The Healthy Lifestyle Index (HLI) integrates key behaviours to assess their cumulative impact on health. While higher HLI adherence is linked to lower disease and mortality risk, its long-term trajectory association remains understudied. This study aims to examine the dose-response relationship and long-term association of HLI on mortality risks.

Systematic review and dose-response meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.

PubMed, Scopus and Web of Science were searched until June 2024.

We included observational cohort studies that assessed the relationship of HLI or its trajectories with all-cause, cardiovascular disease (CVD)-cause or cancer-cause of mortality.

Analysis of 13.7 million participants demonstrated that higher adherence to the HLI is linked to lower risk of all-cause (HR: 0.48; 95% CI 0.46 to 0.53; GRADE: moderate), CVD-cause (HR: 0.49; 95% CI 0.44 to 0.51; GRADE: moderate) and cancer-cause mortality (HR: 0.55; 95% CI 0.49 to 0.61; GRADE: low). These associations were further confirmed in a dose-response manner. Moreover, compared with maintaining an unhealthy lifestyle, a decline in HLI adherence was associated with a 14% higher risk of all-cause and a 19% higher risk of cancer-related mortality. In contrast, an improvement in HLI adherence was linked to a 20% lower risk of all-cause and a 13% lower risk of cancer-related mortality.

Adherence to HLI and its long-term patterns are associated with lower mortality risk. These findings emphasise the importance of lifestyle-based prevention and intervention strategies in reducing mortality.

CRD42024500538.

Scabies is a common skin condition and poses a substantial disease burden in resource-poor tropical settings. The Rohingya refugee camps in Cox’s Bazar, Bangladesh represent one of the world’s largest and most protracted humanitarian crises. Using 3 years of data from 2021 to 2023, this study analysed the seasonality of scabies and examined its association with climatic factors.

This is a retrospective observational study conducted in the Rohingya refugee camps and adjacent host communities in Ukhiya and Teknaf, Cox’s Bazar. All patients clinically diagnosed with scabies and who received treatment at 35 International Organization for Migration (IOM)-supported health facilities between 1 January 2021 and 31 December 2023 were included. Climate data, including daily mean, minimum and maximum temperature and total and maximum rainfall, were obtained from the Bangladesh Meteorological Department. Seasonal–Trend decomposition using LOESS (locally estimated scatterplot smoothing) (STL) was applied. Associations between climatic variables and the decomposed seasonal component of scabies cases and corresponding attack rate, as well as overall scabies case counts and overall attack rate, were assessed using Pearson’s correlation tests.

A total of 323 106 new scabies cases were reported from IOM-supported health facilities between January 2021 and December 2023. Children aged under 5 years and 6–18 years accounted for the highest proportion of cases (32.08% and 38.95%, respectively). The average monthly number of scabies cases was highest in November (12 625) and lowest in May (5862). Case numbers increased from November to February (high season), with a peak between October and November, and declined between April and June (low season). An inverse relationship was observed between temperature and scabies incidence, with higher case numbers during cooler months and lower numbers during warmer months. Pearson’s correlation analysis demonstrated a strong and significant negative correlation between the seasonal components of both scabies cases and attack rate and temperature variables, including maximum (cases: r=–0.492, p=0.002; attack rate: r=–0.484, p=0.003), minimum (cases: r=–0.506, p=0.002; attack rate: r=–0.489, p=0.002) and mean temperature (cases: r=–0.525, p=0.001; attack rate: r=–0.511, p=0.001). No significant association was observed between the seasonal component of scabies cases or attack rate and humidity or rainfall.

This study identified a distinct seasonal pattern of scabies, with higher caseloads and attack rate during late autumn and winter (October to February) and lower caseloads and attack rate during summer months (April to June). Temperature showed a strong negative association with the seasonal component of scabies burden. These findings may inform the timing of public health strategies, including mass drug administration, intensified case management and social and behavioural change communication, in humanitarian settings.

Adhesive capsulitis (frozen shoulder) is a common condition characterised by pain, stiffness and reduced function. While conventional physiotherapy (typically comprising joint mobilisation, stretching, strengthening and electrotherapy) is widely used, there is limited evidence for the effectiveness of advanced neuromuscular techniques such as the reciprocal inhibition technique (RIT). This study aims to evaluate the impact of incorporating RIT into standard physiotherapy compared with standard physiotherapy alone in individuals with adhesive capsulitis.

This is a double-blind, randomised controlled trial. 30 adults aged 30–70 years with clinically confirmed adhesive capsulitis will be recruited from a tertiary rehabilitation centre in Dhaka, Bangladesh. Participants will be randomly allocated to receive either RIT combined with conventional physiotherapy or conventional physiotherapy alone, with both groups undergoing 12 treatment sessions over 4 weeks. The primary outcome is pain intensity at 4 weeks post-randomisation, measured by the Numeric Pain Rating Scale. Secondary outcomes include shoulder range of motion (abduction, internal and external rotation, assessed with a universal goniometer), functional ability (Shoulder Pain and Disability Index) and muscle strength (abduction, internal and external rotation, measured by hand-held dynamometry). Blinded assessors will conduct evaluations at baseline and after the intervention. Data will be analysed using intention-to-treat principles. Between-group comparisons will be made using linear mixed models with fixed effects for group, time and group-by-time interaction, and a random intercept for participants to account for repeated measurements. Within-group changes will be estimated from the models.

This trial has received ethical clearance from the Institutional Review Board of the Institute of Physiotherapy, Rehabilitation & Research (approval number BPA-IPRR/IRB/18/02/2025/32). Results will be disseminated through peer-reviewed publications and international conferences in accordance with Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. By addressing a significant evidence gap, this study may establish RIT as an effective and affordable adjunct to standard physiotherapy for managing adhesive capsulitis.

CTRI/2025/06/089288 [Registered on: 23/06/2025]

Diabetes is a chronic disease characterised by elevated blood sugar levels, which can lead to damage across various body systems. Bangladesh has the second highest number of adults with diabetes in South Asia and faces a significant economic burden from this condition. The objective of this study was to investigate the economic burden of diabetes and its associated factors among patients with diabetes registered at a tertiary-level diabetes hospital in the Rajshahi region of Bangladesh.

This was a cross-sectional hospital-based study.

Primary data were collected from patients with diabetes at a tertiary-level diabetes hospital in Bangladesh.

The study recruited 400 patientswith diabetes, who were randomly selected. The economic burden was assessed using the Catastrophic Health Expenditure (CHE) threshold of ≥10% of household income. Descriptive statistics, 2 tests, t-tests, linear regression and binary logistic regression were employed for analysis, with statistical significance set at p

The proportion of diabetes-related burden among patients with diabetes was 50.7%. 95.8% of patients had type 2 diabetes, and over half (52.5%) were overweight or obese. Treatment costs were significantly associated with diabetes duration, insulin use and age (35–55 vs ≥56 years). The economic burden was strongly associated with lower income levels (poor income and middle income vs high income) and longer diabetes duration. Participants not adhering to a healthy diet had 43% lower odds of experiencing economic burden than those following a healthy diet.

Approximately half of the patients experienced catastrophic health expenditure due to diabetes, indicating a substantial economic burden in the Rajshahi region of Bangladesh. This burden was significantly higher among lower-income and middle-income groups and patients with longer disease duration, and treatment-related factors such as insulin use were associated with greater financial strain. These findings emphasise the need for targeted financial protection strategies, including subsidised care and preventive interventions.

This study investigates the association between healthcare staff turnover and quality of care in nursing homes.1 2 In recent years, the healthcare industry has faced serious challenges regarding workforce shortages. Particularly in long-term care facilities such as nursing homes, staff shortages and high turnover rates are considered major problems.1 2 This situation has not only negatively impacted patient care quality, but has also placed considerable pressure on healthcare systems...

Sodium-glucose cotransporter (SGLT) inhibitors have shown substantial benefit in reducing cardiovascular and kidney events across diverse clinical populations, but the underlying physiological mechanisms remain unclear. However, existing mechanistic studies on renal and cardiovascular haemodynamics show variability in design, have limited statistical power and yield inconsistent outcomes, thus limiting the ability to draw generalisable conclusions. To address this gap, we conducted a systematic review and proposed the first meta-analysis to aggregate individual participant-level data from mechanistic studies to identify consistent physiological patterns and enhance understanding of the therapeutic effects of SGLT inhibition.

Gold-standard measured glomerular filtration rate (mGFR) was selected as the primary outcome for this systematic review, which aimed to identify all completed mechanistic studies investigating the effects of SGLT inhibition. Electronic databases including Ovid MEDLINE; Ovid Embase; Cochrane Database of Systematic Reviews; and Cochrane Central Register of Controlled Trials were searched using a detailed search strategy. In total, 24 studies (n=1296) were identified. This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Key variables including demographics, medical history, concomitant medications, vital signs, mGFR, renal haemodynamics, urine and plasma biochemistry, tubular sodium handling, echocardiography, cardiac output monitoring, arterial stiffness and fluid volume will be extracted. A one-stage individual participant data meta-analysis under a Bayesian framework will be conducted, using hierarchical models to simultaneously analyse data from all eligible studies. The risk of bias due to missing results will be assessed. Sensitivity analyses and subgroup evaluations will be incorporated to explore sources of heterogeneity and assess robustness of findings.

Ethics approval was obtained from University Health Network, Toronto, Canada. Findings from the Mechanisms of SGLT Inhibitor Action and Physiological Mediators (MOSAIC) meta-analysis will be published in peer-reviewed journals and results will be disseminated at scientific conferences.

CRD420251001413.

The study evaluated the feasibility and efficacy of a non-immersive virtual reality (VR) system on upper extremity (UE) recovery in ischaemic stroke patients in comparison to a conventional physiotherapy.

An open-label, parallel-group, randomised controlled trial randomly assigned the participants to two groups, VR intervention or conventional physiotherapy.

Two tertiary stroke care centres in South India participated in the study.

Sixty first-ever ischaemic stroke patients (1–6 months of stroke onset) having spasticity grades of 1 or 1+ as per Modified Ashworth scale and Brunnstrom recovery stages of 3, 4 or 5 in the UE were included in the intention-to-treat analysis.

High-intensity non-immersive VR-based comprehensive rehabilitation gaming system with a duration of 12 weeks (3 days/week) was compared with equally intensive conventional physiotherapy.

The feasibility outcome was the compliance with the treatment. The primary efficacy outcome was the improvement in the motor function assessed by the Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT). The secondary outcomes included the performance in activities of daily living by the Barthel index (BI) and the quality of life by the 36-item short form health survey (SF-36).

The treatment compliance was similar in two groups (p=0.19). Both groups improved in motor performance, activities of daily living and quality of life. However, there were no significant differences in the FMA (p=0.58), WMFT (functional ability scale, p=0.33; performance time, p=0.44), BI (p=0.84) and SF-36 (physical, p=0.87; mental, p=0.99) scores between the groups.

The non-immersive VR system was feasible, effective and safe; however, it was not found to be superior to conventional physiotherapy. The trial was stopped early and did not reach its proposed sample size and hence, the findings are to be interpreted cautiously.

Clinical trial registry India: CTRI/2021/11/038339 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc1OTI=&Enc=&userName=CTRI/2021/11/038339).

This study aims to investigate the association between physical fitness and markers of cognitive function in adults aged 40 and above in Qatar.

A cross-sectional study.

The Qatar Biobank, data of 1000 adults aged 40 and above.

A population of 1000 adults aged 40 years and older was included. Available data comprised measures of physical fitness including cardiorespiratory fitness, muscular strength, body composition and physical fitness capacity, as well as cognitive function assessed through tests of short-term visual memory and psychomotor coordination.

This paper investigated the physical fitness effect on cognitive functioning through short-term visual memory and psychomotor coordination testing. Logistic regression was used to measure the association between physical fitness and cognitive functioning tests.

Our study showed that lower physical fitness capacity was significantly associated with lower psychomotor coordination in females (OR=1.57, p=0.040) and showed no significant association in males (OR=1.65, p=0.062). For short-term visual memory, the association was significant in females (OR=1.68, p=0.042) unlike in males (OR=1.58, p=0.062). Males with greater muscle strength were about half as likely to have lower psychomotor coordination (OR=0.48, p=0.04). In females, a higher body fat percentage was associated with poorer cognitive function, with each 1% increase in body fat being linked to 6% higher odds of low short-term visual memory (p=0.02) and low psychomotor coordination (p=0.006). Cardiorespiratory fitness showed no statistically significant association with short-term visual memory and psychomotor coordination level in either sex.

Our findings suggest that overall physical fitness capacity is associated with better cognitive function in Qatari adults. The relationship between specific fitness measures and cognitive function varied by sex, with muscle strength having a stronger effect for males and body composition for females. These results highlight the potential importance of maintaining physical fitness for cognitive health in adulthood.

To assess the sex-specific status of dietary diversity (DD) and its associated factors among older men and women (aged ≥60 years) in Bangladesh.

A nationally representative cross-sectional survey was conducted in 2018–2019 on food security, nutrition and health of older adults of both sexes.

Data were collected from 82 clusters (rural 57, non-slum urban 15 and slum 10) from all eight administrative divisions of Bangladesh.

A total of 4817 participants aged ≥60 years (2482 men and 2335 women) were enrolled.

A list-based (24-item) recall method was employed, and the items were later aggregated into 10 food groups. The outcome variable was the prevalence of inadequate DD, defined as consumption of less than 5 food groups out of 10.

Men and women had mean DD scores of 4.33±1.6 and 4.13±1.7, respectively. Women had a higher prevalence of inadequate DD than men (61.2% vs 56.3%, p=0.028). Among the food groups, women consumed significantly less fish and eggs than men (fish: 50.96% vs 57.76%, p=0.002; eggs: 17.13% vs 22.10%, p=0.004). Poor education, rural dwellings, living in homes with fewer individuals and living in food-insecure households were associated with inadequate DD in both sexes. Furthermore, among men, older age and not being currently married, and among women, lower age and living in households with middle wealth status were associated with inadequate DD.

The study found that older women consume relatively less diverse diets than men, and several sociodemographic factors influence inadequate DD among older adults of both sexes in Bangladesh. These factors should be considered while developing policies and programmes to promote equitable access to a diversified diet and improve geriatric health and nutritional outcomes.

Despite a high disease burden, care-seeking for mental health symptoms is low in Bangladesh, particularly among women.

To evaluate help-seeking behaviours for anxiety and depression symptoms among Bangladeshi women aged 15–49 and its association with women’s empowerment.

Data from the Bangladesh Demographic and Health Survey 2022 including 2881 women reporting anxiety or depression symptoms were analysed. Help-seeking behaviours, sociodemographics and women’s empowerment using the Survey-based Women’s Empowerment (SWPER) index were assessed. Logistic regression models were used to explore associations.

The mean age of participants was 33.3 years (SD 8.7); two-thirds lived in rural areas. In the SWPER index, 83% of women had high empowerment in the attitude to violence domain, 16% in social independence and 60% in decision-making. Among women with anxiety or depression symptoms, 18.7% sought help, mainly from spouses (43%) or family (52%), and 15% consulted doctors. Women aged >30 years (adjusted OR, aOR 1.25, 95% CI 1.02 to 1.53), from rich households (aOR 1.49, 95% CI 1.09 to 1.89), and with secondary (aOR 1.47, 95% CI 1.08 to 2.01) or higher education (aOR 1.56, 95% CI 1.03 to 2.36) were more likely to seek help. High empowerment in attitude to violence (aOR 0.54, 95% CI 0.37 to 0.81) and decision-making (aOR 0.53, 95% CI 0.41 to 0.68) correlated negatively with help-seeking.

Few Bangladeshi women seek help for mental health symptoms, relying on informal sources. Age, education, wealth and employment predict help-seeking, while high empowerment level in attitude to violence and decision-making domain of SWPER index shows an inverse relationship.

Alzheimer’s disease (AD) impacts over 55 million individuals worldwide and remains the leading cause of dementia (60–70% of cases). By 2050, South and Southeast Asia are projected to have an older adult population more than double, bearing a major share of Alzheimer’s disease burden. This will exert a heavy strain on healthcare systems, particularly in resource-limited countries where support and infrastructure are already stretched. Despite this, no review has yet explored the regional epidemiology and associated risk factors in this context. Thus, this study protocol outlines to synthesise prevailing evidence from these densely populated regions, particularly low- and middle-income nations within South and Southeast Asia.

This review will include studies that reported epidemiological characteristics including prevalence, age of onset, mortality, and risk factors of AD and related dementias comprising in South and Southeast Asian regions. Studies published in any language from inception to date will be extracted from PubMed, Scopus, CINAHL, EMBASE and APA PsycNet, following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We will also search grey literature sources and screen the reference lists of the articles selected for full-text review to identify additional relevant studies. Observational studies including case–control, cohort, and cross-sectional designs reporting desired outcomes will be included and appraised for quality assessment with the modified Newcastle-Ottawa Scale (mNOS). The included articles will be appraised by two independent reviewers, with a third resolving any conflicts. Pooled estimates of prevalence, age of onset and mortality will be analysed using random effect meta-analysis (REML) model. Associated risk factors, including modifiable and non-modifiable will be narratively synthesised. Forest plots will be used to visualise the findings, and heterogeneity across the included studies will be assessed using the I² and Cochrane’s Q statistics. Potential publication bias will be assessed using a funnel plot along with the Begg’s and Egger’s tests. Sensitivity and subgroup analyses will also be conducted to assess the robustness of pooled estimates and to explore potential sources of heterogeneity. Statistical analysis will be conducted using Rstudio (v.4.3.2) and GraphPad Prism V.9.0.2.

The systematic review is focused on the analysis of secondary data from published literature; thus, no ethical approval will be needed. The protocol will follow international standard guidelines, findings will be reported in a reputed journal and disseminated through (inter)national conferences, webinars and key stakeholders to inform policy, research and AD management strategies.

CRD 420251047105.

Scoping reviews, mapping reviews and evidence and gap maps (collectively known as ‘big picture reviews’) in health continue to gain popularity within the evidence ecosystem. These big-picture reviews are beneficial for policy-makers, guideline developers and researchers within the field of health for understanding the available evidence, characteristics, concepts and research gaps, which are often needed to support the development of policies, guidelines and practice. However, these reviews often face criticism related to poor and inconsistent methodological conduct and reporting. There is a need to understand which areas of these reviews require further methodological clarification and exploration. The aim of this project is to develop a research agenda for scoping reviews, mapping reviews and evidence and gap maps in health by identifying and prioritising specific research questions related to methodological uncertainties.

A modified e-Delphi process will be adopted. Participants (anticipated N=100) will include patients, clinicians, the public, researchers and others invested in creating a strategic research agenda for these reviews. This Delphi will be completed in four consecutive stages, including a survey collecting the methodological uncertainties for each of the big picture reviews, the development of research questions based on that survey and two further surveys and four workshops to prioritise the research questions.

This study was approved by the University of Adelaide Human Research Ethics Committee (H-2024-188). The results will be communicated through open-access peer-reviewed publications and conferences. Videos and infographics will be developed and placed on the JBI (previously Joanna Briggs Institute) Scoping Review Network webpage.