Shift work is associated with disrupted sleep, circadian misalignment and increased risks of adverse health, performance and safety outcomes. Although recommendations for shift workers typically focus on obtaining one long sleep period, many shift workers divide sleep into two episodes, referred to as biphasic sleep. Biphasic sleep may help mitigate sleep loss-related impairments, yet its prevalence, characteristics and potential benefits for shift working populations remain unclear. Existing reviews have examined sleep duration, mental health, or the consequences of shift work broadly, but none have specifically mapped evidence comparing biphasic and monophasic sleep between shifts. This scoping review will identify and summarise the available literature on biphasic sleep among adult shift workers. In addition, we will describe the outcomes and subsequently highlight any possible gaps to inform future research.

This review will follow the Joanna Briggs Institute methodology for scoping reviews and be reported in accordance with the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines. Biphasic sleep is defined as two distinct sleep episodes within a 24-hour period between work shifts, including two similarly timed sleep periods or one longer sleep combined with a shorter nap. A comprehensive search will be conducted in April 2026 in MEDLINE, Embase, PsycINFO, Web of Science and CENTRAL using controlled vocabulary (eg, Medical Subject Headings) and free-text terms related to shift work and split sleep. Peer-reviewed primary research examining biphasic sleep among adult shift workers will be included, and studies focusing solely on naps during work hours will be excluded. Two reviewers will independently screen titles/abstracts and full texts, with discrepancies resolved through discussion or by consulting a third reviewer. Data will be extracted using a standardised template including study characteristics, sleep parameters and reported outcomes. Results will be summarised descriptively and presented in tables and evidence maps. No statistical synthesis will be performed.

This scoping review will synthesise data from articles published in peer-reviewed journals. As no primary data will be collected and no human participants will be involved, the review is exempted from formal ethical approval. Findings will be disseminated in terms of a peer-reviewed publication and will inform future systematic reviews on sleep strategies among shift workers.

This project is registered with the Open Science Framework accessible at 10.17605/OSF.IO/WY7KJ.

Individuals experiencing moderate to severe mental illness have low rates of workforce inclusion, with a consequence of high welfare dependency, affecting both societal costs and health. Individual Placement and Support (IPS) is an approach to supported employment where the goal is to help people obtain jobs on the open rather than sheltered labour markets. Despite multiple randomised controlled trials (RCTs) indicating that the IPS model enables employment better than treatment as usual, with widespread adoption in some jurisdictions, the broader impacts of this large-scale implementation on mental health, quality of life and social functioning remain unknown.

Between 2012 and 2019, Norway introduced IPS through both local and national government projects. This study assesses the social and economic benefits of the implementation of IPS using Norwegian registry data, focusing on 18–45-year-old people receiving specialist mental healthcare, and who did not have steady employment at treatment start. Instead of assessing IPS efficacy in an RCT design, we use a naturalistic study design, evaluating IPS effectiveness by comparing aggregate population-level outcomes over time between areas where IPS was not available.

In work package (WP) 1, we mapped the availability and implementation of IPS across Norway. This involved analysing information on funding, resource and capacity levels to understand how IPS had been rolled out across the country. While completed, we include a description of WP1 here, as it informs WP2 and WP3. WP2 is an effectiveness evaluation investigating the population-level outcomes of implementing IPS, focusing on health, mortality, quality of life and social functioning. Finally, in WP3, we assess the financial implications of implementing IPS from a public purse perspective, synthesising data on resource use and costs of implementation with data from WP2.

Overall, we will examine the societal effects of IPS implementation on employment, welfare dependency, mental healthcare use, emergency care visits, self-harm and suicide, general mortality, crime and victimisation. Emphasis will be on long-term outcomes, and we will model the economic consequences of IPS. This study aims to inform policy making and strategies for implementing IPS at scale.

This is an effectiveness study using registry data. The Regional Committee for Medical Research Ethics Northern Norway, REK North has approved the use of registry data without informed consent for this project (approval number 134553).

The findings will be disseminated both in academic peer-reviewed journals, directly to informants in WP1, to the public through media and the project website, and at relevant conferences and seminars for specific relevant target groups.

Not applicable

Prior research, mostly from North America, suggests improved clinical outcomes for female patients treated by female physicians. Whether these findings apply in European healthcare systems and how underlying processes of care vary by sex remains unclear. This study aimed to assess whether in-hospital outcomes and processes of care differ by patient sex, physician sex or their interaction, in a European setting.

Retrospective cohort study.

General internal medicine division of a Swiss tertiary teaching hospital.

Adult inpatients (≥18 years) hospitalised between 2014 and 2024 and their primarily responsible physicians, classified by administrative sex (male vs female). The cohort included 20 094 hospitalisations (44.6% female patients) and 216 physicians (48.1% female).

Outcomes included in-hospital mortality, 30-day mortality and 30-day readmission, as well as processes of care (resource use, advance care planning and cardiovascular low-value care). Multilevel mixed-effects regression models adjusted for patient and physician characteristics.

Female patients had lower in-hospital mortality (OR 0.72, 95% CI 0.59 to 0.89) and 30-day mortality (OR 0.75, 95% CI 0.65 to 0.87), lower hospitalisation costs (–4.26%, 95% CI –6.08% to –2.41%), fewer diagnostic and therapeutic procedures (–6.44%, 95% CI –9.76% to –3.01%), fewer blood tests (–8.95%, 95% CI –12.98% to –4.73%) and were less likely to have resuscitation orders (OR 0.64, 95% CI 0.58 to 0.71) or intensive care unit transfer orders (OR 0.64, 95% CI 0.55 to 0.73). They were, however, more likely to receive non-indicated antihypertensive treatment (OR 1.86, 95% CI 1.38 to 2.51). No significant differences were observed by physician sex or patient–physician sex interaction.

In a European tertiary teaching hospital with universal healthcare coverage, in-hospital outcomes and processes of care did not differ by physician sex or patient–physician sex interaction. Nevertheless, disparities by patient sex persisted, underscoring the need for sex-disaggregated quality monitoring and sex-sensitive medical training.

To explore differences in health-related benefit status over 3 years, focusing on patterns of sick leave, work assessment allowance and disability benefits, between people who underwent rehabilitation and a matched control group.

Prospective longitudinal multicentre cohort study using registry data over three consecutive years.

Secondary specialist rehabilitation services at 17 institutions across Norway.

Patients (n=2710), 42% with rheumatic and musculoskeletal diseases, aged 18–65 years referred for multidisciplinary rehabilitation at one of the participating institutions. They were propensity score matched with 37 760 controls from the national sick leave registry, based on sociodemographic factors and health-related benefit status.

Multidisciplinary rehabilitation programmes, commonly lasting 3 weeks (range: 1 week to 6 months), tailored to individual needs.

Days on health-related benefits (sick leave, work assessment allowance (WAA) and disability benefits) were quantified as lost workdays per month. Differences between groups were analysed using Generalised Estimating Equations across three consecutive years: the year before rehabilitation, the rehabilitation year and the year after rehabilitation.

The rehabilitation group had more days on health-related benefits per month than controls throughout the observation period. During the rehabilitation year, they had on average 1.7 more days on sick leave (95 % CI 1.3 to 1.9), 2.3 more WAA days (95% CI 1.9 to 2.7) and 0.2 more days on disability benefits (95% CI 0.1 to 0.3). In the year after rehabilitation, they had 0.6 fewer days on sick leave (95% CI –0.8 to –0.3), but 3.7 more days on WAA (95% CI 3.1 to 4.2) and 0.6 more days on disability benefits (95% CI 0.4 to 0.8). Patterns were similar for the subgroup with rheumatic and musculoskeletal diseases.

People undergoing rehabilitation had more days on health-related benefits and a greater increase in long-term benefits, even after matching, indicating a higher disease and support burden than controls. Tailoring interventions and health-related benefits is an essential aspect of rehabilitation for people with complex work participation needs. Future research should include longer observation periods to explore long-term outcomes of rehabilitation.

NCT03764982

This study aimed to describe women’s experiences of perineal wound dehiscence of a second-degree perineal tear and choice of resuturing or conservative treatment in the first two months after birth.

A qualitative descriptive study using individual semistructured interviews was conducted. Data were analysed using Braun and Clarke’s reflexive thematic analysis approach to explore women’s experiences and perspectives on dehisced perineal wounds of a second-degree perineal tear. Interviews were audio-recorded, transcribed verbatim and analysed concurrently with data collection.

Perineal clinics at the Department of Obstetrics and Gynaecology at two large University Hospitals in Copenhagen, Denmark.

17 women with dehisced perineal wound of a second-degree perineal tear.

Three main themes were identified: (1) The unforeseen troubles: for the women with perineal wound dehiscence, the pain intensified immensely after the birth. It was an unexpected complication, and it affected the women negatively in various ways. (2) The emotional turmoil: it was a crisis for the women that their lower bodies were not intact. They were terrified, and they wondered if they had themselves to blame. Most women emphasised that choosing between resuturing or conservative treatment was a difficult and lonely decision. (3) Living with changes: regardless of treatment approach, women in both groups reported gradually managing their complicated healing and pain, but were concerned about their genitals and future births.

The findings indicate that wound dehiscence was related to a painful postpartum period and an altered body image, and that the women generally found choosing between resuturing or conservative treatment difficult.

Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are among the leading non-communicable diseases (NCDs) worldwide. However, diagnosing CRDs in low-income and middle-income countries (LMICs) remains challenging due to limited access to spirometry and trained professionals. Aggravating the burden, CRDs often coexist with other NCDs, increasing healthcare costs, reducing quality of life and elevating mortality. These challenges highlight the need for simple case-finding approaches for CRDs, such as the COPD in Low-Income and Middle-Income Countries Assessment (COLA-6) questionnaire, to support prompt identification and appropriate care within NCD services in LMICs.

To evaluate the discriminative accuracy, feasibility and implementation of the COLA-6 questionnaire in identifying and managing CRDs in Brazilian Primary Healthcare (PHC) services for NCDs.

The Multimorbidity Approach for REspiratory Solutions (MARES) study consists of three work packages to be conducted in PHC services in São Carlos/SP and São Paulo/SP, Brazil.

MARES-1: A cross-sectional observational study enrolling 859 individuals with at least one NCD receiving care in PHC. The COLA-6 questionnaire will be administered by the research team and compared with quality-assured spirometry. The Chronic Airways Assessment Test (CAAT), Asthma Control Questionnaire (ACQ-7) and fractional exhaled nitric oxide (FeNO) will also be assessed. The diagnostic performance of COLA-6 for identifying CRDs—including COPD, asthma, preserved ratio impaired spirometry, restriction and overlaps—will be assessed using area under receiver operating characteristic curves and 95% CIs.

MARES-2: A cross-sectional observational study enrolling 20 healthcare professionals (physicians, physiotherapists, community health agents and nurses) from five PHC services. These professionals will apply the COLA-6 during routine NCD care to a total sample of 1000 patients. Qualitative interviews will be conducted to explore barriers and facilitators to the implementation of COLA-6, using deductive thematic analysis.

MARES-3: A longitudinal, prospective observational study in which patients from MARES-1 and MARES-2 will be reassessed at 6-month follow-up. A total sample of 473 participants with abnormal spirometry, a diagnosis of CRD or high risk for CRDs is expected. Participants will undergo spirometry, and a subset will be interviewed to explore their healthcare experiences through qualitative thematic analysis. Access to diagnostic and treatment services in Brazil will be assessed. Changes in spirometry values, FeNO, CAAT and ACQ-7 scores from baseline to 6 months in patients from MARES-1 will be analysed.

This study has been approved by the Ethics Committees of Federal University of São Carlos and University of Santo Amaro (UNISA). Ethical approval was also granted by the University College London. Results will be disseminated through peer-reviewed medical journals and presentations at international conferences. Results will improve identification of CRDs, addressing a significant gap in current PHC settings.

NCT07050823/NCT07093021/NCT07134855.

We aimed to explore the patient-related and organisational characteristics associated with late cancellations and non-attendance in diabetes outpatient care and present our findings organised as a risk matrix based on these characteristics.

A cross-sectional study.

Our study was conducted at an endocrinology outpatient clinic based on data extracted between January and December 2019 from electronic medical records.

Adult patients with type 1 diabetes with late cancellations or non-attendance. We compared our sample with national data for comparison and to assess representativeness.

Main outcome was late cancellations or non-attendance, while secondary outcomes included type of cancellations and reason for cancellation.

In total, 541 patients had late cancellations or non-attendance across 5040 diabetes consultations. These patients had a mean age of 43 years, 57.9% were men and half (n=301, 55%) were employed. The mean diabetes duration was 18 years, and the mean HbA1c level was elevated at 72 mmol/L. The outpatient clinic had a higher number of consultations, but the patient characteristics were comparable to the national average. Half of the patients (n=258, 52.3%) had late cancellations ahead of their consultations. Most cancellations occurred during the winter, mainly due to illness being the most frequent reason. Unemployed men with poorly regulated diabetes were more likely not to attend compared with employed females.

Characteristics such as being male, unemployed and having elevated HbA1c levels were significantly associated with non-attendance. Our findings contribute to understanding the reasons for at-risk patients missing consultations.

Insomnia is a common complaint among patients with opioid use disorder (OUD) maintained on buprenorphine (BUP). However, people with OUD have historically been excluded from insomnia clinical trials, leaving clinicians without evidence-based treatment options for this patient population. Lemborexant, the Food and Drug Administration (FDA)-approved dual orexin receptor antagonist for the treatment of insomnia, was recently shown to be safe and tolerable among a sample of patients with insomnia who were maintained on BUP. We hypothesise that pharmacologically antagonising the orexin system with lemborexant may improve insomnia symptoms in individuals with OUD and also enhance BUP treatment benefits by improving performance in neurofunctional domains identified in the National Institute on Drug Abuse Phenotyping Assessment Battery.

Participants with insomnia and OUD who have been stabilised on BUP for at least 4 weeks will be randomly assigned to receive either lemborexant (n=50) or placebo (n=50) for 8 weeks. Participants will complete assessments at baseline, during the 8-week intervention, postintervention and at a 2-week follow-up. Primary outcomes are insomnia severity and impulsivity. Secondary measures include objective sleep metrics (total sleep time, sleep efficiency, sleep onset latency and wake after sleep onset) and performance in the neurofunctional domains of negative emotionality and metacognition.

The study was approved by the Virginia Commonwealth University Institutional Review Board in April 2025 (protocol number HM20031777). Data collection began in May 2025 and is expected to be completed by May 2029. The trial is conducted under FDA IND no. 154797 (FGM). The dissemination plan for the trial includes presentations at local and national conferences, submission of primary and secondary outcome manuscripts for publication in peer-reviewed journals and circulation of findings to popular media outlets, as available. Results will also be shared with interested participants and clinical collaborators upon completion of the trial.

NCT06981195.

To systematically review the evidence on the association between non-standard working time arrangements (such as night work or shift work) and the occurrence of safety incidents.

Systematic review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a structured narrative approach and the Synthesis Without Meta-analysis framework to evaluate and summarise findings.

MEDLINE, Embase, PsycINFO, Web of Science and ProQuest Health and Safety Science Abstracts were searched through February 2024.

We included peer-reviewed English-language studies of paid workers (18–70 years) that examined the association between non-standard working time arrangements and safety incidents (accidents, near-accidents, safety incidents or injuries), excluding cross-sectional designs and studies on unpaid workers, athletes or military personnel.

Two reviewers independently extracted data and assessed risk of bias using standardised forms, extracting study characteristics (author, year, country, sector and population), working time arrangements and exposure assessment, outcomes and their assessment, and reported risk estimates. We conducted a narrative synthesis, classifying studies into three exposure contrasts (shift worker versus non-shift worker, time-of-day and shift intensity), and summarised risk estimates using forest plots without calculating pooled effects.

A total of 13 569 records were screened, and 24 studies met the inclusion criteria. The results indicated that shift workers generally had an elevated safety incident risk compared with non-shift workers (risk estimates ranged from 1.11 to 5.33). Most of the included studies found an increased risk of safety incidents during or after night shifts. Accumulated exposure to evening or night shifts increased the risk of safety incidents during the following 7 days. However, bias and heterogeneity across studies in design, populations and outcome measures resulted in an overall low to very low certainty of the evidence.

Non-standard working time arrangements, including night and evening shifts, appear to increase the risk of occupational safety incidents. Despite the low certainty of evidence, the findings highlight a potential area for preventive measures in work scheduling. Future longitudinal studies using individual data on daily working hours are needed.

Asthma is a leading cause of morbidity and healthcare use among children. Risk factors of childhood asthma include atopic predisposition and severe wheezing episodes caused by rhinovirus infection in early life. In children with first-time rhinovirus-induced wheezing, we aim to study the response of a short corticosteroid treatment to prevent recurrent wheezing and asthma.

This is a double-blind, randomised, placebo-controlled, phase IV, international multicentre trial involving eight sites in Norway, Sweden and Finland. Two hundred and eighty 3–23 months old steroid-naïve children are randomised 1:1 to receive oral dexamethasone (0.3 mg/kg/day) versus placebo in 3 days for their first wheezing episode and rhinovirus infection. Rhinovirus is diagnosed with multiplex PCR. The two co-primary outcomes are time to next physician-confirmed wheezing episode, and time to asthma, within 24 months from inclusion. Asthma is defined as fulfilment of the 2007 National Asthma Education and Prevention Program—criteria for initiating asthma controller medication in children aged 0–4 years. Primary interaction analyses are age, gender, atopic predisposition, risk genotypes and viral co-detection. The optimal cut-off on the rhinovirus genome load used to define a true rhinovirus infection will be assessed by exploring interactions between rhinovirus genomic loads and study drug on the co-primary outcomes. Secondary outcomes are number of wheezing episodes, duration and severity of each wheezing episode, bronchial hyperreactivity, quality of life and safety (height/weight development) at 24 months from inclusion.

Rhinovirus positive children with acute wheezing fulfilling inclusion and exclusion criteria are enrolled after informed consent from both caregivers. This trial has received ethical approval from all sites. Results will be submitted to Competent Authorities and disseminated via peer-reviewed publications and conferences within paediatrics and other relevant fields. If proven effective, findings may be implemented directly into paediatric clinical guidelines.

NCT03889743.