Human papillomavirus (HPV) affects nearly 85% of sexually active adults during their lifetime and is responsible for HPV-related cancers in both males and females. Although the HPV vaccine can prevent up to 90% of these cancers, vaccination rates remain low, particularly among college students. Recently, video has emerged as a powerful intervention for shaping public opinion and behaviour toward health-related topics; however, most interventions have primarily focused on adolescents, their parents and females. The primary objective of this study is to develop a video-based intervention, informed by input from a diverse group of stakeholders and evaluate its preliminary effectiveness in promoting HPV vaccination intention, attitudes toward vaccination, subjective norms, perceived behavioural control (PBC) and uptake of the first HPV vaccine dose among college students through a randomised controlled trial (RCT).

The study is guided by the Theory of Planned Behaviour. A Student Advisory Board of eight college students was established to provide insights and guidance across all phases, including the co-development of HPV and HPV vaccine-related videos with faculty mentors. A pilot RCT will then be conducted in which participants in the intervention group view the stakeholder-created videos, while those in the control group watch four Centers for Disease Control and Prevention (CDC)-based videos of comparable length and content. The effectiveness of the videos will be compared by measuring participants’ intentions, attitudes, subjective norms and PBC regarding the HPV vaccine between the intervention and control groups at baseline, immediately after the intervention and 2 months after implementing the intervention. The uptake of the first dose of the HPV vaccine will be assessed at the 2-month time point. Moderators, including message fatigue and processing fluency, participants’ satisfaction and intervention dose as well as confounding variables such as provider recommendation and encouragement will also be measured. A research team member responsible for data management and analysis will be blinded to the study condition/group allocation, while another team member will send reminder texts.

Ethical approval from the Michigan State University’s Biomedical and Health Institutional Review Board has been obtained (Study ID: STUDY00010264). The results will be disseminated to the broader public through public forums, social media and seminars organised by the college health centre, community resource centre and local health departments. Additionally, the findings will be shared with healthcare professionals through professional training and meetings, and with researchers via conferences and publications.

14 March 2025 submitted. Revised manuscript—V.1 27 September 2025.

NCT06397378.

To assess factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 at primary healthcare (PHC) facilities in Nepal after healthcare workers received training.

Cross-sectional study.

PHC facilities across various provinces in Nepal.

A total of 180 healthcare workers trained in PEN, recruited from a random selection of 105 basic healthcare facilities.

The adoption of PEN Protocol 1 components: blood pressure measurement, blood glucose screening, 10-year cardiovascular disease (CVD) risk assessment using WHO/International Society of Hypertension risk charts and body mass index (BMI) assessment. Factors associated with protocol adoption were assessed using generalised estimating equations for ORs.

Among participants, 100% reported measuring blood pressure, while 56% measured blood sugar, 28% assessed CVD risk and 27% assessed BMI. The adoption of the CVD risk prediction chart was positively associated with the availability of amlodipine (adjusted OR (aOR) 3.00; 95% CI 1.09 to 8.27). The adoption of BMI assessment was positively associated with access to a stadiometer (aOR 3.23; 95% CI 1.26 to 8.30) and a glucometer (aOR 3.07; 95% CI 1.12 to 8.40), and negatively associated with lack of motivation/inertia of previous practice (aOR 0.60; 95% CI 0.42 to 0.87) and environmental factors such as lack of time and resources (aOR 0.57; 95% CI 0.37 to 0.89). Blood glucose level measurements were positively associated with being at a PHC centre (aOR 7.34; 95% CI 2.79 to 19.3) and the availability of metformin (OR 2.40; 95% CI 1.08 to 5.29).

Adoption of PEN Protocol 1 varied by component and was influenced by resource availability, provider motivation and system barriers. Addressing these factors is key to optimising implementation in low-resource settings.

Exacerbations of chronic obstructive pulmonary disease (COPD) can lead to reduced lung function and worse clinical outcomes. Previous studies have reported associations between severe exacerbations and increased risk of hospitalisation and/or mortality. This meta-analysis examined the impact of moderate exacerbations on the risk of future exacerbations and all-cause mortality.

This meta-analysis included seven observational studies from the EXACOS (EXAcerbations of COPD and their OutcomeS)/AVOIDEX (Impact of AVOIDing EXacerbations of COPD) programme studies.

This meta-analysis used data from regional claims databases or electronic healthcare records from seven countries.

The individual studies included patients with a diagnosis of COPD and ≥12 months of data availability before (regarded as baseline) and after the index (ie, the date of the first COPD diagnosis), with postindex data considered the follow-up period.

The number of COPD exacerbations experienced during the baseline period (ie, the exposure variable) was used to categorise patients into the following groups: no exacerbations, one moderate exacerbation only or two or more moderate/severe exacerbations. Outcomes assessed included risk of COPD exacerbations and all-cause mortality during follow-up as a function of baseline exacerbations. For meta-analyses, all rate ratios (RRs) were log-transformed, and associations were pooled across studies using random-effects meta-analysis models.

Among 2 733 162 patients with COPD, one moderate exacerbation was significantly associated with a twofold increased risk of future exacerbations compared with having no exacerbations during baseline, with pooled RRs (95% CIs) of 2.47 (1.47 to 4.14) at 1 year, 2.49 (1.38 to 4.49) at 2 years and 2.38 (1.30 to 4.34) at 3 years postindex. The pooled RR (95% CI) for all-cause mortality was 1.30 (1.05 to 1.62), indicating a 30% increase in risk following one moderate exacerbation versus no exacerbations.

Preventing moderate exacerbations in patients with COPD should be a priority that may improve patient trajectories and outcomes.