Older adult loneliness is associated with depression, disability and higher mortality rates. As a public health concern, it contributes to increased medical and nursing care costs. Several intervention studies have been conducted to reduce loneliness; however, no universally effective method has been established. We hypothesise that if older adults use their physical abilities to perform petit volunteering, their feelings of loneliness would likely be reduced. This trial aims to investigate the benefits of using petit volunteers for loneliness alleviation (PetitVOLA) application as a sustainable programme to prevent loneliness through the creation of an Ikigai-based volunteer system.

We intend to conduct a randomised controlled trial with a 3-month intervention period to verify the effectiveness of the PetitVOLA programme (sample size, 126 participants; power, 0.8; significance level, 0.05). The primary outcome is loneliness, which we will measure using the UCLA Loneliness Scale (V.3). Secondary outcomes include social isolation (assessed via multicomponent objective criteria), life satisfaction, physical function (gait speed and grip strength), cognitive function, psychological status and lifestyle, each assessed with validated instruments (eg, Mini-Mental State Examination, Geriatric Depression Scale-15 and the Active Mobility Index). The main analysis uses an intention-to-treat approach, while a full analysis set and a per-protocol set are included for sub-analyses.

The trial was approved by the Human Research Ethics Committee of the National Center for Geriatrics and Gerontology, Japan (approval No. 1794). The results of this trial will be disseminated through peer-reviewed journals, conference presentations and reports to the participating community.

UMIN000056649.

Rising patient numbers and limited resources are creating a challenging environment for healthcare providers recently. Anaesthesiologists are also increasingly faced with complex situations, requiring high adaptability in the operating room. To enhance team adaptability during emergencies, effective communication methods are essential. This study aimed to compare the impact of mobile phones and intercoms on the response time and effectiveness of anaesthesiologist teams in emergency situations.

Prospective, observational and simulation study.

Anaesthesiology and Critical Care, Yokohama City University Medical Center, Yokohama, Japan.

This study, conducted at Yokohama City University Medical Center (Yokohama, Japan), evaluated how communication methods (intercoms vs mobile phones) impact the efficiency of anaesthesiologists in the simulation setting. Two scenarios were tested: (1) retrieving a video laryngoscope during a difficult intubation and (2) gathering support during cardiac arrest.

Outcomes measured included time to secure equipment, time for assistance to arrive and staff numbers gathered. The Wilcoxon signed-rank test was used to compare the outcomes between the intercom and mobile phone groups.

In scenario 1, the time to secure the video laryngoscope was significantly shorter with intercom use compared with mobile phones (intercom vs mobile phone, median (IQR): 29 (25–33) s vs 50 (39–62) s; p=0.013, effect size 20 (95% CI 7 to 31)). In scenario 2, the time from the request for assistance until the first supporting staff member reached the operating room was significantly shorter in using the intercoms (intercom vs mobile phone, median (IQR): 16 (14–18) s vs 35 (31–38) s; p=0.04, effect size 17 (95% CI 6 to 24)), and more personnel were available in the intercom group (intercom vs mobile phone, median (IQR): 3 (3–3.5) persons vs 2 (1–2) persons; p=0.04, effect size 1.5 (95% CI 1 to 3)).

Real-time information sharing through intercoms improved the ability of the anaesthesiologist team to respond more rapidly and effectively in emergency situations, enhancing overall team adaptability. This approach may improve patients’ outcomes by shortening response times and increasing team coordination.

Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are among the leading non-communicable diseases (NCDs) worldwide. However, diagnosing CRDs in low-income and middle-income countries (LMICs) remains challenging due to limited access to spirometry and trained professionals. Aggravating the burden, CRDs often coexist with other NCDs, increasing healthcare costs, reducing quality of life and elevating mortality. These challenges highlight the need for simple case-finding approaches for CRDs, such as the COPD in Low-Income and Middle-Income Countries Assessment (COLA-6) questionnaire, to support prompt identification and appropriate care within NCD services in LMICs.

To evaluate the discriminative accuracy, feasibility and implementation of the COLA-6 questionnaire in identifying and managing CRDs in Brazilian Primary Healthcare (PHC) services for NCDs.

The Multimorbidity Approach for REspiratory Solutions (MARES) study consists of three work packages to be conducted in PHC services in São Carlos/SP and São Paulo/SP, Brazil.

MARES-1: A cross-sectional observational study enrolling 859 individuals with at least one NCD receiving care in PHC. The COLA-6 questionnaire will be administered by the research team and compared with quality-assured spirometry. The Chronic Airways Assessment Test (CAAT), Asthma Control Questionnaire (ACQ-7) and fractional exhaled nitric oxide (FeNO) will also be assessed. The diagnostic performance of COLA-6 for identifying CRDs—including COPD, asthma, preserved ratio impaired spirometry, restriction and overlaps—will be assessed using area under receiver operating characteristic curves and 95% CIs.

MARES-2: A cross-sectional observational study enrolling 20 healthcare professionals (physicians, physiotherapists, community health agents and nurses) from five PHC services. These professionals will apply the COLA-6 during routine NCD care to a total sample of 1000 patients. Qualitative interviews will be conducted to explore barriers and facilitators to the implementation of COLA-6, using deductive thematic analysis.

MARES-3: A longitudinal, prospective observational study in which patients from MARES-1 and MARES-2 will be reassessed at 6-month follow-up. A total sample of 473 participants with abnormal spirometry, a diagnosis of CRD or high risk for CRDs is expected. Participants will undergo spirometry, and a subset will be interviewed to explore their healthcare experiences through qualitative thematic analysis. Access to diagnostic and treatment services in Brazil will be assessed. Changes in spirometry values, FeNO, CAAT and ACQ-7 scores from baseline to 6 months in patients from MARES-1 will be analysed.

This study has been approved by the Ethics Committees of Federal University of São Carlos and University of Santo Amaro (UNISA). Ethical approval was also granted by the University College London. Results will be disseminated through peer-reviewed medical journals and presentations at international conferences. Results will improve identification of CRDs, addressing a significant gap in current PHC settings.

NCT07050823/NCT07093021/NCT07134855.

The global need for developing comprehensive mental healthcare systems for children and adolescents has been increasingly evident. The system-of-care (SOC) model in the USA is among the most studied cases for such a system, which demonstrates how integrated services, encompassing psychiatric care, can effectively support children and adolescents with severe emotional disturbance. Over the past decades, the SOC framework has been widely expanded, with nearly every state in the USA receiving federal funding to implement or expand the SOC initiatives. The number of studies investigating the efficacy of the SOC is increasing, but no systematic review of the instruments for the evaluation of the implementation of the SOC exists today. This protocol paper documents the plan of a systematic review, which aims to identify and synthesise the existing instruments, which are designed and used to evaluate the implementation of the SOC.

This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocol guidelines. To identify relevant studies, we will perform a comprehensive search in five databases: PubMed, PsycINFO, ERIC, Social Work Abstracts and Web of Science. The title and abstracts of all searched articles will be screened independently by two reviewers according to the eligible criteria. Full-text screening of potentially relevant articles will be performed by at least two independent reviewers. A summary of included articles will describe the availability, progress and cultural adaptability of instruments.

The current systematic review will be solely based on previously reported data and will not involve new data collection. There are no concerns that require ethical vetting. Findings of the review will be disseminated through conference presentations and publication in a peer-reviewed journal.

1065693.

Adolescent pregnancy is a global issue. Early childbearing is strongly linked to poverty and negative health outcomes, including increased neonatal death risk. This study explores spatial patterns of adolescent pregnancies and neonatal deaths and their association with socioeconomic characteristics.

This population-based study used spatial analysis techniques to investigate the geographical distribution of adolescent pregnancies, socioeconomic characteristics and neonatal mortality rate (NMR).

The 645 municipalities of State of Sao Paulo, Brazil.

All live births to mothers residing in the State of Sao Paulo, Brazil, between 2004 and 2020.

The socioeconomic indicators used were: municipal human development index and per capita income (PCI). Spatial patterns were assessed for spatial autocorrelation (Moran’s I, LISA), and smoothed using local Bayesian estimation. Spearman’s correlation was used to ascertain the relationship between the percentage of live births to adolescent mothers and socioeconomic indexes. This calculation was also undertaken between different maternal age groups of NMR.

The study analysed over 10 million live births, with 14.3% attributed to adolescent mothers. Spatial analysis revealed significant clustering of adolescent pregnancies, strongly associated with lower socioeconomic indicators. NMR also exhibited spatial clustering, particularly after smoothing. Statistically significant differences were observed in PCI medians between high–high and low–low clusters for adolescent births. High and low incidence areas of NMR, both in all maternal ages and stratified by adolescent and non-adolescent mothers, demonstrated considerable overlap.

The results indicated the existence of clustering areas of adolescent pregnancy and neonatal deaths and suggested that the prevalence of births to adolescent mothers is not distributed equally and is higher in lower socioeconomic developed areas.

Patients living with chronic obstructive pulmonary disease (COPD) experience periods of disease stability and exacerbations (ECOPD). COPD imposes a negative and impactful extrapulmonary impairment and commonly overlaps with multimorbidity, particularly cardiovascular disease. Pulmonary rehabilitation (PR) aims to improve physical activity (PA) and quality of life, while behavioural change interventions (BCIs) aim to promote lifestyle changes and autonomy. However, after ECOPD, a variety of barriers often delay patient referral to PR. This study aims to assess the effects of a BCI for patients after ECOPD, focusing on cardiovascular health, PA and functionality. Additionally, the study will assess 6-month sustainability of PA and conduct a cost-utility analysis comparing a non-intervention group in the Unified Health System.

This randomised clinical trial will assess patients with ECOPD over 12 weeks using a BCI based on self-determination theory to increase daily steps. First, the cardiovascular and functional profile will be evaluated. Afterwards, the patients will receive an accelerometer to monitor the PA level. After 7 days, questionnaires will be applied on quality of life, symptoms and motivational levels for PA. Patients will be randomised into control group or intervention groups, both will receive educational booklets and IG will also receive an educational interview. PA will be tracked using activPAL accelerometer at weeks 1, 4 and 12, and follow-up at 6 months. Data analysis will include unpaired Student’s t-test or Mann-Whitney test for group comparison, and a linear mixed model to assess intervention effects over time. Economic evaluation, using STATA (V.14), will involve correlation analysis, and p

This study has been approved by the Federal University of São Carlos’ Ethics Committee, Irmandade Santa Casa de Misericórdia de São Carlos and Base Hospital of São José do Rio Preto. All procedures will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and applicable regulatory requirements. All results will be presented in peer-reviewed medical journals and international conferences.

Brazilian Registry of Clinical Trials under the registration number RBR-6m9pwb7.

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is included in the routine immunisation programme for adults aged 65 years and those aged 60–64 years with serious chronic medical conditions (CMCs). To improve the vaccination coverage rates, a catch-up subsidy programme was implemented by the Japanese government from October 2014 to March 2024, which resulted in no improvement in the coverage rates. For further facilitation of pneumococcal vaccination, research is warranted to understand public attitudes toward pneumococcal vaccination by assessing coverage rates and reasons for vaccination among not only the subsidy-eligible population but also in individuals aged 19–64 years with CMCs who self-pay for pneumococcal vaccination.

Nationwide, cross-sectional survey.

A web-based questionnaire study using a validated consumer panel in Japan.

Japanese adults aged 19–64 years with CMCs and those aged ≥65 years registered in the consumer panel as of March 2023.

Vaccine coverage rates, reasons for receiving or not receiving the vaccination, willingness of unvaccinated individuals to receive the vaccine in the future under the current vaccination programme and factors associated with pneumococcal vaccination coverage rates.

Vaccination coverage rates were 12.4% in those aged 19–49 years, 3.2% in those aged 50–59 years and 4.0% in those aged 60–64 years with CMCs and 55.1% in those aged ≥65 years (61.6% and 52.9% in those with and without CMCs, respectively). The majority (89.1%) of unvaccinated participants aged 19–64 years with CMCs had a positive or neutral attitude towards receiving future pneumococcal vaccinations. Among vaccinated individuals, 79.0% of those aged 19–64 years with CMCs and 56.0% of those aged ≥65 years reported that they had received a doctor’s recommendation. Doctors’ recommendation was the most common reason for receiving the vaccine among participants aged 19–64 years with CMCs (35.1%), whereas notification from the municipality was the most important reason among those aged ≥65 years (46.1%).

Data from this study suggest that recommendations from doctors are crucial for increasing coverage rates of pneumococcal vaccines, particularly among adults aged 19–64 years with CMCs. The majority of unvaccinated participants in this group had a positive or neutral attitude towards future vaccination, highlighting the importance of strong recommendations by doctors.

jRCT1030220606.