In 2023, cholera caused over 95 000 deaths globally, predominantly in low-income and conflict settings, and contributed to the wasting, stunting and malnutrition of millions in countries where the disease is endemic. Moreover, the frequency and magnitude of cholera outbreaks are rising. As a result, the demand for outbreak control interventions is quickly outpacing existing resources. Oral cholera vaccination (OCV) is one intervention among many used to limit further transmission. Since 2022, one-dose OCV (OCV1) has replaced the standard two-dose OCV due to limited global supply. However, only a handful of on-the-ground surveys of OCV1 effectiveness presently exist.

This study aims to assess the transmission of cholera in outbreak settings using digital public health approaches and quantify OCV1 effectiveness in complement to on-the-ground surveys.

Using Haiti and Cameroon as natural case studies representing two disparate geographical and sociodemographic contexts, we employed computational digitisation techniques to extract weekly case counts from non–machine-readable images of outbreak epidemic curves. We then leveraged the R package EpiEstim to derive estimates of the effective reproduction number (R_t). To assess OCV1 effectiveness in the two considered countries, we applied VaxEstim, an extension of EpiEstim requiring three inputs: the basic reproduction number (R₀), R_t, and vaccine coverage. Notably, our work provides the first known real-world application of VaxEstim in low-resource settings.

Early in either outbreak, weekly estimates of R_t were elevated (Haiti, 2.60 (95% credible interval (CrI) 2.42 to 2.79); Cameroon, 1.90 (95% CrI 1.14 to 2.95)). Thereafter, R_t estimates oscillated around the critical threshold of 1 in both settings. Haiti exhibited marginally higher OCV1 effectiveness than Cameroon (75.3% (95% CrI 54.0 to 86.4%) versus 54.9% (95% CrI 18.9 to 84.9%)).

This study underscores the value of combining digitised case data with computational techniques and the utility of VaxEstim for rapid, inexpensive estimation of vaccine effectiveness in data-poor outbreak settings.

This study was to estimate the potential social value and net benefit of OpenUp, a 24/7 text-based online counselling service for youth in Hong Kong, and draw policy-relevant conclusions for service provision.

A retrospective, model-based cost–benefit analysis using social return on investment (SROI) methods. Adopting a societal perspective, service, health and social outcomes were valued over a 1-year period, and productivity gains associated with avoided suicide deaths were valued over a 10-year period. Costs are reported in 2022 HK dollars (HK$; US$1=HK$7.8). Reporting was guided by Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement.

A text-based, synchronous online emotional support counselling platform in Hong Kong was accessible through WhatsApp, Facebook, SMS and the official web portal.

A total of 19 543 users aged 11–35 years accessed OpenUp services during the study period (1 December 2020 to 31 May 2022).

These included total social value (HK$), net social benefit (social value minus investment) and the SROI ratio. The secondary outcomes included monetised savings in medical and social services and productivity gains from avoiding suicide attempts and death.

The total social value was estimated to be HK$226 119 729 against an investment of HK$47 655 000 (SROI=4.74). Suicide risk reduction (productivity gains from avoided attempts and deaths) accounted for 75.4% of the social value. Deterministic one-way sensitivity analyses yielded SROI values ranging from 3.62 to 6.99 aggregated across the three groups, with results being most sensitive to assumptions about the duration of productivity impacts for avoided attempts and avoidable mortality.

Based on conservative assumptions, OpenUp can generate potential social value by providing an online emotional support service. Given the study’s reliance on modelling and proxy monetisation, these estimates should be interpreted with caution. Further integration of offline services with online intervention strategies requires continuous investment and evaluation.

Diarrhoeal illnesses remain a leading cause of morbidity and mortality worldwide. Understanding when and where individuals seek healthcare is essential for accurately assessing disease burden and improving access to appropriate care. We conducted a meta-synthesis of qualitative research examining barriers and facilitators to care-seeking for diarrhoeal illness among individuals and caregivers of children.

We systematically reviewed qualitative studies examining the motivations for seeking care for diarrhoeal illness and conducted a thematic analysis to synthesise findings across studies.

PubMed, Embase, Web of Science and Global Index Medicus were searched through 3 September 2024.

We included qualitative studies that used interviews and/or focus group discussions to examine care-seeking decisions for diarrhoeal illness.

Two independent reviewers assessed studies for eligibility, extracted study information and coded factors influencing care-seeking decisions. The two researchers then independently created thematic trees based on patterns in the coded data and, through discussion with the full research team, synthesised findings into a thematic framework.

In total, 47 studies met our inclusion criteria, 36 of which focused on caregiver decision-making for children with diarrhoea in low- and middle-income countries. Our meta-synthesis identified several key factors that influenced whether and when individuals sought care. Sociocultural norms, including locally held beliefs about disease causation, were frequently cited as influencing decisions to seek or delay formal care. Additional barriers included long travel distances to health facilities, transportation costs, limited trust in healthcare providers, negative feelings and inconsistent availability of care. Conversely, episodes perceived as severe were more likely to prompt care-seeking outside the home.

These findings highlight the importance of contextually grounded interventions that improve physical and financial access to care, foster trust in healthcare providers through consistent and effective service delivery and strengthen community engagement around recognising signs of severe illness and the potential benefits of timely treatment. They also underscore the need for future studies to define diarrhoea in locally relevant terms and to clearly define sources of care-seeking, as variation in these definitions can limit our full understanding of who is affected and how individuals respond to illness.

Common mental health outcomes among children in conflict with the law in correctional facilities in Africa are an under-researched area with significant public health implications. This review will synthesise available and accessible evidence on the prevalence and associated factors of common mental health outcomes among children in conflict with the law in Africa.

Comprehensive electronic searches will date from 01 January 2015 to 31 December 2025 and will be conducted in PubMed, Sabinet, Scopus, EBSCOhost, Web of Science and PsycINFO. Articles will be screened using defined inclusion and exclusion criteria and assessed for eligibility by three independent reviewers. Discrepancies will be reviewed by a ninth reviewer. The selection process of included articles will be reported by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses will be used. The Mixed Methods Appraisal Tool will assess study quality, and data will be synthesised using meta-analysis or a narrative synthesis approach, depending on heterogeneity levels.

This study will not require ethical approval from an institutional review board, as it does not entail the direct collection of data from children in conflict with the law, nor does it pose any risk to their privacy. Once finalised, the full review report will be submitted for publication in a peer-reviewed journal. The key findings will also be shared at both local and international conferences, highlighting common mental health outcomes among children in conflict with the law.

CRD420251011484.

Perioperative randomised controlled trials (RCTs) in liver transplantation are relatively infrequent. RCTs performed in this complex patient population need to be robustly conducted to maximise patient benefit and graft utility given the scarcity of donor organs. Recruitment challenges can compromise RCTs and studies in this population face unique challenges due to recipient illness severity, their comorbidities, demographics and the geographical constraints of specialist transplant centres. Emergency presentation and after-hours admission may further limit patients’ capacity or readiness to consider trial participation. This Study Within a Trial (SWAT) specifically explored motivators and barriers to recruitment in patients awaiting liver transplantation.

An observational mixed-methods ‘Study within a Trial’, nested within a feasibility RCT.

This study was dual centred at two Tertiary National Health Service Hospitals; The Royal Free Hospital, a liver transplant centre in North London and University Hospital Birmingham, a liver transplant centre in Birmingham.

Adults who were eligible for liver transplantation and recruitment into the associated RCT were eligible for inclusion into the SWAT.

Completion of an 18-question validated written questionnaire which explored motivation for accepting or declining participation in the RCT.

Through completion of the questionnaire, participants shared their perspectives on the RCT and their rationale for consenting or declining participation. Responses were analysed, providing feedback to the Trial Management Group (TMG) to refine recruitment strategies for future trials. An additional component, comprising interviews and audio recordings of recruitment consultations, was planned if the RCT recruitment rates fell below prespecified thresholds or concerns were raised by the RCT TMG, neither of which occurred.

84 completed questionnaires were received. Motivators included patients believing that the trial will benefit others, interest in helping with research, perception that benefits outweigh risks and belief that it offered the best treatment. Barriers included concerns about randomisation, feeling overburdened and a perception of lack of support from family or friends.

This is the first study exploring recruitment to a perioperative RCT involving patients undergoing liver transplantation. Key motivators were altruism and perceived safety, while barriers included concerns about randomisation and lack of family support. Future focus during recruitment should be on neutral patient-centred consultations, adequate information sharing, fostering of patient trust, improved explanation of randomisation and engagement of the patient’s support network.

NCT04941911 (Health Research Authority) and SWAT 152 (the Study With A Trial Database).

MRI is increasingly recognised as a valuable tool for assessing prognosis and predicting outcomes following traumatic spinal cord injury (SCI). Several potential MRI biomarkers have been identified, but efforts are still needed to improve the accuracy and feasibility of these biomarkers in clinical practice. This study aims to build a national Canadian SCI imaging repository for storing and analysing imaging data for SCI, with the goal of improving SCI MRI biomarkers to predict outcomes and inform clinical management.

As a substudy of the Rick Hansen SCI Registry (RHSCIR), this retrospective multisite study includes individuals who sustained a traumatic cervical SCI between 2015 and 2021, were previously enrolled in RHSCIR, and had MRI scans acquired within 72 hours of injury and before any surgical intervention. Individuals with a penetrating trauma and/or with any prior spine surgery are excluded. The study principal investigator and research associates, experienced with data curation and with the standardised format and specifications of the Brain Imaging Data Structure standard, guide the site’s curator on the steps to perform image deidentification and curation to create standardised datasets across all sites. These datasets are transferred to a Digital Research Alliance of Canada (‘the Alliance’) server designated for this project and concatenated to form the national Canadian SCI imaging repository (Neurogitea). We are using a semiautomated processing pipeline to quantify lesion morphology, together with additional imaging measures that are manually extracted from the images (for instance, the relative maximal spinal cord compression and the maximum canal compromise). Through linkage to RHSCIR clinical and epidemiological data already available on eligible participants, regression analysis is planned to predict neurological outcomes at discharge, including the American Spinal Injury Association Impairment Scale grade, upper and lower extremity motor and sensory scores.

This protocol has been submitted by the participating sites to obtain ethics and institutional approvals prior to the study initiation at each site. All 12 sites across Canada have now obtained ethics and institutional approvals. Study results will be disseminated at local, national and international conferences and by journal publications.

Total mesorectal excision (TME) is highly effective for early-stage rectal cancer, but is associated with considerable morbidity, which can substantially impair the quality of life (QoL) of patients. For very early tumours (low-risk cT1), local excision (LE) offers the possibility of organ preservation (OP) with reduced morbidity; however, its application is limited to a selected group. For early tumours where upfront LE is not feasible, primary OP with (chemo)radiotherapy as an alternative to TME surgery has been evaluated in the STARTREC phase II/III studies, which reported promising 1-year OP rates.

The STARTREC-3 trial aims to increase the 2-year OP rate from 60% to 80% in early rectal cancer (cT1–3abN0) and from 30% to 60% in early-intermediate rectal cancer (cT1–3abN1, ≤3 mesorectal nodes measuring ≤8 mm) by intensifying neoadjuvant treatment in different study arms.

STARTREC-3 is embedded in the STARTREC master trial protocol, which uses an adaptive platform study design allowing early termination of inferior treatment arms and the addition of novel arms. The multicentre STARTREC-3 trial investigates three parallel, non-comparative treatment strategies for patients with early and early-intermediate rectal adenocarcinoma who prefer OP over primary TME surgery. All arms start with 5x5 Gy radiotherapy, followed by: an endoluminal boost via contact X-ray brachytherapy (arm 1), an external beam radiotherapy (EBRT) boost by MR-guided EBRT (arm 2) or three cycles of capecitabine oxaliplatin systemic treatment chemotherapy (arm 3). Treatment allocation is predefined and centre-dependent. Response evaluations (MRI and endoscopy) are planned at 14–16 weeks and 26 weeks after onset of radiotherapy. The primary endpoint is the proportion of patients with successful OP at 24 months from onset of therapy. Secondary endpoints include toxicity, QoL, functional and oncological outcomes. Data will be analysed separately for early (cN0) and early-intermediate (cN1) disease. The total planned sample size is 210 patients across the three arms. Interim analyses will be performed for each study arm to determine early failures and discontinue ineffective arms.

The trial was approved by the medical ethics committee NedMec of the Netherlands and is registered in the EU Clinical Trials Information System (CTIS). The results will be published in an international peer-reviewed journal.

CTIS EU 2024-514620-17-00

Forcibly displaced children and adolescents in the WHO European Region have high mental health needs, yet few manage to access mental health services and even fewer receive high-quality care. Addressing this gap is crucial, as inadequate mental health support has profound and lasting negative effects on individuals, families and communities. This scoping review aims to identify and synthesise the available evidence on the barriers and facilitators to quality mental healthcare for forcibly displaced children and adolescents in the WHO European Region.

Quantitative, qualitative and mixed-method studies that examine barriers and facilitators of quality mental healthcare for forcibly displaced children and adolescents in the WHO European Region will be included. Eligible participants include forcibly displaced children and adolescents, mental healthcare providers, policymakers and humanitarian actors in the mental health and psychosocial support field. We will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. A comprehensive search of databases, including Embase, Medline, PsycINFO, Scopus and Web of Science, will be conducted. We will systematically search for relevant studies published between January 2004 and December 2024. At least two reviewers will independently screen titles, abstracts and full texts. Data extraction will involve systematically charting relevant information from included studies. We will use the WHO Quality Standards for Child and Adolescent Mental Health Services as an analytical lens to map the evidence. Our study will provide a comprehensive overview of the barriers and facilitators to quality mental healthcare for forcibly displaced children and adolescents, and identify knowledge gaps and areas for potential quality improvement.

Ethical approval will not be required since this study will retrieve data from already published research and no new data will be collected. The results of this study will be published in a peer-reviewed journal and presented at international conferences in order to disseminate to academic and non-academic stakeholders such as non-governmental organisations, government bodies and community organisations involved in mental healthcare for forcibly displaced persons.

https://doi.org/10.17605/OSF.IO/AK74F.

The prevalence of HIV in adolescents is a major global health concern, and research into the influence of HIV on mental health outcomes in this demographic is ongoing. We will conduct a comprehensive systematic review of common mental health outcomes in adolescents with HIV infection (aged 10–24 years). Recognising the specific psychosocial issues that adolescents living with HIV infection are confronted with, this review aims to integrate existing research on the prevalence, risk factors and protective factors related to both positive and negative mental health outcomes in this population.

The following electronic databases will be searched for publications from 1959 up to December 2025: PubMed, PsycINFO, Global Health, Embase, African Journals OnLine and African Index Medicus. The review will focus on both positive and negative mental health outcomes: positive outcomes include resilience, subjective happiness and post-traumatic growth, whereas the negative outcomes include depression, anxiety, post-traumatic stress disorder, substance use disorder and suicidality. Peer-reviewed primary observational studies that report prevalence rates for common mental health outcomes outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, and the International Classification of Diseases, 11th Edition, their associated factors, as well as barriers to and facilitators of use of mental health support services among this population, will be included in the review. Google Scholar and ProQuest Dissertations & Theses Global as well as Electronic Theses and Dissertations from Ghana, South Africa, Uganda and Kenya, will also be searched for grey literature. The review will be limited to publications in English or French. To assess the methodological rigour of the selected studies, the Joanna Briggs Critical Appraisal Tools will be used. The synthesis will include a narrative summary and, if applicable, a meta-analysis of quantitative data depending on the extent of heterogeneity observed in the included studies. Subgroup analyses will be conducted to investigate differences in mental health outcomes by age, sex and socioeconomic position, where applicable. This systematic review will be reported in accordance with the PRISMA statement.

This review will use secondary data and does not require ethical approval. The findings will be shared through peer-reviewed publications and conference presentations. The emphasis will be on translating research findings into practical mental health interventions and HIV-specific support services for adolescents.

CRD42024568512.

Individuals are diagnosed with terminal/chronic conditions on a daily basis globally. Unfortunately, a substantial proportion of the global disease burden of chronic illnesses is recorded within sub-Saharan Africa. Providing or receiving such news can be devastating and may be influenced by cultural preferences and contextual differences. Identifying existing trends and how such news is broken in sub-Saharan Africa will be relevant to identify and inform practice and future research.

This systematic review protocol was developed by following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P), and findings will be reported by following the guidelines and recommendations of PRISMA-2020. CINAHL, Global Health, MEDLINE, PubMed, Scopus, AJOL and APA PsycINFO will be searched for articles. Additional records will be gathered through reference harvesting in Google Scholar search. QualSyst will be used to assess the methodological quality of studies included. Thematic synthesis will be used to analyse and synthesise the findings from the eligible studies.

Due to the fact that systematic reviews focus on accessible and available literature without the direct involvement of human participants, ethical approval will not be sought. The completed review will be submitted to a peer-reviewed journal and may be presented at health conferences. The important findings would be shared with stakeholders and those involved in developing and conducting training for health practitioners, all of whom are involved in breaking bad news.

CRD42025642707.