Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) entails substantial morbidity and mortality, yet no epidemiologic evidence exists on its outcomes in Mexico. This study assessed national hospitalisations (2005–2022) and mortality (2000–2022) related to AAV using data from the General Board of Health Information.

Retrospective, population-based time-trend analysis on administrative health data.

Mexico’s national hospital discharge and mortality registries, covering 1 January 2000 through 31 December 2022.

All individuals aged ≥ 15 years with a primary or secondary International Classification of Diseases, 10th revision, diagnosis of AAV recorded during hospitalisation or on death certificates nationwide.

The study’s primary outcomes were the age-standardised hospitalisation and mortality rates for AAV (expressed per 100 000 population, overall and by sex), with temporal trends in both rates quantified using Joinpoint regression to calculate annual percent change (APC) and average APC (AAPC).

We identified 2804 hospitalisations and 599 deaths. Females accounted for 49.7% of hospitalisations, while males represented 48.7% of deaths. Although the overall age-standardised hospitalisation rate (ASHR) and mortality rate (ASMR) AAPCs were not statistically significant, relevant trends emerged. From 2010 to 2022, ASHR declined significantly (APC: –5.2%; 95% CI –9.7, –0.5; p=0.03), whereas mortality rates remained stable from 2000 to 2022 (AAPC: +3%; 95% CI –4.6, 11.3; p=0.45). Nevertheless, mortality increased among males (APC: +6.4%; 95% CI 0.9, 12.2; p=0.02) and individuals over 45 years (APC: +8.6%; 95% CI 1.7, 16.0; p=0.02) from 2008 onwards.

Overall, these findings indicate no major changes in national rates but reveal a decline in hospitalisations since 2010 and a rise in mortality for specific subgroups since 2008. Targeted interventions, particularly for older adults and men, appear warranted to address this evolving disease burden. Future research should explore underlying risk factors and evaluate tailored strategies to improve clinical outcomes in AAV across Mexico.

Digital health interventions (DHIs) are changing the healthcare landscape. However, using these tools effectively for people with chronic conditions in rural areas comes with challenges, highlighting the need to understand their lived experiences. No systematic review was found that examines the inclusion of lived experience in DHI for individuals with chronic conditions in rural areas and how this impacts their acceptance of technology. A systematic review grounded by Technology Acceptance Model (TAM) will be conducted to examine the lived experiences of individuals in rural areas who use DHIs. Individuals with chronic conditions will be examined specifically and how their experiences influence the adoption, use and satisfaction with DHI for managing their health needs. This systematic literature review is significant because it will be used as a crucial starting point for a larger project aimed at creating digitally transformed primary healthcare in rural areas, particularly for Indigenous communities. The insights gained will inform the development of a digital transformation model for the larger project.

Guided by the TAM and PRISMA to explore the lived experiences of patients and caregivers with digital health, a search will be conducted for peer-reviewed studies on DHIs, including qualitative, quantitative and mixed-method approaches, including systematic reviews. The studies must be published in English from 2019 to the present and will be sourced from databases such as PubMed, EBSCO, Cochrane Library, Scopus and Web of Science. MeSH will be utilised to identify terms like user experience, acceptability and engagement with DHIs. Eligibility will be based on relevance, population, intervention and outcomes. A standardised data extraction form will be developed and tested to capture important information from each study included in the review. Data extraction and quality appraisal will be performed independently by two reviewers, with a third reviewer addressing any discrepancies. Software will be used to manage extracted data, assess risk of bias and synthesise the data. Meta-analysis will be included to enhance our findings if sufficient quantitative data is available. Our findings will be reported in accordance with the PRISMA guidelines. This review protocol was refined in June 2025; commencement of the study will be in July 2025 and will be completed in 2026.

This study used previously published literature and did not collect primary data from humans or animals. No ethical committee approval was required. Findings will be disseminated through peer-reviewed publication and will be presented at conferences related to the field.

osf.io/jw5yp.

Postoperative arrhythmias are common and clinically significant complications. They are a cause of increased morbidity and mortality rates in surgical patients. Although various pharmacological and procedural strategies have been explored for preventing postoperative arrhythmia, evidence regarding their effectiveness remains inconsistent. The stellate ganglion block (SGB) has emerged as a promising alternative to reduce the occurrence of postoperative arrhythmias. By summarising the existing evidence, this meta-analysis aims to assess the effectiveness of SGB in preventing postoperative arrhythmias.

We will review literature from January 1970 to April 2025 using MEDLINE, Cochrane CENTRAL and Embase. Studies eligible for inclusion will be randomised controlled trials and observational studies reporting postoperative arrhythmia incidence in surgical patients who received preoperative or intraoperative SGB. We will include articles in the following languages: English, Spanish, Chinese or Portuguese. Secondary outcomes are SGB-related complications. The risk of bias will be determined by Rob-2 and ROBINS-I tools. Meta-analyses, reporting relative risks or ORs with 95% confidence intervals will be performed when at least three studies report the same outcome under comparable conditions. Quality of evidence will be evaluated using GRADE guidelines.

We will use information from previously published manuscripts found in reputable databases, and ethical approval is not necessary.

CRD420251029643.

To explore the challenges experienced by people with intellectual disability, their carers and health and social care professionals when using and managing medication.

A synthesis of qualitative research using meta-ethnography.

We searched seven databases: MEDLINE, Embase, CINAHL, Science, Social Science and Conference Proceedings Citation Indices (Web of Science), Cochrane Library, PsycINFO and Proquest Dissertations and Theses from inception to September 2022 (updated in July 2023).

We included studies exploring the challenges and perceptions of people with intellectual disability, their carers and health and social care professionals regarding medication management and use.

We reviewed 7593 abstracts and 475 full texts, resulting in 45 included papers. Four major themes were identified: (1) Medication-related issues, (2) navigating autonomy and relationships, (3) knowledge and training needs and (4) inequalities in the healthcare system. We formulated a conceptual framework centred around people with intellectual disability and described the interconnectedness between them, their carers and health and social care professionals in the process of managing and using medication. We identified challenges that could be associated with the person, the medication and/or the context, along with a lack of understanding of these challenges and a lack of capability or resources to tackle them. We developed an overarching concept of ‘collective collaboration’ as a potential solution to prevent or mitigate problems related to medication use in people with intellectual disability.

The effective management of medication for people with intellectual disability requires a collaborative and holistic approach. By fostering person-centred care and shared decision-making, providing educational and practical support, and nurturing strong relationships between all partners involved to form a collective collaboration surrounding people with intellectual disability, improved medication adherence and optimised therapeutic outcomes can be achieved.

CRD42022362903.

Dietary (poly)phenols have beneficial properties that may play a relevant role in the management of overweight/obesity and cardiometabolic risk factors, modulating physiological and molecular pathways involved in energy metabolism, adiposity and gut microbiota-derived metabolites.

The Prevention/Precision Diet in Araucanía (PREDIET-ARAC) trial is a randomised, single-blind, parallel arm, placebo-controlled, clinical trial designed to assess the potential health benefits of (poly)phenol intake through either diet or supplementation. The study will evaluate the effectiveness of a healthy plant-based diet (PBD) rich in (poly)phenols compared with (poly)phenol supplementation during a caloric restriction intervention.

A total of 99 adults (aged 25–45 years) with overweight or obesity (body mass index: 25–35 kg/m²) and cardiovascular risk factors will be recruited from primary health centres in Temuco, Araucanía Region, Chile. Participants will be randomised (stratified by age:

Dietary data will be collected using dedicated software through three 24-hour dietary recalls at baseline and post-intervention. (Poly)phenol intake will be estimated using the Phenol-Explorer database. The main data collection will include general and lifestyle questionnaires, anthropometric and bioimpedance measurements, blood pressure assessments using sphygmomanometers, physical activity monitoring through accelerometers and strength evaluations via dynamometry. Blood samples will be collected at both baseline and after 12 weeks. For the analysis of plasma metabolites, a large-scale targeted metabolomics approach will be employed, specifically utilising ultra-high performance liquid chromatography coupled to tandem mass spectrometry. The healthy PBD will be primarily supplied by the food industry, encompassing a selection of regional and Latin American foods: blueberries, apple, nuts, olive oil and coffee. A descriptive and inferential statistical plan will be conducted, based on comparison tests, regression models and machine-learning algorithms.

This trial adheres to the Declaration of Helsinki and the CONSORT statement. Signed informed consent will be obtained from all participants. Ethical approval has been granted by the Ethical-Scientific Committee of the Health Service of Araucanía Sur, Chile (Approval No 11250095–58) and the Biosafety Committee of the Catholic University of Temuco. Findings will be disseminated through peer-reviewed publications, conference presentations and engagement with healthcare professionals and policymakers.

NCT06911346.

Self-harm is the strongest predictor of suicide in young people. Self-harm presentations to the emergency department (ED) are associated with repeat self-harm and suicide. Rapid follow-up contact after ED offers an opportunity to intervene before self-harm becomes an established coping strategy. Despite recent progress in self-harm treatment, currently, there are no evidence-based interventions to prevent future self-harm and suicide offered to young people after visits to the ED. Preliminary evidence suggests therapeutic assessment and rapid follow-up contacts may reduce self-harm and improve engagement in follow-up care. In this study, we assess the clinical and cost-effectiveness of a brief psychological intervention, supporting adolescents with self-harm (SASH), in addition to standard care in a randomised controlled trial, compared with standard care only. As per National Institute for Health and Care Excellence guidelines, standard care involves at least one follow-up by a mental health professional within 7 days of ED discharge.

The SASH intervention comprises up to six follow-up contacts with a mental health professional delivered over approximately 2 months for young people and their carers using a solution-focused approach, shortly after presenting to the ED. Participants are aged 12–18, presenting to the ED with self-harm or suicidal ideation (with self-harm in the past month), with capacity to consent. We aim to recruit 144 young people into the trial who will be randomised on a 1:1 basis to the SASH intervention or treatment as usual. Participants are assessed postintervention/standard care and at 6-month follow-up after randomisation. Self-reported self-harm is assessed via text message survey every 2 weeks during the 6-month follow-up period. The primary outcome is self-reported episodes of self-harm in the past month assessed at 6 months by summing three behavioural domains of the self-injurious thoughts and behaviours interview. We hypothesise that the therapeutic relationship with the mental health practitioner will mediate this relationship. Secondary outcomes include symptoms of depression and anxiety, frequency of reattendance at ED, death by suicide, school attendance, well-being and additional domains of self-harm-related behaviour and thoughts in the past month. The trial will also consider service use, costs to carer and carer health-related quality of life to evaluate the costs and cost-effectiveness of the intervention.

London-Riverside Nation Health Service REC (22/LO/0400) provided a favourable ethical opinion. Findings will be disseminated through social media, a website, scientific papers, conferences and reports, in collaboration with our Young Person’s Lived Experience Advisory Group.

ISRCTN81846131.

13.0, 30.06.2025.

To examine trends in the prevalence of diabetes and pre-diabetes in Indonesia from 2013 to 2023 and to explore demographic and socioeconomic factors associated with these changes.

Secondary data analysis on multiseries cross-sectional study.

Three waves of the Indonesian National Health Survey (2013, 2018 and 2023), each employing nationally representative, stratified multistage sampling.

Nationally representative respondents aged 15 years and older who completed fasting plasma glucose (FPG) and oral glucose tolerance tests (OGTT).

Diabetes and pre-diabetes were defined based on FPG and OGTT tests and self-reported diagnosis. Multivariable and ordinal logistic regression models assessed associations between glycaemic status and demographic, socioeconomic and health-related factors.

From 2013 to 2023, the prevalence of diabetes rose from 10.7% (95% CI: 10.2% to 11.2%) in 2013 to 11.8% (11.3% to 12.3%) in 2018, before declining to 11.3% (10.7% to 11.9%) in 2023. Meanwhile, pre-diabetes prevalence decreased from 44.5% (43.6% to 45.3%) in 2013 to 39.2% (38.0% to 40.3%) in 2023. Age-standardised and synthetic cohort analysis revealed that younger birth cohorts had lower diabetes prevalence at the same age compared with older generations. In contrast, diabetes prevalence remained high and stable among older adults, suggesting that an increase in diabetes prevalence was due to the increase in older population size rather than increased risk. Multivariable regression confirms that higher age and BMI were strong predictors for diabetes, pre-diabetes and abnormal glycaemic states. Wealth quintiles showed different associations: higher wealth was linked to lower pre-diabetes odds, but not consistently to diabetes.

The ageing population drives the rise of diabetes prevalence in Indonesia. Generational improvements were shown among younger adults, while persistent high diabetes prevalence in older adults underscores ongoing challenges. These findings highlight the importance of age-targeted and cohort-targeted screening and prevention strategies.

The COVID-19 pandemic has made long-standing nursing workforce challenges apparent on an international scale. Decision-makers must develop multi-pronged approaches to foster the development and maintenance of a strong nursing workforce to support health systems. These approaches require attendance to recruitment and retention initiatives that show promise for stabilising the nursing workforce now and into the future.

Searches were conducted across MEDLINE, Embase, CINAHL and Scopus from January 2014 up to 11 March 2024. This rapid umbrella review protocol is guided by the Joanna Briggs Institute scoping review methodology and adheres to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The research question guiding this review is: what structures have healthcare systems put in place to stabilise, support and sustain the nursing workforce? This review will include existing reviews of nursing workforce initiatives with outcomes that impact nursing recruitment and retention. Results will support local health transformation including the development of a jurisdictional nursing workforce stabilisation strategy. Findings from this review will be relevant for the design, refinement and implementation of nursing workforce sustainability strategies in countries around the globe and may apply to strategies for other healthcare workers.

Institutional research ethics board exemption was received. The research team is supported by an advisory group that includes provider and patient partners. The results from this study will inform the Nursing Workforce Strategy for the province of Nova Scotia as part of a larger Canadian Institutes of Health Research-funded project. They will also inform broader planning and strategy in Canada through integration with other evidence-generation activities such as comparative policy analyses and workforce planning exercises. Finally, the results will be published in a peer-reviewed journal.

Registered through Open Science Framework: https://doi.org/10.17605/OSF.IO/CUJYK

Adolescence and youth are periods of significant maturational changes, which seem to involve greater susceptibility to disruptive events in the brain, such as binge drinking (BD). This pattern—characterised by repeated episodes of alcohol intoxication—is of particular concern, as it has been associated with significant alterations in the developing brain. Recent evidence indicates that alcohol may also induce changes in gut microbiota composition and that such disturbances can lead to impairments in both brain function and behaviour. Moreover, there is evidence suggesting that microbiota-targeted interventions (psychobiotics) may help mitigate alcohol-induced damage in individuals with chronic alcohol use, positively influencing cognitive and brain functioning. However, the triadic relationship between BD, gut microbiota and brain structure/function, as well as the therapeutic potential of gut microbiota-targeted interventions in young binge drinkers, remains largely unexplored.

This double-blind, parallel, randomised controlled study aims to evaluate whether a BD pattern disrupts gut microbiota diversity in young college students (primary outcome). Additionally, it seeks to determine whether alcohol-induced alterations in the microbial composition and function are associated with immunological, cognitive, neurostructural and neurofunctional impairments (secondary outcomes). A total of 82 college students (36 non/low drinkers and 46 binge drinkers (BDs)), matched for age and sex, will be recruited from the University of Minho (Portugal). During the pre-intervention phase, all participants will undergo a comprehensive assessment protocol, including gut microbiota profiling, measurement of inflammatory markers, neuropsychological testing and structural and functional MRI. BDs will then be randomly assigned to a 6-week intervention with either a prebiotic (inulin) or a placebo (maltodextrin). Post-intervention assessment will mirror the baseline protocol, and craving and alcohol use will be monitored for 3 months.

The present protocol was approved by the Ethics Committee for Social and Human Sciences of the University of Minho (CEICSH 078/2022), ensuring compliance with national and international ethical guidelines, including the Declaration of Helsinki. Participation is voluntary and preceded by informed consent, with confidentiality and data processing safeguarded in accordance with the General Data Protection Regulation. All procedures are safe and non-invasive, and the prebiotics used are recognised as food ingredients in Europe, hold Generally Recognized as Safe status in the USA and are classified as dietary fibres by the Food and Drug Administration. Findings will be disseminated in national and international scientific forums, with preference for publication in open-access, peer-reviewed journals.

NCT05946083

Childhood cancer accounts for a significant proportion of global childhood mortality, especially in low-income and middle-income countries (LMICs). Unlike many adult malignancies, primary prevention of childhood cancers is not possible. Improving survival requires a two-pronged strategy: earlier diagnosis and effective treatment. Our study aims to establish the feasibility, clinical and implementation effectiveness of an adapted early warning signs and symptoms (EWSS) intervention in Cameroon and Kenya. It will equip healthcare workers, Ministry of Health (MOH) representatives and National Cancer Institute leaders with evidence-informed guidance on implementing context-adapted interventions to improve the early detection and referral of childhood cancers in these countries.

The study is a quasi-experimental, hybrid type 2 implementation effectiveness study based on a Ghanaian adaptation of the ‘Saint Siluan’ EWSS campaign. Our protocol proposes context-specific adaptation and evidence-based implementation of the EWSS intervention through iterative engagement with country-level implementation teams to train healthcare workers and improve referral pathways for earlier childhood cancer diagnoses in each study country. Training effectiveness will be measured through pretraining and post-training tests of knowledge and application, as well as training satisfaction surveys. Clinical effectiveness will be assessed by using a REDCap database to track the number of newly diagnosed childhood cancer cases in the study regions and counties, healthcare timelines and paths to diagnosis, and the stage and proportion of metastatic disease at diagnosis. Implementation effectiveness will be evaluated through interviews with senior and mid-level health system partners and clinicians, tracking fidelity to the implementation process as laid out in The Implementation Roadmap Workbook, and analysis of meeting minutes from monthly local implementation team meetings.

This study has received ethical approval from The Hospital for Sick Children (REB # 1000080092) and all participating sites. We have received National Ethical Clearance from the Cameroon Ethical Board (#1699) and Regional Administrative Authorizations from our piloting regions (Centre and West). We have also received ethical clearance from Kenyatta National Hospital (KNH) (ERB# KNH-ERC/RR/955) and our National Commission for Science, Technology and Innovation in Kenya licence from the counties we are piloting in Kenya. As clinical data will be collected from existing health registries and patient charts, patient consent will not be required; however, we will obtain consent from all members of the leadership implementation teams and operational implementation teams for their participation in the implementation meetings and from all individuals participating in the semistructured interviews. We will disseminate findings to build awareness and share findings among various target audiences: (1) key county and regional parties (eg, clinical societies, advocacy groups, country MOHs and regional bodies such as the East African Community, Economic Community of West African States); (2) international bodies such as the WHO; and (3) the academic community.

Aboriginal and Torres Strait Islander people living with disability have unequal access to health and disability support services. The impacts of colonialism and the deficit-based, Western medical model of disability have been identified as barriers to services in remote Aboriginal communities. This study explored different perceptions of disability and identified strategies to help bridge the gap between Aboriginal community members in the Fitzroy Valley and Western health and disability support services.

Aboriginal Participatory Action Research approach with in-depth interviews. Transcripts were analysed using reflexive thematic analysis. Preliminary results were presented to community representatives for contextualisation, validation and to co-design recommendations.

Fitzroy Valley in the Kimberley region, Western Australia.

Aboriginal community members with lived experience of disability (n=7) and health and disability support service providers (n=12).

Eight themes were identified: (1) Aboriginal kinship systems are a community strength and support for people living with disability; (2) Aboriginal people from the Fitzroy Valley perceive disability as a social construct; (3) Western medical model of disability differs from Aboriginal perceptions of disability; (4) Aboriginal people from the Fitzroy Valley perceive different types of disabilities in various ways; (5) good awareness of fetal alcohol spectrum disorder in the Fitzroy Valley, but more education is wanted; (6) focus on functional needs and supports for disability; (7) barriers to disability services and (8) decolonise disability services. Community co-designed recommendations focus on centring the Aboriginal worldviews of disability in the Fitzroy Valley.

Decolonising disability services is needed to improve access for Aboriginal and Torres Strait Islander communities. This should involve adapting the current Western medical model of services to enable strengths-based diagnostic and support services that align with Aboriginal and Torres Strait Islander kinship systems, cultures and ways of being. Community leadership must play a central role in this shift.

A spinal cord injury (SCI) disrupts synaptic connections between the corticospinal tract and motor neurons, impairing muscle control below the injury site. Many individuals with an SCI have impaired trunk control, affecting the performance of activities of daily living and quality of life. Work has shown improvements in trunk control after home-based, unsupervised arm-crank exercise training (ACET) in people with chronic motor-incomplete SCI. However, no studies have examined ACET’s impact on trunk control in individuals with subacute SCI. This study aims to investigate ACET’s effects on trunk control in adults with subacute incomplete SCI, and its mechanisms, and its long-term benefits on neuropathic pain, psychological well-being, physical activity levels and health-related quality of life.

This multicentre, parallel-group, randomised controlled trial will evaluate self-directed ACET in 60 individuals with subacute SCI (

This study was approved by The Health Research Authority and Health and Care Research Wales (22/NS/0054). Results will be published in peer-reviewed journals. Findings will be presented at National and International conferences for researchers and clinicians. Finally, results will be disseminated to the SCI community.

ISRCTN17247972

Knee osteoarthritis often starts in the patellofemoral compartment of the knee and is diagnosed in about 39% of people with knee pain aged above 30 years. Patellofemoral osteoarthritis plays a crucial role in the reduction of quality of life and in the rise of healthcare costs. There is still no consensus for treatment recommendation for isolated patella-femoral osteoarthritis in clinical guidelines. Current therapeutic approaches are limited to pain management, alleviation of symptoms or total knee replacement. Nasal chondrocyte tissue-engineered cartilage (N-TEC) has already been successfully introduced in clinical studies phase I and II for the treatment of focal cartilage lesions and in pilot studies in osteoarthritis patients.

A randomised controlled trial involving 75 patients with patellofemoral osteoarthritis from nine different clinical centres in Switzerland, Germany and Croatia is being conducted to evaluate the effectiveness of N-TEC implantation compared with standard treatment with platelet-rich plasma (PRP). In the intervention group, an autologous nasal cartilage cell-derived graft is implanted into the cartilage defects of the patella and/or trochlea during an open surgical procedure. The control group receives three PRP injections at weekly intervals. The primary outcome is the mean Knee Injury and Osteoarthritis Outcome Score Pain Change from baseline to 24 months between groups. Secondary outcomes, including patients’ self-assessed questionnaires, X-ray and MRI scans, physiotherapeutic assessments and safety, will be assessed and compared between the intervention and control group. In addition, the study is complemented with a health-economic evaluation to establish the intervention’s value for money and impact on productivity in working-age individuals. The planned duration of the study is 4 years including baseline and follow-up measurements at 6, 12 and 24 months.

All centres involved in the implementation of the intervention have obtained approval from their respective competent ethics committees. This includes approval from the following ethics committees: Ethics Committees of North-Western and Central Switzerland (EKNZ): 2024–00075 (associated ethical committees: Cantonal Ethics Committee Bern, Cantonal Research Ethics Commission Geneva (CCER), Cantonal Ethics Committee Ticino, Cantonal Ethics Committee Zurich). The EKNZ covers several cantons in Switzerland, including Basel. The site in Lugano falls under the Cantonal Ethics Committee Ticino. Ethics Germany according to CTIS: 2023-508640-21-00 (Medicinal Ethical Commission of the Julius-Maximilians-University Wuerzburg, Ethical Commission of the Albert-Ludwigs-University Freiburg) and Central Ethical Committee Croatia, Republic of Croatia Ministry of Health: 2023-508640-21-00. The Swissmedic reference number is 701788.

Prior to participation, all participants must have signed informed consent. Study information will be disseminated via hospital websites, newsletters and an open-access publication of the protocol. Results will be published in peer-reviewed journals, presented at national and international conferences and shared with the public.

ClinicalTrials.gov Registration No.: NCT06163573; Registration number CTIS: 2023-508640-21-00.