This systematic review and meta-analysis aimed to determine the prevalence, patterns and associated factors of complementary and alternative medicine (CAM) use among pregnant women in Iran.

A systematic review and meta-analysis of observational studies.

A comprehensive search was conducted in PubMed/MEDLINE, Web of Science, Scopus, ScienceDirect and major Iranian databases from inception to 30 November 2024.

We included observational studies published in peer-reviewed journals that assessed CAM use among pregnant women in Iran and reported prevalence estimates or relevant associated factors.

Data extraction and quality assessment were performed independently by two reviewers using a standardised form and the Quality Assessment Tool. Meta-analyses of proportions were performed using the DerSimonian and Laird random effects model. The between-study heterogeneity was assessed using the I-squared (I²) statistic. Subgroup analysis, 95% prediction intervals (95% PrIs) and sensitivity analysis were conducted to explore the sources of heterogeneity and to evaluate the robustness of the overall effects, respectively. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO.

20 studies with a total of 8106 participants were included. The pooled prevalence of CAM use was 49% (95% CI 39% to 59%). The between-study heterogeneity was very high (I²=94.69%) with a wide 95% PrIs range of 3%–94%. The very high between-study heterogeneity and the wide range of PrI for the pooled prevalence were not explained by the quality of the studies, geographical regions of Iran or the methods of data collection. Mentha longifolia, Zataria multiflora and Boswellia thurifera were the most commonly used herbs. Across the included studies, the first trimester of pregnancy was most frequently reported as the period of CAM use, with socioeconomic factors identified as significant predictors. Family and friends were the primary sources of information regarding CAM. The most common reasons for CAM use included gastrointestinal issues, respiratory problems such as colds and coughs, and the desire to improve general health. Only 31% of participants disclosed their use of CAM to their healthcare provider.

Nearly half of pregnant women in Iran use CAM, yet disclosure to healthcare providers is low. An actionable implication is the critical need to integrate routine enquiry about CAM use into standard antenatal care to ensure safe practice. Further research is recommended to evaluate the effectiveness, safety and outcomes of CAM use among pregnant women.

CRD42024618490

To evaluate the feasibility, acceptability and potential efficacy of the culturally adapted Educate, Nurture, Advise Before Life Ends (ENABLE) programme in Singapore for patients with heart failure (HF) and their family caregivers.

Non-blinded randomised wait-list controlled pilot study, using Simon’s randomised phase II trial design.

Specialist outpatient clinics in a tertiary cardiac centre in Singapore.

Patients had a diagnosis of American Heart Association Stage C or D HF, were symptomatic with New York Heart Association functional class 2 and above symptoms, had a prognosis of 6 months, a hospitalisation in prior 6 months and were on disease-directed HF management. Patients already known to palliative care (PC) were excluded. Recruited caregivers were family caregivers of patients.

ENABLE integrates PC early into HF care. It starts with a comprehensive PC assessment with a PC physician and nurse. This is followed by a series of nurse coach-led health coaching sessions for both patients and caregivers. After the completion of health coaching, participants would receive follow-up phone calls to review their coping up to 6 months post-enrolment.

Feasibility was defined by the proportion of approached patient-caregiver dyads who consented to participate and the proportion of participants who completed health coaching. Acceptability was defined by a score of at least 12 out of a maximum of 16 for the Client Satisfaction Questionnaire 4-Item Survey. Primary efficacy outcome measure was the change in patient quality of life (QOL) at 6 months as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) total score, with the target effect size (Cohen’s d) being at least 0.25 SD in favour of ENABLE. Other secondary outcomes included patient/caregiver anxiety and depression scores on the Hospital Anxiety and Depression Scale, spirituality scores on the Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing Scale and caregiver QOL on the Singapore Caregiver Quality of Life Scale.

Feasibility: recruitment was carried out from February 2022 to October 2023. We approached 164 patient-caregiver dyads and 60 patient-caregiver dyads (36.6%) consented. A total of 48 patients and 44 caregivers started on health coaching, of which 44 patients (91.7%) and 43 caregivers (97.7%) completed health coaching.

Acceptability: patients’ satisfaction was high, at 85.7% and 87.5% in the intervention and wait-list arm, respectively. Caregivers were similarly satisfied, at 100% and 87.5% in the two arms, respectively.

Efficacy: intervention-arm patients had a higher mean total KCCQ score at 6 months than wait-list-arm patients (difference in means=12.4; 95% CI 0.9 to 24.0; Cohen’s d=0.43). There was no difference in caregiver QOL changes between trial arms at 3 months and 6 months. Both patients and caregivers had improvements in anxiety at 3 months and sustained improvements in depression and spirituality at 6 months.

Proportion of participants who completed health coaching was high, though proportion of approached participants who consented was lower than expected. Our acceptability and efficacy targets were met. Further phase III testing is planned.

NCT05211882.

Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are heterogeneous conditions with a high multimorbidity burden. However, existing risk assessment instruments prioritise physiological measures while overlooking systemic comorbidities. We aim to develop and validate an electronic health record (EHR)-embedded artificial intelligence (AI) model—AiRES (AI in patients with RESpiratory disease)—to predict the 30-day, 90-day and 180-day risks of all-cause and index-disease hospitalisations. This model represents a first step towards a clinical decision support tool for personalised multimorbidity management in patients with CRD.

Patients aged ≥18 years with a validated case definition of asthma and COPD will be identified from Singapore health administrative data (2012–2020). Candidate predictors will include age, sex, ethnicity, housing type, and comorbidities, measured across multiple care settings as visit frequency, grouped at quarterly intervals in Year 1 and annually for Years 2 and 3 over a 3-year lookback window. We will predict 30-day, 90-day, and 180-day risks of (1) all-cause and (2) asthma/COPD-specific hospital admissions using up to five randomly selected index dates per individual. Three machine learning algorithms—logistic regression (LR) with Lasso regularisation, eXtreme Gradient Boosting, and Categorical Boosting—will be trained using 10-fold cross-validation (CV) with an ensemble feature selection strategy. The optimal model, selected based on performance and feature importance, will be benchmarked against two reference models: a full LR and a Zero-Inflated Negative Binomial regression with hospitalisation history as the sole predictor. Discrimination and calibration will be assessed using internal-external cluster-based and temporal CV. Clinical utility will be evaluated using decision curve analysis.

This study obtained ethics approval from the National University of Singapore (NUS-IRB-2024-849). Results will be published in international peer-reviewed journals.

To study the association between job demands and distress among working adults and to test whether perceived supervisor support moderates this relationship.

Mixed-effects analysis of repeated measures from a population-based cohort study, estimating overall (combined within-person and between-person) associations.

The Netherlands Longitudinal Study on Hearing (NL-SH), an ongoing Dutch cohort with nationwide recruitment and follow-up including four measurement waves.

A total of 989 employed individuals (≥12 hours/week) with 1858 observations had complete data on distress, job demands, supervisor support and covariates.

The dependent variable was distress, measured using the 16-item distress subscale (range 0–32) of the Four-Dimensional Symptom Questionnaire. Job demands and supervisor support were assessed with subscales from the Job Content Questionnaire. Multilevel linear models were used to estimate main and interaction effects, adjusted for age, sex, educational level, hearing impairment, contract type and chronic diseases.

Higher job demands were associated with greater distress (B=0.22, 95% CI (0.17 to 0.27)). Higher supervisor support was associated with lower distress (B=–0.26, 95% CI (–0.38 to –0.15)). The interaction between job demands and supervisor support was statistically significant (B=-0.02, 95% CI (-0.04 to 0.001), p=0.042). Stratified analyses showed that the association between job demands and distress was stronger among employees with low supervisor support (B=0.27, p

Job demands and supervisor support were independently associated with distress. Supervisor support appeared to buffer the impact of job demands, as the association between job demands and distress was stronger among employees reporting low levels of supervisor support. These findings underscore the importance of strengthening supportive supervisor practices, alongside addressing excessive job demands, as integral components of workplace mental health strategies.

Active patient involvement is a core principle of patient-centred care, yet public experiences of medical decision-making in non-Western settings remain underexamined. In South Korea, nationwide evidence on how adults experience, perceive and prefer medical decision-making is limited. This study, therefore, examined Korean adults’ experiences, perceptions and preferences regarding medical decision-making.

A cross-sectional study was conducted between March and April 2025 using online data collection for adults aged 19–59 years and face-to-face interviews for those aged 60 years or older.

This nationwide survey was conducted in South Korea.

A total of 1081 Korean adults were recruited using proportional quotas for sex, age group and region. After excluding withdrawals and invalid responses, 1000 were included (response rate 92.5%).

Overall, 70.4% of respondents reported at least one significant health-related decision in the past 2 years. Although 34.1% reported making their most recent decision independently, a larger proportion preferred collaborative decision-making involving clinicians and/or family members. The clinician’s explanation was the most influential factor (77.4%). Preferences for primary decision-maker varied by clinical context: patient-led decisions were favoured for low-risk interventions such as vaccination (78.5%), whereas physician involvement was preferred for life-threatening illness (86.2%). Communication ratings were highest for presentation of treatment options (mean score 3.56±0.79 on a 5-point scale) and lowest for explanation of potential treatment risks (mean score 3.20±0.89). Participants satisfied with decision outcomes reported higher communication quality (p

Medical decision-making was common, but respondents’ experiences did not always match their preference for collaborative involvement. The findings suggest that strengthening patient-centred care in South Korea will require not only improvements in patient–clinician communication, but also attention to family involvement and structural conditions such as limited consultation time and current reimbursement arrangements.

With the proliferation of digital technology, the health sector, like other sectors of society, has increasingly adopted digital technologies, resulting in a dynamic landscape where the roles and impacts of digital health tools in different contexts are constantly evolving. This integration of digital technology into the health space has extended into the field of HIV prevention, ushering in new possibilities and challenges. However, review studies documenting the evolving use of digital health tools in HIV prevention are scant, particularly in regions with many low- and middle-income countries, such as in Africa, which have some of the highest HIV prevalence and incidence rates in the world.

This scoping review will follow the Joanna Briggs Institute (JBI) 2020 guidelines for methodological rigour and will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR). Relevant published literature will be searched using a combination of keywords, Boolean terms and Medical Subject Headings in the following databases: CINAHL, Medline, Web of Science, Cochrane Library, Scopus, PubMed, WHO Digital Health ATLAS and Health Source with no date limits for the studies chosen. The Joint United Nations Programme on HIV/AIDS (UNAIDS) website and the reference lists of selected articles will also be used for backward searching, and Google Scholar will be used for forward citation tracking. The search strategy will be formulated following the guidelines provided by the Peer review of Electronic Search Strategies statement for peer assessment of electronic search strategies. Two reviewers will independently assess the references to ensure that they align with the predetermined eligibility criteria. Subsequently, the data from the included studies, published between January 2004 and January 2026, reflecting the period in which digital health innovations have rapidly expanded in Africa, will be extracted and any discrepancies resolved using a third reviewer. Thematic analysis will be used to analyse the data, and the findings will be reported using both tables and figures. The PRISMA-ScR will be followed to report this study’s results. Quality appraisal of the included studies will be done using the mixed methods appraisal tool V.2018.

This study does not involve human participants and only reviews existing literature in the public domain, and therefore ethical approval was not required. Our intention is to disseminate our research findings through a diverse range of channels, including peer-reviewed journals, conferences and webinars.

To evaluate the feasibility of implementing a coordinator-facilitated Serious Illness Care Programme (SICP) in outpatient oncology, cardiology and palliative medicine clinics.

Single-arm, mixed-methods, prospective feasibility study conducted over three sequential phases across 9 months, guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.

Outpatient oncology, cardiology and palliative medicine clinics in two tertiary medical centres in Singapore.

Eleven clinicians (eight doctors and three nurses) participated. Clinicians had prior serious illness conversation (SIC) training and were purposively sampled for diversity in specialty, seniority and mode of care delivery. One participant disengaged midway due to concerns about intervention fit but completed endline measures. A total of 101 patients participated in an SIC during the intervention period.

Implementation supports were developed with reference to the Capability, Opportunity, Motivation–Behaviour model of behaviour change, and adapted to the workflows and needs of participating clinicians. These included email reminders, in-person prompting by a coordinator, access to a locally adapted SIC guide, a structured documentation template and optional patient preparation materials. Supports were introduced in full during phase 2, with in-person prompting and support withdrawn in phase 3.

Feasibility was the primary outcome, operationalised through clinician perceptions of implementation support (acceptability) and the proportionality of implementation effort to observed benefits (practicality). Secondary outcomes included SIC engagement rates (reach), clinician retention (adoption) and continuity intentions among clinicians (maintenance).

Clinician retention was 91% (n=10/11) with the only dropout being in the cardiology setting. Most clinicians felt support was acceptable and adequate (n=9/11). While 101 patients had SICs, engagement activity in oncology and cardiology declined following the withdrawal of in-person prompting, while engagement among palliative medicine clinicians remained stable or increased. Coordinator time commitment decreased by 75.8% between phases 2 and 3. Key barriers faced by clinicians included the documentation burden. Additionally, there was a perceived lack of fit in outpatient cardiology.

A coordinator-facilitated SICP is feasible and acceptable in outpatient oncology and palliative care settings. Active coordination reduces clinician burden. As in-person prompting may be necessary to sustain engagement in non-palliative specialties, further research should focus on institutionalising supports in these settings.

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.

Type 2 diabetes mellitus has been associated with an increased risk of cognitive decline and dementia, with patients being 1.5–2 times more likely to develop these conditions. While both sodium-glucose co-transporter 2 (SGLT2) inhibitors and thiazolidinediones (TZDs) have shown potential neuroprotective effects in previous studies, their comparative effectiveness for preventing neurodegenerative outcomes has not been established. This study aimed to compare the risk of stroke, dementia and Alzheimer’s disease (AD) between patients treated with SGLT2 inhibitors and those treated with TZDs.

Multicentre, retrospective, observational, new-user, active-comparator cohort study.

Electronic health record-based databases from 11 secondary and tertiary institutions in South Korea from 1 January 2014 to 31 July 2025. The study period began in 2014, following the post-marketing surveillance initiation of SGLT2 inhibitors in Korea (November 2013), to ensure adequate drug availability and clinical adoption.

Patients aged 40 years or older who were newly prescribed either SGLT2 inhibitors or TZDs without prior exposure.

Propensity score matching (1:1) was performed using sex as the primary covariate due to data availability constraints in the Observational Medical Outcomes Partnership Common Data Model framework. The HRs with 95% CIs were measured via Cox regression analysis.

The study analysed 24 172 matched pairs for stroke outcomes (40 483 person-years in the SGLT2 inhibitor group and 39 363 person-years in the TZD group), 25 111 matched pairs for dementia (41 924 person-years in the SGLT2 inhibitor group and 40 726 person-years in the TZD group) and 25 237 matched pairs for AD (42 139 person-years in the SGLT2 inhibitor group and 40 895 person-years in the TZD group) across 11 participating hospitals. After a 1:1 propensity score matching, the SGLT2 inhibitors showed no significant difference in stroke risk (HR 1.18, 95% CI 0.62 to 2.23, p=0.62), while having significant reductions in dementia risk (HR 0.66, 95% CI 0.45 to 0.98, p=0.04) and AD risk (HR 0.54, 95% CI 0.35 to 0.83, p=0.005). Moreover, these protective effects for neurodegenerative outcomes were shown to be consistent across multiple hospital sites.

SGLT2 inhibitors are associated with a reduced risk of dementia and AD compared with TZDs in patients aged 40 years or older with type 2 diabetes and have neutral effects on stroke risk. These findings confirm the potential selective neuroprotective benefits of SGLT2 inhibitors for neurodegenerative outcomes, which may inform therapeutic decision-making for diabetic patients at risk of cognitive decline.

Persistent postsurgical pain (PPSP) affects up to 15% of patients after major surgery, impairing physical function, quality of life and increasing risk for long-term opioid use. Current PPSP prediction models rely on static or retrospective data and fail to incorporate dynamic perioperative factors. The Personalised Prediction of Persistent Postsurgical Pain (P5) study aims to develop individualised, multimodal prediction models by integrating preoperative behavioural, psychophysical and neurocognitive assessments and high-frequency symptom monitoring.

P5 is a prospective, single-centre cohort study enrolling 2500 adults aged 18–75 undergoing major surgery at a tertiary academic hospital. Participants complete baseline surveys, cognitive testing and quantitative sensory testing preoperatively. Ecological momentary assessments (EMAs) are collected via smartphone three times per day through 30 days postoperatively, capturing pain, mood, catastrophising and medication use. Participants are assessed on postoperative day 1 and complete online surveys at 3 and 6 months, evaluating pain persistence, interference, neuropathic symptoms and related outcomes. Clinical and perioperative data are extracted from the electronic health record. The primary outcome is PPSP at 3 months. Predictive models will be developed using supervised machine learning and dynamic structural equation modelling to extract latent features from EMA data. Model performance will be assessed using area under the receiver operating characteristic curve, area under the precision-recall curve and SHapley Additive exPlanations for interpretability.

This study has received ethics approval from the Washington University School of Medicine Institutional Review Board #202101123. Informed consent is required. Results will be submitted for publication in peer-reviewed journals and presented at research conferences.

NCT04864275.

To report on the development and refinement of a questionnaire of personal recovery for use by older adults with bipolar disorder.

An integrated knowledge translation approach was used to structure collaboration of individuals with clinical, research and service users. Focus groups, online meetings and online feedback were used to support information sharing.

Knowledge users from across the UK including older adults with experience of bipolar, clinicians and academics.

A final draft of the Bipolar Recovery Questionnaire for Older Adults with bipolar (BRQ-OA).

Five service users and 15 stakeholders engaged with the study. The views and recommendations of the groups were integrated into the development of the BRQ-OA across four phases. Service users identified factors of personal recovery they felt had changed with ageing, including the impact of physical health and the importance of finding a purpose following changes to role. Collaboration with key stakeholders allowed for the development of a personal recovery questionnaire relevant to the experiences of older adults.

An integrated knowledge translation approach successfully structured engagement with key stakeholders to allow for active and meaningful engagement. Collaboration of individuals with experience of bipolar, clinicians and academics allowed for the development of the first questionnaire of personal recovery specifically adapted for older adults with bipolar. Future research is needed to validate the BRQ-OA in older adult samples so that it can be used in mental health services and intervention studies.

Generative artificial intelligence (AI) tools are rapidly transforming case-based learning (CBL) within medical education. Despite growing interest, the literature is heterogeneous, fragmented and inconsistent in terminology and methodology. This scoping review aims to systematically map and synthesise evidence on the integration of generative AI in CBL, identifying key themes, educational outcomes, challenges and research gaps to guide future investigations, curricular innovation and policy development.

A comprehensive search strategy, developed with a health sciences librarian, will be implemented across multidisciplinary databases, including PubMed/MEDLINE, ERIC, Scopus, Web of Science, EMBASE and CINAHL, covering publications from 2019 to 2025. Two independent reviewers will conduct title/abstract and full-text screening using predefined eligibility criteria. Data extraction will use standardised charting forms capturing study characteristics, AI applications, educational contexts, outcomes and user perceptions. Data synthesis will involve descriptive statistics and inductive thematic analysis to create an evidence map of generative AI-supported CBL in medical education.

No ethics approval is required, as the review synthesises published literature. Findings will be disseminated through peer-reviewed journals, conferences and stakeholder networks to inform educators, researchers and policymakers.

Interstitial lung diseases (ILD) associated with an underlying connective tissue disease (CTD), also known as a systemic autoimmune rheumatic disease or SARD, are chronic conditions with a tendency to progress. CTD-ILDs are increasingly diagnosed and pose an important global health challenge. This systematic review aims to provide an overarching evaluation of their epidemiology and disease burden in Asia. In this review, the term CTD-ILD will be used to denote all major forms of ILD arising in the context of a SARD.

This systematic review will adhere to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including a flow diagram to depict the process by four independent reviewers that will assess titles and abstracts against the following predetermined criteria. A systematic review of the literature search published from 2000 to 2024 will be conducted using five electronic databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library and Web of Science. Publications that meet the inclusion criteria of this review will be subjected to a full-text review to extract relevant data. Collated data will be analysed and organised into categories based on the expected outcome and objectives. The quality of published evidence, including heterogeneity across studies, will be checked against PRISMA checklists and assessed by Newcastle-Ottawa Scale.

Ethics approval is not applicable for this study since no original data will be collected. The findings of this review will be disseminated through a peer-reviewed publication in a scientific journal and conference communications, with the aim of contributing insights to the field by identifying research gaps and informing clinical practice.

The protocol of this systematic review is registered with the National Medical & Research Register (ID-24–03600-GUB) and International Prospective Register of Systematic Reviews PROSPERO (CRD420251037095).

Sepsis is a life-threatening response to infection and remains a critical challenge with high morbidity and mortality rates. The Surviving Sepsis Campaign (SSC) guidelines serve as a cornerstone for sepsis management and are pivotal in standardising care. Taylor et al’s article1 scrutinises the real-world implications of updated SSC antibiotic timing recommendations2 and offers critical insights into the practical effects of the revised antibiotic timing guidelines.

The prevalence of depression and mood disorders has been steadily rising in Australian youth, with a concomitant increase in antidepressant pharmacotherapy prescription rates. Yet, the tolerability and efficacy of antidepressant drugs in youth remain poor. Pharmacogenetic (PGx) testing, or the personalised and guided treatment of medication based on genetic data, has been suggested to improve the effectiveness and tolerability of antidepressants. However, limited studies have evaluated the utility of antidepressant PGx-guided treatment in adolescent and young adult populations. Thus, this pilot randomised controlled trial (RCT), the GENE-YD Study, will evaluate the feasibility for a large-scale RCT assessing the effect of PGx-guided antidepressant prescription vs treatment as usual in youth with major depressive disorder (MDD).

Eighty young people between 16 and 24 years of age and in the early stages of pharmacotherapy treatment for MDD will be recruited. Following initial screening, participants will be randomised on a 1:1 ratio to either the intervention or control study group. Participants in the intervention condition will have their treatment tailored based on their PGx profile. Participants randomised into the control group will have their prescription based on current best practice recommendations, or treatment as usual. Individuals will be assessed at drug prescription baseline and again 6 and 12 weeks following drug prescription. The primary outcome of the study will be to evaluate the feasibility and acceptability of the GENE-YD protocol. Specifically, this study will explore participation recruitment strategies and attrition to the study protocols to guide the recruitment processes of a large-scale RCT, along with participating satisfaction in overall study protocols. Secondary outcomes will inform the utility and variability of specific measures (eg, depression rating scales, quality of life measures and medication adherence scales) that may be scaled up for use in a future full-scale trial.

Ethics approval was granted by the Department of Health, Western Australia’s Human Research Ethics Committee (RGS0000006822) and recognised by the University of Western Australia’s Human Research Ethics Committee (2024/ET000685). All participants will be required to provide written informed consent. Results will be published in international peer-reviewed journals.

ACTRN12624000760572.

As of 2024, 123.2 million people had been forcibly displaced as a result of persecution, armed conflict or climate-related catastrophes, and these numbers are predicted to rise. There is a growing awareness of possible intergenerational effects of trauma on life-course health and well-being, however few studies have followed individuals longitudinally starting prenatally. This paper describes the first large prenatal birth cohort study in a refugee context in a lower middle-income country. This study aims to investigate the potential lifespan health and developmental implications of being born into a protracted humanitarian context, and what factors can buffer from the adversity posed by conflict and displacement.

We outline our approach of recruiting, consenting and gathering data from pregnant Rohingya refugee and host community women (N=2888; 80% Rohingya) over the course of 12 months in Cox’s Bazar, Bangladesh.

A fifth wave of data collection, when children were 6 months old, was completed in April 2025. Rohingya women were substantially less literate; were marrying and having children at slightly younger ages, were more likely to live in crowded, resource-limited households and exhibited higher rates of clinically significant post-traumatic stress disorder and anxiety than host community women.

There is a critical need for research in displaced populations in order to elucidate potentially lasting transgenerational impacts of experiencing conflict and displacement trauma, and the prenatal and postnatal factors that support health and development across the life span. The next follow-up is planned when the children turn 36 months of age (starting March 2026).

To describe the association between place of residence in Alberta, Canada, and cardiovascular event risk among adults newly treated with metformin for type 2 diabetes.

Retrospective cohort study.

Administrative data from Alberta, Canada between 2008 and 2023.

Adult new metformin users, categorised by residence (rural, urban, metropolitan) from postal codes 1 year before metformin.

Cause-specific hazard models were constructed for the primary composite outcome (cardiovascular mortality, hospitalisation for an acute coronary syndrome or stroke) and each of the secondary outcomes (components of the primary outcome and all-cause mortality). Models were adjusted for baseline demographics, healthcare utilisation and diabetes complications.

A total of 236 005 adult new metformin users were identified and distributed across the rural-urban continuum (66% metropolitan, 10% urban, 24% rural). Mean age was 55 years, 55% were men, and mean follow-up time was 5.7 years. There were 19 059 primary composite outcome events, and rural residents were more likely to experience the outcome, adjusted HR (aHR): 1.09 (95% CI 1.06 to 1.13), compared with metropolitan. A significant interaction between residence and cardiovascular event history was identified. When stratified, risk of the primary outcome among those without cardiovascular history and living in a rural area was aHR: 1.16 (95% CI 1.11 to 1.20). Among rural residents with cardiovascular history, the risk was aHR: 0.84 (95% CI 0.78 to 0.91).

Quantifying the association between residence and risk of cardiovascular events may focus the allocation of healthcare resources. Development of targeted intervention programmes should focus on primary prevention in rural areas and secondary prevention in metropolitan areas.

To assess the association of normal systolic blood pressure maintenance (SBP_maintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk.

Retrospective cohort study with a mean follow-up of 3.3 years.

Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed.

10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBP_maintain (maintain (≥120 mmHg) at the time of follow-up CAC scan.

CAC progression was defined as a difference of ≥2.5 between the square roots () of the baseline and follow-up coronary artery calcium score (CACS) (transformed CACS). Annualised transformed CACS was defined as transformed CACS divided by the interscan period.

Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, pmaintain was inversely associated with an annualised transformed CACS (β: –0.18, 95% CI: –0.25 to –0.12, pmaintain showed a lower risk of CAC progression than ≥elevated SBP_maintain in non-diabetics; however, this association was not observed in patients with diabetes.

Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.

To adapt the Serious Illness Conversation Guide (SICG), Ariadne Labs, Massachusetts USA, to a local Singapore version and evaluate its acceptability.

Qualitative study using semistructured interviews.

49 participants (30 patients with serious illnesses, five family caregivers and 14 healthcare providers (HCP)) recruited from three public hospitals in Singapore.

Face-to-face or virtual indepth interviews.

Guided by the Heuristic Framework and Cultural Sensitivity model, we employed a multi-stage iterative design. Starting with the original SICG, we iterated the guide following three rounds of cognitive interviews among patients followed by expert consultation (n=4) to derive a local version, subsequently reviewed by caregivers and HCP. We assessed acceptability of the SICG using traffic light colour codes—red (unacceptable), orange (needs change) and green (no change) and gathered suggestions to rephrase them. Using content analysis, we compared acceptability of questions as proportion of red, orange and green responses at each interview round and inductively derived themes reflecting views towards the guide.

The original SICG showed low acceptability, and most questions received high proportions of red responses. Negative words and phrases dampening hope, lack of comprehension due to complex framing and cultural insensitivity to prognostic discussions were key themes reflecting low acceptability. Surface and deep structural revisions that centred around positive framing with hopeful language, focusing on current values and individualising conversations (‘use if appropriate’ prompts) significantly improved the guide’s acceptability.

We derived a local Singapore SICG that aligns with the core elements of the original guide and fosters cultural sensitivity. The adapted version could be further tested in other Asian countries.

To explore the association between the degree of coronary artery calcium (CAC) and the progression of calcific aortic valve disease (CAVD).

A single-centre retrospective cohort study using a hospital-based database.

A total of 2898 patients who underwent coronary CT angiography and serial echocardiograms at ≥6 months apart were included. Initial echocardiography was performed within 6 months from the time of CCTA.

CAC was divided into four groups: 0, 1–99, 100–399 and ≥400 (Agatston units, AU). The progression of CAVD was defined in two ways: progression 1 as at least one grade of progression, progression 2 as at least moderate aortic stenosis (AS) at follow-up.

At the initial CAVD grade, patients with at least mild AS tended to increase with increasing CAC (p

CAC was significantly associated with the progression of CAVD. Particularly, CAC≥400 was linked to progression toward significant AS.