To explore the barriers and facilitators in adherence to the guidelines in the management of benign paroxysmal positional vertigo from the perspective of primary care physicians.

Qualitative study using focus groups.

L’Hospitalet del Llobregat (Barcelona), Spain.

Qualitative study using focus groups. Structured 90 min focus groups were conducted until data saturation was reached. Each session included a moderator and an observer from the research team. Sessions were transcribed and thematically analysed by three independent researchers.

Purposeful sampling was used to form four groups of 4–10 participants, selected by sex, age, years of experience and primary care team (PCT). Participants were recruited between January and February 2023.

A total of 34 family physicians belonging to four PCTs participated in the study. The main barriers identified were a lack of time, negative initial experiences, a fear of harming patients (especially older adults), difficulty in nystagmus visualisation and challenges in managing patient expectations, as many preferred medication over physical manoeuvres. Facilitators included potential time savings from effective early management, the value of initial practical training with periodic refreshers, access to expert consultants for case discussions and the availability of digital tools, such as tutorials, videos and aids for nystagmus interpretation.

Health systems should invest in protected time for history-taking and physical examination, and in regular, updated training for primary care professionals. This could improve vertigo management and reduce unnecessary investigations and medications, ultimately benefiting both patients and the healthcare system.

To analyse demographic trends and decision-making patterns regarding prenatal diagnosis (PND) in couples at risk for hereditary haemoglobinopathies at the Thalassemia and Rare Haematological Disease Centre in Turin over a 40-year period.

Retrospective observational study analysing demographic and clinical data from 1983 to 2023.

Tertiary care genetic service Centre in Orbassano (TO), Northern Italy.

Couples seeking genetic counselling and PND for hereditary haemoglobinopathies. Selection criteria included couples at risk of having children affected by β-thalassaemia major or Sickle Cell Disease (SCD).

Primary outcomes included acceptance rates of PND and pregnancy termination (TOP). Variables analysed included couples’ age at first consultation, age at first PND, birthplace, employment status, specific haemoglobinopathy risk and number of pregnancies.

The analysis identified three main factors influencing PND and TOP decisions: nationality, type of haemoglobinopathy risk and number of previous pregnancies. Age showed no significant correlation with decision-making patterns. The impact of education level and employment status could not be definitively determined due to unavailable or unfit data.

The 40-year analysis of prenatal diagnosis for haemoglobinopathies in Turin shows evolving trends influenced by immigration patterns, improved medical treatments and cultural factors, leading to increased acceptance of affected pregnancies in recent years, particularly after 2015, due to better disease management and comprehensive healthcare support. This comprehensive analysis of our centre’s experience provides valuable insights that can serve as a model for similar institutions worldwide in supporting couples through carrier screening and PND processes.

To develop prediction models for short-term outcomes following a first acute myocardial infarction (AMI) event (index) or for past AMI events (prevalent) in a national primary care cohort.

Retrospective cohort study using logistic regression models to estimate 1-year and 5-year risks of all-cause mortality and composite cardiovascular outcomes.

Primary care practices in England contributing data to the Clinical Practice Research Datalink (CPRD) Aurum and CPRD GOLD databases between 2006 and 2019.

Patients with an incident (index) or prevalent AMI event. Models were trained on a random 80% sample of CPRD Aurum (n=1018 practices), internally validated on the remaining 20% (n=255) and externally validated using CPRD GOLD (n=248).

Discrimination assessed using sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Calibration assessed using calibration plots.

In the index (prevalent) cohorts, 94 241 (64 789) patients were included in the training and internal validation sets, and 16 832 (7479) in the external validation set. For the index cohort, AUCs for 1-year [5-year] all-cause mortality were 0.802 (95% CI 0.793 to 0.812) [0.847 (0.841 to 0.853)] internally and 0.800 (0.790 to 0.810) [0.841 (0.835 to 0.847)] externally. For the primary composite outcome (stroke, heart failure and all-cause death), AUCs were 0.763 (0.756 to 0.771) [0.824 (0.818 to 0.830)] internally and 0.748 (0.739 to 0.756) [0.808 (0.801 to 0.815)] externally. Discrimination was higher in the prevalent cohort, particularly for 1-year mortality (AUC: 0.896, 95% CI 0.887 to 0.904). Models excluding treatment variables showed slightly lower but comparable performance. Calibration was acceptable across models.

These models can support clinicians in identifying patients at increased risk of short-term adverse outcomes following AMI, whether newly diagnosed or with a prior history. This can inform monitoring strategies and secondary prevention and guide patient counselling on modifiable risk factors.

Epidemics pose significant challenges for fragile health systems, particularly in humanitarian emergencies. Recent responses to epidemics such as cholera in Yemen and Ebola virus disease in the Democratic Republic of the Congo have highlighted the lack of effective and integrated coordination. We review existing global models for addressing large-scale epidemics in humanitarian emergencies, identify gaps and inefficiencies, and propose operational recommendations to enhance response mechanisms.

A two-pronged approach was used to identify and critically assess current response coordination frameworks. Using the Arksey and O’Malley framework, a scoping review was undertaken, which was complemented by key informant interviews with humanitarian emergency response experts. The interviews focused on identifying the existing challenges and potential strategies to improve epidemic response in humanitarian contexts.

The scoping review included 51 documents (13 peer-reviewed articles and 38 grey literature documents). We conducted in-depth interviews with 28 respondents representing 17 different agencies and donors.

We focused on two major response architectures: the Incident Management System (IMS) and the cluster system. IMS is an important coordination and response instrument increasingly being used to respond to infectious disease threats.

Outcome measures of interest included the gaps in the current mechanisms to address infectious disease threats in complex humanitarian emergencies.

Unlike the cluster system model, which relies on consensus decision-making, IMS has a command-and-control approach, ensuring rapid decision-making. However, it can also lead to vertical responses that neglect the cross-sectoral and complex needs of affected communities. In addition, we found that the absence of context-specific response coordination mechanisms, with clear roles and responsibilities for involved stakeholders, was a common shortcoming. Fragmented response efforts that sidelined national and local stakeholders and a lack of reliable funding were also identified as important weaknesses.

We recommend the integration of coordination mechanisms into a sufficiently flexible framework that can be adapted to local contexts, while empowering national and local actors and ensuring the continuity of essential humanitarian services. We propose a paradigm shift towards mechanisms that respect humanitarian principles, effectively addressing the epidemic threats while remaining focused on deploying community-centric response efforts.

This study aimed to understand the knowledge possessed by informal medicine vendors regarding antibiotics and antibiotic resistance, identify the perceptions held by informal medicine vendors about antibiotics and their uses and examine the practices employed by informal medicine vendors in the sale and distribution of antibiotics.

Exploratory qualitative study using semi-structured interviews and direct observations.

Markets and shops across 11 villages in the Nanoro health district, Burkina Faso.

23 informal medicine vendors, aged between 25 and 55 years and with 8–30 years of experience, were recruited through snowball sampling in the Nanoro health district of Burkina Faso.

Informal medicine vendors exhibited a limited understanding of antibiotics, often confusing them with other treatments and referring to them using local terminologies based on perceived use and effectiveness. Antibiotics were perceived as universal remedies, supported by therapeutic belief, empirical reasoning and community solidarity, with empirical diagnosis, approximate dosing and informal preparation techniques passed on through imitation. These findings emerged across themes including perceptions, symbolic attributes and sales practices.

Informal medicine vendors in rural Burkina Faso demonstrated limited understanding of antibiotics and antimicrobial resistance, with practices shaped by local beliefs and empirical experience. These findings underscore the need for context-sensitive interventions that include tailored education and regulatory engagement to improve antibiotic stewardship and mitigate the spread of resistance.

The global prevalence of osteoarthritis (OA) is expected to rise as the population ages, leading to increased physical impairments that often reduce physical activity. Knee OA, in particular, is a leading cause of chronic pain and disability in people over 40. OA progression varies among individuals, with factors such as higher age and body mass index contributing to a more rapid progression. However, research suggests that engaging in physical activity such as hiking and running may help alleviate pain and slow OA progression. However, current literature on the relationship between physical activity and knee OA is largely retrospective, lacks comparative analyses across different physical activity types and rarely considers the intensity of physical activity. To address these gaps, the LoaD study was designed as a prospective cohort study aimed at examining how different physical activity types (ie, hiking, running, cycling and tennis) and their intensities relate to knee OA progression over 24 months in physically active individuals with early signs of the condition.

This prospective cohort study will include 300 participants (75 per physical activity group), who will be followed for 24 months. Eligible participants are aged 45–65, meet the National Institute for Health and Care Excellence (NICE) criteria for clinical knee OA and engage in a minimum weekly activity level for either running (60 min), cycling (120 min), playing tennis (60 min) or hiking (1 hike of 10 km). Baseline and follow-up assessments will include MRI, physical examination (eg, biometrics, lower extremity strength) and blood sampling for molecular biomarker assessment (eg, genetics, inflammatory biomarkers). Participants will receive monthly online questionnaires (eg, demographics, lifestyle, general health, history of knee injuries) and their physical activities will be tracked continuously by global positioning system data from wearable devices. The study’s primary outcomes focus on knee OA progression and symptom changes. These will be assessed through (1) structural progression of knee OA, measured using the MRI Osteoarthritis Knee Score (MOAKS) and (2) clinical symptom progression evaluated by (a) the Knee Injury and Osteoarthritis Outcome Score sport and recreation function subscale and (b) Visual Analogue Scale for pain during an activity nominated by the participant to be the most aggravating for knee pain in the past month (VASNA, 0–10). Differences between groups on the primary outcomes will be analysed using mixed-effects models to determine the impact of activity type and intensity on knee OA progression.

The study is approved by the Erasmus MC Medical Research and Ethics Committee (MREC) (MEC-2022-0420). The results of this study will be made publicly available through peer-reviewed international open-access scientific journals and national and international conferences. Participants will be informed about the results as soon as they are published.

A successful extubation process is critical for the future health outcomes of paediatric patients, as it tests the functioning of the respiratory system without the support of mechanical ventilation. However, extubation can cause stress, pain, anxiety or discomfort in patients, which may sometimes lead to an increased likelihood of reintubation. Music-based interventions and therapies have been shown to be effective in reducing anxiety and stress levels in ventilated patients in the paediatric intensive care unit (PICU), but studies evaluating the effect of music therapy during the extubation process in the PICU are scarce.

This is a pragmatic multicentre randomised clinical trial with two parallel arms. The intervention group will receive standard care + music therapy during the extubation process, and the control group will receive standard care alone. The main outcome measure is heart rate, which will be measured every minute for 5 min pre-extubation, during the extubation process and up to 10 min postextubation. Secondary outcome measures are: oxygen saturation, respiratory rate, blood pressure and heart rate variability. A total of 82 patients will be randomised.

This study was approved by the Research Ethics Committee of the Fundación Universitaria Sanitas (CEIFUS 1356-24, date of approval: 3 May 2024). All parents or legal guardians of patients will sign a written informed consent, and if applicable, assent from participants will be sought. The results will be disseminated through publications in peer-reviewed journals, conferences and presentations at the hospitals’ clinical committees.

Version 1.0, 18 December 2024.

NCT06591533, trial registration date: 10 September 2024.

To assess the pooled prevalence of self-reported sexually transmitted infections (STIs) and their associated factors among adults in South and Southeast Asia, using the Demographic and Health Survey data collected between 2015 and 2023.

A community-based cross-sectional study design was conducted using a multistage cluster sampling approach. Multilevel multivariable logistic regression analysis was employed to identify predictors of self-reported sexually transmitted infections (STIs). Model selection was guided by Akaike’s information criterion, and adjusted odds ratios (AORs) with 95% CIs were estimated to determine statistically significant associations.

South and Southeast Asia.

This analysis included a weighted sample of 791 019 adults aged 15–49 who reported ever having had sexual intercourse. The majority of the participants were female (n=6 87 880; 87%), and most were from Southeast Asia (n=7 00 539; 89%).

The pooled prevalence of self-reported STIs among adults in South and Southeast Asia was 12.94% (95% CI 7.73% to 18.14%). At the individual level, higher odds of reporting STIs were associated with being female (AOR 1.84; 95% CI1.68 to 2.02), having middle (AOR 1.11; 95% CI 1.04 to 1.19) or high wealth status (AOR 1.15; 95% CI 1.07 to 1.24]), being employed (AOR 1.14; 95% CI 1.07 to 1.22), having multiple sexual partners (AOR 2.79; 95% CI 2.22 to 3.52) and having undergone HIV testing (AOR 1.10; 95% CI: 1.02 to 1.20). Conversely, lower odds of self-reported STIs were observed among individuals aged 35–39 years (AOR 0.78; 95% CI 0.66 to 0.92), 40–44 years (AOR 0.68; 95% CI 0.58 to 0.82) and 45–49 years (AOR 0.61; 95% CI 0.52 to 0.73); those who had ever been in a union (AOR 0.71; 95% CI 0.62 to 0.83); individuals with higher education (AOR 0.84; 95% CI 0.76 to 0.93); and those with comprehensive HIV knowledge (AOR 0.82; 95% CI 0.77 to 0.87). At the community level, high illiteracy rates (AOR 1.25; 95% CI 1.15 to 1.35) and high media non-exposure (AOR 1.11; 95% CI 1.02 to 1.20) were positively associated with STIs, while rural residence (AOR 0.81; 95% CI 0.74 to 0.89) and living in Southeast Asia (AOR: 0.47; 95% CI 0.42 to 0.53) were linked to lower odds of self-reported STIs.

A substantial prevalence of self-reported STIs was observed among adults in South and Southeast Asia. Both individual- and community-level factors influence STI risk. The individual-level determinants include socio-demographic characteristics, sexual behaviours, HIV-related knowledge and testing history, while community-level factors reflect disparities in geographic location, educational attainment and media exposure.

Functional constipation (FC) is prevalent among children and often persists despite standard pharmacological treatment with oral laxatives. Many parents turn to complementary therapies, including acupuncture, which has been shown to relieve symptoms in adults with FC. However, studies in children with FC are scarce and have important limitations. This study will evaluate the feasibility, safety and potential efficacy of acupuncture for children with FC.

Prospective, non-randomised, open-label pilot study in children with FC (6–18 years). Participants will undergo eight acupuncture sessions over 10 weeks. Concurrent pharmacological treatment with polyethylene glycol (≥0.2 g/kg/day) will continue as initiated prior to enrolment. The primary endpoint is feasibility, defined by an attrition rate of ≥70%. Secondary feasibility endpoints include consent rate, patient/parent satisfaction and personnel requirements. Safety will be assessed by systematic monitoring of adverse events. Efficacy endpoints include treatment success, defined as no longer meeting the Rome IV criteria for FC at the end of the intervention period, as well as defecation frequency, stool consistency, painful defecation, faecal incontinence frequency, abdominal pain, medication use and quality of life, based on a previously published core outcome set.

Ethical approval was provided by the Medical Ethics Committee of Amsterdam UMC (Netherlands; NL87083.018.24). Results will be published in peer-reviewed journals and presented to scientific and consumer audiences.

NCT06836362 and NL-OMON57236.

Pneumonia and diarrhoea are two of the major causes of child mortality globally. Countries affected by conflict and other humanitarian emergencies, such as Somalia, have a particularly high burden of these diseases. Published reports from UNICEF and WHO have shown that various factors, including social, economic and environmental factors, are all associated with the occurrence of childhood pneumonia and diarrhoea. The objective of this study was to determine the prevalence, burden and associated sociodemographic determinants of pneumonia and diarrhoea among children younger than 5 years (under-5 children) in Somalia.

A community-based survey using an interviewer-administered questionnaire was conducted employing a modified WHO Expanded Program on Immunization (EPI) 30-Cluster sampling technique to identify households and respondents in nine selected districts across six member states in Somalia. The interviewers began selecting households starting from house number 1 and continued until 75 households were surveyed in each cluster.

We considered the catchment areas of 12 target maternal and child health (MCH) centres as our study areas. Villages were considered as primary sampling units (PSU) while households within villages were considered as secondary sampling units, where women (with under-5 children) within households were the respondents.

A total of 36 clusters (villages) were selected from the catchment areas of 12 target MCH centres. All households within the selected villages’ PSUs were listed. The interviewer started interviewing from house number 1 and continued till 75 households were covered to conduct interviews with mothers of under-5 children. Data collection took place between October and December 2023.

The prevalence and burden of childhood pneumonia and diarrhoea were estimated. A logistic regression model was employed to examine the determinants of childhood pneumonia and diarrhoea.

A total of 2483 under-5 morbidities were reported, 1712 probable pneumonia cases and 825 diarrhoea cases. Our calculations suggest that the prevalence of overall under-5 morbidity was 458.4 per 1000 children (95% CI 444.3 to 472.6) in the last 90 days. The prevalence of pneumonia and diarrhoea was 316.0 (95% CI 303.5 to 328.8) and 152.3 (95% CI 142.2 to 162.8) per 1000 under-5 children, respectively. A total of 70 under-5 deaths occurred in the past year, of which 37 were infants. Our exploration depicts an under-5 mortality rate of 39.3 deaths per 1000 live births per year (95% CI 30.6 to 49.7), and the infant mortality rate was 20.8 per 1000 live births per year (95% CI 14.8 to 28.6) in the study area, which is much lower than earlier estimates. The crude birth rate was 106.6 per 1000 population, and the stillbirth rate was 149.8 per 1000 births (95% CI 134.9 to 165.7), which is very high. We explored probable causes of 70 under-5 deaths and found that the highest proportion of under-5 deaths (22.9%) was due to acute respiratory infections (ARI), and about 15.7% were due to diarrhoea. Among other probable causes, congenital diseases (12.9%), accidents (11.4%) and measles (8.6%) were noteworthy.

This study revealed a high burden of pneumonia and diarrhoea among the studied population in Somalia. The study also identified important sociodemographic and environmental determinants that tend to increase the risk of pneumonia and diarrhoea among under-5 children.

To construct a data-driven composite from (a subset of) currently used quality indicators for oesophagogastric cancer surgery and to evaluate whether this approach enhances the reliability of between-hospital comparisons on outcome relative to the expert-driven composite indicator ‘textbook outcome (TO)’.

In this retrospective cohort study, we applied Item Response Theory (IRT) to construct a data-driven continuous composite indicator reflecting a single latent variable—the quality of surgical care—and estimated latent variable scores for all individual patients. Reliability was compared between the expert-driven (TO) and data-driven (IRT) composite indicators.

All Dutch hospitals providing oesophagogastric cancer surgery.

All patients who underwent oesophagectomy (n=3588) or gastrectomy (n=1782) between 2018 and 2022 as registered in the Dutch Upper GI Cancer Audit (DUCA).

We evaluated the reliability of between-hospital comparisons using ‘rankability’, which quantifies the proportion of observed variation in indicator scores between hospitals not attributable to chance.

Seven out of 15 quality indicators were included in the IRT composite indicator. Most of the patients were assigned the artificial maximum of the continuous quality score (ie, ceiling effect), resulting in similar average hospital scores. Relative to TO, rankability increased when using the IRT composite for oesophagectomy (57% vs 41%) but declined for gastrectomy (38% vs 47%).

The selected seven quality indicators for oesophageal and gastric cancer surgery represent a single latent variable but are not yet optimal for differentiating surgical care quality due to ceiling effects. Despite using fewer indicators, the continuous IRT score showed a promising increase in rankability for oesophagectomy, suggesting that data-driven composite indicators may enhance hospital benchmarking reliability.

To evaluate the impact of video use in out-of-hours primary care (OOH-PC) telephone triage by examining how triage outcomes (ie, ended by telephone, clinic consultation or home visit) changed during a period with video service failure.

Observational register-based study, using periods of video service failure as a randomisation mechanism for a controlled study.

OOH-PC in four of the five Danish regions.

All telephone triage contacts to the OOH-PC call centres between April 2020 and December 2021.

Video service failures resulted in a subset of telephone triage contacts without the option of using video as a triage tool. Video service failures were identified algorithmically based on observed periods without video use.

Proportion of telephone triage contacts with clinic consultations or home visits as triage outcome during a period of video service failure compared with matched reference telephone triage contacts taking place during normal service (1:10), presented as risk ratios (RR) with 95% CI).

The algorithm identified 6605 telephone triage contacts during video service failure. Compared with matched contacts during normal service, these had a 15% higher risk of resulting in a clinic consultation (RR: 1.15, 95% CI 1.09 to 1.20). This effect was primarily isolated to the year 2021 (RR: 1.23, 95% CI 1.16 to 1.31) compared with 2020 (RR: 1.05%, 95% CI 0.97 to 1.13). Video service failure did not significantly affect the risk of a home visit.

Results strongly suggest that the unavailability of the video service is likely to significantly increase the number of clinic consultations in OOH-PC as a triage outcome. Whether this effect is likely to persist in the long term remains unclear.

Multiple sclerosis (MS) competence is crucial for caregivers of people with MS (PwMS). Having validated MS-specific tools to measure caregivers’ Sense of Competence (SoC) is fundamental to understand if they are coping with their role and/or need support and training. The aim of the study was to develop and validate the Caregiver SoC questionnaire for caregivers of PwMS (CareSoC-MS), a self-report questionnaire, to assess SoC in MS caregivers.

Cross-sectional study.

Italy.

191 MS caregivers (sex: 48.7% females; age: 58.6±12.6 years; education: 62.8% high-school/university) self-administered the 27-item CareSoC-MS questionnaire. Psychometric evaluation consisted of analyses of structural validity and reliability, construct validity and discriminant validity. The final version of the CareSoC-MS includes 14 items covering 4 relevant SoC domains: L1-Psychological well-being, L2-Impact on personal social life, L3-Efficacy of the provided care and L4-Satisfaction with one’s own performance as a caregiver.

The 14-item CareSoC-MS is a psychometrically valid questionnaire with no ceiling or floor effects. Test–retest reliability analysis showed significant intraclass correlation coefficients for L1 (0.80), L2 (0.96), L3 (0.88) and L4 (0.61). L1 and L2 were correlated with self-reported measures of burden, anxiety and depression. Care recipient disability was correlated with L1 and L2, caregiver sex with L1, and caregiver age with L3.

The CareSoC-MS is a valid self-report questionnaire that can be used in clinical practice and research. CareSoC-MS could inform healthcare professionals about how informal caregivers feel capable to face the caregiving requests and, in turn, could help prevent or postpone caregiver burden.

In recent decades, transcranial electrical stimulation (tES) has become a widely used non-invasive method for modulating brain function in clinical and non-clinical populations. However, existing tES trials exhibit substantial methodological heterogeneity, often limiting the reproducibility and interpretability of findings. There currently exists a paucity of consensus-driven, standardised recommendations outlining the key factors that should be reported and/or controlled in tES studies. Accordingly, this project aims to develop Consolidated Guidelines for Reporting and Evaluation of studies using tES (CoRE-tES), a tool designed to assess the methodological quality and reporting of laboratory-based and home-based tES studies. These guidelines will support improved quality, consistency, replication and transparency in research involving tES modalities, including transcranial direct current stimulation, transcranial alternating current stimulation and transcranial random noise stimulation.

CoRE-tES will be developed and disseminated over five stages. Stage 1 will comprise a review of recent tES literature to assess methodological and reporting quality. Stage 2 will employ a Delphi process to seek agreement among international tES experts on a list of items for inclusion in CoRE-tES. In stage 3, a consensus meeting will be held to synthesise and prioritise the agreed items to form CoRE-tES. Stage 4 will involve production of the final CoRE-tES checklist and an accompanying evaluation and elaboration document. In stage 5, CoRE-tES will be disseminated via journal publication, conferences, professional meetings and social media campaigns.

Ethics approval has been obtained from the Western Sydney University Human Research Ethics Committee (approval number H16803). Findings will be disseminated through scientific conferences and peer-reviewed journal publications, and CoRE-tES will be indexed on the Enhancing the QUAlity and Transparency Of health Research Network website.

As of 2024, 123.2 million people had been forcibly displaced as a result of persecution, armed conflict or climate-related catastrophes, and these numbers are predicted to rise. There is a growing awareness of possible intergenerational effects of trauma on life-course health and well-being, however few studies have followed individuals longitudinally starting prenatally. This paper describes the first large prenatal birth cohort study in a refugee context in a lower middle-income country. This study aims to investigate the potential lifespan health and developmental implications of being born into a protracted humanitarian context, and what factors can buffer from the adversity posed by conflict and displacement.

We outline our approach of recruiting, consenting and gathering data from pregnant Rohingya refugee and host community women (N=2888; 80% Rohingya) over the course of 12 months in Cox’s Bazar, Bangladesh.

A fifth wave of data collection, when children were 6 months old, was completed in April 2025. Rohingya women were substantially less literate; were marrying and having children at slightly younger ages, were more likely to live in crowded, resource-limited households and exhibited higher rates of clinically significant post-traumatic stress disorder and anxiety than host community women.

There is a critical need for research in displaced populations in order to elucidate potentially lasting transgenerational impacts of experiencing conflict and displacement trauma, and the prenatal and postnatal factors that support health and development across the life span. The next follow-up is planned when the children turn 36 months of age (starting March 2026).

To assess the validity of the International Classification of Diseases, 10th Revision (ICD-10) healthcare database diagnosis codes for lithium toxicity at hospital admission in Ontario, Canada.

Population-based retrospective validation study.

A total of 152 hospitals linked to a provincial laboratory database in Ontario, Canada, from 2007 to 2023.

Patients 50 years of age or older taking lithium with hospital-based serum lithium laboratory measurements during admission to the hospital (n=2804).

Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) comparing an ICD-10 diagnostic coding algorithm for lithium toxicity to a serum lithium concentration of 1.5 mmol/L or more. The codes used in the algorithm were T568, T435, Y495, X41 and X49. Serum lithium values and changes in the concentration of serum lithium from baseline levels in patients with and without a diagnosis code for lithium toxicity (code-positive and code-negative, respectively).

The sensitivity of the ICD-10 coding algorithm for identifying a serum lithium level≥1.5 mmol/L was 84% (95% CI 81% to 87%). The specificity and the NPV were over 88%, and the PPV was 63% (95% CI 60% to 66%). The median (IQR) serum lithium measurement in code-positive patients was 1.7 (1.2 to 2.2) mmol/L, and it was 0.6 (0.4 to 0.9) mmol/L in code-negative patients. The median (IQR) increase in serum lithium concentration compared with the most recent prehospital baseline values was 0.7 (0.2 to 1.3) mmol/L in code-positive patients and 0.0 (–0.2 to 0.2) mmol/L in code-negative patients.

In Ontario, the sensitivity of the ICD-10 coding algorithms was moderate for identifying a serum lithium level≥1.5 mmol/L at hospital admission. The presence or absence of the ICD-10 codes for lithium toxicity at hospital admission successfully differentiated two groups of patients with distinct serum lithium measurements.

This study aimed to investigate the factors influencing health-related quality of life (HRQoL) in patients undergoing haemodialysis, focusing on the association between HRQoL dimensions and sociodemographic variables, clinical parameters, mental health status and biochemical indicators.

A multicentre cross-sectional study conducted over 30 months.

The study was carried out in secondary care centres across multiple locations in the Community of Extremadura, Spain.

A total of 150 patients undergoing haemodialysis were recruited between March 2022 and September 2023. Inclusion criteria required patients to be diagnosed with chronic kidney disease (CKD) and undergoing haemodialysis. Patients unable to provide informed consent or with severe cognitive impairment were excluded.

HRQoL was assessed using the Kidney Disease Quality of Life 36-item Short Form scale. Mental health parameters, specifically anxiety and depression, were evaluated using the Hospital Anxiety and Depression Scale. Biochemical markers such as haemoglobin and haematocrit levels, as well as sociodemographic and clinical data, were analysed for their influence on HRQoL.

Symptoms of anxiety and depression were prevalent among patients undergoing haemodialysis. Anxiety had the greatest negative effect on HRQoL, being significantly associated with lower scores in the mental component summary (MCS) (β = –2.06; 95% CI –2.78 to –1.33; R² = 0.106; p

Depression and anxiety, along with older age, were identified as key factors negatively affecting HRQoL of patients undergoing haemodialysis. Management of mental health, alongside optimisation of clinical care to minimise complications, could enhance the HRQoL in this patient population. Further research is recommended to develop targeted interventions addressing anxiety and other modifiable factors influencing HRQoL in haemodialysis patients.

Hysterectomy, a common surgical procedure, is frequently associated with moderate-to-severe postoperative pain and a high incidence of postoperative nausea and vomiting (PONV). Dexamethasone, a corticosteroid, may help alleviate these symptoms; however, existing evidence is largely drawn from mixed surgical populations and does not specifically address its efficacy and safety in hysterectomy patients. This meta-analysis provides a focused and updated synthesis of randomised controlled trials (RCTs) in this population, incorporating time-stratified pain outcomes and subgroup analyses by dose, surgical approach, timing and route of administration to evaluate the role of dexamethasone in postoperative recovery.

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

PubMed, Scopus, Google Scholar and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched through 1 November 2024.

We included RCTs comparing dexamethasone with placebo for postoperative outcomes in hysterectomy patients.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Meta-analysis was conducted using random effects models. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.

15 RCTs (1362 patients) were included. Dexamethasone significantly reduced PONV (risk ratio (RR): 0.53, 95% CI 0.47 to 0.61, p2: 0% high certainty) and pain scores at 24 hours (mean difference (MD): –0.20, 95% CI –0.35 to –0.05, p=0.009, I²=0%, moderate certainty), 8–12 hours (MD: –0.60, 95% CI –0.88 to –0.31, p2: 27%, moderate certainty and 4 hours (MD: –0.43, 95% CI –1.07 to 0.21, p=0.19, 93%, moderate certainty). It also decreased the use of rescue antiemetics (RR: 0.57, 95% CI 0.43 to 0.75, I²: 39%, high certainty) and postoperative opioid consumption (standardised MD: –0.48, 95% CI –0.90 to –0.05, p=0.03, I²: 74%, low certainty). The effects of rescue analgesics and hospital stay duration were nonsignificant. Subgroup analyses showed consistent antiemetic efficacy of dexamethasone across doses, timings, routes and procedures. For pain, greater analgesic effects were seen with higher doses and perineural administration, particularly at 8–12 hours. The risk of bias was low in most studies, but evidence of publication bias was observed for the pain score outcome.

Dexamethasone is an effective adjunct in hysterectomy, significantly reducing PONV and postoperative pain at 8–12 and 24 hours, particularly with 4–10 mg doses. Benefits are consistent across routes, timings and surgical approaches, with greater early analgesia after perineural use. It reduces opioid consumption but has a limited effect on rescue analgesia, supporting its role as a complementary analgesic. While generally considered safe, current safety data are limited, highlighting the need for further research. These results support its use in multimodal recovery protocols and identify priorities for future studies in high-risk and diverse surgical populations.

CRD42024608067.

Hearing loss is highly prevalent and impacts many aspects of a person’s life, including communication, social engagement, employment, general health and well-being. Yet, many people do not access hearing healthcare and are unaware of the range of hearing healthcare options available. Barriers to hearing healthcare include poor understanding of hearing loss and its impact; poor knowledge of help-seeking for hearing healthcare options; minimal support to help decide which option is best; and stigma related to hearing loss. These barriers lead to many people not receiving the hearing healthcare they need. Guided by theories of behaviour change and implementation science, HearChoice, an online tailored decision support intervention, has been co-developed to empower adults with hearing difficulties by offering them choice and control over their own hearing healthcare. HearChoice aims to facilitate informed decisions, accessibility and uptake of hearing healthcare, including a wide range of interventions, for adults with hearing difficulties. The objectives of the trial are to evaluate the effectiveness, health economics and feasibility of HearChoice.

This online randomised controlled trial will recruit participants with hearing difficulties across Australia, with an anticipated sample size of 640. Participants will be randomised to either HearChoice (treatment) or an Australia-specific Hearing Option Grid (active control), both delivered online. Outcomes will be assessed at baseline when the interventions will be offered, at 7 days post-intervention (primary endpoint) and at 3 months post-intervention. An email reminder will be sent at 1-month post-intervention. The primary outcome is decisional conflict. Secondary outcomes include measures of readiness and self-efficacy to take action, hearing-related quality of life and empowerment, assessment of the value and impact of HearChoice, work performance and health, and feasibility measures. Primary analysis will compare outcomes between HearChoice and the active control at the primary endpoint.

The study was approved by the Curtin University Human Ethics Committee (HRE2023-0024). All participants will provide written informed consent prior to participation. A broad dissemination plan of the study findings includes peer-reviewed publications, scientific conference presentations, articles and presentations for the wider community and public written in lay and accessible language, and social media.

Australian New Zealand Clinical Trials Registry (ACTRN12624001139561).

Infants born to pregnant women living with HIV (WLHIV) are at greater risk for morbidity and mortality and may also have poorer developmental outcomes as compared with infants who are not exposed to HIV. Nutrition interventions in pregnancy may affect developmental outcomes.

This study evaluated the effect of maternal vitamin D supplementation on infant development outcomes.

We conducted a secondary analysis of a randomised, triple-blind, placebo-controlled trial of maternal vitamin D supplementation from June 2015 to October 2019.

Antenatal care clinics in Dar es Salaam, Tanzania.

Pregnant WLHIV and their offspring.

Daily 3000 IU vitamin D₃ or placebo supplements taken during pregnancy and lactation.

Infants were assessed for cognitive, language and motor development at 1 year of age with the Caregiver Reported Early Development Instruments (CREDI).

A total of 2167 infants were eligible, and 1312 of them completed CREDI assessments at 1 year of age. Vitamin D supplementation had no effect on overall CREDI z-scores (standardised mean difference (SMD) 0.03, 95% CI –0.09, 0.15, p value 0.66). There was also no evidence of a difference between vitamin D and placebo groups in language (SMD 0.06, 95% CI –0.08, 0.21, p value 0.40), motor (SMD 0.02, 95% CI –0.09, 0.14, p value 0.69) or cognitive domain z-scores (SMD 0.05, 95% CI –0.08, 0.17, p 0.48).

Maternal vitamin D supplementation during pregnancy and lactation did not affect infant development outcomes.

ClinicalTrials.gov identifier: NCT02305927.