Self-rated health (SRH) is a well-established predictor of all-cause mortality. However, its predictive value in patients with cancer remains unclear. We aimed to elucidate the relationship between prediagnostic SRH and mortality among patients with cancer using data from the Norwegian Women and Health (NOWAC) Study.

A prospective cohort study.

This study included 26 405 women from the NOWAC cohort who were diagnosed with cancer between 1992 and 2020. Subgroup analyses focused on the most common cancer types among Norwegian women: breast (n=8299), colorectal (n=3653) and lung and bronchial (n=2428) cancers.

Prediagnostic SRH was assessed using a single-item measure with four response alternatives and categorised into ‘very good’, ‘good’ and ‘poor’ SRH. We used flexible parametric survival analysis and competing risk regression models to evaluate the association between SRH and all-cause and cancer-specific mortality after adjusting for age, physical activity, Body Mass Index, smoking, alcohol consumption and education.

Poor prediagnostic SRH was associated with increased all-cause mortality among long-term cancer survivors. For specific cancer sites, the adjusted HRs and 95% CI for poor versus very good SRH were 1.29 (95% CI: 1.06 to 1.58) for breast cancer and 1.50 (95% CI: 1.20 to 1.88) for colorectal cancer. These associations were more pronounced among long-term survivors than short-term survivors. No association was observed between prediagnostic SRH and mortality for patients with lung cancer. For cancer-specific mortality, prediagnostic SRH predicted mortality from all cancers, as well as from colorectal cancer.

Prediagnostic SRH is a significant predictor of mortality in patients with cancer, particularly among long-term survivors. These findings indicate the potential of SRH as a predictive tool for mortality, underscoring the importance of integrating SRH assessments into identifying individuals at higher risk of mortality and highlighting the potential benefits of public health interventions aimed at improving overall health, but further studies are required to assess the effect of such interventions on SRH.

To investigate discrepancies in perceptions regarding the accessibility and availability of rest and relaxation (R&R) spaces between hospital doctors in Scotland and NHS Scotland regional health boards (HBs), with the intention of informing best practices for organisational policy on the provision of R&R spaces both now and in the future.

A qualitative study, through an inhabited institutionalism (II) lens, of semi-structured interviews of hospital doctors across the career continuum in Scotland and all NHS regional HBs in Scotland providing written information relating to R&R space provision.

NHS Scotland during the COVID-19 pandemic and beyond.

Hospital doctors (n=30) who had participated in a larger qualitative study and provided specific insights on R&R spaces. All NHS Scotland regional HBs (n=14).

Although HBs reported the provision of R&R spaces, numerous doctors reported R&R spaces had been removed, relocated or were inaccessible. Furthermore, limited awareness of their availability attributed to inadequate communication, compounded the issue. This divergence between institutional reporting and front-line experience can be interpreted through the lens of II, which posits that institutional polices are often interpreted and implemented differently.

This study emphasises how crucial R&R spaces are to promoting doctors’ well-being especially during the time of high stress. HBs must not only guarantee the accessibility and physical availability of R&R spaces but also enhance their communication regarding the provision.

To evaluate staffing conditions, patient outcomes, quality of care, patient safety and nurse job outcomes in British Columbia (BC), Canada hospitals.

Cross-sectional study of 58 hospitals in BC with surveys of nurses and independent measures of patient outcomes.

58 hospitals in BC.

6685 hospital-based nurses working in a direct patient care role.

Hospital-wide and unit-specific patient-to-nurse staffing ratios derived from registered nurse reports of how many patients and how many nurses were on their unit during their last shift worked.

Objective patient outcome measures included the Hospital Standardized Mortality Ratio (HSMR) and 30-day Readmission Rate, from 2022 to 2023 Canadian Institute for Health Information data. Nurses4All@BC provided data from 2024 using validated items on multiple measures (eg, nurse burnout, missed health breaks, intentions to leave, quality and safety measures such as culture of patient safety, quality of nursing care, missed nursing care).

Burnout (59.4%), missed health breaks (41.7%), job dissatisfaction (36.0%), intentions to leave (19.3%) and patient outcomes (HSMR mean 95.4, median 96.0, range 26–180; readmission rate mean 10.0%, median 9.5%, range 7.9%–13.8%) were high and varied across hospitals. 68.3% of nurses reported there were not enough staff, and 77.3% reported their workloads were unsafe for patients. 60.6% of nurses gave their hospital an unfavourable patient safety rating. More patients per nurse were associated with poorer hospital mortality and readmission rates, poorer job outcomes for nurses, more adverse events for patients, less favourable ratings of quality of care and patient safety, more missed nursing care and poorer ratings of staffing adequacy and management.

Given the variability in staffing, quality and patient outcomes across BC hospitals, the implementation of a minimum nurse-to-patient ratio policy has the potential to improve patient care safety and retention of nurses.

Social norms are often implicit informal rules that most people accept and abide by, and can influence how people behave, sometimes based on perceived rewards and/or sanctions. Social norms are propelled by some reference or population groups who exert a considerable amount of influence on behaviour because people value their approval or disapproval. Despite these observations, little research exists on the influence of social norms on diabetes risk-taking behaviours. We explored diet-related social norms and their influence on risk-taking behaviours for type 2 diabetes (T2D).

We conducted a multi-method qualitative study guided by the Social Norms Exploration Toolkit participatory tools. A total of 45 participants were interviewed for this study, including (10) T2D patients, (10) caregivers of T2D patients, (10) healthcare providers, (2) village health teams, (4) diabetes-free community members; (4) community influencers like cultural leaders and (5) family members. The study was conducted in eastern Uganda in the districts of Bugiri and Busia. Data were collected on health workers, caregivers, patients and community members using focus group discussions, in-depth interviews and non-participant observation. Data were manually analysed to identify emerging social norms and other information of interest following a thematic framework approach.

Most participants were aware that frequent consumption of fatty foods and sugary refined foods could increase one’s risk of getting T2D. The study highlights three themes: general awareness of T2D risk factors, common social norms influencing dietary behaviours and behavioural risk factors that are influenced by the social norms. The study highlights significant behavioural and social drivers of T2D, which include consumption of high-fat, high-sugar diets, limited exercise and stress. Gendered and cultural norms strongly influence dietary behaviours, with women preparing unhealthy foods to meet societal expectations, fearing sanctions like divorce or community stigma, while men’s dietary preferences were linked to respect and social status. Norms around staple food preferences and respect linked to weight further perpetuate T2D risk behaviours. Community influencers, family dynamics and cultural traditions reinforce these practices, underscoring the need for gender-transformative, culturally sensitive and community-centred interventions. However, healthcare providers and village health teams are critical for promoting healthier behaviours and reducing T2D prevalence.

Our deep-dive social norms diagnosis has revealed that even when people know the risk factors for T2D, they will still follow the social norm influence regarding lifestyles. Inclusive strategies that actively engage and reshape norms are therefore vital to reduce the prevalence of T2D.

People living with HIV/AIDS (PLWHA) have complex physical, psychological, social and spiritual needs following diagnosis and poorer health-related quality of life than the general population. Holistic assessment and care delivery incorporating person-centred principles is required to address these needs. This protocol describes a cluster randomised controlled trial (cRCT) and process evaluation to evaluate the effectiveness of the extra community-based enhanced care intervention (ExtraCECI) to improve the quality of life and person-centred outcomes for PLWHA in Ghana.

This cRCT will randomly assign 26 recruited HIV clinics using 1:1 allocation to either ExtraCECI intervention or standard HIV care, with each clinic recruiting an average of 25 participants, that is, 650 in total. Eligible participants are adult PLWHA aged at least 18 years and in HIV care for at least 6 months, with cognitive ability to consent as guided by the Mental Capacity Act, clinically well to participate, attending an outpatient clinic. Healthcare professionals (HCP) at clinics randomised to the ExtraCECI intervention arm will receive training on person-centred care and holistic assessment of PLWHA in the domains of physical, psychological, social and spiritual well-being. PLWHA will be empowered to contribute to their care decisions including HCP using telehealth for ExtraCECI delivery with ongoing mentorship, while participants in the Standard HIV Care arm continue with usual care. The primary outcome is quality of life measured at the individual level using Medical Outcomes Study-HIV (MOS-HIV). The primary analysis will compare MOS-HIV total scores between groups using repeated measure linear mixed model and adjusting for important baseline characteristics (including stratification factors) and random effect of clinic. The incremental cost-effectiveness ratio will be used to estimate the cost-effectiveness of the ExtraCECI intervention, and a process evaluation will be conducted.

This protocol was approved by Edinburgh Napier University School of Health and Social Care Research Integrity Committee (REF: SHSC3681836) and the Ghana Health Service Ethics Review Committee (GHS-ERC:010/07/24). Results from this study whether positive or negative will be presented to participating sites, communities, at scientific conferences and published in peer-reviewed journals.

ISRCTN77405303.

The study aimed to identify the predictive factors associated with virological failure among adult patients living with HIV on first-line highly active antiretroviral therapy (HAART) in selected hospitals in Southeast Oromia, Ethiopia.

A facility-based unmatched case–control study was conducted.

The study was conducted in three selected hospitals in Southeast Oromia, Ethiopia.

The study included a final sample size of 282 participants, comprising 94 cases and 188 controls. A simple random sampling technique was employed to select participants.

The main outcome of this study was virological failure among adult patients living with HIV on first-line HAART. Virological failure was defined as a binary outcome: a case indicated the presence of failure, defined as adults aged≥15 years with a viral load (VL)>1000 copies/mm³ in two consecutive measurements taken 3 months apart, following enhanced adherence counselling (EAC) after 6 months of treatment. A control indicated the absence of failure, defined as patients aged≥15 years with a VL3 in two consecutive measurements after at least 6 months of treatment. The study used routine viral load testing records, recommended at 6 and 12 months and annually thereafter, with the WHO threshold of 1000 copies/mL used to define virological failure.

Individuals under the age of 35 had higher odds of virological failure (adjusted OR (AOR): 2.0; 95% CI (1.1 to 3.6)) compared with those older than 35. People with a body mass index (BMI) below 18.5 had higher odds of virological failure (AOR: 2.4; 95% CI (1.0 to 5.7)). Those with poor adherence had significantly higher odds of virological failure (AOR: 5.1; 95% CI (2.7 to 9.9)). Individuals attending less than 50% of their scheduled visits had increased odds of virological failure (AOR: 3.2; 95% CI (1.3 to 8.0)). Those with a history of co-trimoxazole preventive therapy use had higher odds of virological failure (AOR: 4.1; 95% CI (1.4 to 11.9)). Individuals with a baseline CD4 (cluster of differentiation) count below 200 cells/mm³ had higher odds of virological failure (AOR: 3.6; 95% CI (2.0 to 6.7)) compared with those with higher counts.

The study has identified several key factors, including education level, marital status, duration of HAART, younger age, current BMI, adherence to treatment, scheduled healthcare visits, history of co-trimoxazole preventive therapy use and baseline CD4 count, as significant determinants of virological failure within the studied population. The study’s identification of determinants of virological failure among people living with HIV is crucial for decreasing the prevalence of virological failure and improving the health of people living with HIV. Therefore, targeted counselling and support can play a crucial role in enhancing patient understanding, motivation and engagement with their treatment, ultimately contributing to improved virological suppression and overall health.

Greater trochanteric pain syndrome (GTPS) is a common and disabling condition characterised by lateral hip pain. The condition often persists for several months, and there is low evidence for any superior treatment. The aim of this study protocol is to describe a randomised controlled trial (RCT) investigating the effectiveness of a self-management programme versus usual care for patients with GTPS.

The study is designed as an observer-blinded, parallel group, superiority RCTcomparing a self-management programme (n=55) with usual care (n=55). Eligible patients with GTPS will be included based on reproduction of pain on palpation in the greater trochanteric region and at least one positive clinical provocation test. The self-management programme includes 3–5 individual sessions with a physiotherapist over 12 weeks, addressing physical, emotional and behavioural factors deemed relevant by the patient. Usual care will receive general information about GTPS, activity management and are free to seek further treatment in primary care as wanted. The primary outcome measure is the Norwegian version of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire (VISA-G-Norwegian). Outcomes will be assessed at baseline, 3, 6 and 12 months. A longitudinal mixed effects model will be used to assess the effectiveness of treatment on pain and disability across all time points, with the primary endpoint at 6 months. Cost-effectiveness will be expressed by mean incremental cost-effectiveness ratios (ICERs) from a societal and healthcare perspective. Bootstrapping will be used to estimate ICER uncertainty.

The Norwegian Regional Committees for Medical and Health Research Ethics have approved the project (2023/590816), and it will be in accordance with recommendations from the Data Inspectorate at Oslo University Hospital (22/26396). The results from the study will be disseminated through publications in peer-reviewed journals, in conference presentations and through the user representative.

NCT06297148.

Effective glucose control in surgical patients at risk of hyperglycaemia and hypoglycaemia is crucial, as these conditions can lead to surgical site infections, prolonged hospital stays and death. Fingerstick glucose monitoring (FSGM), the standard measurement of glucose, can be painful for patients and time-consuming for nursing staff, especially with hourly monitoring around surgery. Continuous glucose monitoring systems (CGMS) offer a less invasive alternative with better glucose regulation in outpatients.

The GLUCOSENS study compares the effects of CGMS and FSGM on point-of-care measurements and time-in-range (3.9–10.0 mmol/l) glucose levels (primary outcome), patient satisfaction and experience and nursing staff workload and experience in surgical wards. Furthermore, it evaluates CGMS accuracy during perioperative periods and medical imaging.

This Danish two-centre study will be conducted at the general surgical wards of Odense and Zealand University Hospital and will involve 305 patients over 18 months. The study is divided into three periods: first, a standard care period with point-of-care FSGM (110 patients); second, an intervention period with point-of-care CGMS (110 patients); third, another standard care period with point-of-care FSGM combined with a blinded sensor for comparing continuous glucose data from this period with continuous glucose data from the intervention period (85 patients). Furthermore, the study will include 24 nursing staff.

Data will be collected through medical file reviews on glucose levels, patient satisfaction questionnaires, a patient field study, an observation study of the nursing staff’s workload and qualitative interviews of nursing staff.

The study is registered with the Records of Processing Activities in the Region of Southern Denmark for research and quality projects (ID number: 23/36734) and has been approved by the Regional Scientific Ethical Committee in Southern Denmark (ID number: S-20240041). The results will be published in international peer-reviewed journals.

ClinicalTrials.gov Registry (NCT06473480)