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.

Cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are both efficacious treatments for depression, but it is less clear how both compare on outcome domains other than depression and in the longer term. Moreover, it is unclear which of these two psychotherapies works better for whom. This article describes the protocol for a systematic review and individual participant data (IPD) meta-analysis that aims to compare the efficacy of CBT and IPT for adults with depression on a range of outcomes in both the short and long term, and to explore moderators of the treatment effect. This study can enhance our understanding of treatments for depression and inform treatment personalisation.

Systematic literature searches will be conducted in PubMed, PsycINFO, EMBASE and the Cochrane Library from inception to 1 January 2026, to identify randomised clinical trials (RCTs) comparing CBT and IPT for adult depression. Researchers of eligible studies will be invited to contribute their participant-level data. One-stage IPD meta-analyses will be conducted with mixed-effects models to examine (a) treatment efficacy on all outcome measures that are assessed at post-treatment or follow-up in at least two studies, and (b) various baseline participant characteristics as potential moderators of depressive symptom level at treatment completion.

Ethical approval is not required for this study since it will be based on anonymised data from RCTs that have already been completed. The findings of the present study will be disseminated through a peer-reviewed journal or conference presentation.

Acute coronary syndrome (ACS) is the leading cause of morbidity and mortality among individuals with cardiovascular disease, accounting for half of all global cardiovascular-related deaths. No prior research has examined ACS treatment outcomes and associated factors in the study area. This study aimed to evaluate the risk factors and treatment outcome of ACS patients admitted to public hospitals in Harari Regional State, Eastern Ethiopia.

A retrospective hospital-based cross-sectional study was conducted among 308 ACS patients. Patient records from admissions between 1 November 2018 and 31 October 2023 were reviewed, with data collected between 10 January and 10 February 2024 using a structured checklist adapted from previous research. Statistical analysis was performed using SPSS V.25.0, with bivariable and multivariable logistic regression identifying significant associations at a p value

The mean patient age was 56.4±16 years, with males comprising 77.3% of participants. Half (51.6%) resided in rural areas, and only 16.2% presented within 12 hours of symptom onset. Overall, 81 patients (26.3%) experienced a poor treatment outcome for ACS, including 39 (12.7%) in-hospital deaths, 24 (7.8%) referrals to higher-level facilities and 18 (5.8%) who left against medical advice. Factors significantly associated with poor outcome included hospital presentation more than 72 hours after symptom onset (AOR 2.734 (95% CI 1.006 to 7.435)), left ventricular ejection fraction (LVEF)

Poor treatment outcome was independently predicted by the presence of ischaemia features on the echocardiography, LVEF (

The widespread application of interleukin (IL) inhibitors for various conditions, including gastrointestinal, rheumatologic, dermatologic and pulmonary diseases, has raised concerns regarding the potential for hepatitis B virus reactivation (HBVr). However, the precise risk of HBVr remains unclear due to inconsistencies in existing research. This systematic review aims to quantify the risk of HBVr in patients receiving IL inhibitor therapies.

This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search will be conducted in MEDLINE, PubMed, Google Scholar, CENTRAL, Scopus, Embase, Web of Science and ClinicalTrials.gov up to October 2025. Two reviewers will independently screen studies and extract data, resolving discrepancies by consensus. Eligible studies will include HBV-infected patients receiving IL inhibitors. HBVr rates will be estimated using a generalised linear mixed model with a binomial distribution, applying random-effects models to account for interstudy variability. Heterogeneity will be assessed using I², Cochran’s Q and ². Leave-one-out sensitivity analyses will evaluate robustness. Subgroup analyses will consider HBV serostatus, IL inhibitor type and study characteristics. Studies including patients on antiviral prophylaxis will be excluded from the primary analysis. A secondary analysis will assess prophylaxis efficacy in preventing HBVr according to hepatitis B surface antigen status. Publication bias will be evaluated using Doi plots and the Luis Furuya-Kanamori index.

This study does not require ethics approval as it involves no patient-specific data. Findings will be disseminated at gastroenterology conferences and through peer-reviewed publications.

The protocol is registered in PROSPERO (CRD42024614179).

Pregnancy is a period of physiological, psychological, hormonal and social changes. Mothers experience pregnancy anxiety during this period. One treatment used to reduce anxiety is Mandala colouring. In the present study, we intend to determine the effectiveness of Mandala colouring on anxiety and health status in the second trimester of pregnancy in pregnant women.

In this randomised controlled clinical trial study, 60 women with a gestational age of 14–28 weeks and 43–96 scores on the Vandenberg Pregnancy Anxiety Questionnaire will be selected by convenience sampling and will be assigned to intervention and control groups by block randomisation. Information will be collected using demographic and midwifery, Vandenberg Pregnancy Anxiety and General Health Questionnaires. For pregnant women in the intervention group, Mandala colouring will be performed for 6 days, with each session lasting 30 min. The control group will receive routine care. Analyses will be done using SPSS V.22 software.

This study was approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.REC.1402.129). The trial will adhere to the ethical principles of the Declaration of Helsinki. Findings will be disseminated through publication in peer-reviewed journals and presentation at scientific conferences.

Iranian Registry of Clinical Trials (IRCT20180218038783N6).

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.

The only supportive therapy for patients with severe acute kidney injury (AKI), a common complication among the critically ill, is dialysis. Based on the literature and current guidelines, continuous renal replacement therapy (CRRT) with a total effluent dose of 20–25 mL/kg/hour and adjustments to ensure such dose is delivered despite down time (eg, due to surgical procedures) is recommended. However, experimental and clinical studies suggest that azotaemia, which can be induced by lowering the effluent dose, may accelerate renal recovery. This clinical study investigates whether a lower effluent dose (10–15 mL/kg/hour) for a maximum of 7 days or until successful (>24 hours) liberation of CRRT in critically ill patients with a dialysis-dependent AKI accelerates renal recovery and reduces time on CRRT compared with guideline-directed standard dose (25–30 mL/kg/hour).

The Ketzerei trial is an international, multicentre randomised, controlled trial, designed to investigate if a lower effluent dose (10–15 mL/kg/hour) accelerates renal recovery and reduces the time on CRRT compared with the guideline directed standard effluent dose (25–30 mL/kg/hour). The study aims to enrol 150 critically ill patients with a dialysis-dependent AKI. Eligible patients will be randomised to receive either a standard effluent dose (control group, 25–30 mL/kg/hour) or lower effluent dose (interventional group, 10–15 mL/kg/hour). The primary endpoint is the number of days free from CRRT and alive (from randomisation through day 28). Key secondary endpoints include the number of (serious) adverse events due to potential uremia, the duration of RRT and intensive care unit survival.

The Ketzerei trial has been approved by the Ethics Committee of the Chamber of Physicians Westfalen-Lippe (2023–343 f-s), the University of Muenster and subsequently by the corresponding Ethics Committee of the participating sites. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research.

clinicaltrials.gov (NCT06021288).

Identifying anxiety disorders in autistic youth can be challenging due to the unique presentation of anxiety symptoms in autistic youth and the difficulties youth may have reporting on their own anxiety symptoms. These challenges underscore the need for objective and reliable measures. Understanding whether autonomic activity is associated with the presence of anxiety may lead to its use as an objective anxiety assessment tool in individuals who may otherwise struggle to communicate their feelings of anxiety. Most published studies examining autonomic activity and anxiety in autistic individuals lack information regarding racial demographic information, and those that do are predominantly composed of White individuals. These findings highlight the critical need for future research that includes more diverse samples and uses consistent, ecologically valid methods to examine the relation between anxiety and autonomic activity in autistic populations. This study aims to recruit a large sample of racially diverse adolescents to evaluate whether atypical autonomic activity serves as a biomarker of anxiety in autistic and non-autistic youth. This manuscript outlines the recruitment strategies for this study protocol, providing a framework for understanding the interplay between physiological, psychological and contextual factors including self-identified race in anxiety among autistic and non-autistic adolescents.

Autistic (n=80) and non-autistic (n=80) adolescents aged 11–14 years and their caregivers will be invited to participate in the current study. Autism diagnosis will be confirmed by gold-standard assessments. All participants will complete an in-person visit assessing their child’s cognitive abilities and trait-level anxiety and mental health symptoms, learn how to wear a non-invasive heart rate band that will collect ECG and respiration data, complete a 5-minute in-lab baseline of autonomic activity and enroll in experience sampling. Next, participants will complete three 5-minute baselines of autonomic activity at home, followed by 5 days of wearing the heart rate band for 5 hours per day, overlapping with ecological momentary assessment of their mood. Primary outcome measures include trait-level parent and self-reports of anxiety, real-time self-reports of anxiety captured through ecological momentary assessment, and both baseline and in-the-moment heart rate variability.

The study protocol has been approved by the University of Maryland’s Institutional Review Board. Results will be disseminated through peer-reviewed publications and conferences. Deidentified data from participants who consent to have their data shared with other researchers will be uploaded to the National Data Archive Collection C5316.

Despite an increasing use of screens among preschool children and evidence suggesting potential adverse effects, there is a paucity of longitudinal research that aims to disentangle the multifaceted components of screen use and their unique associations with development. We present a protocol for a large-scale national longitudinal study with repeated measurements in Danish preschool children, with the aim of investigating the cross-sectional and cross-lagged longitudinal associations between screen use and psychological outcomes.

The Digital Child Study is a national prospective observational cohort of Danish preschool children. Baseline parent-report data collection commenced in 2024 via online questionnaires, and in total will include three time points over 1 year: baseline (age 4 years), and follow-ups at 6 and 12 months (ages 4.5 and 5 years). Participants were divided into two waves based on birth dates, starting in March and September 2024. Recruitment targeted parents and primary caregivers of all Danish children born between specific dates in 2020. Of 30 235 children whose parents were sent invitations, baseline questionnaire data were available for 11 690 (39%).

Children’s screen use was measured by detailed information of amount, content and timing of children’s screen use, and the broader context, incorporating parental mediation strategies, attitudes, motivations and practices. Cognitive and socioemotional developmental outcomes were measured using validated tools such as the Strengths and Difficulties Questionnaire, the Nordic Five-to-Fifteen parent questionnaire and the Behaviour Rating Inventory of Executive Function—Preschool Version. Questionnaire data will be linked to national social and health registries to enable long-term follow-up. Statistical analyses will include longitudinal modelling to explore associations between screen use and developmental outcomes, with sensitivity analyses for robustness. The study’s large sample size provides high statistical power to detect meaningful effects.

The study adheres to ethical research guidelines, ensuring voluntary participation, confidentiality and compliance with data protection laws, with approvals from relevant authorities. Findings will be disseminated through peer-reviewed publications, conferences and plain-language summaries to engage stakeholders and the broader community.

Competency assessment tools are well-recognised as a method to achieve a standardised level of practice for a group of healthcare professionals with similar characteristics. The aim of this study is to develop and pilot a new competency assessment tool to support therapists caring for patients with blunt chest trauma from prehospital care through to long-term follow-up following hospital discharge.

A mixed-methods study will be undertaken, with three distinct phases: (1) an integrative narrative review to examine the literature regarding therapist competencies; (2) focus groups with patients, therapists and key stakeholders to explore opinions regarding important aspects of care (phases I and II will inform the content of the tool), followed by final tool development by an international expert panel; and (3) a multicentre pilot study using questionnaires and elicitation interviews, in which final tool acceptability to therapists will be tested. The total sample size will be between 40 and 50 participants for the focus groups. For the final tool development work, a panel of 10 international experts will be identified, with a subgroup of 3–5 experts who will be recruited to confirm content validity. We will pilot the tool at five health boards in Wales, aiming for 10 therapists from each. Elicitation interviews will be undertaken with a smaller sample size of between 15 and 20 therapists. A mixed qualitative and quantitative data analysis approach will be used.

Proportionate ethics approval has been granted (South Yorkshire Research Ethics Committee, reference number: 24/YH/0231). We will publish the work in an open-access peer-reviewed journal to ensure equitable access and present at relevant conferences. Webinars will be used to achieve a wide audience. The results will be shared with the research participants via an infographic which will be designed and developed with the public research partners.

Integrative review is registered at the Open Science Framework: https://doi.org/10.17605/OSF.IO/CEXNR

Patients with metastatic oncogene-driven non-small cell lung cancer (NSCLC) are experiencing longer and uncertain trajectories of life-limiting illness due to advances in precision medicine. These advanced cancer survivors face new challenges related to living with uncertainty and desire more support to maximize their health and quality of life. Therefore, we developed a population-specific, blended palliative and survivorship care intervention to address the supportive care needs of patients recently diagnosed with advanced lung cancer and who are receiving targeted therapy for NSCLC with EGFR, ALK, ROS1 or RET driver mutations.

This study is a single-site, non-blinded pilot randomised controlled trial of an intervention for patients with metastatic oncogene-driven NSCLC, Patient-centred, Optimal Integration of Survivorship and palliative carE (POISE) versus usual care. POISE consists of a brief series of structured visits with a trained palliative care clinician to address coping with uncertainty, increase prognostic awareness and promote healthy lifestyle behaviours. We will recruit 60 patients from the Massachusetts General Hospital Cancer Center. Patients will be randomised into a 1:1 ratio to the intervention arm or the usual care arm. Patients randomised to the intervention arm will complete four 60 min virtual or in-person visits with a palliative care physician. The usual care arm will receive standard oncology care. Patients in both arms will complete survey assessments at enrolment, 12 weeks and 20 weeks after enrolment, and patients in the intervention group will complete an exit interview. The primary outcome measure of this trial is feasibility, which will be defined by ≥60% enrolment among eligible patients, ≥70% completion of all sessions for participants in the intervention arm and ≥70% completion of all surveys for all study participants. Exploratory outcomes include acceptability, emotional coping with prognosis, self-efficacy for chronic disease management, prognostic awareness, quality of life, anxiety, depression, intolerance of uncertainty and documentation of goals and values discussions in the electronic health record.

This study was approved by the Dana-Farber/Harvard Cancer Center’s institutional review board (protocol 20-722). The protocol is reported in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines, and the study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials.

NCT04900935.

This study aimed to assess the proportion of nutrition-related information-seeking behaviour and its associated factors among pregnant women attending antenatal care at public hospitals in Bahir Dar City, northwest Ethiopia, 2023.

A cross-sectional quantitative supplemented with qualitative study design was conducted from March to April 2023 among 406 pregnant women. Pre-tested structured interviewer-administered and semistructured open-ended questionnaires were used to collect quantitative and qualitative data, respectively. Data were collected using the Kobo toolbox, and SPSS V.25 was used for analysis. Descriptive statistics were used to describe study subjects, and multivariate logistic regression analysis was employed to investigate the associated factors. The strength of associations was described using the OR with the corresponding 95% CI.

The study included 406 pregnant mothers with a median age of 28 with an IQR of 8 and 212 (52.2%) from rural settings. Of the total respondents, 173 (42.6%; 95% CI 37.7 to 47.6) of pregnant mothers were nutrition-related information seekers. Educational status, residence, monthly income and nutrition information literacy were significantly associated with nutrition-related information-seeking behaviour.

The proportion of nutrition information seeking among pregnant mothers in Bahir Dar City public hospitals was low. Lower educational status, low nutrition information literacy level, being from a rural residence and low monthly income are significantly associated factors.

Awareness creation for pregnant mothers from rural areas and with low educational status and improving nutrition information literacy of pregnant mothers are important activities to improve their nutrition information-seeking behaviour.

To determine the prevalence and its associated factors of dual tobacco use among Malaysian adolescents in developing effective public health strategies.

Cross-sectional study.

This study analysed data from the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey (AHS), a nationwide cross-sectional survey conducted among secondary school students across Malaysia.

This cross-sectional study used data from the NHMS 2022: AHS, which included a representative national sample of Malaysian adolescents between the ages of 13 and 17. Using a two-stage stratified sampling approach, this study included participation from 33 523 adolescents from 240 schools nationwide.

The primary outcome was the prevalence of dual tobacco use among Malaysian school-going adolescents aged 13–17, defined as self-reported concurrent use of conventional cigarettes and e-cigarettes in the past 30 days. Secondary outcomes included the factors associated with dual tobacco use, such as sociodemographic characteristics, dual tobacco use behaviour, marital status of parents, tobacco use of parent or guardian, supervision, connectedness, bonding and respect for privacy of parent or guardian, along with peer support and truancy. A complex sample analysis was performed using SPSS V.27.0, maintaining a 95% CI and multiple logistic regression was applied.

Out of 33 380 Malaysian adolescents surveyed, 1728 (5.5%; 95% CI: 4.88% to 6.28%) reported dual tobacco use. The prevalence was significantly higher among males (9.7%; 95% CI: 8.54% to 10.98%) compared with females (1.4%; 95% CI: 1.15% to 1.70%) and highest among 17 years (8.6%; 95% CI: 7.05% to 10.41%), with a decreasing trend in younger age groups. Predominant vapers constituted the largest proportion (9.9%, 95% CI: 8.66% to 10.13%) among adolescents who reported dual tobacco use, followed by predominant smokers (6.2%, 95% CI: 5.53% to 7.06%), dual daily users (4.5%, 95% CI: 3.18% to 5.64%) and non-daily dual users (3.9%, 95% CI: 2.79% to 4.39%). Dual tobacco use was more prevalent among adolescents whose parents or guardians used tobacco (8.1%; 95% CI: 7.10% to 9.20%). Multiple logistic regression analysis suggested that significant predictors of dual tobacco use included older age (adjusted OR (AOR) for 17 years: 2.92; 95% CI: 2.19 to 3.89), male sex (AOR: 8.53; 95% CI: 6.78 to 10.74), ‘others’ ethnicity (AOR: 1.82; 95% CI: 1.40 to 2.35), predominant vapers (AOR 2.65, 95% CI: 1.96 to 2.72), separated or widowed parental status (AOR: 1.69; 95% CI: 1.42 to 2.02), parental or guardian tobacco use (AOR: 2.47; 95% CI: 2.08 to 2.94), lack of bonding (AOR: 1.79; 95% CI: 1.49 to 2.14), lack of privacy respect (AOR: 1.53; 95% CI: 1.29 to 1.81), lack of peer support (AOR: 1.65; 95% CI: 1.39 to 1.96) and truancy (AOR: 1.81; 95% CI: 1.55 to 2.10).

This study highlights a concerning prevalence of dual tobacco use (5.5%) among Malaysian adolescents, which is notably higher than the current prevalence of exclusive cigarette smoking (6.2%) and closely approaches that of e-cigarette use (14.9%). Compared with previous national surveys and international benchmarks, the prevalence of dual use among Malaysian youth appears to be rising and represents a significant public health concern. These findings underscore the urgent need for targeted prevention and control strategies addressing both conventional and emerging tobacco products in this population.

For several decades, mortality has decreased more rapidly among individuals with a higher socioeconomic position than among those with a lower position. This widening social inequality gap has increasingly been recognised as an important aspect of public health research and policies. The objective of this study was to examine trends in educational inequality in healthy life expectancy (HLE) in Denmark between 2010 and 2021 at the age of 30 years.

The study is a population-based study based on register data on longest attained education, standard life tables and self-reported health information from nationwide health surveys.

The study is conducted among the general adult population in Denmark.

Participants include respondents from the Danish National Health Survey and the Danish Health and Morbidity Survey in 2010, 2013, 2017 and 2021 aged ≥30 years.

Expected lifetime in good self-rated health, with no long-standing illness and with no activity limitations was estimated by Sullivan’s method, and educational inequality was expressed by the Slope Index of Inequality.

Between 2010 and 2021, educational inequality in HLE increased among both men and women for long-standing illness (5-year trend: +1.1 and +1.2 years) and activity limitations (+2.4 and +2.6 years) but remained stable among men (+0.1 year) and decreased among women (–0.3 year) for self-rated health. For the latter two indicators, the inequality gap narrowed after 2017.

Trends in educational inequality in HLE in Denmark 2010–2021 vary by health indicator. Steadily widening gaps were demonstrated for long-standing illness, while narrowing gaps were seen after 2017 for activity limitations and self-rated health. Future studies are encouraged to explore potential health risk behaviours that may explain or modify these inequality trends.