Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. In the USA, individuals who racially identify as African American or Black experience disproportionately higher rates of TBI and sustain worse prognosis compared with White patients; however, this population continues to be under-represented in contemporary translational research agendas. This protocol aims to comprehensively evaluate and synthesise what is currently known about the molecular epidemiology of TBI outcome among individuals of Black racial identity or African ancestry.

This review will use the established scoping review framework from the Joanna Briggs Institute. The search strategy will be implemented in PubMed (MEDLINE) and expanded to Embase and Cochrane CENTRAL Library (Wiley) databases in the final review. The date range will span from database inception to 20 July 2025 (date of final search). A two-stage screening process will be performed first at the title and abstract level before full-text assessment. Screening will be performed by two independent reviewers and discrepancies will be reconciled by a third reviewer. Articles that meet the following inclusion criteria will be considered: we will include human studies that investigate molecular and biochemical markers associated with TBI outcome. Studies must include individuals who are (A) of Black or African American racial identity, (B) of African ancestry and/or (C) performed in Sub-Saharan African countries. There is no eligibility criteria related to participant age, sex or gender. Eligible studies will be limited to English, Spanish or French. Data extracted from will be analysed and presented as written narrative, summary statistics of study characteristics and graphical or tabular displays.

Ethical approval is not required for this scoping review. The results of this review will be disseminated through peer-reviewed publications and academic conferences.

As the HIV epidemic stabilises in Sub-Saharan Africa with effective antiretroviral therapy, cardiometabolic disorders (CMDs) remain the next major challenge for people living with HIV. Relationship dynamics and spousal support are important for the medical management of single diseases such as HIV, yet little is known about how couples manage the complexity of multiple competing health conditions and their synergistic effects on health. The Healthy Hearts study aimed to develop a conceptual model of dyadic management of HIV and CMDs, inform interventions for couples in Sub-Saharan Africa, and ultimately improve clinical practice and disease management for HIV and CMD comorbidities.

This study will enrol 250 couples who have at least one partner living with HIV and CMD (either hypertension or diabetes) for a prospective observational cohort study. Patients will be recruited from HIV and CMD clinics in Zomba and Blantyre, Malawi. Couples will attend four study visits at quarterly intervals over 12 months. Both partners are given interviewer-administered surveys and complete a clinical assessment. Regression techniques will be used to test associations between key constructs in our conceptual model, including communal coping, multimorbidity illness perceptions, relationship quality, psychosocial health, disease management (eg, adherence to lifestyle advice and medications) and disease outcomes (eg, viral suppression and CMD control). Findings will be used to identify elements to target in a couple-based intervention for CMD and HIV.

This study was approved by the University of California, San Francisco (HRPP (Human Research Protection Program); Protocol number 20–32126), and the National Health Sciences Research Committee of Malawi (Protocol number 21/04/2677). The results will be disseminated at local community meetings and conferences focused on relationships, CMDs and HIV and published in scientific journals.

To assess the knowledge and practices of community pharmacists regarding managing diabetes in fasting patients during Ramadan and the barriers the community pharmacists face when managing diabetic patients who fast in Ramadan.

A survey-based cross-sectional study.

A structured questionnaire was distributed online during April and May 2024.

Community pharmacists who are registered with the Jordan Pharmacists Association and working in Jordan.

The questionnaire consisted of four sections: sociodemographic characteristics, pharmacists’ knowledge of diabetes management during Ramadan, practices in managing diabetic patients during fasting, and barriers encountered in providing care. The knowledge level was classified according to the total score of 13 as poor (0–4), intermediate (5–8) or excellent (9–13). Practice was classified into three categories based on scores: low (0–12), moderate (13–24) and high (25–36). Continuous variables were expressed as mean±SD, while categorical variables were reported as frequencies and percentages. Logistic regression was employed to determine the significant factors influencing the knowledge and practice of pharmacists.

A total of 473 pharmacists participated in the survey. While 9.5% demonstrated excellent knowledge, the majority (72.3%) had intermediate knowledge, and 18.2% showed poor understanding of diabetes management during Ramadan. Key gaps in knowledge were in risk stratification, dose adjustment and patient counselling. Assessment of diabetes management practices revealed that most pharmacists demonstrated high practice levels (58.1%), while 35.1% showed moderate, and only 6.8% had poor practice. Assessment of diabetes management practices revealed that most pharmacists demonstrated high practice levels (58.1%), while 35.1% showed intermediate, and only 6.8% had poor practice. The least frequently performed practices were stratifying patients by their fasting risk level and adjusting medication doses for fasting patients. Pharmacists reported barriers to providing effective care, such as time constraints, high workload, lack of educational resources and insufficient clinical knowledge.

The study reveals moderate knowledge and high practice levels among community pharmacists in Jordan regarding diabetes management during Ramadan. However, gaps in medication adjustments and patient risk stratification remain. Continuous professional development programmes are needed to enhance pharmacists’ knowledge and skills in these areas. Strengthening pharmacy resources, such as access to updated guidelines and patient education tools, can support better care practices. Future research should explore interprofessional collaboration, compare practice settings and regions, and employ qualitative and interventional study designs to deepen understanding and improve management of diabetes during Ramadan.

To assess the incidence of delirium and its predictors among adult patients admitted to the intensive care units of comprehensive specialised hospitals in the Amhara region of northwest Ethiopia from 18 October 2024 to 20 February 2025.

A multicentre prospective observational study was conducted.

Four comprehensive specialised hospitals in the Amhara region of northwest Ethiopia, from 18 October 2024 to 20 February 2025.

A total of 351 patients were included in the final analysis during the study period.

The primary outcome measure of this study was the incidence of delirium. Additionally, the study investigated the factors associated with delirium incidence among adult patients admitted to intensive care units.

The incidence of delirium among adult patients in intensive care units was 42.17% (95% CI: 37.08 to 47.42). Pain (adjusted HR (AHR) = 4.74; 95% CI: 2.38 to 9.44), mechanical ventilation (AHR = 2.96; 95% CI: 1.56 to 5.63), age 65 years or older (AHR = 2.18; 95% CI: 1.48 to 3.21) and agitation (Richmond Agitation-Sedation Scale (RASS) ≥1) (AHR = 3.26; 95% CI: 2.09 to 5.09) were statistically significant factors associated with delirium.

In the present study, more than one-third of patients developed delirium. Pain, mechanical ventilation, age 65 or older and agitation (RASS≥1) were significantly associated with delirium occurrence. To reduce the incidence of delirium, the current study recommends treating or preventing pain and agitation. Additionally, special attention should be given to patients receiving mechanical ventilation and those aged 65 or older during care.

Despite the abundant evidence showing the benefits of muscle-strengthening exercise (MSE), no epidemiological tool is available for assessing MSE among Indonesian university students. This study is the first to adapt the Muscle-Strengthening Exercise Questionnaire (MSEQ) from its original English version into another language, specifically Indonesian, incorporating cultural adaptations and to pilot test it to assess its validity and reliability among university students in Indonesia.

Translation and cultural adaptation, content validity studies, concurrent validity studies and reliability studies were conducted following COnsensus-based Standards for the Selection of Health Status Measurement INstruments guidelines. Content validation, conducted with three experts and nine university students, informed the development of the MSEQ Indonesian version. The concurrent validity study compared the results of measuring MSE frequency, intensity, duration and volume with those of the 7-day diary and relative handgrip strength with 22 respondents for concurrent validity against subjective measurement and 70 respondents for concurrent validity against objective measurement. For the reliability study, 39 respondents were asked to fill the MSEQ Indonesian version twice with a time interval of 7 days.

The study involved 143 participants, including experts and university students from three universities across two different islands in Indonesia.

Single administration MSEQ, consecutive administration MSEQ and 7-day diary recording resulted in 0%, 33.8% and 68.5% dropout rate, respectively. Moderate-to-strong correlations were observed between the results for the weekly frequency, duration, intensity and volume of MSE and those of the 7-day diary and hand grip strength. Test–retest reliabilities were good to excellent for machine weight, holistic and overall MSE but poor for bodyweight MSE. In assessing the target muscle group, the MSEQ Indonesian version showed good test–retest reliability for machine-weight MSE but poor-to-very good test–retest reliability for bodyweight, free weight and holistic MSE.

Our study demonstrated the acceptable validity and reliability of the Indonesian version of the MSEQ for assessing MSE among university students in Indonesia, not only by comparing each dimension of MSE with subjective measures but also by comparing MSE volume with objective measures. To enhance the generalisability of these findings, future studies should assess the MSEQ Indonesian version in diverse adult populations by considering dropout rates found by our study, ensuring its broader applicability and sample size adequacy.

Targeted oxygenation protocols in mechanically ventilated patients are critical in avoiding the deleterious effects of hypoxaemia and hyperoxaemia. Peripheral oxygen saturation (SpO2) is a practical metric that commonly drives oxygen titration protocols and guidelines but has inaccuracies attributable to patient variability that can lead to occult hypoxaemia. Conversely, arterial oxygen saturation (SaO2) offers accuracy but is costly and invasive. We aim to develop a novel approach to targeted oxygenation that collectively uses the accuracy of SaO2 and the feasibility of SpO2 to mitigate occult hypoxaemia and prevent hyperoxaemia.

The Optimization of Inspired Oxygen during Mechanical Ventilation trial is a pragmatic stepped wedge, open label, cluster-randomised controlled trial of an algorithm-based SpO2-SaO2 electronic alert-based oxygen titration protocol. The intervention arm includes targeted oxygenation via an electronic SpO2-SaO2 driven alert protocol. The control group will be subjected to oxygen titration according to standard practice. Within the intervention arm, patients will be assigned to groups with different SpO2 targets based on the degree of SpO2-SaO2 difference. In the ‘Conserve O2’ group, where SpO2SaO2 by 1–2%, electronic alerts will be used to titrate FiO2 to a target SpO2 of 90–94%. In the ‘Boosted O2’ group, where SpO2>SaO2 by 3–5%, electronic alerts will be used to titrate FiO2 to a target SpO2 of 93–97%. Patients with an SpO2-SaO2 difference >5% in either direction will be monitored but not assigned to either group. The sample size to determine efficacy is 1620 subjects, randomised over 60 weeks. The primary outcome is the proportion of time during mechanical ventilation spent within the target range, SpO2 of 90–94% (Conserve O2) or SpO2 of 93–97% (Boosted O2) at any FiO2. Secondary outcomes include the proportion of time with SpO2 >94% or SpO2 >97% with FiO2 ≤0.4 within each respective algorithm, the proportion of time with SpO2

The protocol was approved by The Ohio State University Institutional Review Board (Protocol # 2023H0016) and is registered at ClinicalTrials.gov (NCT 05923853). Progress and safety of the trial are monitored by an independent Data and Safety Monitoring Board. Study results will be published in peer-reviewed medical journals. This study is being carried out with a waiver of consent as participation in the study presents no more than minimal incremental risk compared with routine clinical care for mechanically ventilated critically ill adults outside of the study.

NCT05923853.

Childhood obesity is a global public health concern, drawing widespread attention for its negative impact on children’s health. While the determinants are multifaceted, limited information exists on the impact of cultural beliefs and parental feeding practices in the context of childhood obesity in Ghana. The primary objective of this exploratory study was to investigate the influence of cultural beliefs and parental feeding practices on obesity among schoolchildren in Ghana.

Data for the study were collected through an online interview and focus group discussion from a purposively sampled 60 respondents. An audio recording device was used to compile information shared with respondents during the interview and focus group discussion, both held remotely over the internet. Following Braun and Clarke’s procedure for analysing data, audio-recorded information was transcribed verbatim using Microsoft Word. Vital information to address research questions was assigned codes for collation. Similar codes were collated to form subthemes and major themes which aligned with the Attride-Stirling transcription approach of thematic analysis.

Four themes emerged from data analysis: parental beliefs and perception of weight and feeding practices; evolving dietary practices; the impact of westernisation and socioeconomic status; and lifestyle at home and obesogenic environments. The cultural inclination towards considering obesity as a sign of a ‘well-fed child’ was evident, and traditional feeding practices were found inadequate, necessitating supplementation with modern approaches. Additionally, factors such as digital media, limited playing space and sedentary behaviours facilitated by transportation to school and easy access to electronic devices contributed to obesity among schoolchildren.

While parents actively promoted mixed food diets, this often conflicted with nutritional needs. Parents also inadvertently encouraged sedentary behaviours hindering physical activity and contributing to weight gain among children. The study highlighted the challenges posed by cultural beliefs on body image and modern influences, necessitating a comprehensive understanding to formulate effective interventions to address childhood obesity in the Ghanaian context.

To assess the severity of anaemia and associated factors among drug-resistant tuberculosis (DR-TB) patients treated in DR-TB treatment-initiating centers in Addis Ababa, Ethiopia.

A retrospective cross-sectional study.

This study was conducted in Alert and St. Peters specialised hospitals, Addis Ababa, from 20 September to 15 October 2022.

Data was collected from 331 patients with DR-TB. The data was entered into Epi-Data 4.1, and SPSS version 25 was used for data cleaning and analysis. A multinomial logistic regression model was fitted after the multi-collinearity assumptions, and goodness-of-fit tests were done. The OR with 95% CI was reported for each outcome variable, taking normal haemoglobin level as a reference category. Variables with a P value of 0.05 were considered statistically significant.

Of the 331 patients, 51.4% had baseline anaemia, of which 5.7%, 15.7% and 29.9% had severe, moderate and mild anaemia, respectively.

Patients who were urban residents (AOR: 0.06, 95% CI: 0.012, 0.32), government employees (AOR: 0.33, 95% CI: 0.001, 0.79), private job holders (AOR: 0.02, 95% CI: 0.001, 0.27), undernourished (AOR: 15.72, 95% CI: 2.46, 100.28), patients with HIV (AOR: 7.28, 95% CI: 1.627, 32.628) and farmers and students (AOR: 0.05, 95% CI: 0.004, 0.58) were significantly associated with severe anaemia.

Patients who were male (AOR: 0.31, 95% CI: 0.11, 0.93), single (AOR: 0.19, 95% CI: 0.04, 0.85), daily labourer (AOR: 6.19, 95% CI: 1.27, 30.2), undernourished (AOR: 12.83, 95% CI: 4.88, 33.7) and patients with HIV (AOR: 12.74, 95% CI: 4.67, 34.75) were significantly associated with moderate anaemia. Patients with undernutrition (AOR: 3.92, 95% CI: 2.1, 7.35), HIV (AOR: 2.79, 95% CI: 1.22, 6.39) and primary and secondary education (AOR: 0.36, 95% CI: 0.17, 0.77) were significantly associated with mild anaemia.

In our study, more than 50% of patients with DR-TB had baseline anaemia, of which mild anaemia was the most common typeanaemia. Rural residents were at a higher risk of developing severe anaemia (11.5%), while the overall rate of anaemia (58.8%) was higher among urban residents.

Non-adherence to antidiabetic medication remains a major barrier to achieve optimal health outcomes among individuals with diabetes, particularly in developing countries. This issue exacerbates poor health outcomes and leads to the wastage of limited healthcare resources.

This study aimed to assess the prevalence of non-adherence to antidiabetic medications and identify associated factors among adult type 2 diabetes mellitus (DM) patients in the North Wollo zone.

An institutional-based cross-sectional study.

The study was conducted in three randomly selected public hospitals in the North Wollo zone: Woldia Comprehensive Specialized Hospital, Lalibela General Hospital and Mersa Primary Hospital.

A total of 327 adult type 2 DM patients receiving follow-up care were included. Participants were selected proportionally from each hospital using consecutive sampling. Inclusion criteria included individuals aged ≥18 years, on antidiabetic treatment for at least 6 months and actively on follow-up care during the study period. Patients with hearing impairment, severe illness or incomplete medical records were excluded.

Adherence was assessed using the Morisky Medication Adherence Scale-8, a validated eight-item, self-reported questionnaire. Scores ranged from 0 to 8, with adherence levels classified as high (≥8), medium (6–7.75) and low (

Data were analysed using SPSS V.27. Descriptive statistics were used to summarise the data, and multivariable logistic regression analysis was performed to identify factors associated with non-adherence. A p value ≤0.05 was considered statistically significant.

The overall prevalence of medication non-adherence was 24.5%. Factors significantly associated with non-adherence included living with diabetes for less than 3 years (adjusted OR (AOR) 3.37, 95% CI 1.91 to 5.95), residing in rural areas (AOR 2.67, 95% CI 1.49 to 4.79), having comorbidities (AOR 2.99, 95% CI 1.67 to 5.34) and having no formal education (AOR 3.26, 95% CI 1.49 to 7.00).

The prevalence of non-adherence to antidiabetic medications (24.5%) exceeded the widely accepted benchmark of ≤20%. Key factors such as rural residence, comorbidities, lower education levels and shorter duration since diagnosis were significantly associated with non-adherence. These findings underscore the need for targeted interventions, including patient education, improved rural healthcare access and integrated care models, to enhance adherence and diabetes management outcomes.

To estimate the recurrence of hypoglycaemia and the associated factors in neonates with birth asphyxia admitted to the neonatal intensive care unit in Northwest Amhara region’s comprehensive specialised hospitals, Northwest Ethiopia, in 2024.

A multicentre, institution-based, retrospective follow-up study.

Tertiary hospitals in Northwest Amhara Regional State, Northwest Ethiopia, from 1 July 2020 to 30 July 2024.

A total of 761 neonates with perinatal asphyxia were admitted to the neonatal intensive care unit of selected public hospitals in Northwest Amhara from July 2020 to July 2024.

The primary outcome measure of this study was recurrence of hypoglycaemia. Furthermore, the factors associated with recurrence of hypoglycaemia in newborns with perinatal asphyxia were noted.

The average number of hypoglycaemia cases among neonates with birth asphyxia was 2.05 (95% CI 1.939, 2.163) over the 28-day follow-up period. Meningitis (adjusted incidence rate ratio (AIRR)=1.16; 95% CI 1.04, 1.30), feeding in less than 72 hours (AIRR=1.17; 95% CI 1.05, 1.31), stage 3 hypoxic-ischaemic injury (AIRR=1.20; 95% CI 1.04, 1.39), length of hospital stay (AIRR=1.01; 95% CI 1.01, 1.03) and macrosomia (AIRR=1.39; 95% CI 1.19, 1.63) were significant factors associated with recurrence of hypoglycaemia.

The current study indicated that the mean recurrence of hypoglycaemia in newborns experiencing perinatal asphyxia was considerably higher. Presence of neonatal meningitis, delayed initiation of feeding 72 hours after birth, stage 3 hypoxic-ischaemic injury, length of hospital stay and macrosomia were the key factors associated with recurrence of hypoglycaemia.