To estimate the prevalence of sleep problems among children aged 2–5 years residing in South India, assess its association with screen time and identify a predictive screen time threshold.
Population-based cross-sectional study.
Field practice areas in rural and urban centres of a medical college in South India.
In total, 523 children aged 2–5 years were selected by simple random sampling.
Sleep problems were assessed using the validated bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity of sleep and snoring sleep screening tool. Sociodemographic and behavioural factors, including screen time, were also examined. The optimal predictive screen time cut-off was identified using receiver operating characteristic (ROC) analysis.
Sleep disturbances were reported in 39.6% of children (95% CI 35.5% to 43.8%). The most common sleep problems were irregular sleep (22.2%), bedtime resistance (20.8%) and night awakening (19.9%). Multivariate logistic regression showed strong associations between sleep problems and screen use in bed (adjusted OR (AOR) = 3.8; 95% CI 2.4 to 6.1), excess screen time (AOR=3.3; 95% CI 1.8 to 6), smaller family size (AOR=3.1; 95% CI 1.5 to 6.1), reduced physical activity (AOR=2.6; 95% CI 1.6 to 4.2), shorter birth spacing (AOR=1.8; 95% CI 1.1 to 2.8), lower socioeconomic status (AOR=1.8; 95% CI 1.2 to 2.8) and maternal screen time>2 hours/day (AOR=1.6; 95% CI 1.04 to 2.6). ROC analysis identified ≥2.4 hours per day of screen time as the optimal threshold for predicting sleep problems (area under the curve=0.800; sensitivity, 73.9% and specificity, 77.2%).
In this large population-based study, two of the five preschool children experienced sleep problems, with excess screen time, particularly screen use in bed, being the key contributing factor. This is one of the few Indian studies to establish an ROC-derived screen time threshold for identifying sleep problems. These findings can guide targeted parental advice and early preventive strategies to promote healthy sleep in preschool children.
Community health workers (CHWs) are trained lay people and trusted members of communities worldwide who play crucial roles in bridging healthcare gaps in low–middle-income countries yet remain underused and not well integrated within high-income countries like Canada. The objective of this scoping review is to map out available evidence on the integration of CHWs in high-income countries with universal healthcare systems.
This scoping review will include all available literature involving CHWs, or similar designations, and their integration into universal health systems within high-income countries. Literature will be excluded if it does not involve CHWs, universal healthcare systems, address integration or is conducted in low–middle-income countries. This review will include all available literature (including those that show null or negative results) that examines the integration of CHWs in high-income countries with a universal healthcare system. Documents describing integration may include, but are not limited to: tools, policies, models, frameworks, programmes or organisational features that seek to promote positive integration. Peer-reviewed and grey literature examining CHW integration in high-income countries with universal healthcare systems will be eligible for inclusion. Databases/sources to be searched (from inception until November 2025) will include: Medline (Ovid), Embase (Elsevier), Scopus (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Academic Search Premier (EBSCO), Business Source Complete (EBSCO), ProQuest Dissertations and Theses Global. Retrieval of full-text, all language studies (and other literature), data extraction, synthesis and mapping will be performed independently by two reviewers, following Joanna Briggs Institute methodology. Findings will be organised and presented according to the Levesque conceptual framework for healthcare access.
Ethics approval is not required for this scoping review and literature search will start in October 2025 or on acceptance of this protocol. The findings of the scoping review will be available (February 2026) and will be published in a peer-reviewed journal.
The COVID-19 pandemic has made long-standing nursing workforce challenges apparent on an international scale. Decision-makers must develop multi-pronged approaches to foster the development and maintenance of a strong nursing workforce to support health systems. These approaches require attendance to recruitment and retention initiatives that show promise for stabilising the nursing workforce now and into the future.
Searches were conducted across MEDLINE, Embase, CINAHL and Scopus from January 2014 up to 11 March 2024. This rapid umbrella review protocol is guided by the Joanna Briggs Institute scoping review methodology and adheres to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The research question guiding this review is: what structures have healthcare systems put in place to stabilise, support and sustain the nursing workforce? This review will include existing reviews of nursing workforce initiatives with outcomes that impact nursing recruitment and retention. Results will support local health transformation including the development of a jurisdictional nursing workforce stabilisation strategy. Findings from this review will be relevant for the design, refinement and implementation of nursing workforce sustainability strategies in countries around the globe and may apply to strategies for other healthcare workers.
Institutional research ethics board exemption was received. The research team is supported by an advisory group that includes provider and patient partners. The results from this study will inform the Nursing Workforce Strategy for the province of Nova Scotia as part of a larger Canadian Institutes of Health Research-funded project. They will also inform broader planning and strategy in Canada through integration with other evidence-generation activities such as comparative policy analyses and workforce planning exercises. Finally, the results will be published in a peer-reviewed journal.
Registered through Open Science Framework: https://doi.org/10.17605/OSF.IO/CUJYK
The necessity of enhancing resuscitation training has been encouraged by The International Liaison Committee on Resuscitation and the American Heart Association to reduce mortality, disability and healthcare costs. Resuscitation training is a complicated approach that encompasses various components and their mixture. It is essential to identify the most effective of these components and their combinations, to measure the corresponding effect size and to understand which participant groups may enjoy the greatest advantage.
We will systematically search 12 databases and two clinical trial registries for randomised controlled trials (RCTs) that examine different resuscitation training methods from inception to April 2025. The analysis will be carried out using the standard network meta-analysis and component network meta-analysis models. Resuscitation skills of staff will be the primary outcome of this analysis. Paired reviewers will independently screen and extract data. A consensus will be sought with the principal investigators to resolve any disagreements that cannot be achieved through regular meetings. Each intervention in each RCT will be decomposed according to its constituent components, such as delivery method, interactivity, teamwork, digitalisation and type of simulator. The analysis will be conducted using the frequentist and bayesian approach in the R environment. RoB V.2.0 and Confidence in Network Meta-Analysis will, respectively, be used to assess the risk of bias and the certainty of the evidence.
As we will use only aggregated secondary data without individual identities, ethical approval is not required. Results of this review will be shared through a peer-reviewed publication and presentation of papers at any relevant conferences.
CRD42024532878