Developmental regression is when children lose one or more skills they have established. Families caring for these children need timely recognition to assist diagnosis and tailored interventions. Families also need support to develop practical skills for caregiving and strategies to promote family well-being and community participation. Given the high caring demands, flexibly delivered approaches are needed to accommodate family routines. Online delivery of health-related interventions that provide coaching, information, or both has been found to be a feasible and effective option for families. Family Focus is a new family-centred online programme, co-designed with parents and family advocates, clinicians, and researchers to support and empower primary carers.

This study is a prospective, pragmatic randomised controlled trial comparing the effectiveness of online parent coaching plus Family Focus (Coaching+FF) to Family Focus alone (FF) for primary carers of children experiencing developmental regression. A sample of 56 families will be randomised in a 1:1 ratio. Outcomes are assessed at baseline, post-intervention and 12-month post-randomisation. The primary outcome is parental stress symptoms at post-intervention. Secondary outcomes include parental depressive and anxiety symptoms, parental engagement in health-promoting activities, family empowerment, family quality of life and child global health outcomes. The study will also examine the uptake and acceptability of specific coaching and FF components and explore the facilitators and barriers to their delivery and implementation.

Ethics approvals were obtained from the participating organisations (Monash Health HREC/107806). Informed consent is obtained from parents/guardians of children prior to study enrolment. Study findings will be disseminated through peer-reviewed publications, conference presentations and lived experience agencies.

ISRCTN25513446.

The United Nations (UN) Sustainable Development Goal 6 seeks to ensure universal access to safe drinking water by 2030, but vast inequities in access exist, especially among vulnerable communities including limited resource, rural, disaster-affected areas. Flood disasters, exacerbated by the climate crisis, hinder the ability of individuals and families to meet essential drinking water needs and increase their susceptibility to waterborne illnesses. Point-of-use (POU) water treatment is an effective solution for water-insecure populations during and immediately following flood emergencies. However, an initial literature search identified knowledge gaps surrounding implementation of POU water systems. This scoping review aims to synthesise published evidence between January 2015 and July 2025 on barriers and facilitators to utilisation of POU water treatment systems during and immediately following flood-related disasters. The findings will inform efforts to promote resilience and agency among water insecure communities, specifically by equipping them with actionable knowledge on sustainable access to safe drinking water.

This scoping review will be guided by the work of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Search terms will be identified through an iterative process using the PICOT method and Boolean logic. Four databases—Scopus, PubMed, Web of Science and Google Scholar—with the addition of grey literature from UN agencies and non-governmental organisations focused on water-related issues will be searched. Two independent reviewers will apply a priori eligibility criteria to select studies. Conflicts will be resolved through discussion and a third independent reviewer absent agreement between the first two reviewers. Cohen’s kappa statistic will be calculated to assess inter-rater reliability. Data extraction will be guided by predefined data points, and the Consolidated Framework for Implementation Research will guide evidence synthesis through a solution-based approach.

Institutional research ethics review is not required because no human subjects are involved. Findings will be disseminated through a peer-reviewed publication, a policy brief, conference presentations and infographics for use by organisations serving flood disaster impacted communities.

Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases, and a relationship between altitude and hypertension has been demonstrated. To better characterise this relationship, this study investigated the prevalence of hypertension and its association with altitude in community-dwelling older adults living at different altitudes in Xinjiang, northwest China.

A cross-sectional study.

Xinjiang, China.

50 778 community-dwelling older adults residing at varying altitudes across Xinjiang.

A multistage stratified sampling method was used to conduct an epidemiological survey from January 2019 to December 2019 among 50 778 community-dwelling older adults aged ≥60 years who were long-term residents of Kashgar (1289 m), Hami (738 m) and Turpan (35 m), Xinjiang. Logistic regression analysis was conducted to evaluate the association between altitude and hypertension risk.

Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) showed significant variations (both p

In community-dwelling older adults residing in lowland to mid-elevation zones (35–1289 m) of Xinjiang, the prevalence and risk of hypertension were found to be inversely associated with residential altitude. These findings may reflect an environmental gradient effect specific to mid-to-low altitude settings, and their generalisability may be limited to populations at higher altitudes (>1500 m) or regions with distinct ethnic, genetic or healthcare backgrounds. Furthermore, it should be emphasised that this association likely reflects altitude-related environmental factors rather than direct physiological effects of hypoxia. Additional studies are warranted to further elucidate these complex relationships.

Gambling encompasses all activities that involve betting or wagering money. It is highly prevalent both in Canada and worldwide. While most individuals gamble without experiencing harm, some develop problem gambling, which is associated with serious psychological, relational and financial outcomes. Sexual and gender diversity (SGD) populations experience disproportionately high rates of mental health disorders, although little is known about their gambling trajectories. Knowledge in this regard is mainly based on cross-sectional studies, with no longitudinal evidence being available internationally. This gap in the literature restricts understanding of how problematic gambling emerges and evolves among SGD populations. It also limits the development of prevention and harm reduction strategies tailored to their realities.

This five-year longitudinal study will use a mixed-methods explanatory and sequential design in two phases. The first phase is a prospective cohort study. A self-report questionnaire will be administered online via a web panel to Canadian residents who are 18 years of age or older, self-identify as SGD and have gambled at least once in the previous 12 months (n=2500). This survey will be repeated annually over the course of three years to describe respondents’ gambling habits, model their trajectories and identify factors associated with problematic gambling. The second phase is a descriptive qualitative study. Semi-structured interviews will be conducted with respondents from phase 1 who present problematic gambling (n=40) to explore their experiences and lived realities.

This research project has been ethically and scientifically approved by the Research Ethics Committee and by the CIUSSS de l’Estrie—CHUS scientific evaluation committee on November 3, 2025 (reference number: 2026-6060 Trajectoires-JHA-LGBTQ). For all phases of the study, written or verbal consent will be obtained from each participant. A copy of the consent form and contact information will be sent to each participant.

To develop a core information set for induction of labour. Rates of induction of labour for childbirth are rising in many high-income countries. In England, a third of women have their labours induced. National guidelines recommend women receive information to make informed decisions about induction.

Two-stage consensus study using modified Delphi.

UK.

Pregnant people, parents and professionals.

Stage 1: A long list of information points was identified through a systematic review of reviews, reviewing patient leaflets, qualitative interviews and a stakeholder survey, with ongoing patient, public and professional involvement. Stage 2: Think-aloud interviews were undertaken to refine the Delphi survey before a two-round modified Delphi process where participants voted on the importance of the information items. Pre-specified criteria were used to select items taken forward to a consensus meeting.

199 information points were identified through systematic review (110), patient information leaflets (162), qualitative interviews (58) and a survey (93). 46 unique information items entered the first Delphi round after four think-aloud interviews, 2 items were added following round 2. 368 people (310 parents/58 professionals) participated in round 1 and 177 people (154 parents/23 professionals) in round 2. 44 items met inclusion criteria; one item excluded, and three items were carried forward for consensus meeting discussion where 12 overarching information points were agreed on.

This study has established a consensus-based core information set for induction of labour from a sample of the birthing population and staff providing their care. The resultant set has been populated with evidence in line with national guidelines. It can be used by women and clinicians as a standardised starting point from which to personalise discussions about birth.

COMET Initiative registration 2600: Developing a core information set for induction of labour.

Teenage pregnancy is a major public health problem with huge consequences for maternal health and pregnancy outcomes. This calls for a concerted effort from different stakeholders involved in issues of teenagers’ sexual reproductive health to achieve the SDG target of 2030 on the reduction of maternal mortality. The objective of this systematic review was to estimate the prevalence of teenage pregnancy and its associated factors in Uganda.

We conducted a systematic review and random-effects meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-analysis standards.

After prospective registration (PROSPERO CRD42023486460), a literature search was conducted in PubMed, African Journals Online and Google Scholar in December 2023.

Observational studies that reported the prevalence of teenage pregnancy among teenagers were included.

Articles were screened for relevance at the title, abstract and full-text levels by multiple reviewers. The quality of studies was independently appraised using the Joanna Briggs Institute Critical Appraisal Checklist and Newcastle-Ottawa Scale. Any discrepancies were resolved by reaching a consensus. The process of extracting data included study information, geographical categorisation, type of studies, population, sample size, results/outcomes and prevalence of teenage pregnancy. The risk of bias was determined by Egger’s test. The results were pooled using random-effects models to calculate the prevalence of teenage pregnancy with a CI of 95% and I² statistic.

Of 918 records screened, 10 studies (4143 participants) were included. The pooled prevalence of teenage pregnancy was 25.5% (95% CI 13.7% to 39.5%; I²=98.9%), with individual study estimates ranging widely from 3.0% to 56.4%, reflecting substantial heterogeneity across study settings, populations and periods of data collection. Higher estimates were observed in the Central–Eastern region (31.7%, 95% CI 19.5% to 45.1%). The overall certainty of evidence was rated as very low using the Grading of Recommendations, Assessment, Development and Evaluation framework, primarily due to very serious inconsistency across included studies (I²=98.9%).

Pooling studies of mixed quality revealed a slightly higher prevalence of teenage pregnancy in Uganda. This review provides valuable insight for policymakers and healthcare providers in developing interventions and policies to reduce the burden of teenage pregnancy from disadvantaged backgrounds.

CRD42023486460.

Adnexal surgery is one of the most common surgeries performed in women. Minimally invasive methods are on the rise globally as they have been shown to decrease surgical morbidity compared with abdominal surgery. Adnexal surgery by vaginal natural orifice transluminal endoscopic surgery (vNOTES) is the latest innovation. It combines the vaginal approach and endoscopy via the vagina. Large pragmatic randomised controlled trials (RCTs) are lacking comparing outcomes after vNOTES and conventional laparoscopy.

A multicentre pragmatic RCT aiming to recruit 200 women aged 18 years and above undergoing adnexal surgery for benign disease or prophylactic reasons. Patients will be randomised to vNOTES or laparoscopy. Recruitment will start Q4 2025, and the study is estimated to end 2028.

The primary outcome is postoperative pain. Secondary outcomes are units of postoperative opioid and non-opioid analgesics used, perioperative complications, operation time, postoperative complications, readmission, conversion rate and the surgeon’s experience.

The national Swedish ethical board at the main centre, Helsingborg Hospital, Sweden, has given ethical agreement (dated 20 March 2025). Before including patients, all centres will require local or national ethical approval. The results of the study will be published in international peer-reviewed journals.

NCT06964594.

Diabetic foot ulceration represents a prevalent, persistent and resource-intensive complication of diabetes. These ulcers are slow to heal, prone to recurrence and impose a substantial burden on both patients and healthcare providers. The reducing the impact of diabetic foot ulcers (REDUCE) intervention has been designed as a multifaceted approach targeting psychological and behavioural determinants linked to diabetic foot ulcer (DFU) outcomes. Following a successful pilot trial, the REDUCE trial has been designed as a pragmatic, multicentre randomised trial to compare the effectiveness and cost-effectiveness of the REDUCE intervention plus usual care versus usual care alone in reducing recurrence in people with healed DFUs. Additionally, there is an embedded process evaluation and two sub-studies which will be carried out alongside the main trial.

Adults over 18 years of age, with a recently healed DFU and two lower limbs, will be identified from around 30 specialist multidisciplinary diabetic foot clinics at participating National Health Service Trusts in the UK. Patients with active Charcot neuro-osteoarthropathy, active DFU or ulcers healed for more than 12 weeks will be excluded. We will aim to recruit 544 participants (1:1 randomisation). The primary outcome for this trial will be total ulcer-free days with limbs intact (ie, without amputation) between randomisation and the end of follow-up (18 months post-randomisation). Secondary outcomes include time to re-ulceration, total number of ulcers, amputation, quality of life (EQ-5D-5L), Patient Health Questionnaire-9, Nottingham Assessment of Functional Footcare, ICEpop capability measure for adults and resource use. As part of the process evaluation, up to 20 REDUCE intervention patient-participants will be interviewed, and the healthcare professionals delivering the intervention will also be interviewed. An assessment of intervention fidelity will also be carried out.

Ethics approval was granted by Wales 3 Research Ethics Committee (REC reference 22/WA/0053) on 16 March 2022. The findings will be presented at relevant conferences and disseminated via peer-reviewed research publications and to relevant stakeholders.

ISRCTN15570706.

Misophonia is a newly recognised sound sensitivity disorder with clinically significant symptoms affecting up to 18% of the population. It is characterised by extreme negative reactions to specific sounds which are often repetitive and generated by the human oral-nasal tract (eg, sniffing and eating sounds). Although misophonia currently has no standard treatment, research suggests that transcutaneous auricular vagus nerve stimulation (taVNS) holds promise therapeutically. This study aims to investigate both the effects of 4 weeks taVNS (compared with sham) on misophonia and related symptoms as well as its underlying neurophysiological mechanisms. To our knowledge, this is the first trial on taVNS in misophonia.

This is a single-centre double-blind sham-controlled trial in which 60 participants with clinically significant misophonia are randomly allocated in a 1:1 ratio to receive taVNS or sham stimulation. The intervention will be self-administered over 4 weeks (two times per day for 30 mins each). The primary efficacy outcome is self-reported misophonia severity with secondary outcomes, including mental health and audiological symptoms. In addition, all participants will undergo preintervention and postintervention testing, including MRI and physiology to investigate neurophysiological mechanisms underlying taVNS effects.

The study has been approved by the Brighton and Sussex Medical School ethics board (ER/GLP28/4). Results will be submitted for publication in peer-reviewed journals. Data will be anonymised and made available for sharing after completion of the study.

This trial is registered in ISRCTN; ISRCTN79500062.

Depression is up to four times more common among individuals with cancer compared with the general population. Psychological therapies are effective in treating depression among patients in cancer care, but access is often delayed, which can exacerbate symptoms, increase dropout and reduce therapeutic effectiveness. This study evaluates the clinical and cost-effectiveness of a therapy preparation intervention (TPI) designed to enhance engagement and outcomes among patients awaiting psychological therapy in cancer care.

This study is a parallel-group, two-arm, multicentre, single-blind randomised controlled trial. A total of 150 adults (≥18 years) living with or beyond cancer and experiencing moderate-to-severe depression will be recruited from health services in the East Midlands region of England. Participants will be randomised (1:1) to receive either TPI plus treatment as usual (TAU) or TAU alone.

The primary outcome is depression severity measured using the Patient Health Questionnaire 9-items (PHQ-9) over a 24-week follow-up. Secondary outcomes include anxiety, functioning, mental well-being, patient activation, readiness for change, health-related quality of life and health economics, and therapy engagement including attendance and dropout. Hope and in-session patient activation, assessed using recorded treatment preparation sessions, will be explored as additional mechanistic variables. Health economic outcomes will be assessed at baseline and 24 weeks. Data will be collected via online or telephone surveys at baseline, and at 4, 8, 12 and 24 weeks post randomisation. Qualitative interviews with a subset of participants will explore intervention experiences, analysed using reflexive thematic analysis.

Ethical approval has been obtained from the Health Research Authority and National Health Service Research Ethics Committee (Bromley) (REC reference: 24/LO/0610). Findings will be disseminated through peer-reviewed journals, academic conferences and clinical and patient networks.

ISRCTN registry: ISRCTN13692666, registered on 18 October 2024.

Midwives/nurse midwives are the healthcare professionals most often present on the birth scene. However, they have been the professionals who are most justified to defend their legally established position by arguing their competence and autonomy. Thus, it is important to show their reality through experiences, particularly when autonomy does not

align with regulations. This meta-synthesis aims to bring together scientific evidence regarding midwife/nurse midwife’s autonomy experience in caring for labouring women in health facilities.

The meta-aggregation will be used to conduct a systematic review of qualitative studies. In January 2025, a search was carried out in scientific databases: EBSCOhost (CINAHL Ultimate, MEDLINE Ultimate and Academic Search Complete), LILACS, PubMed, Wiley Online Library, Scopus and Web of Science. The articles will be independently reviewed by two authors who will assess data quality, extraction and synthesis. Studies will be assessed for rigour using critical appraisal tools provided by the Joanna Briggs Institute. Data extraction and synthesis will be carried out using software, and results will be presented in tables. The results of the qualitative research will, where possible, be grouped according to the meta-aggregation approach proposed by the Joanna Briggs Institute.

Ethical approval to analyse secondary data is not required. The results will be published in peer-reviewed journals and presented at international and national conferences.

CRD42024572542

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.

To explore priorities, barriers to and experiences of palliative and end-of-life care from the perspectives of people living with HIV.

Cross-sectional online survey conducted in the UK between September 2024 and November 2024.

Online survey of people living with HIV.

The sample (N=90) was adults living with HIV in the UK. The majority of participants were male (82.4%), gay men (77.8%) and white (88.1%).

The majority of participants (58.9%) reported knowing what palliative care was and that they could explain it to someone else; however, a misconception about palliative care being only for the end of life was evident. Over a quarter of respondents (27.8%) reported that their HIV status ‘Sometimes’ negatively affected their experiences of care in general practitioner, hospital and dental settings. The top three priorities for end of life were (1) being in a calm atmosphere, (2) being free of pain and (3) support with psychological well-being. Not being judged was also identified as a priority.

To promote integration of palliative and end-of-life care into care pathways for people living with HIV, partnerships with HIV services and charities may be needed as well as tailored messaging and training for staff in generalist services.

To explore barriers and facilitators to midwifery practice of intermittent auscultation according to national guidance in the UK.

Multisite ethnographic study using observations of practice, semistructured interviews and informal conversations. Framework analysis using the Consolidated Framework for Implementation Research (CFIR).

11 maternity units across seven NHS maternity services in England and Wales in 2024.

Midwives and other maternity care professionals involved in fetal monitoring during labour.

‘Intermittent auscultation’ (IA), or listening to the fetal heart rate at regular intervals, to monitor fetal well-being during active labour.

Not applicable.

IA monitoring was frequently observed to be marginalised due to national and local pressures. IA is a complex skill that requires expertise and practice to develop and maintain. However, lack of a robust evidence base for IA methods is a further barrier to implementation. The study uncovered examples of facilitators that include: leadership engagement, access to knowledge and information supported in mentorship programmes and peer support models. These features created micro-environments where IA was valued, supported and integrated into care.

Our study highlights the significant impact of multilevel factors on the implementation of IA within UK maternity care. However, when organisational readiness, strong leadership engagement and supportive conditions are present, IA can be delivered in accordance with guidance. These findings underscore the need to align policy, infrastructure and organisational culture to sustain evidence-based, woman-centred practices such as IA.