An affordable heart-healthy dietary approach is essential for the management of familial hypercholesterolaemia (FH); however, the optimal dietary pattern and the role of adjunctive nutrient supplementation remain uncertain. This study aims to evaluate the effects of the Brazilian Cardioprotective Diet (DICA Br), adapted from the Portfolio Diet, with or without phytosterol and/or krill oil supplementation in individuals with probable or definite FH according to the Dutch Lipid Clinic Network (Dutch MEDPED) criteria.

The DICA-FH study is a national, multicentre, randomised, factorial, parallel-group, superiority, placebo-controlled clinical trial with a 1:1:1:1 allocation ratio. Participants aged ≥16 years receiving age-appropriate lipid-lowering therapy will be randomised into four groups: (1) adapted cardioprotective diet (DICA-FH) plus phytosterol placebo and krill oil placebo; (2) DICA-FH plus phytosterol 2 g/day and krill oil placebo; (3) DICA-FH plus phytosterol placebo and krill oil 2 g/day or (4) DICA-FH plus phytosterol 2 g/day and krill oil 2 g/day. All participants will undergo whole-genome sequencing and receive appropriate genetic counselling. Primary outcomes will be means of low-density lipoprotein cholesterol and lipoprotein(a) levels after 120 days. Secondary outcomes will include additional lipid biomarkers, adherence to protocol and adverse events. The planned sample size is 300 participants. Follow-up is expected to conclude in July 2026.

This study was registered under CAAE 65549622.2.1001.0060 and received ethical approval from the Hcor Research Ethics Committee (approval number 5.805.072) and the Brazilian National Research Ethics Commission (CONEP; approval number 6.864.951). Written informed consent will be obtained from all participants prior to enrolment. The study findings will be disseminated through peer-reviewed publications, scientific conferences and channels aimed at the general public.

NCT06331195.

To assess the relationship between the structural position of individuals within their village network and symptoms of depression and postpartum depression, among men and women.

Community-based, observational, cross-sectional study.

176 villages in the Copan region of Honduras.

Village residents, comprising 25 605 adults surveyed in a census-based study; using data collected between October 2015 and December 2019.

Symptoms of depression and postpartum depression, among men and women.

Across all participants, 34.99% reported depression symptoms (40.50% for women and 27.62% for men). Among recent parents with a new child in the last 6 months, 28.89% reported postpartum depression symptoms (31.29% for women and 24.31% for men). Women with higher social intransitivity (ie, a greater proportion of friend-pairs among their friends that were not themselves connected) had higher odds of depression symptoms (OR=1.27, 95% CI 1.14 to 1.41), an association not found for men nor in postpartum parents. Because this coefficient is estimated on a 0–1 scale, it corresponds to approximately 2.4% higher odds of depression per 10 percentage-point increase in social intransitivity. In a signed-network decomposition that also included adversarial ties, only the proportion of incomplete/no-tie friend-pairs was associated with depression in women (OR=1.03, 95% CI 1.01 to 1.04), corresponding to approximately 3% higher odds of depression per 10 percentage-point increase.

We report that structural social network position and connectedness beyond dyadic ties, including the friendships and adversarial ties of a person’s friends, are associated with depression. These findings highlight the importance of linking psychological health to broader social connections in the context of face-to-face relationships.

Despite implementation of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), screening coverage for oral, breast and cervical cancers remains below 2%. Screening quality is inadequately addressed and delays in diagnosis and treatment initiation continue to persist. This multisite implementation research aims to improve district-level coverage and quality of screening, early diagnosis and timeliness of treatment initiation through a model co-developed within the NP-NCD context.

The study will be conducted in three phases across seven districts in diverse regions of India. In phase I (formative), the current status, barriers and facilitators of cancer screening, diagnosis and treatment initiation under NP-NCD will be assessed. In phase II (optimisation), a model (package of implementation strategies) will be co-developed and iteratively optimised with multistakeholder engagement at the subdistrict level to improve screening coverage and quality and strengthen the referral system for early diagnosis and treatment initiation. In phase III (scale-up and evaluation), the model will be implemented at the district level and evaluated for improvements in screening, early diagnosis and treatment initiation. A convergent mixed-methods design will be used, incorporating household surveys, facility assessments and stakeholder interviews. Implementation Research Logic Model will guide planning, execution and evaluation in the present study. Determinants of screening coverage and quality, early diagnosis and treatment initiation will be assessed using the Consolidated Framework for Implementation Research. Implementation strategies for the model will be finalised using the Expert Recommendations for Implementing Change framework. Implementation and service outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.

Ethical approval has been obtained from all study sites. The study findings will be disseminated at the state, national and global levels through meetings and conferences and submitted to a peer-reviewed journal for publication.

CTRI/2025/08/092672.

The aim of this study was to translate the Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire into Norwegian and assess its psychometric properties among individuals with a history of myocardial infarction.

The study adopted a cross-sectional design. The original questionnaire was translated into Norwegian and adapted for use in the target population. The Norwegian version was pilot tested in a sample of patients and then validated in the target population.

Norway, using a web-based solution to collect data.

A random sample of Norwegian individuals

Internal consistency was tested using Cronbach’s α and test–retest reliability using intraclass correlation coefficient (ICC). Difficulty and discrimination indices were determined for the Knowledge scale. Confirmatory factor analysis (CFA) was used to assess structural validity of the Risk scale.

Data for 746 participants (mean age, SD: 66.4, 10.3 years), of which 26.9% females were analysed. The Norwegian version showed satisfactory internal consistency (Cronbach’s α 0.73–0.79) but modest test–retest reliability (ICC 0.35–0.64). The Knowledge scale showed moderate difficulty (0.39–0.84) and good discrimination power (0.44–0.60). The one-factor model CFA for each scale achieved acceptable fit, and the four-factor model showed moderate fit (root mean square error of approximation=0.05, standardised root mean squared residual=0.07, Comparative Fit Index=0.91, Tucker-Lewis Index=0.88).

The Norwegian translated ABCD Risk Questionnaire demonstrated satisfactory psychometric properties and can be considered a useful instrument for assessing knowledge and risk perception among individuals with a history of myocardial infarction.

Genitourinary syndrome of menopause (GSM) is a chronic, oestrogen-deficient condition that is frequently underdiagnosed and undertreated. Although low-dose vaginal estriol improves epithelial trophism and microbial balance, a substantial proportion of women report persistent symptoms. High-quality randomised evidence evaluating combined therapeutic strategies remains scarce. Energy-based modalities, including the erbium:YAG (Er:YAG) laser (=2940 nm), have been proposed as adjunctive treatments. This trial aims to assess the efficacy of Er:YAG laser therapy combined with vaginal estriol compared with estriol alone in postmenopausal women with GSM.

This is a single-centre, randomised, double-blind, controlled clinical trial. Postmenopausal women aged 45–70 years with vaginal pH ≥5.0 and at least one moderate GSM symptom (Visual Analogue Scale ≥4) will be eligible. Exclusion criteria include current systemic or local hormone therapy, previous vaginal energy-based treatment, abnormal cervical cytology and body mass index ≥35 kg/m². All participants will receive vaginal estriol cream (0.5 mg per dose) daily for 14 days, followed by twice-weekly administration for 16 weeks. Participants will be randomised (1:1) to receive either estriol plus sham Er:YAG laser or estriol plus active Er:YAG laser. Three laser sessions will be delivered at approximately 4-week intervals. Assessments will occur at baseline, monthly during treatment and 4 months after the final session. The primary outcome is the Vulvovaginal Health Index, with the primary endpoint defined as the change from baseline to 4 months post-treatment, reflecting sustained effect. Secondary outcomes include GSM symptom severity, vaginal microbiome composition (16S rRNA sequencing), quality of life (Menopause Rating Scale) and sexual function (Female Sexual Function Index). Data will be analysed using repeated-measures analysis of variance or appropriate non-parametric tests, with significance set at p

Ethical approval has been obtained from the Human Research Ethics Committee of UNINOVE. Written informed consent will be obtained. Findings will be disseminated via peer-reviewed journals and scientific meetings.

NCT06873971.

Access to musculoskeletal healthcare services in Sub-Saharan Africa is inadequate. As osteoarthritis is the most prevalent chronic osteoarticular disease globally, it’s essential to understand its social and economic impact, as well as the determinants of inequities in access to healthcare services in Sub-Saharan Africa. The absence of systematised knowledge on this topic makes this review pertinent. However, due to data scarcity, assessing this burden is challenging. The objective of this scoping review is to map and summarise the available literature up to 2025 on the socioeconomic burden and health inequity determinants among the Sub-Saharan African population with osteoarthritis.

A predefined search strategy will be applied to MEDLINE (via PubMed), Embase, African Journals Online and African Index Medicus to incorporate articles relevant to adults diagnosed with osteoarthritis who are residents of sub-Saharan Africa. We will also include grey literature sources such as Google Scholar, Research Square, manuals, books, medical society websites, secondary databases, theses and dissertation repositories and conference proceedings. Study selection will be conducted in two stages by a pair of reviewers who will independently screen titles and abstracts according to the eligibility criteria, followed by a full-text review of the selected studies. The search period was from October 2025 to January 2026. Data extraction will be performed using a standardised charting form developed by the review team.

This scoping review maps evidence on OA-related socioeconomic impacts and healthcare inequities in Sub-Saharan Africa. As a secondary data analysis, ethical approval is not required. Findings will be disseminated via peer-reviewed journals and academic conferences to clinicians and policymakers.

To identify subgroups with similar social determinants of health (SDOH) characteristics using latent class analysis (LCA) and examine their associations with physical and mental health, cognitive function and missed workdays at 3 and 6 months post-SARS-CoV-2 infection. We hypothesised that intersecting SDOH factors would differentially influence COVID-19-related health outcomes across subgroups.

Prospective cohort study from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), with longitudinal data collection and cross-sectional analyses at baseline, 3-month and 6-month follow-ups.

Multicentre registry across eight US academic medical centres (Chicago, Dallas, Houston, Los Angeles, New Haven, Philadelphia, San Francisco and Seattle).

Adults aged ≥18 years, fluent in English or Spanish, with self-reported acute COVID-19 symptoms and a confirmed positive SARS-CoV-2 test within 42 days before enrolment (9 December 2020 to 12 August 2022), and access to an internet-connected device. Exclusions included incarceration, inability to provide informed consent, lack of confirmed SARS-CoV-2 infection or no internet access. Of 3791 eligible participants with complete baseline data, 2897 (76.4%) completed the 3-month follow-up and 2666 (70.3%) completed the 6-month follow-up; most were aged 18–49 years (74–75%), female (66–67%), white (86.6–87.5%) and non-Hispanic (86.6–87.5%).

Prespecified primary outcomes were physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS)-29 V.2.1 T-scores for depression, anxiety, fatigue, sleep disturbance, pain interference, physical function and social participation), cognitive function (PROMIS Cognitive Function Short Form 8 T-scores) and missed workdays due to illness (binary: >1 week vs ≤1 week, from a single-item survey). All measures were self-reported and collected at baseline, 3 months and 6 months; no changes from protocol.

LCA identified a 4-class model as optimal (lowest Bayesian Information Criterion (BIC) after evaluating 1–7 class models; significant demographic differences (² p

In this US prospective cohort, SDOH-based subgroups showed persistent disparities in health outcomes post-SARS-CoV-2 infection. Findings highlight the urgent need for intersectional approaches to address systemic inequities in post-COVID-19 recovery.

NCT04610515.

Preserved Ratio Impaired Spirometry (PRISm) is a new spirometric entity defined in international guidelines, associated with overall worse outcomes. It remains unclear whether this represents a distinct entity or an early phase of multiple other diseases, such as chronic obstructive pulmonary disease (COPD) and restrictive lung diseases. There is a notable scarcity of data on PRISm, particularly in Lebanon. This study aimed to evaluate the prevalence of PRISm and COPD, and their associated factors, among individuals aged 40 years and above who underwent spirometry in a single university medical centre between 2022 and 2024.

Outpatient Pulmonary Function Tests Laboratory at a Lebanese university medical centre.

All individuals aged 40 years or older who performed spirometry between 2022 and 2024

A retrospective analysis of pulmonary function tests (PFTs) and demographics was performed. Patients were classified based on the spirometry patterns that are consistent with COPD (forced expiratory volume in the first second (FEV₁)/forced vital capacity (FVC)1/FVC≥0.7 and FEV₁1/FVC≥0.7 and FEV₁≥80%). A small number of PFTs did not meet the above criteria and were classified as ‘others’; they were excluded from the main analysis but retained for descriptive estimation of PRISm and COPD prevalence over the past 3 years. The prevalence and associated risk factors of PRISm and COPD were assessed. Descriptive, bivariate and multinomial regression models were performed using IBM’s Statistical Package for the Social Sciences V.29.

A total of 698 PFTs were performed for 639 patients. The prevalence of PRISm and COPD in the centre between 2022 and 2024 was 11% and 17%, respectively. Compared with normal PFTs, subjects with PRISm were older (adjusted OR; aOR (95% CI)=1.03 (1.002 to 1.05); p=0.03) and more likely to be ex-smokers (aOR=2.19 (1.12 to 4.30); p=0.022); patients with COPD were older (aOR 1.09 (1.07 to 1.12); p

These findings highlight PRISm as a potentially relevant pattern within chronic airway disease. Within the context of Sustainable Development Goal 3 on non-communicable diseases, they underscore the importance of identifying this subgroup for closer clinical attention. Further longitudinal and multicentre studies are needed to better understand the clinical significance of PRISm and its relationship to chronic airway diseases.

Irrational prescribing is a major global health concern, contributing significantly to increased morbidity, mortality and antimicrobial resistance (AMR). Despite existing knowledge and awareness, irrational antibiotic use remains prevalent among healthcare professionals.

This qualitative study aimed to explore the contributing factors to irrational antibiotic prescribing, understand healthcare professionals’ perceptions, identify barriers to rational use and gather suggestions for improving rational antibiotic use.

A qualitative study using semi-structured interviews was conducted with participants. A total of 60 healthcare professionals (20 physicians, 20 pharmacists and 20 nurses) participated after providing verbal consent.

Semi-structured interviews were conducted with healthcare professionals across various clinical settings in Pakistan until data saturation was reached. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure transparent reporting. An inductive thematic analysis approach was employed and themes and subthemes were developed from the data.

The findings revealed a generally good understanding of irrational prescribing. Contributing factors included prescriber-related issues, patient expectations, weak regulatory oversight and underutilisation of pharmacists. Key barriers identified were financial constraints, lack of awareness and insufficient resources. Suggestions for improvement included regular audits, public awareness campaigns, an integrated healthcare system, interprofessional collaboration, drug utilisation reviews, adverse drug reaction reporting, standardising hospital policies and strengthening regulatory frameworks.

This study highlights critical factors and barriers contributing to irrational antibiotic prescribing and presents practical suggestions to improve rational use. Implementing evidence-based approaches, updating clinical guidelines, and promoting awareness among healthcare professionals are essential steps toward improving prescribing practices and combating AMR.

Critical care patients face varying degrees of physical and psychological stress; in recent decades, the increasing focus on technologies and clinical processes has led to dehumanisation. In contrast, humanistic care has been introduced as an essential care paradigm, emphasising comprehensive care and considering all stakeholders in the care process (patient, family and staff). In addition to improving clinical outcomes, this approach focuses on family satisfaction, preserving the human dignity of patients and reducing the incidence of acute cognitive disorders such as delirium; therefore, the aim of this study is to assess the impact of humanistic care on these three key areas in the intensive care unit (ICU).

This non-randomised clinical trial was performed in the ICU. There are two distinct groups (194 patients)—a control group that receives usual care and an intervention group that receives both usual care and a set of targeted interventions based on the seven components of the Humanising Intensive Care (HU-CI) model (‘open-door ICU’, ‘communication’, ‘patient well-being’, ‘caring for professionals’, ‘post-ICU syndrome’, ‘end-of-life care’ and ‘humanised infrastructure’) for three main groups including healthcare personnel, patients and their families. The primary outcome is delirium (Confusion Assessment Method for the Intensive Care Unit tool), and secondary outcomes are family satisfaction (Family Satisfaction in the Intensive Care Units Questionnaire) and human dignity (Patient Dignity Inventory). Finally, the data will be analysed through STATA V.18 software using the statistical methods of independent t-test or its non-parametrical equivalent, ² or Fisher’s exact tests, Mann-Whitney or Kruskal-Wallis tests, multivariate binary logistic regression models or analysis of covariance, and non-linear mixed models.

The study protocol has been approved by the Ethics Committee of the Tehran University of Medical Sciences (Ethical code: IR.TUMS.FNM.REC.1404.086). Informed consent will be obtained from all participants. The data will be shared on reasonable request to the corresponding author.

IRCT registration number: IRCT20250727066651N1. Registration date: 30 July 2025.

To analyse the completeness of the COVID-19 vaccination schedule and identify factors associated with vaccine uptake.

Cross-sectional study.

Data were collected through face-to-face interviews conducted in all 26 Brazilian state capitals and the Federal District between 2022 and 2023, using a sequential sampling approach.

A total of 1392 individuals aged 18 years or older experiencing homelessness for at least 6 months were included.

The primary outcome was the completeness of the COVID-19 vaccination schedule (complete vs incomplete), based on self-reported vaccination status. Secondary analyses examined sociodemographic, institutional and behavioural factors associated with vaccine uptake using binary logistic regression.

Completion of the vaccination schedule was positively associated with receiving government aid (OR: 1.58; 95% CI 1.09 to 2.30), visits from street clinic health agents (OR: 3.19; 95% CI 1.95 to 5.36), prior COVID-19 diagnosis (OR: 5.77; 95% CI 3.17 to 11.15), support for mandatory vaccination (OR: 3.76; 95% CI 2.48 to 5.76), trust in vaccine efficacy (OR: 3.92; 95% CI 2.63 to 5.89), seeking information from community sources (OR: 1.91; 95% CI 1.01 to 3.88) and trust in federal authorities (OR: 1.57; 95% CI 1.06 to 2.31).

This study identified structural, social and individual factors associated with complete COVID-19 vaccination among people experiencing homelessness in Brazil. Although overall coverage was substantial, gaps in vaccination completeness persisted. Social support, healthcare outreach and trust in vaccines were associated with higher uptake, highlighting important barriers and facilitators to vaccination in socially vulnerable populations.

This study aimed to evaluate the prevalence and metabolic, hormonal and clinical characteristics of metabolic syndrome among women with polycystic ovary syndrome (PCOS) in the Oran region (western Algeria).

Cross-sectional study.

Outpatient endocrinology and gynaecology services in the Oran region, western Algeria.

A total of 313 women aged 16–45 years diagnosed with PCOS according to the Rotterdam 2004 criteria.

Prevalence of metabolic syndrome and differences in anthropometric (body mass index (BMI)), metabolic (fasting glucose and lipid profile), hormonal (gonadotropins, androgens, anti-Müllerian hormone (AMH), progesterone, vitamin D) and clinical features (hyperandrogenism, menstrual irregularity, infertility) between women with and without metabolic syndrome.

Of the 313 participants, 181 (57.9%) met the criteria for metabolic syndrome. These women had significantly higher BMI (26.70±5.93 vs 25.06±6.47 kg/m²; p=0.004), elevated fasting glucose (133.43±28.52 vs 105.41±28.54 mg/dL; p

More than half of women with PCOS exhibited metabolic syndrome, characterised by obesity, dyslipidaemia, insulin resistance and vitamin D deficiency. These findings highlight the need for early metabolic screening and holistic management in women with PCOS to reduce long-term cardiovascular and reproductive risks.

This observational study aims to provide an overview of consultation-liaison psychiatry (CLP) activity within the high-intensity, complex hospital setting of the ‘Azienda Ospedaliera Universitaria Città della Salute e della Scienza’ in Turin. The study is mainly focused on delirium-related features and predictive factors of clinical outcome.

A retrospective analysis was conducted on 500 psychiatric consultations provided by the University Facility of Psychiatry. Additional analysis was performed in a subgroup of patients with a diagnosis of delirium (143 subjects). The Delirium Rating Scale-Revised-98 (DRS-R-98) was administered at the time of consultation (T0) and 1 week later (T1). Descriptive statistics were performed on the whole sample. In the subgroup of patients with delirium, linear regression for continuous variables and one-way analysis of variance for categorical variables were conducted. Stepwise multiple regression was performed with DRS-R-98 (difference of DRS-R-98 score between T0 and T1) as the dependent variable.

The majority of requests for consultation came from the internal medicine department or from orthopaedic and trauma units and concerned male patients with a positive history of psychiatric disorders. Although psychiatric re-evaluations were frequently required, transfers to the psychiatric ward were rare (9.8%), and there were no compulsory psychiatric admissions in our sample. In addition to delirium, the most frequent reason for requesting CLP evaluation was depressive disorder. Among the 143 cases of delirium, the mean age and prevalence of males were higher than in the whole sample. Mortality was also higher (28%) than in the whole sample (17.6%). In the stepwise multiple regression analysis, variables significantly and independently associated with DRS-R-98 included: age (t=–4.074; p

CLP interventions in our high-complexity general university hospital were mainly requested for patients with mood disorders and delirium. CLP service provides an important opportunity to identify unknown psychiatric disorders or symptoms below the diagnostic threshold. Predictors of improvement of delirium-related symptoms are young age and the use of atypical antipsychotics, while BDZ treatment can be considered a negative predictor of outcome in patients with delirium. Further research on this topic is recommended to better understand the relevance of CLP, particularly the effects of this type of intervention in the management of delirium.

South African women are vulnerable to HIV acquisition during the postpartum period which can result in perinatal transmission via breastfeeding; many male partners do not know their HIV status. Biomedical approaches to preventing HIV for postpartum women include pre-exposure prophylaxis (PrEP) and antiretroviral treatment for male partners with HIV. Gaps in implementation include low uptake of PrEP among postpartum women and infrequent testing of men who may be motivated to test for HIV to protect the health of their infant.

We will conduct a randomised pilot trial in KwaZulu-Natal (KZN) Province, South Africa among postpartum women and their male partners. The study will pilot a combination intervention consisting of cognitive behavioural strategies (including communication skills training, motivational interviewing and problem-solving) to promote HIV self-testing (HIVST) for Partners and PrEP uptake for HIV-uninfected Postpartum Women, the ‘H4P’ intervention. The study aims to determine the feasibility, acceptability and preliminary effectiveness of the H4P intervention. We will enrol 60 HIV-uninfected women, aged 18 years and older, in their third trimester of pregnancy and reporting a partner whose HIV-serostatus is unknown. Sixty male partners will also be eligible to enrol. Enrolled women will receive three oral HIVST kits to distribute to their male partners and standard of care information on HIVST and PrEP. Women randomised to the intervention arm will receive additional counselling and reproductive health-centred HIVST information for the male partner, including information about why HIV testing is important during their partners’ postpartum period. To evaluate feasibility, we will calculate screening-to-enrolment ratios for women and men, the number of women who distribute HIVST kits to their male partners and the number of men who test. Acceptability will be evaluated using the Client Satisfaction Questionnaire and qualitative interviews. Effectiveness will be assessed at 3 months by measuring the proportion of women initiating PrEP via self-report and urine tenofovir measurements or receipt of injectable PrEP and the proportion of men who test positive who link to HIV care. Qualitative interviews will explore perceptions of the intervention.

Ethics approval for this study was obtained from the Human Research Ethics Committee at The University of the Witwatersrand, Johannesburg, South Africa (Reference number: 250612) and the Institutional Review Boards at Massachusetts General Brigham (2025P002271, Boston, Massachusetts, USA) and the University of Alabama at Birmingham (300015167, Birmingham, Alabama, USA) in the USA. Site support and approvals were obtained from the health facility and the KwaZulu-Natal Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations.

NCT07194902.

To examine whether Indigenous Peoples’ and Local Communities’ (IPLC) ontologies are associated with knowledge, attitudes and practices (KAP) related to wildlife cohabitation and zoonotic disease transmission in biodiversity-rich areas of Latin America.

Cross-sectional household survey using a standardised KAP questionnaire. Ontologies were classified using latent class analysis. Associations between ontology classes and outcomes were assessed using multivariable logistic regression models.

Urban, rural and protected areas in biodiversity-rich regions of Bolivia, Brazil, Chile and Guatemala.

A total of 2903 individuals aged ≥10 years were recruited through random household sampling (response rate 85%).

Primary outcomes were defined according to the KAP framework. Knowledge outcomes comprised combined knowledge of zoonotic disease transmission from wildlife to humans and knowledge of zoonotic risks associated with wildlife trade. Perceived training needs related to zoonotic disease prevention were analysed as a secondary knowledge outcome measure. Attitudes were measured through risk perception, operationalised as concern about zoonotic disease transmission. Practices included self-reported hunting and slaughtering of wildlife.

The analysis identified three distinct ontology classes: Relational environmentalism (52% of the population), characterised by strong spiritual connections to animals and a tendency to protect wildlife; Dualistic environmentalism (28%), with a weaker spiritual connection to animals but a commitment to wildlife conservation; and Neutral (20%), demonstrating little spiritual connection to animals and a neutral attitude towards wildlife conservation. In the logistic regression analyses, both environmentalism groups exhibited greater knowledge of zoonotic transmission and concern about outbreaks, with members of the Relational class demonstrating higher levels of these attributes. Furthermore, members of the Dualistic environmentalism class were less likely to have close contact with animals.

In Latin America’s biodiversity-rich regions, individuals whose ontology aligns with environmentalism appear to demonstrate a heightened awareness of zoonoses, particularly those who adhere to a Relational environmentalism perspective. Consequently, the integration of IPLC cultural knowledge holds potential to enhance wildlife conservation measures and contribute to the mitigation of disease transmission. Further research is needed to explore causal pathways and the integration of culturally grounded approaches into public health interventions.

To compare use of electronic nicotine delivery systems (ENDS) with nicotine replacement therapies (NRTs) on risk of cigarette smoking relapse by people who had already quit cigarettes.

Prospective cohort study.

The American Cancer Society Cancer Prevention Study-3, a nationwide US cohort with follow-up every 3 years beginning in 2015.

Adults who in 2015 had already quit smoking (n=3112) or were smoking (n=1018) and who in 2018 reported past or current exclusive use of ENDS or NRT and provided smoking status.

Relapse to cigarette smoking in 2018 among people who were already quit in 2015, and abstinence from cigarettes in 2018 among people who were smoking in 2015.

Among respondents who had already quit in 2015, the unadjusted risk of relapse in 2018 was approximately three times greater for those who reported past exclusive ENDS versus past exclusive NRT use (11.2% vs 3.9%; relative risk (RR)=2.90, 95% CI 2.12 to 3.98). This association remained significant in a multivariable-adjusted model (RR=2.09, 95% CI 1.49 to 2.92). Among those smoking in 2015, the unadjusted likelihood of abstinence in 2018 was higher for those who reported current ENDS versus NRT use (RR=1.35, 95% CI 1.01 to 1.80), but the multivariable model adjusted for smoking frequency indicated no difference in abstinence (RR=1.38; 95% CI 0.93 to 2.05).

ENDS use was associated with greater relapse risk than NRT among people who had already quit. Although ENDS may support shorter-term cessation, further long-term observational research is needed to clarify relapse risks associated with ENDS relative to NRT.

To quantify sex- and age-related differences in hypercholesterolaemia diagnosis and associated comorbidities around the menopausal transition, using a population-based real-world dataset.

Retrospective, multicentre, non-interventional observational cohort study.

Region-wide public healthcare system data (primary and secondary care) from Andalusia (Spain), 2016–2022.

All adult patients meeting inclusion criteria with a recorded diagnosis of hypercholesterolaemia between 1 January 2016 and 31 December 2022 (n=557 034; 227 834 men and 329 200 women).

None.

Primary outcomes were age- and sex-stratified patterns of hypercholesterolaemia diagnosis and comorbidity burden before and after age 50 years (proxy for post-menopausal age). Secondary outcomes included comorbidity-specific comparisons between sexes across age strata and trajectory-based analyses (OR trajectories and incidence-ratio summaries).

Women were diagnosed later than men (mean age 59.1 vs 56.0 years; mean difference 3.1 years, 95% CI 3.03 to 3.17). Hypercholesterolaemia diagnoses in women rose sharply around ages 50–55 and remained higher than in men at older ages. Comorbidity patterns differed by sex across age strata: compared with men, women aged ≥50 years had higher frequencies of osteoporosis (42 255 vs 2623), anxiety disorder (94 916 vs 31 374) and hypertension (147 538 vs 91 532), with statistically significant differences for these comparisons (p

Menopause age is a pivotal period associated with a shift towards higher hypercholesterolaemia diagnosis rates and a greater burden of specific comorbidities in women. These findings support sex-specific prevention and management strategies, particularly targeting the menopausal transition and early post-menopause.

Hypertension is the leading global risk factor for mortality, causing over 10 million deaths annually. In sub-Saharan Africa, hypertension prevalence is high, particularly in rural areas, where it is less likely to be diagnosed, treated or controlled effectively. This results in a high burden of complications, including heart failure, stroke and kidney disease. Community-centred approaches using community health workers (CHWs), risk-based approaches and simplified treatment regimens have shown promise in improving hypertension management. However, there is limited evidence on the effectiveness of such approaches in rural sub-Saharan Africa.

The primary aim of this study is to assess the feasibility of a community-centred intervention for hypertension management in rural Kenya and The Gambia. The objectives are to evaluate the intervention’s adoption, fidelity, reach and dose; understand the mechanisms of action and contextual factors affecting its implementation; assess acceptability from the perspectives of patients, healthcare providers and policymakers; estimate the costs associated with the intervention; and evaluate study procedures to inform the design of a future full-scale trial.

We will conduct a mixed-methods, non-randomised, single-arm feasibility study, designed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) framework and checklist for feasibility and pilot studies, including best practice guidance for non-randomised feasibility studies. The study will be conducted in two rural sites: Kilifi, Kenya and Kiang West, The Gambia. The intervention was codesigned with stakeholders and includes community-based hypertension screening by CHWs, risk stratification and hypertension-mediated organ damage assessment at primary healthcare facilities, followed by treatment initiation using single-pill combination (SPC) antihypertensive therapy for eligible individuals. Training will be provided to all healthcare providers involved in the study. We will screen 500 participants aged 30–80 years at their residence (250 from each country), and we expect that about 45% will be referred for additional assessments and of these 25% (or 10% of the total sample) will be prescribed treatment with SPC. Data collection to evaluate the intervention and its implementation will involve quantitative measures of feasibility and clinical outcomes; observations to assess fidelity and costing measures; and qualitative interviews and focus group discussions with patients, healthcare providers and policymakers to understand the acceptability and contextual influences on intervention implementation.

Ethics approval was obtained from the Kenyan National Committee for Science, Technology and Innovation (ref: 415561), the Gambia Government/Medical Research Council Joint Ethics Committee (ref: 31372) and the London School of Hygiene and Tropical Medicine Ethics Committee (ref: 31372). Study findings will be disseminated through peer-reviewed publications, conferences, policy briefs, community engagement forums and accessible summaries shared via the Improving Hypertension Control in Rural sub-Saharan Africa and partner newsletters.

This study is registered with the ISRCTN- The UK’s Clinical Study Registry (ISRCTN81228019), and Pan African Clinical Trials Registry (PACTR202504839027548).

This study aimed to describe the factors influencing mental health and wellbeing from the perspective of Moroccan youth.

This is a descriptive cross-sectional survey.

All 12 regions in Morocco.

Perceived priority drivers of mental health and well-being among youth.

A total of 1182 participants were included (mean age 20.5 years, 68.2% female, 85.7% from urban settings). Regarding health and nutrition, 46.3% valued sleep, 59.7% emphasised physical health, 53.1% highlighted access to quality healthcare and 56.5% prioritised clean air. In terms of connectedness and contribution, 75.7% rated family relationships as critical to their well-being, while 42.5% emphasised positive peer relationships. Regarding safety and supportive environments, 64.7% considered personal safety essential, 70% prioritised the fulfilment of basic needs and 63.7% valued personal information protection. For education and competence, 54.4% emphasised learning opportunities and 62.2% identified self-confidence as key drivers. Regarding agency and resilience, 59.4% valued independence, 68.5% stressed having a sense of purpose and 55% identified hope and optimism as key to their well-being. In digital well-being, 37.7% believed social media helped maintain connections, 38% viewed it as a learning tool while 31.6% reported it as a source of stress and anxiety

This study provides valuable insights into priority drivers of youth mental health in Morocco from the perspective of Moroccan youth which should be the target for future interventions aiming to promote youth well-being. The findings contribute to the limited data on youth mental health in low and middle-income countries, highlighting the urgency for comprehensive mental health services and further research on subjective well-being.

Uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) is closely associated with the management of HIV and tuberculosis (TB) coinfection because it modulates the metabolism of antiretroviral (ARV) drugs. The frequency of UGT1A1 polymorphisms varies widely among sub-Saharan Africans. However, studies examining the frequency of UGT1A1 polymorphisms and their impact on drug response profiles, accounting for environmental factors, drug–drug and gene–drug interactions and non-compliance remain sparse. Given that HIV and TB treatments often involve complex drug regimens with a high risk of interactions, understanding the role of UGT1A1 polymorphisms in these contexts is crucial. Therefore, this scoping review aims to map existing evidence, synthesise findings on how genetic polymorphisms in the UGT1A1 gene affect the metabolism of ARVs and antituberculosis drugs, and identify gaps in literature regarding their impacts on drug efficacy, toxicity and treatment outcomes in sub-Saharan Africa (SSA).

The methodology for this scoping review will follow the guidelines outlined in the Joanna Briggs Institute Methodology Manual. Using the keywords, UGT1A1 polymorphism, HIV and TB coinfection, treatment outcomes and SSA, we will search for articles on PubMed/Medline, Cochrane Library, Embase, Web of Science and Scopus to obtain relevant articles published from January 2010 to April 2026. Two independent reviewers will screen and assess quality of titles and abstracts against the predefined inclusion and exclusion criteria and manage the data using Microsoft Excel. Conflicts will be resolved through discussion and where necessary a third reviewer will be consulted. Findings will be narratively synthesised across polymorphisms and treatment outcomes. The reviewers will meet and discuss the themes that will arise as well as the interpretation of the themes to minimise bias in the findings.

The scoping review relies on publicly available published resources, exempting it from ethical review board oversight. The review findings will be shared in a peer-reviewed journal.