Sleep problems are an escalating global health concern, with prevalence estimates ranging from 8.3% to 45%. Physicians are disproportionately affected, with rates around 44% compared with 36% in the general population. In Bangladesh, reported rates range from 32% to 58%, with physicians being particularly vulnerable. Poor sleep among physicians is strongly linked to burnout, medical errors and increased mental health risks. Despite these serious implications, existing evidence from Bangladesh remains fragmented and inconsistent, limiting its utility for health policy and workforce interventions. This review therefore seeks to generate reliable pooled prevalence estimates and identify key determinants of sleep problems among Bangladeshi physicians.

The research team will search the PubMed, Scopus, Web of Science, EMBASE, PsycInfo, ProQuest Medical, CINAHL, Google Scholar and BanglaJOL electronic and regional databases following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines for published studies from inception until 1 August 2025, using truncated and phrase-searched keywords, relevant medical subject headings and citation chaining from grey literature. Observational cross-sectional studies published within the predefined timeframe, using validated assessment tools, and published in English or other major international languages will be prioritised for inclusion. Review papers, case reports, case series, intervention studies, commentaries, preprints, meeting abstracts, protocols, unpublished articles and letters will be excluded. Two independent reviewers will screen the retrieved papers using the Rayyan web-based application, with any disagreements resolved by a third reviewer. Quantitative estimates of sleep problems, including prevalence, duration, quality and associated risk factors among Bangladeshi physicians will be extracted. A narrative synthesis and meta-analysis will be performed to assess the pooled prevalence using a random effects meta-analysis model. Forest and funnel plots will be generated for visualisation. Heterogeneity will be assessed using the I² statistic, with sensitivity or subgroup analysis conducted as required. The quality of included studies will be evaluated using Joanna Briggs Institute critical appraisal tools for observational study designs. All statistical analysis will be conducted using Jamovi V2.7.6, R V4.3.2 ‘meta’ packages and GraphPad Prism V9.0.2.

This review will synthesise evidence from existing published literature. While completing the findings, the findings will be submitted to an international peer-reviewed journal and disseminated through conferences, policy forums and stakeholders’ networks to inform future research and interventions.

CRD420251123294.

Burnout and reduced well-being are highly prevalent among Japanese medical students during clinical training. Scalable, evidence-based interventions are urgently needed. This protocol outlines a nationwide randomised controlled trial (RCT) to evaluate a self-guided, on-demand Acceptance and Commitment Training (ACT) programme for reducing burnout and improving well-being during clinical clerkships.

This two-arm, open-label, parallel-group RCT will recruit 128 Japanese medical students in clinical clerkships, randomised to on-demand ACT or no-intervention control. The ACT intervention comprises three self-guided online modules at weeks 0, 2 and 4, plus a 30 min online booster (weeks 8–10). Self-reported outcomes are measured at baseline, mid-intervention, postintervention and at 14-week primary endpoint (week 14). The primary outcome is medical student burnout (Oldenburg Burnout Inventory for Medical Students). Secondary outcomes include well-being (Mental Health Continuum-Short Form), professional burnout (Maslach Burnout Inventory–Human Service Survey), psychological flexibility (Work-related Acceptance and Action Questionnaire, Valuing Questionnaire), depressive symptoms (Patient Health Questionnaire-9), mental illness stigma (Mental Illness: Clinicians’ Attitudes Scale version 4), ACT process knowledge (ACT Check, applied section); adverse events and serious adverse events and adherence (platform completion and engagement metrics), all assessed at prespecified time points. Data will be analysed using mixed-effects models for repeated measures on an intention-to-treat basis.

This protocol was approved by the Nagoya City University Clinical Research Review Board (No. 70-22-0022) and registered with the Japan Registry of Clinical Trials (jRCT1042250024). Results will be disseminated via publications and conference presentations.

jRCT1042250024.

Shared decision-making (SDM) requires that individuals are correctly and smoothly supported to make decisions. However, in Japan, development of decision aids (DAs) to support implementation of SDM is lagging behind Western countries, and there are few reports focused on breast reconstruction. Thus, it is unclear if SDM using a DA in the context of the unique national character and medical culture in Japan is useful in decision-making for breast reconstruction, including whether or not to undergo reconstruction. The aim of this multicentre collaborative study is to investigate the clinical effectiveness of SDM using a DA for patients with breast cancer considering reconstruction, from the perspectives of decisional conflict and postoperative quality of life.

A multisite trial will be conducted at 12 facilities certified by the Japanese Society of Breast Oncoplastic Surgery. A cluster-randomised controlled trial is planned at centres that have implemented SDM with DAs and those that have not implemented SDM, but use a conventional surgical explanation and informed consent to make decisions about reconstruction methods. The study participants will be female patients aged ≥20 years with newly diagnosed stage 0–III breast cancer who are interested in breast reconstruction. Data collection includes baseline and follow-up patient surveys and medical record review. The effectiveness of the DA at reducing conflict and regret in decision-making (primary outcome) will be evaluated using the decision conflict scale.

This protocol has been approved by the Kyoto University Central Institutional Review Board, and permission for performance of the study has been obtained from the Ethics Review Board at each participating centre. We plan to disseminate the findings through journal publications and national meetings, including a presentation of the research results at the Japanese Society of Breast Oncoplastic Surgery. Our findings will advance the science of medical decision-making and have the potential to reduce socioeconomic health disparities.

UMIN000052161.

Ischaemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide. Despite strong recommendations, the implementation rate of outpatient cardiac rehabilitation (CR) in Japan remains low. Mobile health technologies, such as Personal Health Record (PHR) applications combined with wearable devices, may enhance adherence to rehabilitation programmes. This study aims to evaluate the effectiveness of a continuous support programme that integrates a PHR app and counselling services in improving the continuation rate of outpatient CR and exercise tolerance in patients with IHD.

This is a single-blind randomised controlled trial with a parallel-group design. A total of 72 participants with IHD will be recruited from the outpatient departments of Maebashi Red Cross Hospital, Gunma Saiseikai Maebashi Hospital, Okayama University Hospital, Okayama Red Cross Hospital, Momoyama-kai Ono Internal Clinic, Hiroshima University Hospital, Tshuyama Jifu-kai Tsuyama Chuo Hospital and Shinpu-kai Tamashima Chuo Hospital. Participants will be randomly allocated to either the intervention group, which will receive a wearable device, a PHR app, counselling services and a rehabilitation notebook, or the control group, which will receive a wearable device and a rehabilitation notebook without the PHR app and counselling. The primary outcome is the change in peak oxygen uptake from baseline to 150 days. Secondary outcomes include changes in anaerobic threshold, number of outpatient rehabilitation visits, daily steps and vital signs. Data will be analysed using a generalised estimating equations for primary outcomes and appropriate statistical tests for secondary outcomes, following an intention-to-treat approach.

Ethical approval for this study was obtained from the ethics committee of the Kyoto University Graduate School and Faculty of Medicine (C1669-1). In addition, permission to conduct the study was granted by the director of each participating institution. Participants will provide informed consent prior to participation. Findings will be disseminated through peer-reviewed journals, conferences and summary reports to stakeholders.

This trial is registered with the University hospital Medical Information Network (UMIN) Clinical Trials Registry (trial identifier: UMIN000055823).

Depression, affecting 350 million people globally, is notably prevalent among medical students, particularly in South Asia, including Bangladesh. Despite several studies, no meta-analysis has systematically examined the prevalence and contributing factors of depression to address the mental health burden. This systematic review and meta-analysis protocol aims to consolidate findings on the regional prevalence and key risk factors among Bangladeshi medical students.

The research team will search the Medline (Pubmed), Scopus, Web of science, Embase, PsycInfo, BanglaJOL and Google Scholar electronic databases following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines for published studies from their inception till 1^St March 2025, using truncated and phrase-searched keywords and relevant Medical Subject Headings (MeSHs). Observational studies, including cross-sectional, cohort and case-control studies published within the timeframe and following any validated depression assessment tools, with no language restriction, reporting bangladeshi medical students, will be included for the review. Review papers, intervention studies, commentaries, preprints, meeting abstracts, protocols, unpublished studies and letters will be excluded. Two independent reviewers (SS, IA) will screen the retrieved papers using Rayyan, a web-based application, while any disagreements between them will be resolved by a third reviewer (ATS). Exposure will refer to different factors associated with depression among Bangladeshi medical students. Prevalence of depression and associated factors will be extracted. Narrative synthesis (Qualitative information) and meta-analysis (Quantitative data) will be conducted to assess the pooled prevalence using the random-effects meta-analysis (REML) model. For enhanced visualisation of the included studies, forest and funnel plots will be constructed. Heterogeneity among the studies will be assessed using the I ² statistic, sensitivity,and subgroup analyses will be conducted, if necessary, based on study heterogeneity. The quality of the included studies will be assessed using the modified Newcastle-Ottawa Scale (mNOS) tool developed for observational study designs. All statistical analyses and visualization will be conducted using the R studio v.4.3.2 with built-in "meta"-packages and GraphPad Prism v.9.0.2.

This review will analyse existing published evidence. Findings will be submitted to a peer-reviewed journal and disseminated through conferences, policy forums and stakeholders to guide future research and interventions.

CRD 420251006480.

Globally, about 74% of deaths are attributed to non-communicable diseases (NCDs). Tobacco use is one of the key risk factors of NCDs. Tobacco taxes can discourage the use of tobacco. However, how increasing tobacco taxation may reduce the burden of NCDs is not well studied.

This study examines whether higher cigarette taxes are associated with reduced premature deaths—death before the age of 70—from NCDs using multicountry panel data.

The study analysed country-level panel data of 152 countries from 2008 to 2020 collected from various sources. The annual burden of NCDs was measured by the proportion of deaths due to NCDs before age 70 in each country. The tax rate on cigarettes—both specific and total—was used as a key explanatory variable. Other covariates include MPOWER score net of taxes, tobacco prevalence and other country-level characteristics. Panel data regressions with various combinations of country and year fixed effects were used to estimate the association between tobacco taxation and the burden of NCDs.

Cigarette tax was significantly (p

The study provides important evidence that increasing tobacco taxation could be an effective tool in reducing the burden of NCDs. Countries aiming to curb the burden of NCDs could consider raising tobacco taxes.