Respiratory syncytial virus (RSV) is a leading cause of hospitalisation in infants worldwide. New immunoprophylactic products, including long-acting monoclonal antibodies and maternal vaccines, have demonstrated high efficacy in prelicensure clinical trials. Understanding how these interventions perform outside controlled trials, and how viral evolution or host factors influence protection, is essential for sustaining confidence in RSV prevention programmes.

We will conduct a 5-year, test-negative case–control study among infants ≤12 months of age who present with acute respiratory illness (ARI) within a large healthcare delivery network serving a demographically diverse population. Cases will be infants testing positive for RSV by PCR, and controls will be RSV-negative infants meeting the same ARI criteria. Data will be obtained from electronic health records, structured caregiver surveys and state immunization registries to ensure accurate classification of exposures and covariates. Vaccine effectiveness will be estimated using multivariable logistic regression controlling for potential confounding. RSV-positive specimens will undergo full-genome sequencing to identify variant lineages and potential immune-escape mutations. A subset of participants will provide acute and convalescent blood samples for single-cell immune profiling to define innate and adaptive responses associated with breakthrough infection.

The study protocol has been approved by the Yale Human Investigation Committee (HIC #2000036550). Written informed consent will be obtained from all parents or legal guardians prior to participation. Study findings will be disseminated through peer-reviewed publications, scientific meetings and public repositories, with fully de-identified participant data to protect privacy and confidentiality. Viral genomic data will be shared in accordance with the National Institutes of Health Genomic Data Sharing Policy, and analytical code will be made publicly available to ensure reproducibility.

NCT06172660.

To comprehensively analyse the life expectancy at birth of people with intellectual disability, including people with Down syndrome, to inform health equity and service planning.

Retrospective cohort study.

Residents of New South Wales (NSW), Australia, with intellectual disability from birth onwards between 1 January 2001 and 31 December 2018.

Our study sample comprised 100 089 individuals with intellectual disability in the dataset, spanning from birth onwards, between 1 January 2001 and 31 December 2018.

All cause mortality. Life expectancy was estimated using ordinary and abridged life table methods, based on age-specific population count, and compared with the general NSW population.

Life expectancy at birth of people with intellectual disability was 67 years, 16 years shorter than the NSW average. Males and females with intellectual disability had a similar life expectancy. Individuals with Down syndrome had a life expectancy of 54 years, significantly shorter than those without Down syndrome. The life expectancy gap for people with intellectual disability narrowed with increasing age.

People with intellectual disability in Australia experience a substantial life expectancy gap, with greater disparities for those with Down syndrome. These findings underscore the need for targeted health and social interventions to address systemic inequities and improve health outcomes across the lifespan.

This study aims to evaluate a structured nurse-led follow-up programme coordinated by an advanced practice nurse (APN) as an alternative to conventional postdischarge care for patients with heart failure (HF). The main objective is to assess the clinical effectiveness and economic efficiency of the programme using quality-adjusted life years and healthcare costs related to resource use as outcome measures.

A quasiexperimental multicentre study will be conducted including an intervention group and a comparison group of patients discharged with HF from three public hospitals in the province of Málaga, Spain. The intervention group will be followed by an APN using a structured follow-up model, while the comparison group will receive standard care. Sociodemographic, clinical, quality of life, self-care, therapeutic adherence and healthcare resource utilisation data will be collected. The economic evaluation will be conducted from the perspective of the public healthcare system through a cost-utility analysis.

The study protocol has been approved by the corresponding Research Ethics Committee. All participants will provide written informed consent prior to inclusion. The results will be disseminated through peer-reviewed publications and presentations at national and international scientific conferences.

(1) Examine the associations between imprisonment history and mortality among adults with neurodevelopmental disabilities and (2) examine the associations between receipt of disability services and post-release mortality among adults with neurodevelopmental disabilities released from prison.

Population-based data-linkage cohort study using historical administrative data.

New South Wales (NSW), Australia.

67 217 adults aged ≥18 years (59.1% male) with one or more neurodevelopmental disabilities in NSW, Australia, from July 2001 to June 2015.

The main outcome measure was all-cause mortality. In the full cohort, we used Cox regression to examine the associations between release from imprisonment and all-cause mortality. In a subcohort of those released from prison, we used Poisson regression to examine the associations between receipt of disability services and post-release all-cause mortality.

3.3% of participants (n=2214) were imprisoned and released at least once during follow-up. In all age groups

Among adults with neurodevelopmental disabilities, mortality was increased among those released from prison compared with their peers who had not been imprisoned, although this was largely explained by health-related factors, including mental illness, substance use and physical comorbidity. Comprehensive policy and service system responses are required to meet the health and safety needs of people with neurodevelopmental disabilities who have complex needs, including criminal legal system involvement, mental illness and substance use.

Millions of patients receive general anaesthesia every year with either propofol total intravenous anaesthesia (TIVA) or inhaled volatile anaesthesia (INVA). It is currently unknown which of these techniques is superior in relation to patient experience, safety and clinical outcomes. The primary aims of this trial are to determine (1) whether patients undergoing (a) major inpatient surgery, (b) minor inpatient surgery or (c) outpatient surgery have a superior quality of recovery after INVA or TIVA and (2) whether TIVA confers no more than a small (0.2%) increased risk of definite intraoperative awareness than INVA.

This protocol was co-created by a diverse team, including patient partners with personal experience of TIVA or INVA. The design is a 13 000-patient, multicentre, patient-blinded, randomised, comparative effectiveness trial. Patients 18 years of age or older, undergoing elective non-cardiac surgery requiring general anaesthesia with a tracheal tube or laryngeal mask airway will be eligible. Patients will be randomised 1:1 to one of two anaesthetic approaches, TIVA or INVA, using minimisation. The primary effectiveness endpoints are Quality of Recovery-15 (QOR-15) score on postoperative day (POD) 1 in patients undergoing (1) major inpatient surgery, (2) minor inpatient surgery or (3) outpatient surgery, and the primary safety endpoint is the incidence of unintended definite intraoperative awareness with recall in all patients, assessed on POD1 or POD30. Secondary endpoints include QOR-15 score on POD0, POD2 and POD7; incidence of delirium on POD0 and POD1; functional status on POD30 and POD90; health-related quality of life on POD30, POD90, POD180 and POD365; days alive and at home at POD30; patient satisfaction with anaesthesia at POD2; respiratory failure on POD0; kidney injury on POD7; all-cause mortality at POD30 and POD90; intraoperative hypotension; moderate-to-severe intraoperative movement; unplanned hospital admission after outpatient surgery in a free-standing ambulatory surgery centre setting; propofol-related infusion syndrome and malignant hyperthermia.

This study is approved by the ethics board at Washington University, serving as the single Institutional Review Board for all participating sites. Recruitment began in September 2023. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media.

NCT05991453.

Respiratory tract infection tests are increasingly available in primary care and are expected to expand in the future. However, there is limited understanding of clinicians’ views on their benefits and how to effectively integrate them into daily clinical practice.

The aim of this study was to explore healthcare professionals’ views on using respiratory tract infection tests to safely reduce unnecessary antibiotic prescriptions for respiratory tract infections in primary care based on their experience in routine practice.

A qualitative study design was employed. Two focus group discussions were conducted.

These focus group discussions were conducted in February 2025, involving 18 Spanish primary care professionals, both experts and non-experts in rational antibiotic use and antimicrobial resistance. Data were audio-recorded or video-recorded, transcribed and analysed thematically.

Participants agreed that respiratory tract infection tests help optimise antibiotic prescriptions, reduce uncertainty, ensure the appropriate consumption of resources and guide treatment based on aetiology. While most professionals view microbiological tests and C-reactive protein testing as complementary, non-experts preferred microbiological tests. Professionals considered that patients value knowing the aetiology over the prognosis, supporting shared decision-making and addressing patients’ demands more effectively. Concerns remain about using these tests as stand-alone tools and the medicalisation of self-limiting conditions. Other barriers mentioned included the high cost and time-consuming nature, the need for better professional training and the challenge of managing the increased workload associated with their use.

This study highlights how clinicians perceive respiratory tract infection tests to aid prescribing decisions amid uncertainty. Both positive and negative views were reported. Participants agreed that these tests optimise antibiotic prescriptions and guide treatment, but there are still important barriers to their implementation.

Women with recurrent urinary tract infections (UTIs) often undergo intensive antibiotic exposure, especially with suppressive therapies. Suppressive therapy is recommended for women with three UTIs in the past year or two in the last 6 months. However, the collateral long-term effects of this have been poorly studied.

To assess whether suppressive therapy for recurrent UTIs increases the incidence and severity of future infections compared with episodic UTI treatment.

Retrospective cohort study.

The study was conducted using data from the Information System for Research in Primary Care database, including 5.8 million people in Catalonia. Two groups of women with recurrent UTIs (≥3 episodes/year) were compared: those on suppressive antibiotic therapy for ≥6 months and those treated episodically. Primary outcomes were hospitalisations due to pyelonephritis, septicaemia, COVID-19, influenza, pneumonia and mortality by these infections, over a 100-month follow-up period.

Among 36 170 women, 2898 (8%) were treated with continuous suppressive therapy. Overall, 6.9% of the population experienced severe infections, with a higher incidence in women on suppressive therapy (12.6%) compared with those without (6.4%), with a HR of 1.50 (95% CI 1.33 to 1.68). Pyelonephritis presented the greatest difference (HR, 1.95 (95% CI 1.64 to 2.33)), followed by septicaemia (HR, 1.34 (95% CI 1.13 to 1.59)) and COVID-19 (HR 1.23 (95% CI 1.01 to 1.50)).

Suppressive antibiotic therapy in women with recurrent UTIs is associated with a higher incidence and severity of future infections. Future research should focus on clarifying causal relationships and identifying the potential mechanisms involved.