung Disease (GOLD) 2024 strategy document asserts that asthma and COPD are conditions that may coexist in an individual and may require specific personalised approaches and treatments. It is acknowledged that they may share some common treatable traits and clinical features There are many challenges to manage asthma and COPD in the older population, including poor adherence to prescribed medications and poor inhaler techniques. The overall aim of this systematic review is to identify, appraise and synthesise available evidence around digital health interventions used to improve medication adherence in older people with asthma or COPD.

This systematic review will examine studies that evaluated digital health interventions for asthma or COPD in any setting (eg, primary or secondary care). To be included, studies must be reported in English, Arabic or French and published from the year 2000 onwards. A literature search will be performed in MEDLINE via Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE and PsycINFO via Ovid to identify relevant articles published since 2000 and up to December 2024. No language restrictions will be applied.

The Cochrane risk-of-bias tool for randomised trials will be used to assess the quality of retrieved randomised controlled trials and quasi-experimental studies. The quality of cross-sectional, cohort and case-control studies will be assessed using the Newcastle Ottawa Scale. Mixed-methods studies will be assessed using the Mixed Methods Appraisal Tool (MMAT). The quality of qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) qualitative checklist.

Data will be synthesised using a convergent segregated approach, which involves an independent synthesis of quantitative and qualitative data leading to the generation of quantitative and qualitative evidence, which will then be integrated.

Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through a peer-reviewed publication and conference presentations. Findings will be used in a bigger project aimed to answer the question on how to embed a pharmacist-led digital health service to support older people with asthma or COPD into the NHS (National Health Service) usual care.

CRD42024575924.

Practice guidelines recommend addressing patient non-medical drivers of health such as access to nutritious food and transportation as part of whole-person care. Emergent electronic health record (EHR)-based tools can enable non-medical needs care coordination, but adoption commonly faces workflow and infrastructure barriers. Targeted implementation support strategies (eg, training, practice facilitation) can enhance technology adoption in healthcare settings, but no prior research has assessed if implementation strategies can improve how care managers use enabling technologies for non-medical needs care coordination. This study will test whether providing implementation support to primary care health centre care management teams improves the adoption of EHR-based enabling technologies to address patients’ non-medical needs.

This hybrid implementation-effectiveness type 2 pragmatic trial has a mixed methods design. The primary outcomes include: (1) Whether patients enrolled in care management programmes have been screened for unmet non-medical health-related needs and (2) Whether patients with identified unmet non-medical health-related needs received a referral to a community organisation to address their need. The secondary outcomes include: (1) Whether referrals for financial-related non-medical needs had a documented outcome in the EHR, such as successful connection to services, service unavailability or other disposition statuses, (2) Whether the referral outcomes indicated ‘successful connection to services’ and (3) Clinical markers including hypertension and diabetes control. Formative evaluation of barriers and facilitators to using EHR tools to conduct non-medical needs screening, referrals and tracking of receipt of services will include semi-structured interviews and a ‘guided tour’ of enabling technology used by care managers. A modified Delphi process will then inform the development of a set of implementation strategies for inclusion in the intervention. The intervention will be piloted in three health centres, refined, then tested in a stepped-wedge cluster-randomised trial in 20 health centres.

We obtained ethics approval for all study activities from Advarra Institutional Review Board (registration number #00000971). Results will be disseminated to Health Centres and Health Centre network nationally at meetings and we will disseminate to researchers via manuscripts in peer-reviewed journals and scientific meetings.

NCT06489002.

Antenatal depression (AD), a maternal mental health condition, has been increasingly prevalent in recent years. It is often triggered by various stressors, including hormonal changes, relationship problems and economic challenges. In Ghana, there is currently no recent nationally representative prevalence data on AD, despite a number of studies conducted in various regions.

Review will include observational studies which employed standardised diagnostic criteria or validated screening tools. We will search the PubMed, SCOPUS, African Index Medicus (AIM), Science Direct, Web of Science (WoS) and Google Scholar databases. The African Journal Online (AJOL) will also be handsearched. Targeted grey literature search will include selected tertiary institutional repositories, Ghana Health Service, Ministry of Health and Mental Health Authority websites. Studies in English will be included with no limits to date. Data extraction will be performed by two independent reviewers using a structured table, with a third reviewer resolving any discrepancies. Quality assessment of included studies will be conducted using the adapted National Institiute of Health (NIH) Quality Assessment Tool for observational studies. Pooled prevalence estimates will be calculated using a random-effects meta-analysis if studies are sufficiently homogeneous and subgroup analysis.

Given that this study involves no primary data collection, an ethical review is not necessary. The findings will be disseminated through publication in a peer-reviewed journal, presentations at academic conferences and key national stakeholder events.

CRD42025644715.

To assess the time to first optimal glycaemic control and its predictors among adult patients with type 1 and type 2 diabetes at the University of Gondar Comprehensive Specialized Hospital in Ethiopia.

A retrospective cohort study.

University of Gondar Comprehensive Specialized Hospital, northwest, Ethiopia.

We recruited 423 adult diabetic patients who were diagnosed between 1 January 2018 and 30 December 2022 at the University of Gondar Comprehensive Specialized Hospital.

The primary outcome was the time from diagnosis to the achievement of the first optimal glycaemic control, measured in months. A Cox proportional hazards regression model was fitted to identify predictors of time to first optimal glycaemic control. Data were collected with KoboToolbox from patient medical charts and exported to Stata V.17. The log-rank test was used to determine the survival difference between subgroups of participants.

Median time to first optimal glycaemic control was 10.6 months. Among 423 adult diabetic patients, 301 (71.16%) achieved the first optimal glycaemic control during the study period. Age category (middle age (adjusted HR (AHR)=0.56, 95% CI 0.41 to 0.76), older age (AHR=0.52, 95% CI 0.33 to 0.82)), comorbidity (AHR=0.52, 95% CI 0.35 to 0.76), therapeutic inertia (AHR=0.20, 95% CI 0.13 to 0.30) and medication non-compliance (AHR=0.49, 95% CI 0.27 to 0.89) were significant predictors of time to optimal glycaemic control.

The median time to first optimal glycaemic control was prolonged. Diabetic care should focus on controlling the identified predictors to achieve optimal glycaemic control early after diagnosis.

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

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

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

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

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

This review aims to map oral health plans, programmes and policies worldwide in countries with universal health coverage.

This protocol describes a scoping review that will follow the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review checklist, guided by the PCC framework: Population—countries with universal health coverage (78 globally recognised); Concept—oral health plans, programmes and policies; Context—integration into health systems. Searches will be conducted in MEDLINE (PubMed), Scopus, Web of Science, Embase, Health System Evidence and Epistemonikos, with no restrictions on date, language or study type. Grey literature will be accessed through Google Scholar, OpenThesis and the Brazilian Digital Library of Theses and Dissertations. Official documents from ministries of health and international bodies, including the WHO and the International Monetary Fund, will also be reviewed. Two independent reviewers will screen titles and abstracts; a third will resolve disagreements. Eligible records will undergo full-text review. Data will be extracted into predefined categories reflecting health system components: population, structure, services, governance and oral health indicators. Results will be presented using tables, charts and figures to illustrate strategies and innovations.

This review does not involve primary data collection and does not require ethical approval. Results will be disseminated through a peer-reviewed publication and presentations at academic conferences and scientific events.

Open Science Framework (DOI 10.17605/OSF.IO/RCP8N).

This study aimed to assess functional disability and associated factors among people with severe mental illness attending public hospitals in Harar town, Eastern Ethiopia.

An institution-based cross-sectional study was conducted in public hospitals found in Harar town, Eastern Ethiopia, from 1 April to 10 May 2023.

A total of 342 patients with severe mental illness attending public hospitals in Harar town, Eastern Ethiopia, were included.

The main outcome of this study was functional disability, which was measured using a 12-item version of the WHO Disability Assessment Schedule.

In this study, the mean (±) score of functional disability among patients with severe mental illness was 31.8 (±9.6) (95% CI: 30.7 to 32.8). The multiple linear regression model revealed that unemployment (β: 1.93; 95% CI: 0.28 to 3.59), total illness duration (5–10 years and above 10 years) (β: 3.71; 95% CI: 1.95 to 5.48 and β: 4.51; 95% CI: 2.41 to 6.62, respectively), age at illness onset (β: –0.37; 95% CI: –0.45 to –0.28), having drug side effects (β: 3.05; 95% CI: 1.46 to 4.63), medication non-adherence (β: 6.15; 95% CI: 4.56 to 7.73) and having high perceived stigma (β: 2.27; 95% CI: 0.72 to 3.82) were significantly associated with functional disability.

Patients with severe mental illness had a high mean functional disability score. Unemployment, age at onset of mental illness, total duration of illness, medication side effects, medication non-adherence and higher perceived stigma were factors that were associated with functional disability. Given the mean functional disability score observed among respondents, a multipronged intervention strategy that prioritises early detection and management of severe mental illness, particularly targeting individuals at risk, is recommended to mitigate disability and enhance quality of life.

The hospital-at-home (HaH) model has gained traction as a viable alternative to traditional inpatient care, allowing patients to receive care in their own homes. Despite its growing popularity, there is a lack of comprehensive research addressing effectiveness, safety and factors critical to the successful implementation of HaH programmes. We conducted a scoping review to comprehensively map and summarise the evidence on both admission avoidance and early-supported discharge up until now.

A scoping review of randomised controlled trials (RCTs), conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: extension for Scoping Reviews (PRISMA-ScR) guidelines.

Ovid MEDLINE, Embase, CINAHL and Web of Science were systematically searched up to July 2024

We included English-language RCTs published from 2005 onwards, involving adults (≥18 years) receiving acute care at home who would otherwise require hospital admission. Eligible studies evaluated admission avoidance or early supported discharge within HaH settings for acutely ill patients. Studies focusing on outpatient care, non-acute conditions or interventions not aligning with the widely accepted HaH definition were excluded. COVID-19-related studies were also excluded to avoid context-specific bias.

Two reviewers independently extracted data on study characteristics, interventions and outcomes including mortality, length of stay, escalation rates, costs and patient and caregiver satisfaction. Implementation facilitators and barriers were also collected. Discrepancies were resolved by a third reviewer. Results were synthesised descriptively in accordance with PRISMA-ScR guidelines.

Nine RCTs were identified. The review shows that the HaH model is at least as safe as usual care, with lower or comparable mortality rates. Length of stay varied, with some studies reporting longer stays in the HaH group due to cautious clinical practices. Cost analyses often indicate lower healthcare costs with staffing as the largest expense. Patient and caregiver satisfaction was high, but essential implementation factors were not clearly addressed.

The HaH model represents a promising alternative to acute inpatient care for suitable patients. Future research should focus on conducting larger RCTs, expanding the range of conditions suitable for HaH. Despite favourable clinical outcomes, substantial implementation barriers remain underexplored in current RCTs. This underscores the need to identify strategies for successful implementation, including the integration of technological advancements and qualitative insights into patient and caregiver experiences.

Non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases and cancer, are major global public health concerns. Diet quality—particularly the consumption of ultra-processed foods—has been associated with increased risk of NCDs. Traditional cohort studies are often expensive and logistically complex. The NutriNet-Brasil cohort leverages a web-based approach, offering a cost-effective and practical solution for comprehensive data collection and long-term follow-up.

Recruitments began in January 2020 through mass media, social media campaigns and collaborations with health organisations. Eligible participants are adults (aged ≥18 years) living in Brazil with internet access. Participants complete self-administered online questionnaires covering dietary intake, health status and other health determinants. Dietary assessment is based on the Nova classification system, which categorises foods by their level of processing.

Over 88 000 participants have completed the initial questionnaire. The cohort is predominantly women (79.9%) and highly educated (67.9% had completed higher education). The web-based design enabled the development and application of innovative dietary assessment tools, including the Nova24h and the Nova24hScreener, specifically designed to evaluate food processing levels. These tools have shown good performance in capturing dietary patterns and are central to the cohort’s aim. The online platform facilitates efficient recruitment, data collection and participant retention.

NutriNet-Brasil is pioneering the development of web-based cohort methodologies and instruments tailored to food processing research. Future work includes leveraging collaborations with national and international research centres to conduct multidisciplinary analyses and inform public health policies.

The objective of this review is to examine the current available evidence regarding the assessment of speech sound disorders (SSD) in multilingual preschoolers. This review will be conducted through the lens of the International Classification of Functioning and Disability—Child and Youth (ICF) framework, WHO. The ICF has been adopted by speech–language associations globally, offering an appropriate structure to inform this review. Most children across the world speak more than one language daily. However, measures designed to assess SSDs primarily focus on monolingual populations, placing multilingual children at risk for the misdiagnosis of SSD. A deeper understanding of available assessment measures, as well as what aspects of the ICF they address, will support clinicians in assessing SSD in multilingual children and aid researchers in identifying areas for future research. This review will explore studies that involve multilingual preschoolers (up to age 5 years 11 months) with SSD. It will examine measures used to evaluate the current status and/or progress over time in multilingual children with and without SSDs.

This scoping review protocol implements the updated Joanna Briggs Institute (JBI) Scoping Review Methodology. The search will be conducted using Ovid MEDLINE, CINAHL Plus, EMBASE and Web of Science. Grey literature will also be searched using Google Scholar and ProQuest Dissertations and Theses Global. Search, screening, data extraction and data analysis will be conducted by a team of three reviewers. Data will be analysed and mapped through the ICF framework.

Ethical approval is not required for this scoping review. Available evidence will be mapped according to the language pairings and the ICF. This review aims to support clinical and research speech–language pathologists in identifying current evidence and gaps in the knowledge base. Planned dissemination activities include a peer-reviewed publication and conference presentations.

Persons living with HIV (PLWH) have an augmented risk of cardiovascular disease, including atherosclerosis and myocardial dysfunction, despite effective viral suppression with antiretroviral therapy. Despite the majority of PLWH residing in sub-Saharan Africa, there are limited reports from the region on structural cardiovascular changes due to this residual risk.

The Early Structural Cardiovascular Disease, HIV, and Tuberculosis in East Africa (ASANTE) cross-sectional study will be conducted in a public hospital in Nairobi, Kenya. It will enrol 400 participants (50% women, 50% PLWH) to undergo cardiovascular phenotyping using multimodal imaging (coronary CT angiography (CCTA) and echocardiography) and banking of biological samples (whole blood, peripheral blood mononuclear cells, plasma and urine). We will define the prevalence of subclinical coronary atherosclerosis by CCTA and subclinical myocardial dysfunction by transthoracic echocardiography and evaluate both traditional and non-traditional risk factors, including endemic infections such as latent tuberculosis. This study will contribute important data on phenotypes of and risk factors for HIV-associated cardiovascular disease in this understudied region.

Ethical approval for the ASANTE study was granted by the University of Nairobi-Kenyatta National Hospital Ethical Review Committee, Nairobi, Kenya, and the University of Washington Institutional Review Board, USA. Results will be submitted for publication in peer-reviewed journals.

The experimental EuroQol Toddler and Infant Populations (EQ-TIPS) instrument is currently under development as a health-related quality of life (HRQoL) measure for toddlers and infants aged 0–36 months. Using this protocol, researchers can conduct surveys with discrete choice experiments (DCEs) that examine the key properties of HRQoL instruments, specifically whether severity aligns with preferences across each attribute and the extent to which attributes influence choices. To demonstrate this protocol, we will conduct two waves of DCE surveys using different choice tasks and a common scenario (a 1-month health episode for a 1-year-old child).

In the first wave (a general population sample of 400 Australian adults; 14 kaizen tasks each), respondents will view a single EQ-TIPS-five-level (v3.0) profile for each task and be asked to make a series of choices that sequentially alleviate the child’s health problems. Using this exploratory evidence, we will assess whether EQ-TIPS severity aligns with preferences and the extent to which each attribute level influences choices (ie, main effects). In the second wave (1000 Australian adults; 28 paired comparisons), respondents will see two EQ-TIPS profiles for each task and be asked to choose between them. Using this confirmatory evidence, we will compare the main effects and their uncertainty by wave. For each DCE, we will estimate a main-effects conditional logit model and test for differences in effects using cluster bootstrap techniques. As sensitivity analyses, we will evaluate the effects of task sequence, attribute order and sample size on uncertainty in each wave.

The independent review board at Includovate evaluated the application for ethical clearance and approved the study on 19 February 2025. To disseminate our findings, we will prepare multiple manuscripts for publication in peer-reviewed journals and present highlights at scientific meetings, such as the EuroQol Plenary Meeting and the International Academy of Health Preference Research.

This study aimed to assess the coronavirus disease 2019 (COVID-19) hospitalisation costs and its associated factors on Nepalese households during the second wave of the pandemic, within the context of Nepal’s COVID-19 response.

A cost-descriptive cross-sectional study.

Kathmandu Metropolitan City, Nepal.

We enrolled 306 hospitalised patients.

Telephonic interviews were conducted with COVID-19 patients between May and July 2022. Cost was assessed from a patient’s perspective. We assessed factors associated with the medical cost of COVID-19 treatment services using a generalised linear model with gamma distribution and log link in both bivariable and multivariable models for estimating coefficients and confidence intervals. Data were analysed using STATA version 13, adjusting for the potential confounders: socio-demographic characteristics, type of hospital, intensive care unit (ICU) requirement, lead time to hospital admission and number of days at hospital stay.

The total median cost for hospitalisation was US$ 754.9. The median direct medical, direct non-medical and indirect costs were US$ 624.4, US$ 49.3 and US$ 493.02, respectively. After adjusting for potential confounders, the cost of COVID-19 treatment was 6.9 times higher among those admitted to private hospital (95% CI 5.72 to 8.32, p

The cost of the COVID-19 treatment was beyond the average monthly income of Nepalese, indicating adverse consequences from the financial burden of a household. The direct medical cost was associated with the type of hospital, requirement of ICU, lead time to hospital admission, and length of hospital stay. Therefore, it is urgent to address the issue of high medical expenses, particularly to strengthen the health system’s resilience against unforeseen crises and pandemics.