Trauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric post-traumatic stress disorder (PTSD), but access to evidence-based care remains limited. This study aimed to evaluate the feasibility and acceptability of a therapist-guided, 12 week, internet-delivered TF-CBT (iTF-CBT) programme for adolescents with PTSD and to explore preliminary changes in PTSD symptoms.

Single-group feasibility trial.

Save the Children, Sweden.

Twenty-two adolescents (13–17 years, 82% female) with primary PTSD.

A 12 week, therapist-guided, asynchronous, internet-delivered TF-CBT comprising eight modules and parallel caregiver modules with joint adolescent–caregiver activities.

Feasibility measures included recruitment pace, participant retention, treatment adherence (module completion) and therapist time. Acceptability was evaluated through satisfaction, credibility, negative effects and reported adverse events. Within-group changes in PTSD severity using independent evaluator-rated Clinician-Administered PTSD Scale (CAPS-CA-5) and the self-reported Child and Adolescent Trauma Screen 2 (CATS-2) were used as indicators of potential clinical change. Assessments occurred at baseline, during treatment, post-treatment and at 1 month follow-up (primary endpoint).

Recruitment was completed after 7 months of active enrolment. Retention and adherence were high, satisfaction and credibility ratings were favourable, and no intervention-related serious adverse events occurred. Within-group improvements were observed at the primary endpoint, with large reductions on CAPS-CA-5 (Cohen’s d=1.27) and CATS-2 (Cohen’s d=1.51). At follow-up, 47.6% of participants no longer met criteria for PTSD.

Therapist-guided iTF-CBT for adolescents with PTSD was safe, feasible, acceptable and associated with potentially meaningful symptom improvements. These findings support further evaluation in larger, controlled trials to determine efficacy, cost-effectiveness and long-term outcomes.

NCT06185244.

Adnexal surgery is one of the most common surgeries performed in women. Minimally invasive methods are on the rise globally as they have been shown to decrease surgical morbidity compared with abdominal surgery. Adnexal surgery by vaginal natural orifice transluminal endoscopic surgery (vNOTES) is the latest innovation. It combines the vaginal approach and endoscopy via the vagina. Large pragmatic randomised controlled trials (RCTs) are lacking comparing outcomes after vNOTES and conventional laparoscopy.

A multicentre pragmatic RCT aiming to recruit 200 women aged 18 years and above undergoing adnexal surgery for benign disease or prophylactic reasons. Patients will be randomised to vNOTES or laparoscopy. Recruitment will start Q4 2025, and the study is estimated to end 2028.

The primary outcome is postoperative pain. Secondary outcomes are units of postoperative opioid and non-opioid analgesics used, perioperative complications, operation time, postoperative complications, readmission, conversion rate and the surgeon’s experience.

The national Swedish ethical board at the main centre, Helsingborg Hospital, Sweden, has given ethical agreement (dated 20 March 2025). Before including patients, all centres will require local or national ethical approval. The results of the study will be published in international peer-reviewed journals.

NCT06964594.

Population ageing and the rise in chronic diseases are driving a shift from residential models to home care where family carers play a key role. Although education programmes have shown benefits, limited attention has been paid to how family caregivers can be effectively trained to prevent unintentional mistakes in home care and to how they should be prepared to respond to them related to the care they provide.

This scoping review aims to examine education programmes that enhance family caregivers’ knowledge and skills to promote safe home care, prevent unintentional mistakes and mitigate their impact on both care recipients and family caregivers.

This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology for scoping reviews.

Comprehensive searches were conducted in PubMed, Scopus and Embase in April 2024.

The review included studies on family caregivers in home-based care, focusing on education programmes promoting safe practices; quantitative, qualitative and mixed-methods designs were eligible while studies on professional care or unrelated to home safety were excluded.

Extracted data included study characteristics, education type, target population and safety-related outcomes, which were summarised descriptively to map the available evidence.

31 studies on home safety education programmes for family caregivers across oncological, neurological, chronic and paediatric conditions were identified, mostly from the USA and conducted in hospital, home and other health and care facilities. Randomised controlled trials predominated and were generally high quality. Education programmes targeting technical, daily living and self-care skills improved caregiver burden, knowledge, preparedness and quality of life although physical health outcomes showed limited change.

Evidence indicates that structured education programmes enhance family caregivers’ knowledge, preparedness, competence and psychological well-being, supporting safer home care. While current education programmes are mostly short-term and caregiver-centred, this review identifies core technical, daily life and self-care competencies to guide future education programmes, highlighting the need for co-designed, rigorously evaluated education programmes that include patient safety outcomes and caregiver emotional support.

Non-communicable diseases, particularly cardiovascular diseases (CVDs), have become major contributors to morbidity and mortality in sub-Saharan Africa (SSA) and are projected to surpass infectious diseases as the leading cause of death among adults by 2030. Although CVDs have traditionally been associated with older age and obesity, adverse cardiovascular phenotypes are increasingly being observed in younger and leaner individuals in SSA. This pattern suggests that pathways to CVD risk in SSA may differ from those described in high-income countries. Early-life infectious exposures, undernutrition and socio-demographic conditions common in many SSA settings have been proposed as potential risk factors. Still, empirical evidence linking these exposures to cardiovascular risk in early adulthood remains limited due to a scarcity of long-running birth cohorts in the region.

This protocol describes a new round of data collection nested within the Entebbe Mother and Baby Study (EMaBS), a population-based Ugandan birth cohort established originally as a clinical trial (ISRCTN32849447) between 2003 and 2006 with prospective follow-up from pregnancy through adolescence. All participants currently under follow-up will be invited to participate at approximately 21 years of age. Primary outcomes are physiological determinants of CVD measured in early adulthood, including blood pressure, blood lipid levels, body mass index, body composition and markers of glucose metabolism. Secondary outcomes include behavioural CVD risk factors (diet, physical inactivity, alcohol use and tobacco use) and qualitative measures of CVD knowledge and risk perception. Key exposures of interest include prospectively collected early-life and childhood infectious exposures (malaria and helminth infections), markers of growth and undernutrition, micronutrient status, inflammatory markers, socio-demographic factors and selected genetic variants. Quantitative analyses will use multivariable regression and causal modelling approaches and will be complemented by qualitative interviews and focus group discussions.

The study protocol has been reviewed and approved by the Uganda Virus Research Institute Research and Ethics Committee (UVRI REC Ref: GC/127/35), the Uganda National Council for Science and Technology (UNCST Ref: MV625), and the London School of Hygiene & Tropical Medicine Research Ethics Committee (LSHTM Ethics Ref: 8811). Written informed consent will be obtained from all participants before study activities. Study findings will be shared and discussed with participants and community stakeholders through established engagement platforms. Results will be disseminated to the scientific community through peer-reviewed publications and conference presentations, and data will be made available to other researchers via established data-sharing platforms. We will engage policymakers at the district, national and international levels to facilitate the translation of findings into policy-relevant outputs.

Globally, curable sexually transmitted infections (STIs) are increasing, particularly in sub-Saharan Africa, yet epidemiological data remain limited, hindering progress towards the 2030 global STI targets. This study assessed the prevalence of self-reported STIs in the last 12 months among adolescent girls and women (AGW) and adolescent boys and men (ABM) aged 15–59 who ever had sex in Zambia and Zimbabwe at three time points. It also assessed whether observed changes across survey rounds persisted after adjusting for sociodemographic and sexual behaviour characteristics.

We analysed six rounds of Demographic and Health Surveys, three per country, collected between 2005 and 2018, using descriptive statistics and logistic regression, while accounting for survey design.

Zambia and Zimbabwe.

A total weighted sample of 86 366 AGW and ABM was included in the study.

Self-reported STIs in the last 12 months.

Overall, self-reported STI prevalence was higher in Zimbabwe than Zambia. Among Zambian ABM, self-reported STIs increased from 6.2% in 2007 to 7.1% in 2018 (adjOR=1.28, 95% CI 1.05 to 1.57, p=0.005). Among Zimbabwean AGW, prevalence decreased from 11.7% in 2005/2006 to 8.3% in 2015 (adjOR=0.72, 95% CI 0.61 to 0.85, p

These findings highlight differences in STI prevalence by sex and country across survey rounds, underscoring the need for tailored STI prevention, diagnostic and treatment strategies, particularly for high-risk groups.

To explore physical and mental health professionals' hopes and concerns around integrating their services in a colocated children’s hospital.

One-off semi-structured interviews were conducted with 31 participants (16 mental health and 15 physical health professionals). Participants were purposively sampled to ensure representation across each trust and professional background. Participants included allied health professionals, nurses, team managers, paediatricians, psychiatrists and psychologists.

Staff described integration as both promising and ambiguous. While many welcomed the potential for improved collaboration and holistic care, others expressed uncertainty about what integration would entail. Six key themes were identified: (a) siloed and patchy beginnings, (b) one whole child, (c) day-to-day of colocation, (d) the integrated worker, (e) patients not in the same boat and (f) extending integration.

This novel analysis offers insights around the practical and emotional processes involved in integrating care systems. Staff valued the potential for holistic, child-centred care, improved collaboration and shared learning but expressed concerns around ambiguity, shifting professional identities and the practicalities of colocating services. These tensions underscore the need for clearer communication, relationship-building and support structures during service redesign. Our findings also support integrating wider community and social care systems and call for future research involving young people’s perspectives to ensure meaningful, inclusive integration.

The second phase of the Chiba Study of Mother and Child Health (C-MACH) was initiated to investigate how environmental exposures from the fetal period to early childhood influence maternal and child health outcomes. The sub-cohort focuses specifically on detailed assessments of indoor environmental factors and neighbourhood-built and social environments. By integrating environmental metrics with biological, behavioural and sociodemographic data, the study aims to elucidate their role in the development of allergies, neurodevelopmental disorders and other non-communicable diseases in early life.

Between June 2021 and April 2023, 505 pregnant women were enrolled in the second phase of the C-MACH main study. Of these, 298 participants consented to join the sub-cohort study, including 258 in the sleep and physical activity monitoring option (Option 1) and 148 in the indoor allergen exposure sub-study (Option 2). The study includes biological sampling, environmental monitoring and repeated questionnaire surveys. At baseline, 253 live births were recorded from 251 pregnancies.

Of the 298 women, 272 completed early pregnancy questionnaires. The mean maternal age was 33.1 years (SD 4.6); 97.8% were married. University-level education was reported by 51.0% of mothers and 53.7% of fathers. Most households had an annual income of 6 to

Longitudinal follow-up will continue until the children reach age 15. Future analyses will examine associations between environmental exposures and allergic, developmental, endocrine/metabolic and obesity-related outcomes.

The Latarjet procedure is the mainstay treatment in high-demand patients with substantial glenoid bone loss or after failed capsulolabral repairs. Patients typically return to sport (RTS) within 6 months postoperatively, requiring intensive rehabilitation. Current rehabilitation protocols focus on mobility, strength and stability. Yet, psychological factors, such as fear of reinjury, are the main reason not to RTS. Therefore, this study aims to determine whether integrating psychological interventions into postoperative rehabilitation improves patient-reported shoulder function compared with physical therapy alone.

This monocentric randomised controlled trial will enrol 52 patients undergoing a Latarjet procedure for anterior shoulder instability. Participants will be equally and randomly assigned to either postoperative physical therapy combined with cognitive behavioural therapy or physical therapy alone. Eligibility criteria include patients aged 18–67 years undergoing an open or arthroscopic Latarjet procedure at our institution. Exclusion criteria include posterior or multidirectional instability, rotator cuff tear, prior shoulder surgery, anxiety disorder, using anxiolytics, neurological disorder, systemic disease, previous hospitalisation for shoulder pain and proximal humerus fractures.

The primary outcome is the Western Ontario Shoulder Index at 6 months postoperatively. Secondary outcomes include incidence of recurrent dislocations, RTS and return-to-work rates, Tampa Scale of Kinesiophobia for Shoulder Instability, subjective shoulder value and visual analogue score for pain at 6 months postoperatively as well as the Shoulder Instability Return to Sport after Injury scale at 4.5 months postoperatively.

This study was approved by the French Committee of Person Protection West I. The national registration number is 2023-A02057-38. The study has been registered at Clinicaltrials.gov with trial registration number NCT06154889. Patients are not financially compensated for participation and are allowed to withdraw from the study at any time without any preconditions. The final results of the study will be submitted for publication in a peer-reviewed journal and an abstract of the study will be submitted to international scientific meetings by the end of 2026. Data will be made available by the corresponding author on reasonable request.

The study has been registered at Clinicaltrials.gov with trial registration number NCT06154889. The trial sponsor is Vivalto Santé.

NCT06154889.

Glaucoma is the leading cause of irreversible blindness worldwide and the number of people with glaucoma is expected to increase to more than 112 million by the year 2040, making it a disease of public health interest. However, there is no consensus on public health indicators to monitor glaucoma care coverage. This scoping review aims to summarise published indicators for monitoring effective glaucoma care coverage globally, focusing on care needs, use of care services and outcomes achieved.

We will include studies that report the development and use of public health indicators for effective glaucoma care coverage in patients aged 18 years and older. Studies published from 1 January 2000, in all languages, will be included, provided they can be accurately and easily translated into English using Google Translate. Searches will be conducted by an information specialist on MEDLINE, Embase, Global Health and CENTRAL in the Cochrane Library. Two reviewers working independently will screen the search results, select studies for inclusion and extract data; any disagreements will be discussed with or resolved by a third reviewer. Data will be presented in tabular form, followed by a narrative synthesis based on the review objectives.

Ethical approval is not required as the review will use published data. Results will be published in a peer-reviewed journal, and summarised results will be available and contribute to the development of standardised glaucoma care indicators.

OSF registration on 19 May 2025: https://osf.io/zsyw9/

For large primary spontaneous pneumothorax (PSP), drainage or simple aspiration are the two first-line treatment options. Outpatient ambulatory strategies have a success rate of almost 80% with few complications. New French recommendations suggest that an outpatient strategy should be preferred if an appropriate care network is in place. However, establishing this care network remains the main obstacle to the use of this strategy. Thus, outpatient management of PSP remains rare, which is neither optimal for the patient, with a likely impact on quality of life (QOL) and satisfaction with care, nor for the healthcare system, with increased costs. We hypothesise that outpatient treatment of PSP compared with usual inpatient management could improve quality of care and represent a more efficient, generalisable and sustainable strategy.

In this multicentre, cluster-controlled, randomised interventional study with stepped wedge implementation, patients aged 18–50 presenting to the emergency department (ED) with a first episode of large PSP will be enrolled in seven university hospitals in France. The main objective of this study is to evaluate the impact on changes in QOL of an ambulatory strategy for the management of large PSP in the ED compared with usual inpatient management. The primary outcome is the difference in QOL as measured by SF-36 score, between drain placement and 6 months. Clinical criteria (pulmonary expansion at 6 days, pain, dyspnoea, complications, recurrence), perceived quality of care (satisfaction, patient preference, anxiety) and ease of implementation of the care pathway will also be assessed. A cost-utility analysis will be carried out to evaluate the incremental cost-utility ratio at 1 year, defined as the difference in costs divided by the difference in utility estimated by the EQ-5D scores.

Ethics approval has been obtained by the Comité de Protection des Personnes Nord Ouest III N° 2024-36. Study findings will be disseminated by publication in a high-impact international journal. Results will be presented at national and international emergency healthcare meetings, and participating patients notified of the main conclusions.

This trial is registered with Clinical Trials Registry NCT06471608. The trial protocol and statistical design are fully described in this study protocol. Additional data can be provided on reasonable request to the sponsor. Protocol version: V2.1 - 21/11/2024.

To explore the experience and impact of physical chronic illnesses in the lives of young people.

Qualitative study using semi-structured interviews.

Interviews were conducted between March 2023 and February 2024 either via video call (14) or face-to-face (19). Recruitment was done primarily through flyers in public spaces, specialists’ waiting rooms and research pages of chronic disease websites and supplemented through snowballing.

Young adults aged 19–29 years (n=33, mean age 23 years) who had lived with a physical chronic illness for 6 months or more. All participants lived in Australia.

Three key findings were identified: (i) chronic illness impacts the lives of young people in a particular way, as participants reported that their young age, and the youth of their peers, influenced their interactions with healthcare professionals, their access to support and their sense of isolation; (ii) participants struggled to come to terms with, and describe, the influence of their chronic illness on their overall life and lifestyle, particularly when outside of the ‘expected’ symptoms of disease; (iii) the lack of education and guidance about the wide range of impacts that chronic illness can have seemed to compound participants’ reported sense of guilt, self-blame and exhaustion.

This study illustrates how youth is a critical contextual element when considering different population groups’ challenges in managing chronic illnesses. It finds that young people may internalise blame for these challenges despite the fact they are structural issues. Understanding this context will aid the provision of better healthcare experiences and support programmes. Further research could help establish better expert and peer support models to help adults and young people better anticipate, understand and manage the wide-reaching impacts of chronic illness.

Genitourinary syndrome of menopause (GSM) is a prevalent condition among breast cancer survivors, often exacerbated by oncological treatments. Hormonal therapies are typically contraindicated in this population, necessitating effective non-hormonal interventions.

This randomised controlled trial aims to compare the effectiveness and cost-effectiveness of multimodal pelvic floor physiotherapy—comprising pelvic floor muscle training, non-ablative radiofrequency, therapeutic pelvic health education and the use of vaginal moisturisers—versus fractional CO₂ laser therapy combined with vaginal moisturisers in alleviating GSM symptoms in breast cancer survivors. Participants will be randomly assigned to one of the two intervention groups. Primary outcomes include measures of sexual function (assessed by the Female Sexual Function Index), subjective pelvic perineal pain intensity (measured with a 100 mm Visual Analogue Scale) and health-related quality of life (assessed by the Functional Assessment of Cancer Therapy-Breast), assessed at baseline, post-intervention and at 3, 6 and 12 months of follow-up. Statistical analyses will be conducted to evaluate the clinical efficacy and cost-effectiveness of the interventions.

The study protocol has been approved by the Ethics and Health Research Committee of the University of Alcalá (Reference: CEIP/2024/1/012). All participants will provide informed consent prior to inclusion in the study. Findings will be disseminated through peer-reviewed journals and conference presentations, and by engaging with patient associations and survivor groups through tailored materials.

NCT06721936.

To quantify the costs associated with a stepped model of depression care—Integrated Chronic Care Clinics-Depression Module (IC3D)—in rural Malawi.

Cross-sectional cost analysis.

Integrated chronic care clinics (n=14) throughout Neno District, Malawi.

The stepped model of depression care provided behavioural therapy (Problem Management Plus (PM+)) to adults (aged 18+) with moderate depression and joint PM+ and antidepressant therapy (ADT) to those with moderate-to-severe and severe depression. The model incorporated two cost-saving features: treatment was integrated into existing chronic care services within the health system, and PM+ was group-based rather than one-on-one.

We conducted time-driven activity-based costing to quantify the marginal economic cost of implementing PM+ and ADT, inclusive of training and supervision. We measured all costs in 2025 US dollars and quantified costs from a societal perspective—including human resources, infrastructure, equipment, consumables, indirect costs and opportunity costs.

The marginal cost of PM+ was $90 per patient treated for five sessions over 2 months, while ADT was $138 for eight sessions over 8 months. In both instances, human resources (45% from PM+, 52% for ADT) and consumables (30% for PM+, 31% for ADT) represented primary health system cost drivers. In the first year of implementation, 15 002 depression screenings were conducted, 724 adults were evaluated with a diagnostic tool and 398 adults subsequently received care: 263 received PM+ alone, 31 received ADT alone and 104 received both PM+ and ADT. The total cost of introducing operations throughout Neno District was $62 806.

These findings indicate that integrating depression care services into the Malawian health system is financially feasible and successfully reached many individuals with major depressive disorder.

NCT04777006.

The present study aimed to develop and psychometrically validate a culturally sensitive instrument, the women’s empowerment in dealing with intimate partner violence (WED-IPV) scale, in Iran.

A mixed-methods research study to collect and analyse quantitative and qualitative data.

Social emergency centres, healthcare centres and psychotherapy clinics in three Iranian metropolises.

The participants were 31 married women in the qualitative phase and 420 in the quantitative phase.

The primary outcome was the validation of the WED-IPV scale, including the assessment of face, content, construct validity and the assessment of internal consistency through Cronbach’s alpha, test–retest reliability through intraclass correlation coefficients (ICC) and stability of the factor structure. Secondary outcomes included the assessment of WED-IPV indicators in women using values obtained from levels specified according to the Interval of SD from the Mean formula for each indicator and total empowerment.

The scale development process refined the initial 72 items down to 28 key items through expert review and validity testing. Exploratory factor analysis identified five factors: self-esteem, attitude, self-efficacy, access to support resources and economic empowerment that explained 65.72% of the variance. The scale showed excellent reliability (Cronbach’s α=0.97; ICC=0.95) and valid associations with related measures. Analysis of completed questionnaires of 412 women revealed that a significant portion scored low or moderate in each domain: 41% in self-esteem, 35% in self-efficacy, 39% in attitude, 47% in access to support and 45% in economic empowerment.

The WED-IPV scale is a psychometrically robust, reliable and valid instrument for assessing women’s empowerment concerning IPV in Iranian contexts. Its brevity and user-friendly design facilitate routine application in primary and secondary care settings. Future research should explore cross-cultural validation and predictive validity in longitudinal studies to inform targeted interventions and policy formulation.

Gastrostomy tube feeding is a well-established safe and relatively common way of delivering nutrients to the gastrointestinal tract in individual who cannot use the oral route. In children, there are several indications for using chronic gastrostomy tube feeding, including neurodevelopmental conditions, cardiac problems, metabolic conditions, gastrointestinal diseases and malignancy.1 Nutrients delivered through the gastrostomy...