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.

Heatwaves are among the fastest-growing climate-related threats to human health, increasing in frequency, intensity and duration with climate change. Older adults are disproportionately affected, reflecting intersecting physiological, social and economic vulnerabilities. Beyond mortality, heatwaves drive substantial but often under-recognised morbidity, including emergency visits and hospitalisations for cardiovascular, respiratory, renal and metabolic conditions. Health administrative data provide valuable opportunities to improve understanding of these phenomena and for the quantification of their impacts. However, comparability is limited by heterogeneity in case definitions, that is, the criteria used to determine which health events are counted as cases: some studies only clinically diagnosed heat illness, while others also capture outcomes plausibly triggered or exacerbated by heat. It is further constrained by differences in International Classification of Diseases (ICD) versions, national adaptations, coding practices and adoption timelines across countries. No synthesis has yet mapped these heterogeneous approaches for older adults, despite their over-representation among those most affected by heat-health risks. This heterogeneity limits the ability to capture the true burden of disease and to inform adaptation planning.

We will conduct a scoping review to map how heat-related diagnoses among older adults are identified and measured in health administrative data. The review will follow the initial methodological framework of Arksey and O’Malley refined by Levac et al and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search strategy will be developed with a public health librarian and applied to MEDLINE (Ovid), Embase and Web of Science. We will include peer-reviewed and grey literature published in English or French from 2010 onward. Two reviewers will independently screen titles, abstracts and full texts in Covidence, with disagreements resolved by consensus or a third reviewer. Data will be extracted using a standardised form to capture study characteristics, ICD codes, definitions of heat exposure and approaches to measurement. A descriptive and thematic analysis will be conducted, and findings will be presented narratively and in tables.

Ethical approval is not required for this review as it involves secondary analysis of published and publicly available data; for more information, contact University of Montreal’s Research Integrity department at plaintes-crr@umontreal.ca. Results will be published through a peer-reviewed publication, conference presentations and knowledge transfer activities with public health stakeholders in Québec. This review contributes to the MEDICCS (Modélisation économique des impacts des changements climatiques sur la santé) project and will support recommendations for improving the capture of heat-related morbidity in health administrative data.

In response to the high maternal mortality in Afghanistan, the government emphasised enhancing antenatal care (ANC) coverage to improve skilled birth attendance and reduce maternal mortality. This study aimed to explain how and why ANC interventions worked, for whom, and under what circumstances in Afghanistan between 2000 and 2024.

A rapid realist review was conducted to identify underlying programme theories and examine contextual factors and key mechanisms influencing ANC outcomes, with input from a panel of national experts. Data were extracted using context–mechanism–outcome (CMO) configurations to develop and refine theories for policy recommendations.

From 3502 papers, 1860 duplicates were removed, 63 were screened for full text and 25 were included in the final review. In total, 29 CMOs were inferred across nine interventions, classified at individual, interpersonal, community and institutional levels. We found that ANC interventions could work best by empowering women and healthcare workers (HCWs), involving husbands, hiring female community health workers (CHWs), ensuring regular contact with the same HCWs, endorsing health messages by the government, incentivising CHWs and designing and implementing interventions using participatory approaches. Interventions are less successful when there is a lack of community trust in service quality or HCW qualifications, low decision-making ability among women, discomfort during travel to health facilities, adherence to traditional practices and beliefs, hiring CHWs from outside the community, chronic stress and lack of support among HCWs and unrecognised incentives.

Our evidence synthesis can inform donors, policymakers and implementers on how to design more effective ANC interventions to achieve better health outcomes in Afghanistan. By emphasising intervention evaluation and ANC quality improvement, it highlights the importance of key social elements, such as cultural norms, power dynamics, relationships, beliefs and trust, which are likely to maximise impact. Community involvement is essential for designing and implementing effective and sustainable ANC interventions.