Administration of antibiotics before incising the skin (‘surgical antimicrobial prophylaxis’) is a critical infection prevention strategy in surgery. Extending doses of prophylaxis into the postoperative period is a common practice in cardiac surgery; however, the benefit has not been clearly established and may lead to emergence of antimicrobial resistance and patient harm. We present the protocol for a large international multicentre, adaptive, pragmatic, double-blind, three-arm, placebo-controlled, randomised, non-inferiority clinical trial to compare the incidence of surgical site infection after three different durations of postoperative surgical antimicrobial prophylaxis in patients undergoing cardiac surgery.

This adaptive, multi-arm multistage non-inferiority trial will compare intraoperative only (Arm A), to intraoperative and 24 hours (Arm B) and, to intraoperative and 48 hours (Arm C) of intravenous cefazolin and placebo as surgical antimicrobial prophylaxis in 9180 patients undergoing cardiac surgery. The adaptive design allows for potential dropping of any of the three arms if clear inferiority is indicated at any of the scheduled interim analyses. The trial will evaluate the clinical and cost-effectiveness of the three different antibiotic prophylaxis durations.

Ethics approval will be obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals and the key findings presented at national and international conferences. Patients and members of the public will also be involved in the dissemination and translation of the trial results.

NCT05447559.

This study assessed the associations between asthma, gastro-oesophageal reflux disease (GORD) and health-related quality-of-life (HRQoL) among adolescents.

A cross-sectional survey.

Six randomly selected schools across all five educational zones of the Anuradhapura district in Sri Lanka.

A total of 1127 adolescents aged 13–14 years were included from six randomly selected schools representing all five educational zones in the Anuradhapura district, Sri Lanka.

Prevalence of asthma and GORD, the associations between asthma, GORD and HRQoL among adolescents in Sri Lanka.

This study of 1127 adolescents (44.8% male, mean age 13.66±0.56 years) found that 16.1% (n=181) had current asthma and 17.9% (n=202) exhibited symptoms of GORD. A significant association was observed between current asthma and GORD (OR 2.30, 95% CI 1.59 to 3.31, p=0.0005). Comorbidity of asthma and GORD was observed in 4.8% of participants (n=54). The total HRQoL score was not associated with asthma, GORD or those having both asthma and GORD. However, the presence of GORD was associated with poor emotional functioning (unstandardized regression coefficient ± standard error = -4.7±1.7, p=0.008).

Asthma and GORD were significantly associated among early adolescents in Sri Lanka. While overall HRQoL did not differ by disease status, the presence of GORD was associated with poorer emotional functioning.

Few studies have examined how psychosocial risk and protective factors in adolescence shape mental health outcomes and other multimorbid conditions in adulthood, particularly among Canadian youth. The Research on Eating and Adolescent Lifestyle (REAL) 2.0 study was a 15-year follow-up cohort study designed to investigate how early etiological factors, including body image and disordered eating symptoms in adolescence, contribute to the development of eating, weight-related concerns, mental health and substance use health problems in early adulthood. In this paper, we describe the REAL 2.0 cohort’s demographic and clinical characteristics alongside an overview of the study procedures, laying the groundwork for collaboration on future learnings with this unique data.

The cross-sectional REAL study initially surveyed middle and high school students from 2004 to 2010 (n=3043) across 43 schools in the Ottawa, Canada region. Of those, respondents in grade 7 or 9 (n=1197 from 25 of the 43 original schools) were asked to participate in a longitudinal arm of the study that consisted of yearly follow-ups. From the longitudinal cohort, there were 278 participants (29.1% male; M_age=28.6) from those who consented to be re-contacted (n=912), who completed the REAL 2.0 survey electronically (30.4%), providing comprehensive data on demographic, clinical, eating and weight-related behaviour, psychological, social, environmental and substance use health factors in adulthood.

9.4% of REAL 2.0 participants met DSM-5 criteria for an eating disorder, while 17.6% met criteria for disordered eating. Moderate to severe anxiety was reported by 28% of participants, while 21.6% experienced moderate to severe depressive symptoms. Regarding substance use, 16.9% engaged in hazardous drinking, 16.9% used cannabis daily or almost daily, and 4.3% reported daily tobacco use.

REAL 2.0 has the potential to answer multiple research questions about several mental health outcomes, but its priority focus is to answer questions related to risk and protective factors of multimorbidity in adulthood. Additionally, profiling work, linked to health service utilisation data for systems planning work and predictive modelling studies are secondary goals. By leveraging the Health Data Nexus (HDN) platform, we welcome collaboration with interested researchers who would like to utilise the breadth of data both in adolescence and adulthood to answer other pertinent aetiological questions in mental health and substance use health outcomes. Future plans to conduct additional follow-ups remain feasible.

To assess awareness of colorectal cancer (CRC) symptoms and risk factors among adults attending Sri Lanka’s largest tertiary care hospital, and to identify sociodemographic predictors of awareness.

Descriptive cross-sectional study.

Outpatient clinics at the National Hospital of Sri Lanka (NHSL), the country’s largest tertiary care centre.

A total of 506 adults (≥18 years) recruited via convenience sampling. Data were collected from May 2022 to May 2023 at the outpatient clinics of the NHSL, the country’s largest tertiary care centre. Eligible participants included clinic attendees as well as accompanying persons of attendees, provided they met inclusion criteria. Individuals with known gastrointestinal conditions or malignancies were excluded.

Primary outcomes: awareness scores of CRC symptoms and risk factors using a culturally adapted Bowel Cancer Awareness Measure questionnaire.

Secondary outcomes: predictors of awareness based on sociodemographic variables.

58.7% (n=297) of participants could not name any CRC symptoms unprompted; blood in stools (n=93, 18.4%) was the most identified symptom unprompted. Prompted awareness improved markedly, with 75.3% (n=381) identifying blood in stools when provided with a list. Similarly, 44.3% (n=224) could not identify any CRC risk factors unprompted; excessive alcohol intake (n=368, 72.7%) and low fibre intake (n=324, 64.0%) were the most commonly recognised risk factors when prompted. The mean symptom awareness score was 5.63 (SD=2.55), corresponding to ‘fair’ awareness, and the mean risk factor awareness score was 5.47 (SD=2.63), also indicating ‘fair’ awareness. Female gender (B=0.669, p=0.008; n=237) and older age (B=0.023, p=0.034) were significantly associated with higher symptom awareness. Awareness was significantly lower among participants with lower education (B = –0.104, p=0.018; n=219) and among the unemployed (B = –0.175, p=0.045; n=152).

Unprompted awareness of CRC symptoms and risk factors was suboptimal in this population, with marked gaps in spontaneous recall. Public health campaigns should prioritise men, younger adults and individuals with lower education to enhance CRC literacy and promote earlier detection.

This study explored the barriers to and facilitators of weight reduction among urban, young adults with obesity in Sri Lanka.

A qualitative descriptive study, using the framework method in thematic analysis to identify key themes for barriers and facilitators.

An urban community setting in Sri Lanka in January–March 2022.

62 young adults (18–35 years) with obesity (body mass index ≥25 kgm^-2) representing different socio-demographic characteristics were recruited into the focus group discussions (n=10).

The majority of participants were women (n=40; 64.5%). More than 70% (n=45) of the participants were classified as having class I obesity. Inconsistent knowledge, emotions and mood, poor self-control, inadequate support from others, lack of time, lack of resources and facilities and unsafe environment for physical activities were the identified barriers. The desire to improve appearance and body image, health-related concerns, limitations to day-to-day activities, previous positive experiences, support from others and weight-related victimisation were identified as facilitators.

A multitude of factors were found to interfere with weight-reduction attempts. Due consideration of these barriers and facilitators is important when planning weight management programmes targeting young adults with obesity.