Post-COVID syndrome manifests with a diverse array of symptoms for which no standard care plan currently exists. Many questions were raised by patients, which underscored the need for a validated patient-reported outcome measure (PROM). Therefore, a post-COVID module was developed to be included in the Assessment of Burden of Chronic Conditions (ABCC-) tool. The ABCC-tool evaluates and visualises the perceived physical, emotional and social burden of one or multiple chronic disease(s) using a balloon diagram and aims to facilitate person-centred care and structured discussions between patients and healthcare professionals. This study explores the patients’ perspective on the content of the ABCC-tool for post-COVID and the tool’s usability in a home-based setting.

All patients who completed the ABCC-tool for post-COVID were invited for an online semi-structured interview. We selected post-COVID patients who had used the tool in the past three months. Interviews were audio recorded and analysed using a thematic approach with Atlas.ti version 23.

Nineteen post-COVID patients (10 males, mean age 56) were interviewed between May and August 2024. The tool was regarded as user-friendly, and patients indicated they would use the tool again in the future. Patients valued the tool’s broad range of topics, some of which are often overlooked in standard healthcare consultations. The tool was comprehensible and relevant according to all patients. The balloon diagram was easy to understand, but a legend explaining the colours of the balloons was preferred. Other suggestions for improvement included adding open-text fields and periodic reminders to increase usability and adding long-term data.

The ABCC-tool is a promising instrument for post-COVID patients, offering a structured way to monitor and communicate experienced burden in addition to standard healthcare consultations. Refinements addressing usability and comprehensiveness are recommended to facilitate its integration into clinical practices.

This study compared the reliability of two metabolic cart systems, Vyntus CPX and Vmax Encore 29N, to measure whole-body energy metabolism by indirect calorimetry (IC) in individuals with type 2 diabetes (T2D).

Randomised, prospective, crossover study.

Single-centre study conducted in the clinical research centre of the German Diabetes Study (GDS).

Five participants (3 men, 2 women, mean age 49±6 years, body mass index (BMI) 32.62±4.2 kg/m²) with T2D completed the study protocol. Eligibility requires existing participation in GDS and availability for four consecutive study days.

Participants underwent four IC measurements per day on four consecutive days, totalling 16 measurements per device. On each study day, two measurements with both devices, Vyntus CPX and Vmax Encore 29N, were performed in randomised order. Postcalorimetric gas calibration with normalisation was applied after each measurement.

Reliability of respiratory quotient (RQ) and resting energy expenditure (REE), as assessed from the coefficient of variation (CV) and 95% CIs.

Device comparison showed minor differences in CV (95% CI) for carbon dioxide production (VCO₂) (3.5% vs 5.3%; 95% CI –8.2% to 8.0%), oxygen consumption (VO₂) (3.4% vs 5.7%; 95% CI –9.3% to 8.2%), RQ (3.6% vs 2.3%; 95% CI –3.5% to 3.7%) and REE (3.1% vs 5.6%; 95% CI –8.4% to 7.8%). Postcalorimetric calibration did not consistently affect RQ or REE. 

Vyntus CPX provides reliable IC measurements comparable to Vmax Encore 29N and may serve as a suitable replacement in clinical settings.

ClinicalTrials.gov identifier: NCT01055093.

Cardiovascular diseases, overweight, type 2 diabetes and chronic kidney disease increase the risk of cardiovascular events.

Glucagon-like peptide-1 analogues are recommended by the European Society of Cardiology and the American College of Cardiology to lower the risk of death and progression of cardiovascular disease in patients with cardiovascular disease and type 2 diabetes. Semaglutide, tirzepatide and liraglutide are approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of type 2 diabetes mellitus and overweight. CagriSema is currently not approved, but several phase III trials are ongoing.

No previous systematic review has investigated the effects of semaglutide, tirzepatide, CagriSema and liraglutide, which may not be disease-specific, on hard binary outcomes for all trial populations at increased risk of cardiovascular events.

We will conduct a systematic review and search major medical databases (Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Latin American and Caribbean Health Sciences Literature, Science Citation Index Expanded, Conference Proceedings Citation Index—Science) and clinical trial registries from their inception and onwards to identify relevant randomised trials. We expect to perform the literature search in December 2025. Two review authors will independently extract data and assess the risk of bias. We will include randomised trials assessing the effects of semaglutide, tirzepatide, CagriSema and/or liraglutide in participants with an increased risk of cardiovascular events. The primary outcome will be all-cause mortality. Secondary outcomes will be myocardial infarction, stroke and all-cause hospitalisation. Data will be synthesised by aggregate data meta-analyses, Trial Sequential Analyses and network meta-analysis, risk of bias will be assessed with Cochrane Risk of Bias tool V. 2, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations and the Confidence in Network Meta-Analysis approach.

This protocol does not present any results. Findings of this systematic review will be published in international peer-reviewed scientific journals.

CRD42024623312.

National Immunization Technical Advisory Groups (NITAGs) are multidisciplinary groups of national experts who provide independent advice to policy makers on issues related to immunisation and vaccines, based on evidence and the national context. On the other hand, academic institutions can be described as organisations dedicated to education and research. These include schools, colleges, universities and research centres that offer formal education, conduct scholarly research and contribute to knowledge in various fields. NITAGs can enhance their capacity by linking with academic institutions and leveraging scientific expertise in research, data analysis, modelling, resource procurement and management, and policy formulation. The proposed landscape analysis will explore the links between NITAGs and academic institutions, especially in the sub-Saharan African context, and, where such exist, document their characteristics and identify benefits, challenges and best practices for fostering such linkages.

This landscape analysis will use an adaptation of the WHO’s quick guide manual on ‘Performing a landscape analysis: Understanding health product research and development’. The planned landscape analysis will be conducted in two parts. The first part will entail a review of published literature to identify relevant documents on linkages between NITAGs and academic institutions. The second part will entail conducting key informant interviews with NITAG members, partners and other identified key stakeholders in two study countries: Ethiopia and Zambia. The transcribed scripts will be thematically analysed. The findings from both parts will be synthesised and presented as a descriptive landscape analysis report.

The protocol of the parent study has been reviewed and approved by the Human Research Ethics Committee of the University of Cape Town (Reference 417/2025). It has also been approved by the Biomedical Research Ethics Committee of the University of Zambia (REF. NO. 6760-2025) and the Ethiopian Public Health Association (EPHA/06/392/25). The landscape analysis report will be submitted to the commissioning funder (Gavi, the Vaccine Alliance) and will also be published in a peer-reviewed journal.

https://osf.io/vprka

The global rise in the population aged over 65 has led to a corresponding increase in cognitive impairment diagnoses, with dementia as a predominant condition characterised by diverse aetiopathogenetic profiles. Behavioural and psychological symptoms of dementia (BPSD) encompass a range of psychiatric, behavioural and cognitive symptoms associated with cognitive impairment. BPSD significantly affects patients, caregivers and healthcare providers, often necessitating interventions like sedatives or physical restraints that may worsen patient outcomes. Emerging evidence underscores the need for innovative, non-pharmacological interventions to manage BPSD effectively.

The current study intends to investigate the feasibility and acceptability of customised, immersive virtual reality environments (iVRe) to reduce responsive behaviours among individuals with dementia. Building on prior findings demonstrating virtual reality (VR) potential in reducing anxiety and fostering positive emotional states, this pilot study assesses the feasibility, safety and user engagement of customised iVRe interventions.

A longitudinal, mixed-methods design will be employed, enrolling 20 elderly participants with varying levels of cognitive impairment from the APSP ‘Margherita Grazioli’ long-term care facility in Trento. Participants undergo three VR exposure sessions featuring tailored environments adjusted in real-time for visual and auditory preferences. Data collection integrates standardised self-report questionnaires, observational tools and clinical records. Measures include the Functional Assessment Staging Tool, Neuropsychiatric Inventory and Cohen-Mansfield Agitation Inventory, as well as tools assessing pain, anxiety and emotional states before, during and after VR sessions.

The study protocol has been approved by the Comitato Etico Territoriale della Provincia Autonoma di Trento per le Sperimentazioni Cliniche, Azienda Provinciale per i Servizi Sanitari—Trento, Italy (Rep. Int. 12090, 15 May 2025). All participants or their legal representatives will provide written informed consent prior to enrolment. Deidentified data will be securely stored on institutional servers at the Fondazione Bruno Kessler and the APSP ‘Margherita Grazioli’, curated in compliance with the General Data Protection Regulation, and retained for 3 years after study completion. Any data shared externally will be provided in fully anonymised form, and only for scientific purposes, subject to prior ethical and legal approval. Study findings will be disseminated through peer-reviewed publications, conference presentations and executive summaries shared with participating institutions and stakeholders.

NCT06693193.

Neurodegenerative disorders (NDDs) represent an unprecedented public health burden. These disorders are clinically heterogeneous and therapeutically challenging, but advances in discovery science and trial methodology offer hope for translation to new treatments. Against this background, there is an urgent unmet need for biomarkers to aid with early and accurate diagnosis, prognosis and monitoring throughout the care pathway and in clinical trials.

Investigations routinely used in clinical care and trials are often invasive, expensive, time-consuming, subjective and ordinal. Speech data represent a potentially scalable, non-invasive, objective and quantifiable digital biomarker that can be acquired remotely and cost-efficiently using mobile devices, and analysed using state-of-the-art speech signal processing and machine learning approaches. This prospective case–control observational study of multiple NDDs aims to deliver a deeply clinically phenotyped longitudinal speech dataset to facilitate development and evaluation of speech biomarkers.

People living with dementia, motor neuron disease, multiple sclerosis and Parkinson’s disease are eligible to participate. Healthy individuals (including relatives or carers of participants with neurological disease) are also eligible to participate as controls. Participants complete a study app with standardised speech recording tasks (including reading, free speech, picture description and verbal fluency tasks) and patient-reported outcome measures of quality of life and mood (EuroQol-5 Dimension-5 Level, Patient Health Questionnaire 2) every 2 months at home or in clinic. Participants also complete disease severity scales, cognitive screening tests and provide optional samples for blood-based biomarkers at baseline and then 6-monthly. Follow-up is scheduled for up to 24 months. Initially, 30 participants will be recruited to each group. Speech recordings and contemporaneous clinical data will be used to create a dataset for development and evaluation of novel speech-based diagnosis and monitoring algorithms.

Digital App for Speech and Health Monitoring Study was approved by the South Central—Hampshire B Ethics Committee (REC ref. 24/SC/0067), NHS Lothian (R&D ref. 2024/0034) and NHS Forth Valley (R&D ref. FV1494). Results of the study will be submitted for publication in peer-reviewed journals and conferences. Data from the study will be shared with other researchers and used to facilitate speech processing challenges for neurological disorders. Regular updates will be provided on the Anne Rowling Regenerative Neurology Clinic web page and social media platforms.

ClinicalTrials.gov NCT06450418 (pre-results).

Non-occupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP) are effective HIV prevention methods, but their use is low in Sub-Saharan Africa (SSA). Mobile applications (apps) could increase uptake and adherence to these interventions, yet research on their use in communities is limited. Furthermore, there is limited information on the design and development of these apps, impacting their implementation. This scoping review aims to identify, analyse and evaluate mobile apps designed to improve nPEP uptake, adherence and linkage to PrEP services focusing on key features, barriers and facilitators. It also seeks to address gaps in studies assessing the feasibility, usability and acceptability of these apps, with the goal of informing future research, healthcare policies and public health strategies to reduce the HIV burden in Sub-Saharan Africa.

This review will follow the Arksey and O'Malley framework and search databases such as PubMed, Scopus and Web of Science for relevant studies. Two independent reviewers will screen and assess full-text studies. Primarily, the review will include studies on digital interventions for nPEP and PrEP, excluding opinion papers, narrative reviews and sub-studies. Grey literature from sources like Google Scholar will also be considered. Data will be captured using a charting form, and results will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews framework. Completion is expected in December 2025.

No ethical approval is required as publicly available materials will be used. Results will be shared through peer-reviewed journals, conferences and with policymakers to inform HIV prevention strategies.

Ebola disease stigma hinders outbreak control and recovery by deterring care-seeking and driving social exclusion. Although this phenomenon is well recognised, gaps remain in understanding how stigma emerges and operates in outbreak settings, limiting the development of effective reduction strategies. The objective of this study was to examine the drivers, manifestations and public health impacts of stigma following the 2022–2023 Sudan ebolavirus outbreak in central Uganda.

We conducted a cross-sectional, mixed-methods survey to assess Ebola disease stigma in June 2024.

The study was conducted in the Ugandan districts of Mubende, Kassanda and Kyegegwa, which were heavily affected by the outbreak.

A total of 302 respondents completed the survey. Respondents included all 51 eligible adult Ebola survivors in the districts known to the research team, as well as household members, healthcare workers, outbreak support staff and the general public.

The interviewer-administered survey explored personal experiences of stigma, community attitudes and impacts on outbreak control. We used a pillar integration process to identify themes across quantitative and qualitative data in three domains (drivers, manifestations and impacts of stigma).

Participants identified several perceived drivers of stigma, including fear, hygiene-focused public health messaging, distrust in public services and criminal connotations inferred from the outbreak response. Manifestations, including self-stigma and associative stigma, endured beyond the outbreak and across contexts. Nearly all survivors interviewed (n=48, 94%) reported multiple experiences of stigmatisation since discharge, with almost half (n=25, 49%) reporting physical harm or threats. Stigma was reported to affect care-seeking, healthcare worker morale and community socioeconomic well-being.

Stigma remains a major barrier to Ebola disease outbreak control and recovery. The high levels of stigma reported by survivors and anticipated by community members highlight the urgent need for targeted interventions in future outbreaks. We specifically show there are opportunities to address misinformation, avoid criminal connotations in outbreak control efforts and enable peer support.

The home-based primary care cohort was set up to identify the characteristics of Home-Based Primary Care (HBPC) users across three domains: health-related information, utility of healthcare service and care-related information.

A total of 407 patients enrolled in five HBPC centres were recruited between January 2023 and March 2024. The baseline survey was conducted among 332 participants who provided informed consent for both study participation and home visits. The second wave of data collection is scheduled to take place 6 months after enrolment, while the third wave will be conducted 12 months post-enrolment. During each home visit, trained interviewers administered structured survey questionnaires. On completion of the 12-month follow-up period, the dataset will include survey data, intervention records from the five participating HBPC centres, home mortality status and institutionalisation risk linked to each participant.

This study examines HBPC in Korea, integrating the Widely Integrated Services in Home model with the long-term care insurance system. Among participants, 30.1% lived alone, and 74.1% were homebound, showing similarities to findings from a US HBPC study. Analysing cohort data, this study evaluates the impact of HBPC on healthcare utilisation, aligning with international findings on reduced hospitalisations and costs. As the first HBPC effectiveness study in Korea, it highlights its role in enhancing care for homebound older adults and shaping national health policies.

Data on the number of interventions by profession, institutionalisation and hospitalisation status and duration, and death at home occurrence are being separately collected from five HBPC centres and will be included in the analysis. The analysis will examine associations between these variables to identify risk factors influencing institutionalisation. Additionally, this study plans to link the dataset with the National Health Insurance Service-Senior (NHIS-Senior) customised cohort for further analysis.

Older adults transitioning to nursing homes face challenges in adapting to a new environment and imposed lifestyle changes. This study aimed to identify factors associated with poor nursing home adjustment and to assess their impact on 1-year mortality.

This study is a secondary analysis of the KArukera Study of Ageing in ‘Établissement d'Hébergement pour Personnes Agées Dépendantes’ (EHPAD) (KASEHPAD) cohort, a prospective observational study conducted over 1 year in six nursing homes in the French Caribbean.

159 older adults (aged 60 years or older) living in nursing homes who were able to complete the self-administered adaptation scale.

Nursing home adjustment was assessed at baseline using the adaptation scale for older adults to their residence (EAPAR). Bivariate analysis was used to assess associations between adjustment status and sociodemographic or clinical characteristics at baseline. Poisson regressions were used to assess the relationship between 1-year mortality and adjustment status.

A total of 159 older adults (mean age: 79.6 years; male/female ratio: 84/75) were included. The mean length of stay was 4.1 years. Among older adults, 78 (49.1%) were classified as poorly adapted. Age, gender, education level, dependency, cognition and comorbidities were not significantly associated with poor adjustment. In contrast, depressive symptoms, lower social support, lower health-related quality of life, lower subjective quality of life, malnutrition and sleep disturbances were associated with poor adjustment. After 12 months, 14 deaths (17.9%) occurred in the poor adjustment group, compared with 4 (4.9%) in the no major adjustment difficulties group (adjusted relative risk for age, gender and baseline activities of daily living score=4.64 (95% CI 1.53 to 17.5; p=0011).

In a sample of older adults with moderate cognitive impairment, poor adjustment to nursing home was associated with depressive symptomatology and increased 1-year mortality. The issue of adjustment in nursing homes represents an emerging research area that warrants further investigation through dedicated interventional studies.

NCT04587466.

Acute kidney injury (AKI) is a complex, devastating condition characterised by a sudden reduction in renal function, leading to increased mortality and healthcare costs globally. Outcomes of AKI are worsened by factors such as limited access to healthcare, delayed hospital presentation and underlying comorbidities, which severely affect patients in sub-Saharan Africa. The renal resistive index (RRI) has come into view as an encouraging non-invasive imaging approach for the early prediction of AKI. However, the use of the RRI for AKI prediction in sub-Saharan Africa is poorly documented. This research aims to map and describe the evidence for using the RRI for the early detection of AKI in sub-Saharan Africa.

The Joanna Briggs Institute methodology for scoping reviews will be used for this study. It will include a comprehensive search of electronic databases, grey literature (including academic proceedings), as well as an extensive literature review of relevant journals. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews will also be used as a guide. Discrepancies will be handled by consensus or by consulting a third reviewer. This evidence synthesis will explore the usefulness and accuracy of the RRI for early prediction of AKI in sub-Saharan Africa, where the patients are generally younger and have different AKI risk predictors and cardiovascular profiles compared with patients in high-income countries. Evidence of implementation and associated challenges will also be explored. These challenges may include limited access to specialised ultrasound equipment and a lack of trained healthcare providers proficient in RRI measurement and interpretation. The findings will inform future studies and be useful for healthcare providers, policymakers and patient advocates seeking sustainable strategies for preventing AKI.

Ethical approval is not required for this scoping review. The findings of this review will be published in a peer-reviewed journal and presented to decision-makers, health system administrators and healthcare providers at national and international academic conferences.

To assess the magnitude and associated factors of suicidal behaviour and non-suicidal self-injury (NSSI) among youth of the Gurage Zone, Southern Nations, Nationalities, and Peoples Regional, Ethiopia, 2024.

A community-based cross-sectional study was conducted.

This research was carried out in the Gurage Zone.

This study was conducted among 719 Gurage Zone youths from 1 January 2024 to 1 February 2024.

Suicidal behaviours and non-suicidal self-injury were assessed using a pretested, interviewer-administered, structured questionnaire. Data were entered in EpiData V,3.1 and exported to SPSS V.25 for analysis. A binary logistic regression model was used to identify significant factors associated with suicidal behaviours and NSSI. Variables with a p-value less than 0.05 and adjusted ORs with 95% CI were used to declare association with the outcome variable in the final model.

Out of the total 820 study participants, 719 participants participated in the study, giving a response rate of 88%. Among 719 respondents 465 (64.7%) were males. The prevalence of high risk of suicidal behaviours was 11.7% (95% CI 8.14 to 14.30) and it is significantly associated with substance use in the last 3 months (adjusted OR (AOR)=6.84; 95% CI 3.48 to 13.47), having moderate insomnia (AOR=3.09; 95% CI 1.30 to 7.31) and having depression (AOR=6.84; 95% CI 3.48 to 13.47).

The prevalence of NSSI among youths was 38% (95% CI 34.52 to 41.86). Substance use in the last 3 months (AOR=2.459; 95% CI 1.59 to 3.81), youths having depression (AOR=3.348; 95% CI 2.29 to 4.91), youths who were exposed to stressful life events (AOR=9.86; 95% CI 6.46 to 15.07) were significantly associated with NSSI.

Nearly 1 in 10 youths in the Gurage Zone exhibited high-risk suicidal behaviour, and over one-third reported NSSI. Suicidal behaviour was significantly associated with substance use, depression and moderate insomnia, while NSSI was significantly associated with substance use, depression and exposure to stressful life events. These findings highlight the prevalence of self-harm and the key factors associated with these behaviours among youth in this region.

The aims of this study were to investigate the factors affecting career satisfaction within the Pakistani dental community and to assess demographic characteristics as significant predictors of professional satisfaction.

Cross-sectional survey.

Data were collected from registered dentists across urban and rural areas of Pakistan via an electronic survey distributed through professional forums, social media groups and email lists to ensure nationwide representation.

A total of 600 registered dental surgeons were selected across Pakistan using single-stage cluster sampling, with inclusion based on a permanent Pakistan Medical and Dental Council licence, excluding temporary licence holders, non-consenting individuals and those practising abroad.

Career satisfaction was measured using the validated Dentist Satisfaction Survey, which assessed various factors affecting professional fulfilment.

Of 600 participants, 566 valid responses were received, with n=134 (23.67%) men and n=432 (76.33%) women, and a mean age of 33.7±7.4 years. Most were early-career (68.9%), with a mean professional satisfaction score of 3.13±1.35. Gender, provincial background and work experience significantly influenced satisfaction, while current working status did not. Participants were neutral on career domains, such as auxiliary staff quality, professional relations, professional time, management and work-life balance, but had positive views on doctor-patient relationships. Many expressed dissatisfaction with their income, and 35.69% found dentistry stressful. While 26.15% would not recommend dentistry, 30.04% would support their child’s choice to pursue it. Despite uncertainty about career fulfilment, most dentists remained strongly committed to their profession and did not plan to change careers in the near future.

This study highlights factors influencing career satisfaction among Pakistani dentists, offering insights to improve well-being and career fulfilment and inform policy reforms aimed at enhancing professional retention and mental well-being.

The use of data science for health research produces complex ethical, legal and social challenges that traditional ethical oversight mechanisms struggle to address. In Nigeria, the current ethical guidelines were not designed for these challenges which include pervasive data environments, consent for secondary data use, algorithmic decision-making and bias, privacy risks, involvement of commercial entities, data colonisation, inequitable benefit-sharing and commercial data holdings. To address these gaps, we developed a draft guideline incorporating principles like trust, veracity, global justice and alternative ethical approval mechanisms. Here, we describe the protocol for a study aimed at validating the guideline through stakeholder consensus on the content, feasibility and acceptability of this subcode for national implementation.

We describe the use of a modified e-Delphi approach to iteratively synthesize expert opinions about ethical oversight for data science health research (DSHR) led by a multidisciplinary working group from the Bridging Gaps in the ELSI of Data Science Health Research in Nigeria (BridgELSI) team. We will invite 65 experts, including health researchers, ethics committee members, data scientists, health policymakers, funders and key opinion leaders in Nigeria to participate. Participants will rate 13 core principles, including global justice, algorithmic bias, data governance and related governance provisions on importance, desirability for inclusion in national guidelines, feasibility and confidence in implementation, using 5-point Likert scales, with optional free-text comments. We will summarise responses using descriptive statistics, assess consensus and polarity using pre-specified thresholds for the mean and IQR, and iteratively refine statements between rounds using qualitative content analysis of comments.

Ethical approval was obtained from the Nigerian National Health Research Ethics Committee and the University of Maryland IRB, and participants will provide informed consent. Results will be shared with the expert panel and national regulators and disseminated via publications and conferences.

The purpose of this study was to assess changes in diabetes management and healthcare utilisation among First Nations with diabetes in Alberta before and during the COVID-19 pandemic.

This analysis used a retrospective cohort in a case–control design. Individual-level administrative health datasets (1 April 2018 to 31 March 2022) were linked and data were formatted as a segmented interrupted time series.

This study took place in Alberta, Canada using administrative data.

Adult First Nations and non-First Nations (matched 1:1) with diabetes and living in Alberta were included (n=28 101; 53% female, 47% male).

The primary outcome was the change in incidence rate of general practitioner (GP) visits, emergency department (ED) visits, hospitalisations and diabetes-related drug dispenses during-COVID-19 versus pre-COVID-19, quantified using generalised linear regressions. The secondary outcome was to report the reasons for non-drug outcomes pre-COVID-19 and during-COVID-19, based on primary diagnosis International Statistical Classification of Diseases and Related Health Problems codes.

Pre-COVID-19, baseline rates of GP visits, ED visits, hospitalisations and drug dispenses were significantly higher among First Nations compared with non-First Nations (rate differences 398.32 (391.97–404.67), 100.58 (98.32–102.84), 14.49 (13.56–15.43), 876.98 (868.72–885.24) per 100 person-years (PY); p

Healthcare utilisation was substantially elevated among First Nations compared with non-First Nations peoples before and during COVID-19. While the generalisability of our findings to other health systems and populations may be limited, our findings are clinically applicable among First Nations across Alberta in order to help direct public health programming post-COVID-19.

Cervical cancer (CaCx) is a leading cause of cancer-related deaths among women in South Africa, often presenting at advanced stages and requiring chemoradiotherapy. In South Africa, the burden is disproportionately high among women living with HIV, with limited access to radiotherapy further compounding treatment challenges. Despite this documented disparity, limited data exist on patients in a South African context. This protocol describes the research methodology to assess patterns of care, treatment delays, interruptions and survival outcomes in patients with advanced CaCx, addressing an urgent need for local data in low-income and middle-income countries to provide evidence-based improvements in care.

The Cervical Cancer Cohort at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH-CCC), initiated in 2023, is a mixed retrospective and prospective single-centre study investigating the characteristics, challenges and outcomes of patients with advanced CaCx. It includes women aged ≥18 years with a histopathological diagnosis of stage IB3–IVA CaCx treated at CMJAH Radiation Oncology. The retrospective component covers data from September 2018 to August 2023. Data collection is complete and the team is currently conducting quality control. The prospective component began in October 2023 and aims to enrol participants over 2 years, with follow-up for up to 3 years. The study is ongoing, and an extension for continued enrolment beyond September 2025 is being sought. Participants provide baseline data on demographics, socioeconomic status, cultural influences and healthcare access, with updates every 3 months. When necessary, the next of kin provides follow-up information. The study aims to inform strategies to improve outcomes and reduce the CaCx burden in South Africa.

Ethics approval for this study was obtained from the Human Research Ethics Committee (Medical) at the University of the Witwatersrand in Johannesburg, South Africa, with an ethical clearance certificate (MM221001 MED22-09-085). The results will be widely distributed through presentations at national and international conferences and published in peer-reviewed open-access journals, ensuring wide access to the results.

Psychosocial stress is a major public health concern, contributing to significant suffering and costs to society. There is a lack of effective interventions that could be offered at an early stage to people who need to reduce their stress in life. Recent advances in psychology have provided evidence-based exercises suitable for testing in an entirely digital intervention. This study aims to estimate the effectiveness of a 12-week digital course in mindfulness- and acceptance-based stress reduction.

The effectiveness of the 12-week digital course will be estimated in a parallel-groups randomised controlled trial, in which the control group will receive referrals to self-studies on mental health information found online. The study population will be individuals 15 or older, seeking help online for stress and who have access to a mobile phone. Employing a Bayesian sequential design, the primary outcome will be monitored monthly, after the 6-month follow-up, to calculate target criteria for when to stop recruiting. Perceived stress (Cohen’s 10-item version) will be the primary outcome, with estimands of interest being differences between groups at 3 (immediate), 6 (prolonged) and 12 months (maintained). Mediation analysis will reveal if differences between groups are mediated by acquired equanimity. Effectiveness will be analysed with Bayesian regression models, and mediation will be analysed by using a causal inference framework.

The research was approved by the Swedish Ethical Review Authority on 2024-05-07 (2024-01974-01). The study will reach out to a vulnerable population, and participation may displace efforts to seek professional help. We have built-in automatic advice to seek additional help for participants scoring high on the depression scale at baseline, before allocation to study groups. The findings from this study will be submitted to peer-reviewed journals and presented at relevant national and international meetings.

ISRCTN39222610.

The effectiveness of humanitarian health and nutrition programmes in Somalia is critically dependent on seamless collaboration and coordination among a diverse array of actors. While existing literature acknowledges broad challenges to coordination such as insecurity, resource competition and fragmentation, a significant gap remains in understanding how these barriers and their corresponding enablers actively manifest in the daily operations and decision-making processes of frontline practitioners.

This study aims to provide a systematic, in-depth exploration of the barriers and enablers influencing collaboration and coordination mechanisms from the perspective of those directly involved in the response.

A qualitative study was conducted using semi-structured, in-depth interviews. Data were analysed using a deductive thematic approach guided by the Consolidated Framework for Implementation Research.

The study was conducted across the entire territory of Somalia, encompassing its five member states, the capital city Mogadishu, and the self-declared independent state of Somaliland.

A total of 26 participants, including executive directors, health and nutrition programme managers, coordinators from international and national non-governmental organisations (NGOs), government officials and community members, were interviewed.

Key barriers included poor adaptability and high complexity related to collaborative initiatives (intervention characteristics); armed conflicts, climatic shocks, deeply ingrained sociocultural practices and restrictive government policies (outer setting); inadequate information technology infrastructure and hierarchical communication (inner setting); high staff turnover (individual characteristics). Key enablers included strong inter-agency partnerships (outer setting); supportive organisational culture (inner setting); competent and motivated staff (individual characteristics); and robust planning, engaging and evaluation processes (process).

The study highlights the complex contextual factors that impact the effectiveness of collaboration and coordination mechanisms among humanitarianorganisations operating in Somalia. Policymakers should unify governance, agencies prioritise localisation and donors allocate quotas to local NGOs to enhance aid delivery.

To examine the epidemiological patterns and trends of sexual violence against adults and children before and during the COVID-19 pandemic in the Buffalo City and Amathole districts of the Eastern Cape Province, South Africa.

Observational, retrospective, cross-sectional study based on a review of medical records of survivors of sexual violence who reported for healthcare between January–December 2019 and January–December 2020.

The study was conducted in two healthcare facilities in the Buffalo City and Amathole districts of the Eastern Cape Province, South Africa.

A total of 1957 survivors of sexual violence presented for healthcare at the two healthcare facilities during the study period. Inclusion criteria were survivors of all ages with confirmed cases of sexual violence; records with no evidence of sexual violence were excluded.

Primary outcome measures were prevalence and distribution of sexual violence before and during the COVID-19 pandemic. The secondary outcome measures were demographic characteristics of survivors (age, sex and ethnicity), perpetrator identity and location of incidents.

The majority of survivors were female (93.6%), and 49% were under 18 years of age. Most were Black (96.3%) and resided in rural (45.6%) or semiurban (45.6%) areas. Perpetrator identity was unknown in 42.5% of cases. Among known perpetrators, non-partners such as neighbours (22.5%) and family members (13.6%) were most common. More cases were reported pre-pandemic (n=930; 60.5%) compared with during the pandemic (n=608; 39.5%). During the pandemic, 45.0% of cases occurred in the perpetrator’s home, and 53.7% occurred in rural settings. Most pandemic-period cases (63.1%) were reported during alert level 1, when most social and economic activities had resumed.

Overall, there was a high rate of sexual violence, with trends correlating with the extent of COVID-19 restrictions; the highest rates were reported pre-pandemic and during alert level 1. These findings highlight the importance of prioritising the safety of women and children and informing protective strategies in both rural and urban areas during future emergency responses.

Despite the high prevalence of chronic low back pain (cLBP), its underlying mechanisms remain poorly understood. Addressing modifiable psychosocial resources and health behaviours such as physical activity offers a promising avenue for reducing the impact of cLBP. Furthermore, although the relationship between physical activity and pain is theorised as a within-person process, previous research has primarily focused on between-person differences. In this article, we present the protocol for the prospective observational study PRIA (Psychologie und Rückengesundheit im Alltag), which is part of a larger interdisciplinary research consortium investigating preventive, diagnostic and therapeutic aspects of cLBP. Drawing on theories from health and pain psychology, the outlined study examines the interplay between different dimensions of cLBP and back health, physical activity and their psychosocial determinants within individuals in their everyday lives.

This prospective longitudinal study combines online questionnaires with ecological momentary assessment of health behaviours, cognitions, affect, social support and pain using a smartphone-based app (movisensXS) and continuous measurement of physical activity by accelerometry (movisens Move 4). Parameters will be recorded at baseline (T0), daily for the following 14 days (five times per day at 09:00, 12:00, 15:00, 18:00 and 21:00, resulting in up to 70 measurement occasions), 3 and 6 months later (T1 and T2). A total of 230 participants (115 individuals with cLBP and 115 without cLBP) aged 18–64 years will be enrolled. The associations between cLBP and the measured parameters will be examined using multilevel models.

The university’s ethics committee at the MSB Medical School Berlin approved the study on 8 March 2021 (approval number MSB-2021/59, amendment approved on 10 November 2023, amendment number MSB-2023/145). Ethical approval for the FOR 5177 initial screening was granted by Charité – Universitätsmedizin Berlin (EA1/058/21). All participants provided written informed consent. The results of this research will be published in peer-reviewed international journals, presented at national and international conferences, and reported to the German Research Foundation.

DRKS00032978.