Ischaemic stroke, the most prevalent stroke subtype, imposes a significant long-term disease burden. However, patients with first-ever stroke exhibit substantial individual variability in poststroke health trajectories, manifesting heterogeneous clinical presentations. We therefore started with the overall health of patients in order to delineate heterogeneous clusters characterised by distinct demographic profiles, clinical features and behavioural determinants and elucidate shared longitudinal trajectories in the temporal development of adverse health outcomes.

We designed a multicentre, cross-sectional and longitudinal study focusing on patients with first-ever ischaemic stroke. We will employ patient self-reported outcomes and objective measurements to comprehensively evaluate patients’ health status from a multidimensional perspective. Following baseline assessments, participants will undergo follow-up evaluations at 1 month, 3 months and 6 months post inclusion. The primary objective is twofold: (1) to identify distinct patient clusters with heterogeneous multidimensional health profiles using the k-prototype clustering algorithm and (2) to characterise synergistic trajectories of core health attributes within the largest cluster through parallel process latent class growth modelling. By combining cross-sectional and longitudinal analyses, this phased study should elucidate static heterogeneity and dynamic recovery patterns following a first-ever ischaemic stroke.

The project conforms to the ethical principles enshrined in the Declaration of Helsinki (2013 amendment) and all local ethical guidelines. The ethics committee at the University of South China approved the study (approval no. 2024 NHHL023). The ethics committee of Gansu Provincial Hospital approved the study (approval no. 2025–023). The ethics committee of the Central Hospital of Shaoyang approved the study (approval no.KY-2025–12). The findings will be published and presented at conferences for widespread dissemination.

Trial registration number: ChiCTR2500098442

Music-based training programmes, such as learning how to play an instrument or sing in a choir, have been suggested as potential interventions for promoting healthy brain ageing in older adults at risk of cognitive decline because of their ability to enhance cognitive functions and potentially promote neuroplasticity. However, there is limited empirical evidence in older adults at risk of dementia, especially that evaluates both piano and singing interventions and their effects on cognition and neuroplasticity. In this protocol, we outline a study to assess the efficacy of keyboard and singing music training programmes on reducing cognitive decline and other outcomes in older adults with Mild Cognitive Impairment (MCI).

This randomised, single-blind, controlled, parallel-group trial aims to enrol 432 individuals with MCI from the community in Sydney, Australia. Participants are randomly allocated to participate in either keyboard lessons, singing lessons or a film discussion control group once a week for 3 months. The primary objective is to assess the effectiveness of two music training programmes (keyboard and choral singing) for enhancing verbal memory after 3 months compared with control. Additionally, we will examine how these music-based interventions affect other aspects of cognition, mood, sleep, overall well-being, markers of brain plasticity and blood biomarkers of Alzheimer’s disease and neurodegeneration. Tertiary objectives are to identify factors that impact the success of the interventions, such as participation rates, engagement levels and key demographic and clinical features. Outcomes are collected at baseline and at 3 and 9 months. The primary endpoint analysis will include all randomised participants to estimate the treatment effect using intention-to-treat principles. Primary and secondary outcomes will be analysed using linear mixed models and effect size measures will be calculated.

This study will be the first robust, randomised controlled trial to assess the potential and relative value of music engagement for cognitive decline in high-risk MCI individuals, as well as broader effects on other markers of mental health, well-being and neurodegeneration. Co-designed with implementation in mind, the music interventions can potentially be delivered within memory clinic or community settings.

The Sydney University Human Research Ethics Committee (2023-026) has approved this protocol. The trial findings will be shared through conferences, publications and media.

Australian and New Zealand Clinical Trials Registry (ACTRN12623000407695), Registered 21/04/2023 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385552

2.02 29/11/2024.

This study aimed to investigate the evolution of burnout levels and cardiovascular risk among healthcare professionals during the COVID-19 pandemic, identifying associated risk factors, with a particular focus on the impact of working hours, job roles and working units.

A longitudinal, observational study was conducted.

The study was carried out in a medical centre in central Taiwan, encompassing various healthcare settings.

A total of 1502 healthcare workers participated, including nurses, medical technicians, resident doctors, attending physicians and administrative staff. Participants were selected based on consistent completion of a 4-year questionnaire, with exclusion criteria for those who did not complete.

The primary outcome measured was burnout levels using the Chinese version of the Copenhagen Burnout Inventory. The secondary outcome was cardiovascular risk calculated from employees’ health check-up data using the Framingham Risk Score.

Cardiovascular risk showed an upward trend over 4 years. Personal and work-related burnout significantly decreased from 2019 to 2020 but increased from 2020 to 2022, aligning with changes in weekly working hours. Nurses exhibited the most pronounced fluctuations, likely due to their younger average age, shorter professional tenure and frequent direct patient contact, which may heighten vulnerability to pandemic-related stressors. In contrast, attending physicians demonstrated age as a protective factor against burnout, as greater seniority, clinical experience and professional maturity may buffer stress and foster resilience. Participants who worked in COVID-related units generally had elevated burnout levels and working hours. During the initial outbreak in 2020, employees working in COVID-related units had reduced working hours but stable burnout levels, while employees in non-COVID-related units experienced decreased burnout.

This study highlights the critical impact of long working hours on burnout among healthcare professionals during the COVID-19 pandemic. Nurses emerged as a vulnerable group, sensitive to pandemic-induced changes, while attending physicians exhibited more resilience. COVID-related units face greater stress and are less likely to benefit from reductions in patient numbers and working hours during the pandemic. Our findings underscore the urgent need for tailored interventions, such as regulated work hours, flexible scheduling and enhanced organisational and peer support, to protect healthcare workers’ well-being. These strategies can strengthen workforce resilience and sustainability in future public health crises.

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.

Despite growing concerns regarding the impact of smartphone use on adolescents' lifestyle, there is a notable lack of studies utilising national data to explore how smartphone use influences eating habits in this age group. We aimed to investigate the association between smartphone screen time and fast food intake using representative data from Korean adolescents.

Cross-sectional survey.

This cross-sectional analysis used data from the 2017 Korean Youth Risk Behavior Web-based Survey (KYRBS). We used Poisson regression to directly estimate prevalence ratios (PRs) rather than using logistic regression as odds ratios (ORs) tend to overestimate PRs when the outcome is common. Smartphone screen time was categorised into four groups based on the daily time spent using smartphones:

Data from 39 753 individuals were included.

The primary outcome was the frequency of fast food intake, assessed via a self-reported survey that asked: "In the past 7 days, how often did you eat fast food such as pizza, hamburgers, fried chicken, or drink carbonated beverages?". Participants were categorised into two groups based on their median intake: infrequent (≤2 times/week) and frequent (≥3 times/week).

Among 39 753 adolescents, 19 273 reported frequent fast food intake (10 162 (51.9%) boys, 9111 (45.1%) girls), while 20 480 reported infrequent intake (9409 (48.1%) boys, 11 071 (54.9%) girls). The probabilities that adolescents who used smartphones for 6 hours daily would have frequent fast food intake were 1.29 times (95% CI: 1.28 to 1.30) among boys, and 1.43 times (95% CI: 1.42 to 1.44) higher among girls, compared with adolescents who used smartphones for 2 hours daily.

The association between prolonged smartphone screen time and frequent fast food intake in adolescents suggests the need for targeted interventions addressing digital media use to promote healthier eating behaviors.

Stroke is one of the leading causes of disability and mortality worldwide, particularly in China, where it imposes significant economic and psychological burdens on patients and their families. Traditional in-hospital rehabilitation is often limited by resource constraints, leading to interruptions in weekend therapy, which can delay recovery. Remote rehabilitation platforms offer a potential solution by providing continuous, therapist-guided rehabilitation training during weekends. This study aims to evaluate the effectiveness of a remote rehabilitation training platform in improving motor function, self-efficacy and social participation in stroke patients while also assessing its impact on caregiver burden. The findings will provide evidence for the integration of remote rehabilitation into stroke care protocols, offering a scalable solution to enhance recovery and reduce societal costs.

A total of 168 stroke patients will be recruited from three hospitals in Shanghai and randomly assigned to either an intervention group or a control group. A remote rehabilitation platform will be used to perform guided exercises on weekends for the intervention group, whereas the control group will receive standard in-hospital rehabilitation. Primary outcomes will be assessed using the 10 metre walk test, and secondary outcomes will include the Barthel Index, Fugl–Meyer motor function assessment and Zarit Caregiver Burden Scale.

This study was approved by the Ethics Committee of the Institutional Review Board of Shanghai University of Traditional Chinese Medicine (Ethics Approval Number: 2024-2-14-01). All participants will provide written informed consent prior to enrolment. Trial results will be disseminated through peer-reviewed publications, presentations at international stroke and rehabilitation conferences, and engagement with patient advocacy groups. Findings will also be shared with healthcare policymakers to promote the integration of remote rehabilitation into clinical practice. Individual participant data will remain confidential and be stored securely in accordance with data protection regulations.

This trial was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR2500101741). The date of registration was 29 April 2025.

This systematic review aims to: (1) evaluate how behavioural and psychological factors have been incorporated into cardiovascular disease (CVD) risk prediction models; (2) assess their impact on model performance metrics such as area under the curve (AUC) and net reclassification index (NRI); and (3) identify which specific variables are most consistently associated with predictive improvements. This protocol is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P) 2015, and the systematic review will follow the Cochrane Handbook and report findings based on PRISMA 2020.

A systematic review protocol developed in accordance with the (PRISMA-P) 2015 guidelines.

Systematic searches will be carried out in PubMed, Scopus, Web of Science and Google Scholar, limited to studies published from 2019 to 2024.

Peer-reviewed original studies involving adult populations (≥18 years) at risk of CVD, incorporating at least one behavioural or psychological variable into a CVD risk prediction model. Studies must report model performance metrics such as AUC or NRI. Studies focusing solely on biochemical or demographic factors, paediatric populations, or non-CVD outcomes will be excluded.

Two independent reviewers will screen eligible studies, extract data and assess study quality using the Newcastle-Ottawa Scale and Quality in Prognostic Studies tool. A narrative synthesis will be performed, with meta-analysis conducted if feasible.

Ethical approval is not required for this study. Findings will be disseminated through peer-reviewed publication and conference presentations.

CRD420251014218.

Premature acute coronary syndrome (PACS) presents with a poor prognosis and significant risks. This study aimed to investigate the association between small-dense low-density lipoprotein cholesterol (sdLDL-C) levels and the severity of coronary lesions, as well as its potential role in risk stratification for PACS patients with multivessel disease (MVD).

Retrospective cross-sectional study.

First Affiliated Hospital of Xinjiang Medical University in China, between May 2022 and November 2023.

900 PACS patients with MVD confirmed by coronary angiography (CAG) and 600 age-matched and sex-matched controls with normal CAG results.

Patients with PACS and MVD were stratified by the Global Registry of Acute Coronary Events (GRACE) score, and sdLDL-C levels were compared among the different GRACE score groups. The association between sdLDL-C and the GRACE score was evaluated using Pearson’s correlation analysis. Multivariate logistic regression analysis was employed to identify factors associated with PACS and MVD. The discriminatory ability of sdLDL-C for PACS with MVD was assessed using receiver operating characteristic (ROC) curve analysis. Restriction cubic spline (RCS) analysis was used to examine the potential nonlinear association between sdLDL-C levels and the high-risk groups of PACS with MVD.

Patients with PACS and MVD exhibited significantly higher sdLDL-C levels compared with control group (p

Elevated sdLDL-C levels demonstrated a significant association with the risk of PACS and MVD. These findings indicate sdLDL-C may serve as a potential biomarker for risk stratification in this high-risk population. However, causal inferences require validation in prospective studies.

ChiCTR2300074166

This study aimed to determine the association between diabetes mellitus (DM) medication use and glycaemic control.

This was a retrospective diabetes registry-based cohort study.

Singapore.

Patients aged 18 and above with incident DM in the SingHealth Diabetes Registry from 2013 to 2020 were included. The entire study period included a 1 year baseline period, a 1 year observation period and a 3 month outcome period.

Drug use was measured using the proportion of days covered (PDC), and the changes in glycated haemoglobin (HbA1c) between the outcome and baseline periods were assessed. The associations between baseline HbA1c and PDC ≥0.80 and between PDC and change in HbA1c were analysed using logistic regression and the Kruskal–Wallis test, respectively.

Of 184 646 unique patients in the registry from 2013 to 2020, 36 314 met the inclusion and exclusion criteria and were included in the analysis. The median PDC for any DM drug, oral DM drugs and insulin during the observation period was 20.3%, 16.8% and 0%, respectively. Those who had good glycaemic control at baseline were less likely to receive DM drugs and those with poor baseline glycaemic control or missing baseline HbA1c were more likely to be consistent users (PDC >80%) (px 10^-16).

The relationship between DM drug use and glycaemic control is complex and non-monotonic. Higher PDC for any DM drug and oral DM drugs during the observation period was significantly associated with clinically relevant HbA1c improvements.

A spinal cord injury (SCI) disrupts synaptic connections between the corticospinal tract and motor neurons, impairing muscle control below the injury site. Many individuals with an SCI have impaired trunk control, affecting the performance of activities of daily living and quality of life. Work has shown improvements in trunk control after home-based, unsupervised arm-crank exercise training (ACET) in people with chronic motor-incomplete SCI. However, no studies have examined ACET’s impact on trunk control in individuals with subacute SCI. This study aims to investigate ACET’s effects on trunk control in adults with subacute incomplete SCI, and its mechanisms, and its long-term benefits on neuropathic pain, psychological well-being, physical activity levels and health-related quality of life.

This multicentre, parallel-group, randomised controlled trial will evaluate self-directed ACET in 60 individuals with subacute SCI (

This study was approved by The Health Research Authority and Health and Care Research Wales (22/NS/0054). Results will be published in peer-reviewed journals. Findings will be presented at National and International conferences for researchers and clinicians. Finally, results will be disseminated to the SCI community.

ISRCTN17247972

This study assessed changes in the prevalence of malnutrition and obesity in children from North Korean (NK) refugee families resettling in South Korea (SK).

A longitudinal cohort study.

This study, conducted between 2017 and 2023, recruited participants through snowball sampling using local Hana Centres, alternative schools, religious organisations, civic groups, and other community-based networks.

Of the 441 children initially recruited, 406 participated in the baseline survey after excluding 35 with missing height or weight data. Among them, 187 (46.1%) completed a follow-up survey conducted at least 1 year later.

The prevalences of stunting, underweight, wasting and obesity were defined according to the 2017 Korean National Growth Chart: stunting as height-for-age below the third percentile, underweight as weight-for-age below the fifth percentile, wasting as weight-for-height below the fifth percentile for ages 0–23 months or body mass index (BMI)-for-age below the fifth percentile for ages 2–18 years and obesity as BMI-for-age at or above the 95th percentile for ages 2–18 years.

The prevalence of stunting was 7.5% at baseline and 5.4% at follow-up, while those of underweight and wasting were 6.4% vs 5.4% and 11.2% vs 5.9%, respectively; however, none of these changes were statistically significant. In contrast, the prevalence of obesity increased significantly from 11.1% at baseline to 18.8% at follow-up (p=0.045).

Despite residing in SK for an extended period, children from NK refugee families continue to experience malnutrition, while the prevalence of obesity is rising significantly.