Proximal humeral fractures are increasingly common, particularly among older people, whereas the prognosis of surgical treatments for these fractures remains substantially uncertain. In China, where the ageing population is rapidly growing, high-quality prospective data on surgical outcomes, complications and cost-effectiveness are lacking. To address this gap, we propose to initiate a prospective, multicentre cohort study on surgical treatment for proximal humeral fractures in China—Cohort of Acute Shoulder Trauma (CAST) study.

The CAST is a multicentre, prospective cohort study enrolling patients with acute proximal humeral fractures undergoing surgical treatments at eight hospitals in China between May 2024 and December 2029. Patients can receive any of the surgical treatment methods which include percutaneous Kirschner wire fixation, external fixation, open reduction and internal fixation using locking plates or intramedullary nails, suture anchors and shoulder arthroplasty. We will collect patient-reported outcome measures (Quick Disabilities of the Arm, Shoulder and Hand), Constant-Murley, American Shoulder and Elbow Surgeons, EuroQol 5-Dimension and Visual Analogue Scale), physical examination results, imaging assessments (based on X-rays, ultrasound, CT and MRI scans), laboratory tests (including inflammatory cytokines) and data on medical costs. We will follow patients at 1 day, and at 1 month, 3 months, 6 months, 12 months and 24 months postoperatively. The planned sample size is 1500 patients.

The study protocol has been approved by the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University (Approval No. 2024-ky-104(K)). Written informed consent will be obtained from all participants. Findings from the CAST study will be disseminated through peer-reviewed journals and academic conferences.

ChiCTR2500109651.

Growing evidence suggests that vaccines targeting respiratory pathogens have non-specific and broader effects. We aimed to investigate the non-specific effects of respiratory vaccines on acute lower respiratory infection (ALRI) hospitalisations and associated outcomes in children

Systematic review and meta-analysis.

We searched online databases including Medline, Embase, CINAHL, Scopus and Clinical Trials.gov from inception to 24 January 2024.

We included human studies involving non-specific/off-target effects of respiratory vaccines (including maternal, infant and childhood vaccines) and excluded studies investigating the Bacille Calmette-Guérin vaccine and non-pathogen-confirmed outcomes following pneumococcal conjugate vaccination (PCV).

We used Research Screener, a machine learning tool, to semi-automate the abstract screening process and Covidence, a management and streamlining software for full-text reviews and data extraction. A meta-analysis was conducted if four or more studies reported on the same outcome and the same exposure vaccine.

After removing duplicates, 9727 articles were identified. After screening and full-text reviews, 20 articles were eligible. Of those, four met the requirements for a meta-analysis which showed a 21% vaccine effectiveness (VE) (95% CI 8.0% to 32.0%) of maternal influenza vaccine against all-cause ALRI hospitalisations in infants

Our review demonstrated both protective and neutral non-specific effects of respiratory vaccines against ALRI-hospitalisations and related outcomes in young children. Such effects should be considered as part of the full value of a vaccine and how vaccine investments are prioritised. Further research on the impact of respiratory vaccines on antibiotic prescribing rates is essential as consistent reductions may help contribute to reducing the global burden of antimicrobial resistance.

CRD 42023476038.

Older age is one of the greatest risk factors of dementia, and the rural demographic is ageing in Canada. Compared with their urban counterparts, rural older adults often face unique challenges in accessing cognitive healthcare, which is exacerbated by a shortage of healthcare specialists, public transportation, finances, education, services and dispersed geography. This scoping review protocol outlines the methodology that will be used to examine the literature about the care priorities, service needs and lived experiences from the perspectives of rural older adults living with cognitive impairment and dementia in Canada.

Our scoping review protocol will follow the guidance of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions for Scoping Reviews checklist. Our search strategy will identify relevant peer-reviewed literature in databases including Cumulated Index in Nursing and Allied Health Literature (CINAHL), EMBASE, PsycINFO, PubMed, Web of Science and Scopus. The database search dates for this scoping review will be from 1 January 2015 to 1 January 2025. The data will be charted by two reviewers using a standardised data extraction table. Inductive content analysis will be performed using a three-step process.

Given this scoping review will be an examination of the published literature, human subjects will not be included in this research. Therefore, ethics approval is not required. Knowledge mobilisation and dissemination strategies will include peer-reviewed journal articles, conference presentations, community workshops, newsletter articles and webinars. This study may provide valuable information for healthcare practitioners, community leaders and policymakers working to support people living with cognitive impairment and dementia in rural communities.

The WHO recommends task-sharing with community health workers (CHWs) to help overcome the limited access to hearing healthcare and hearing aids in low-income and middle-income settings (LMIs). This systematic review examined the feasibility, efficacy and effectiveness of CHW-facilitated hearing aid provision.

Systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

PubMed, Scopus and Web of Science were searched through 4 June 2025.

Studies in which CHWs facilitated hearing aid provision in any context.

Data on study characteristics, CHW training and roles, hearing-aid outcomes and implementation factors were extracted. Study quality was determined using the National Institute of Health quality assessment tool, and level of evidence was determined using the Centre for Evidence-Based Medicine. A narrative synthesis was conducted.

Six studies published between 2013 and 2025 were included. Two were conducted in high-income countries but implemented in LMI communities. Four studies were conducted in LMI countries. All provided CHW training, though content and duration varied; only one used WHO-endorsed materials. Sustained device use was high as reported at follow-ups, though only one included 12-month outcomes. All studies included validated outcome measures, including the International Outcome Inventory for Hearing Aids, Hearing Handicap Inventory for the Elderly–Screening version, Abbreviated Profile of Hearing Aid Benefit and Self-Efficacy for Situational Communication Management Questionnaire. Implementation facilitators included use of local CHWs, delivery in participants’ home languages, comprehensive CHW training and employing mHealth tools. Barriers included CHW scope constraints and unfamiliarity with outcome subscales in rural contexts. Only two studies used formal feasibility frameworks.

CHW-facilitated hearing aid provision is feasible and effective. However, variation in training and implementation highlights the need for standardised training materials, supervision models and culturally adapted outcome measures. Further research should examine long-term outcomes, cost-effectiveness and scalability using formal implementation frameworks.

Atrial fibrillation (AF), the most common sustained arrhythmia globally, necessitates effective strategies for stroke prevention. Although current risk stratification tools, such as the CHA₂DS₂-VASc score, are widely used to guide anticoagulation therapy, their limited predictive accuracy underscores the urgent need for more precise and reliable models. This study aims to establish a nationwide AF registry incorporating multi-dimensional data to identify novel risk factors and develop a more accurate stroke prediction model to improve risk stratification and guide anticoagulation therapy in patients with AF.

The risk factors for stroke in patients with non-valvular AF in China (REFINE) registry is a nationwide, multicentre, observational registry integrating retrospective (n=20 000) and prospective (n=5000) cohorts. Demographics, lifestyle, medical history, physical examination, laboratory tests, ECG, echocardiography, contrast-enhanced CT scan and blood samples will be collected at baseline. Long-term follow-up will be performed to identify clinical events and treatment at the timepoint. We aim to use the multidimensional dataset to establish a more precise stroke risk predictive tool.

The study is approved by the Ethics Committee of Fuwai Hospital, CAMS&PUMC (No. 2022–1845; No. 2024–2489) and registered at ClinicalTrials.gov, identifier NCT05598632. The results of this study will be disseminated through publications in peer-­reviewed journals and conference presentations.

NCT05598632.

In the Netherlands, approximately 2200 major amputations of the lower extremities are performed each year, the majority in vascular patients. Around 61% of these patients will develop postamputation pain (PAP). PAP is a severe, lifelong, disabling condition profoundly affecting quality of life. During amputations, the common practice is to cut the nerves without employing nerve-surgical techniques to prevent chronic pain due to neuroma formation. In recent years, targeted muscle reinnervation (TMR) has been the most frequently studied technique for treating PAP, inhibiting neuroma formation by rerouting the cut mixed nerve to a functional motor nerve. We hypothesise that a primary TMR procedure during major lower limb amputations will result in a lower prevalence of PAP.

We propose a national, multicentre, randomised, sham-controlled trial comparing TMR with traction neurectomy in major amputations of the lower extremities in patients with vascular disease. 203 patients will be recruited with an indication for a transfemoral to transtibial amputation as a primary or secondary sequela of vascular disease. The subjects are randomly assigned to the TMR group or the traction neurectomy group. PAP will be evaluated 1 year postoperatively as the primary endpoint. Secondary outcomes include quality of life, mobility, neuropathic pain, hospital anxiety and depression, cost-effectiveness and complications.

This study has been reviewed and approved by the local ethical review body, ‘The Medical Ethics Committee Leiden The Hague Delft’, under the reference: P24.073 on 28 November 2024. Results will be published in peer-reviewed journals.

NCT06719245. Dutch trial registry: NL87196.058.24

Idiopathic pulmonary fibrosis (IPF), an unknown aetiology type of interstitial lung disease (ILD), carries the poorest prognosis and is more common in males and the elderly. Gender differences in baseline presentation, lung function and comorbidities may have an impact on prognostic outcomes.

The aim of this study was to explore gender differences in clinical features, comorbidities and outcomes in IPF in a UK cohort.

This was a retrospective cohort study analysing data from the British Thoracic Society UK IPF ILD Registry from January 2013 to February 2024. We compared baseline characteristics between males and females, and a survival analysis in both genders was performed using the Cox proportional hazards model.

We identified 6666 IPF patients with a mean age at diagnosis of 74.1±8.1. Our cohort was predominantly male (5197, 78%), with a higher proportion of current and ex-smokers compared with females (69.9% vs 59.9%, p

Gender differences in baseline characteristics and prognostic factors were observed in IPF. A gender-based approach in managing IPF is warranted, and further studies are needed to clarify these differences and their impact on IPF management.

Stroke is a leading cause of disability and mortality worldwide, with upper limb dysfunction being among its most common effects. Compression therapy has recently gained growing interest as an adjunct to other rehabilitation interventions for managing upper limb dysfunction among stroke survivors. However, the evidence for its effectiveness remains inconsistent and equivocal. Therefore, this systematic review aims to assess the effectiveness of compression therapy in managing upper limb dysfunction in patients with stroke.

A systematic search of databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, PEDro, OTseeker, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform) will be conducted to identify peer-reviewed studies and relevant grey literature on compression therapy on upper limb dysfunction after stroke. Two reviewers will independently screen, select and extract data, with discrepancies resolved through discussion or involvement of a third reviewer. Outcomes of interest include clinical measures of upper limb function, activity, participation and safety (ie, adverse effects). Risk of bias will be assessed using the Cochrane RoB 2 for randomised studies, the Risk Of Bias In Non-randomised Studies of Interventions for non-randomised studies. The certainty of evidence across types of compression therapy and outcomes will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Data will be narratively synthesised, and a meta-analysis will be performed if feasible. The review will be reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and will be conducted from September 2025 to December 2025.

This systematic review does not require ethical approval as only secondary data will be used. This review will synthesise the body of evidence on the effectiveness of compression therapy in managing poststroke upper limb dysfunction. Results will then be disseminated through a peer-reviewed publication to inform research and clinical practice.

CRD42024625815.

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

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

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

Scoliosis-specific exercises require specialist supervision, frequent clinical visits, and high costs, limiting accessibility. Additionally, females with idiopathic scoliosis (IS) engage in less physical activity (PA) than sex- and age-matched peers, leading to poorer bone and muscle health. These challenges underscore the need for accessible, home-based interventions targeting both musculoskeletal health and spinal alignment.

This single-blinded, randomised controlled trial aims to investigate the efficacy of a 16-week home-based exercise intervention on bone mineral density (BMD), Cobb angle, spinal flexibility, core muscle endurance, lean body mass, and quality of life (QoL) in females with IS. 28 participants will be randomly assigned (1:1) to either an intervention group (IG) or a control group (CG). Both groups will perform Schroth and core stabilisation exercises three times per week, while the IG will additionally perform impact-loading exercises. The primary outcome is BMD. Secondary outcomes include Cobb angle, lean body mass, cosmetic trunk deformity, spinal flexibility, core muscle endurance, and QoL. All outcomes will be assessed at baseline and post-intervention, with interim evaluations (excluding BMD, Cobb angle, and lean body mass) conducted at weeks 4, 8, and 12. All assessors, radiologists, and statisticians will remain blinded to group allocation. Treatment effects between groups over time will be analysed using two-way mixed-design analysis of variance (ANOVA).

This study addresses a critical gap in IS management by integrating a preventive and therapeutic home-based programme. The approach aims to improve musculoskeletal health, spinal alignment, and overall QoL. Its accessible format may inform future guidelines for conservative treatment and early intervention. Such interventions could significantly enhance bone health, reduce the risk of progression, and improve long-term musculoskeletal outcomes in young females with mild to moderate IS.

This study has received ethical approval from the Research Ethics Committee, Faculty of Associated Medical Sciences, Chiang Mai University (No. AMSEC-67EX-045). The findings will be disseminated through a peer-reviewed publication.

TCTR20241001001.

Dysmenorrhoea (period pain) is a global public health issue affecting up to 91% of the 1.8 billion individuals who menstruate. While research has emphasised the improvement of menstrual health in low-middle-income countries, undertreated dysmenorrhoea remains an issue in high-income countries (HICs), where individuals often assume their pain experiences are normal. Studies report that individuals with dysmenorrhoea delay seeking medical care, avoid it entirely or are subjected to diagnostic and treatment delays. Difficulties accessing care are troubling, as individuals may suffer without access to evidence-based techniques, as well as the potential for underlying pathologies (eg, endometriosis, pelvic inflammatory disease) to go undiagnosed.

Many HICs have launched strategies for women’s health to address gaps in care access and knowledge around menstruation. Guided by Levesque and colleagues' (2013) Conceptual Framework of Access to Healthcare, this review will contribute to these strategies by providing an overview of factors affecting healthcare access for dysmenorrhoea in HICs from the point of perceiving a healthcare need to engaging with care, as well as factors affecting perceived quality of care.

This scoping review will follow the Joanna Briggs Institute’s (JBI) guidance for scoping reviews and will be conducted with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist extension for Scoping Reviews. Guided by Levesque and colleagues’ (2013) Conceptual Framework of Access to Healthcare, searching will seek to locate both peer-reviewed studies across PubMed, CINAHL, PsycINFO and Web of Science databases, as well as using web scraping to locate relevant grey literature. Results will be synthesised and mapped to construct a pathway to care, highlighting factors affecting the healthcare access for dysmenorrhoea, as well as factors related to the quality of healthcare interactions.

This review does not require ethical approval, as only existing data will be analysed. Results will be shared using peer-reviewed publications and conference presentations. Datasets emerging from the study will be made available on Open Science Framework.

This review was initially registered on Open Science Framework (https://osf.io/2dsrc/) in February 2024, with an updated protocol registered in February 2025.

Impostor syndrome (IS) is a psychological state whereby individuals doubt their abilities despite evidence of competence. Though IS has been studied in specific medical groups, no review to date compares findings across groups. This study aimed to: (1) determine the range of IS rates among medical undergraduates versus postgraduates and (2) examine associated factors across both groups.

This scoping review used the Joanna Briggs Institute methodology for scoping reviews, using a five-step framework.

PubMed, Scopus and PsycINFO databases were searched from inception until September 2024.

Studies were included if they were (1) empirical studies with a defined IS rating scale, (2) involving medical undergraduates, residents or clinicians and (3) published in English.

Three independent reviewers used standardised methods to screen and review selected studies, and extract key variables.

54 studies (77.8% from the West) were included. There was equal study distribution between undergraduates (46.3%, 25 studies) and postgraduates (46.3%, 25 studies), with the rest covering both groups. IS prevalence was substantial across all groups when assessed using the Clance Impostor Phenomenon Scale, ranging from 30.6% to 75.9% among undergraduates, 33.0% to 75.0% among residents and 23.5% to 50.0% among faculty and clinicians. In undergraduates, IS was associated with learning breaks, transition periods and poor academic performance. Among postgraduates, IS was correlated with younger age, junior ranking, fewer work years, inadequate faculty support or self-perceived poor clinical and teaching skills. Additionally, IS affected physical and psychological well-being (stress, anxiety, depression, burnout) and was associated with sociodemographic factors (single status, females), personality (neuroticism, perfectionistic traits, with conscientiousness, agreeableness and extraversion as protective) and interpersonal issues (conflicts, poor sense of belonging).

Given the high IS prevalence and associations with specific factors, practical measures are recommended to address IS and optimise learning and care for medical undergraduates and professionals.

Poststroke individuals have a high incidence of falls during the first months after discharge. The factors contributing to falls in poststroke patients are multifaceted, with balance deficits being the most prominent. Fall-related self-efficacy has also been identified as a key factor influencing the effectiveness of fall prevention interventions. Additionally, family members play a crucial role in fall prevention by providing support, supervision and assistance with mobility and daily activities. While previous studies support the potential benefits of a fall prevention programme for poststroke individuals, further evidence is needed to confirm their effectiveness. Building on the positive outcomes of self-management (SM) interventions in reducing falls across diverse populations, this study aims to evaluate the effects of an individual and family SM (IFSM) fall prevention programme on balance ability and fall-related self-efficacy among poststroke individuals.

This study will be a two-arm, single-blind, pre–post test randomised controlled trial. The target sample will consist of 60 poststroke adults with moderate severity and their primary family members. The intervention group will receive the IFSM fall prevention programme, which consists of 10 weekly sessions. The main components of the programme are exercise, home environment assessment, assistive technology, medication review and safety during daily activities. The control group will receive usual care but will not participate in any specific intervention. Primary outcomes—balance ability and fall-related self-efficacy—will be assessed at baseline and week 8 after discharge. Secondary outcomes will include the number of falls and fall-related injuries.

Ethical approval was obtained from the Research Ethics Committees of the Faculty of Nursing, Chiang Mai University and the Affiliated Hospital of Guizhou Medical University. The results will be disseminated to poststroke individuals and their families through workshops; to healthcare professionals via professional training and meetings; and to researchers via conferences and publications.

NCT06577662.