This study aims to analyse the barriers and facilitators towards an implementation of active breaks (ABs) intervention inside the workplace.

This study used a mixed-methods approach, incorporating virtual focus groups and an online questionnaire, conducted among the workers of Alma Mater Studiorum - University of Bologna (Italy). A total of 30 participants (N=30), including administrative and academic staff, PhD candidates, specialised trainees and research fellows, were involved in the study. Key themes and subthemes related to the barriers and facilitators of ABs interventions at the university were identified and categorised according to the three levels of the socio-ecological model.

The most commonly reported barriers are: lack of time, lack of motivation (intrapersonal level); lack of influence, lack of awareness (social level); physical space, organisational support (environmental level). The most commonly reported facilitators are: access to information, flexible work hours (intrapersonal level); group support, awareness programmes (social level); adequate spaces, organisational structure (environmental level). A significant majority (81.48%) recognised the problem of sedentary time at work, with strong interest (92.59%) in workplace interventions to reduce it. Flexibility in timing for ABs (44.44%) was preferred over fixed schedules, with preference for dedicated areas (37.04%) and outdoor spaces (29.63%). The majority (62.96%) preferred taking ABs in small groups open to all, with a qualified kinesiologist (40.74%) leading the management.

This study identified barriers and facilitators to an ABs intervention from the perspective of administrative staff, residents and researchers. These findings could help institutions foster an environment that promotes physical activity, reduces sedentary behaviour and promotes the well-being and safety of workers through an integrated and individual-centred approach.

Neonatal death and later disability remain common sequelae of hypoxic-ischaemic encephalopathy (HIE) despite the now standard use of therapeutic hypothermia (HT). New therapeutic approaches to brain protection are required. Melatonin is an indolamine hormone with free-radical scavenging, antiapoptotic, anti-inflammatory and gene regulatory neuroprotective properties, which has extensive preclinical evidence of safety and efficacy. Pharmacokinetic (PK) data suggest it is necessary to reach melatonin levels of 15–30 mg/L within 6–8 hours of hypoxia-ischaemia for brain protection. We developed a novel Good Manufacturing Practice (GMP) grade melatonin in ethanol 50 mg/mL solution for intravenous use. In preclinical studies, ethanol is an adjuvant excipient with additional neuroprotective benefit; optimised dosing protocols can achieve therapeutic melatonin levels while limiting blood alcohol concentrations (BACs).

The Acute High Dose Melatonin for Encephalopathy of the Newborn (ACUMEN) Study is a first-in-human, international, multicentre, phase 1 safety study of intravenous melatonin in babies with moderate/severe HIE receiving HT. Sixty babies will be studied over two phases: a dose escalation study including four dose levels to establish the recommended phase 2 dose (RP2D), followed by a 6-month cohort expansion study of RP2D to further characterise PKs and affirm safety. Participants will receive a 2-hour intravenous infusion of melatonin within 6 hours of birth, followed by five maintenance doses every 12 hours to cover the period of HT. Plasma melatonin and BACs will be monitored. The RP2D will be based on the attainment of therapeutic melatonin levels while limiting BACs and the frequency of dose-limiting events (DLEs). A Bayesian Escalation with Overdose Control approach will be used to estimate the risk of DLE per dose level, with a target level of

Approval has been given by the London Central National Health Service Health Research Authority Ethics Committee (25/LO/0170) and UK Clinical Trials Authorisation from the Medicines and Healthcare products Regulatory Agency. Separate approvals have been sought in Ireland and Australia. Dissemination will be via peer-reviewed journals, conference presentations, public registries and plain language summaries for parent/legal guardian(s), in accordance with national requirements.

ISRCTN61218504. EU CT: 2025-520538-49-00.

Publication based on the UK protocol V.3.0, 08 May 2025

To explore the feasibility and acceptability of pain management (transcutaneous electrical nerve stimulation (TENS)) and patient education (PE) to increase physical activity in people with peripheral arterial disease and intermittent claudication (IC).

Feasibility randomised controlled trial with embedded process evaluation.

One secondary care UK vascular centre.

56 community-dwelling adults with a history of stable IC and ankle-brachial pressure index ≤0.9 were recruited via claudication clinics.

Participants randomised to 6 weeks of: TENS+PE, TENS, Placebo TENS+PE or Placebo TENS. PE was a 3-hour workshop plus three follow-up phone calls. The TENS machine was worn during walking (TENS: 120 Hz, 200 μs, intensity ‘strong but comfortable’; Placebo TENS: intensity below sensation threshold).

Primary feasibility outcomes included rates of recruitment, retention and adherence. Acceptability of the intervention and trial procedures was explored with semistructured interviews. Measures of walking capacity, walking behaviour, quality of life, disease perception and pain were recorded at baseline, end of intervention (6 weeks) and follow-up (3 months).

56 participants were randomised from 95 who completed baseline screening. Of the 39 excluded, 97% (38/39) had >20% variability in absolute claudication distance. All participants received their allocated intervention. Outcome completion was 91% at 6 weeks and 80% at 3 months. Attendance at group education was 96% with 63% taking follow-up phone calls. Compliance with TENS was 70% according to participant-completed logs. Interviewed participants (n=9) were generally positive about the acceptability of the interventions and trial procedures; however, experience of TENS use was mixed. Some participants were dissatisfied with the size of the device and electrode wires.

The PrEPAID (Pain management and Patient Education for Physical Activity in Intermittent claudication) trial was feasible to run; however, 40% of potential participants were excluded at screening due to issues of research fidelity rather than participant suitability or willingness to participate. A future definitive trial should consider a revised primary outcome measure and smaller wireless TENS machines.

ClinicalTrials.gov, NCT03204825. Registered on 2 July 2017.

Chief Scientist Office, Scottish Government. Translational grant award (TCS/16/55).

Socioeconomic disparities in diabetes incidence vary across countries and geographical areas. In addition, once diabetes is diagnosed, further disparities can arise during the whole care process. This study aims to evaluate disparities in incidence and glycated haemoglobin (HbA1c) testing in Central Italy.

Cohort study.

Lazio region, Italy.

We used the Lazio Region Longitudinal Study, which is the 2011 census cohort of all residents followed from January 2012 to December 2022. We selected 2 912 539 diabetes-free individuals aged 35–90 years at baseline (54% women). We used educational attainment as the indicator of socioeconomic position and place of residence and birth citizenship as possible confounders.

We identified incident cases of type 2 diabetes from 2012 to 2022 using health databases. We searched for an HbA1c test in the 13 months following case identification. We used Cox proportional hazard models and logistic regression models stratified by sex to study disparities in diabetes incidence and HbA1c testing, respectively.

We identified 192 268 new cases (49% women). We found incidence disparities, with the lowest educational level showing a risk that is twice or more than the highest in men (HR 2.03, 95% CI 1.98 to 2.08) and women (HR 2.32, 95% CI 2.26 to 2.39), respectively. Disparities were less pronounced in the older groups. Fewer than 60% of individuals across all educational levels had at least one HbA1c test. Compared with those with university degrees, people with the lowest education showed a higher probability of being tested for HbA1c in men (OR 1.56, 95% CI 1.48 to 1.64) and women (OR 1.62, 95% CI 1.53 to 1.72).

We found inequalities in diabetes incidence in both sexes, mainly among younger groups. The highly educated were less likely to be tested for HbA1c, although different private sector utilisation could have influenced this result.

To explore the role of shared decision-making (SDM) in the implementation of evidence-based practice in women with chronic hypertension planning birth and investigate the barriers and the facilitators in the provision of antenatal care.

A multimethod multisite approach was used including case-note review (n=55) and structured observations (n=18) to assess the provision of third trimester antenatal care. The barriers and facilitators to implementation were identified from semistructured qualitative interviews with healthcare professionals (n=13) and pregnant women (n=14) using inductive thematic analysis. The findings were integrated and evaluated using the ‘Three Talk Model of Shared Decision-making’.

Pregnant women with chronic hypertension, some with superimposed pre-eclampsia and their principal carers at three National Health Service hospital trusts.

Healthcare professionals delivering care to pregnant women with high blood pressure were aligned with most communication practices (set out in the Calgary-Cambridge communication guide). Pregnant women with hypertension who described being engaged in shared decisions about birth developed a trusting relationship with their maternity team. Despite frequent caesarean section birth (52%) and early term birth (median gestation at delivery 38 weeks (IQR1 37 weeks, IQR3 39 weeks) identified by case-note review; integrated data (observations, case-note review and qualitative interviews) found pregnant women with high blood pressure were not regularly provided with personalised information based on what they would find helpful, encouraged to share their own thoughts or offered choice in relation to timing or mode of birth. Uncertainty regarding the evidence around optimal timing of birth was the main barrier identified by professionals. Facilitators included training for professionals in SDM, midwife-led antenatal classes for high-risk women and multiprofessional clinics.

Strategies to promote more widespread adoption of SDM are likely to improve the experiences of women with high blood pressure making decisions about childbirth.

Emerging research indicates that integrated treatment of co-occurring post-traumatic stress disorder (PTSD) and substance use disorder can be effective among adolescents and young people. However, various barriers exist to young people accessing evidence-based treatments. Telehealth offers an opportunity to address these barriers and provide a scalable and accessible alternative to inperson treatment. This paper describes the study protocol for a randomised controlled trial (RCT) examining the efficacy, safety and cost-effectiveness of an integrated trauma-focused cognitive-behavioural treatment for traumatic stress and substance use among adolescents and young adults (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure – Adolescent and Young Adult version (COPE-A)) when delivered in person compared with via telehealth.

A two-arm, parallel group, single-blind, non-inferiority RCT with follow-up at 4 months and 12 months post study entry will be conducted in Sydney, Australia. Participants (170 adolescents and young adults aged 12–25 years) will be allocated to receive COPE-A either in person or via telehealth (allocation ratio 1:1) using minimisation. Project psychologists will administer treatment via both modes of delivery over a maximum of 16 sessions of 60–90 min. The primary outcome will be between-group differences in change in the severity of PTSD symptoms from baseline to 4-month follow-up, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

This study has been approved by the Sydney Children’s Hospitals Network Human Research Ethics Committee (2024/ETH01050). Research findings will be published in peer-reviewed journals and presented at scientific conferences.

ACTRN12624000776505.

V.2.3, 20 March 2025.

The influence of short-term variations in blood pressure (BP) in acute stroke on clinical outcomes remains uncertain. Our study explores the relationship between BP variability (BPV) from stroke admission up to 72 hours and in-hospital and 1-year mortality.

Retrospective observational cohort study.

Hamad General Hospital (HGH) a tertiary care stroke centre in Qatar.

2820 participants were initially included. After the exclusion of ineligible subjects, 2554 patients (82.5% male, median age 53±9 years) were included. 893 (34.96%) were from the Middle East and North Africa, 1302 (50.98%) were from South Asia, 258 (10.10%) from Southeast Asia, 9 (0.35%) were from East Asia and 92 (3.60%) were from other regions. Eligible participants were adult patients above 18 years of age who presented with acute ischaemic or haemorrhagic stroke. Excluded individuals were those younger than 18 years, had incomplete data, had transient ischaemic attack (TIA), had severe hypoglycaemia on admission (

We measured the BP every 4 hours over 3 days with a total of 18 readings from stroke admission. We then categorised BPV into five (L1–L5) and four (L1–L4) levels for systolic and diastolic BPs, respectively, and evaluated their association with mortality.

There were increased odds of in-hospital mortality with increased systolic and diastolic variability (L2, OR 2.64, 95% CI 1.44 to 4.84; L3, OR 4.20 95% CI 2.14 to 8.24; L4, OR 10.14, 95% CI 4.93 to 20.85; L5, OR 23.18, 95%CI 10.88 to 49.37), (p=0.002 to

In a retrospective cohort of ethnically diverse acute stroke patient population, BPV was significantly associated with both in-hospital and 1-year mortality. Further prospective research is needed to define BPV and establish interventions and management accordingly.

Maternal preconception obesity and adverse gestational metabolic health increase the risk of childhood obesity in offspring, but the preconception period may be an opportune time to intervene, given the motivation of the mother and the epigenetic changes that may be beneficial for the gametes during this period. However, there is a lack of studies evaluating children born to women who have had a preconception intervention. Our group has therefore designed an ancillary study to assess children born to women enrolled in the obesity-fertility randomised controlled trial (RCT), who were 6–12 years of age, with the objective of evaluating the effect of a lifestyle intervention delivered during preconception and pregnancy on adiposity and cardiometabolic parameters in the offspring. This manuscript details the study protocol.

This is an ancillary nested cohort study of the obesity-fertility RCT. Women with obesity and infertility were recruited at an academic fertility clinic and randomised to the control group, which followed usual care, or to the intervention group, which received a lifestyle intervention alone for the first 6 months and then in combination with fertility treatments for up to 18 months or until the end of pregnancy. Those who have given birth to a single child are invited to participate in this follow-up study with their child aged 6–12 years. This study started in November 2023 and is expected to end in May 2025. The primary outcome is age-adjusted and sex-adjusted body mass index z-scores in children. Secondary outcomes are anthropometry, body composition, lifestyle, physical fitness level and blood or saliva markers of cardiometabolic health in both mothers and children. Of the 130 women who participated in the obesity-fertility RCT, 52 mother-child dyads (24 in the control group; 28 in the intervention group) were potentially eligible for this follow-up study. Comparisons between groups will be performed using unpaired tests and adjusted for potential confounders using multivariable regression models. This study will provide important new data on the impact of a preconception lifestyle intervention, maintained throughout pregnancy, on the health trajectory of children and mothers 6–12 years after delivery.

The study has been approved by the institutional research ethics review boards of the Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke. The results will be widely disseminated to the scientific community, relevant health professionals and general public.

ClinicalTrials.gov (NCT06402825).

To report on the findings from a national survey of UK intensive care units (ICUs) exploring nurse staffing models currently in use and changes since COVID-19.

A survey was designed and distributed using a web-based platform to senior unit leads via Intensive care national audit & research centre contacts.

Senior nurses representing the 331 National Health Service adult ICUs across the UK (across 231 hospitals/155 trusts), including the Channel Islands and Isle of Man.

A 15-item survey.

A total of 196 survey responses representing 300 units, majority general and single units, resulting in a 90.6% unit-level response rate. ICU unit characteristics included the average number of total, level 3 and level 2 critical care beds of 26.36 (SD=21.48), 15.67 (SD=15.33) and 10.96 (SD=8.86), respectively. Most units reported nurse to patient ratios compliant with national guidelines and service specifications. Post-COVID-19 changes to ICU nurse staffing establishments were reported by 44% respondents, including increases in non-registered staff. However, limited data were provided regarding decision-making around and changes to bedside allocation of nurses since COVID-19.

Increased numbers and use of non-registered staff within the ICU is indicative of an alternative staffing model to address nursing shortages. However, more research is needed to understand how this staffing group is being used compared with, and alongside, registered nurses.

Clinicaltrials.gov: NCT05917574.

To explore Aboriginal and Torres Strait Islander Australians’ perceptions of telehealth general practice consultations and elements required for a culturally safe telehealth consultation.

Qualitative study.

Primary care telehealth in three centres in regional and remote Australia.

Seventeen Aboriginal or Torres Strait Islander individuals participated in semistructured interviews exploring the experiences of telehealth in general practice settings. Participants were eligible for inclusion if they were Aboriginal or Torres Strait Islander, over 18 years of age and had experienced at least one telehealth appointment with their general practitioner in the preceding 12 months. Data were collected in the form of short surveys and semistructured interviews. Data collection occurred between June 2022 and August 2023. Data were analysed using thematic and content analysis techniques.

Participants had experienced telephone (88%) and videoconference appointments (12%). Reasons for choosing telehealth included being unable to attend due to respiratory symptoms and/or COVID-19 restrictions on in-person consultations (reflecting the study period) and issues of access (eg, availability of doctor, convenience of hours). Participants described benefits of telehealth around reduced barriers to care but also described practical and communication challenges experienced during telehealth. Elements of culturally safe telehealth identified included: consultation skills, a pre-existing doctor-patient relationship and local knowledge (including knowledge of the local cultural and community context).

This study demonstrates the benefits of telehealth and its ability to reduce barriers to care for Aboriginal and Torres Strait Islander Australians. However, the identified disadvantages demonstrate that this modality should be considered as an addition to, rather than a replacement for, face-to-face consultations. The elements identified interact as part of a complex interplay of factors contributing to cultural safety in the telehealth context. These elements provide useful recommendations for practice and policy.