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Commentary on: Reason M, Acton K, Foulds D. Working it out together: Lessons and insights into inclusive research in an arts context. British Journal of Learning Disabilities 2024:1–11.
Implications for practice and research Inclusive research places a strong emphasis on the active empowered participation, particularly in decision-making and agenda-setting, of marginalised/disadvantaged community members in every step of the research process. Implementation research needs to focus on how research methodologies can be democratised through a continuous commitment to allyship with marginalised/disadvantaged populations towards empowered involvement.
Research in the field of learning disabilities has been influenced by ableist practices, often excluding individuals with learning disabilities and autism from the research process. This exclusionary tradition, which also has been observed in research with other marginalised/disadvantaged groups, has diminished their capacity to drive change within their communities.
Our primary objectives were (1) to develop and validate an administrative data algorithm for the identification of hand trauma cases using clinical diagnoses documented in medical records as the reference standard and (2) to estimate the incidence of hand trauma in a universal public healthcare system from 1993 to 2023 using a population-based research cohort constructed using a validated case identification algorithm.
A population-based retrospective validation study.
Ontario, Canada, from 2022 to 2023 (validation) and from 1993 to 2023 (estimation).
Our reference standard was the known hand trauma status of 301 patients (N=147 with hand trauma) who presented to an urban tertiary-care hand trauma centre in Toronto, Ontario.
(1) The sensitivity, specificity, positive and negative predictive values of the optimal algorithm to identify hand trauma using provincial health administrative data and (2) age-standardised and sex-standardised incidence rates of hand trauma among men and women, by age, and by area of patient residence.
The optimal algorithm had a sensitivity of 73.8% (95% CI 66.6% to 81.0%), specificity of 80.1% (95% CI 73.8% to 86.5%), positive predictive value of 78.1% (95% CI 71.2% to 85.0%) and negative predictive value of 76.1% (95% CI 69.5% to 82.7%). Over the study period, the age-standardised and sex-standardised incidence of hand trauma increased from 384 to 530 per 100 000. The greatest increase was observed in males and individuals aged 0–19 and 80+, with higher incidence rates in Southern compared with Northern Ontario.
Our algorithm enabled identification of hand trauma cases using health administrative data suitable for population-level surveillance and health services research, revealing a rising burden of hand trauma from 1993 to 2023. These findings can support improved surveillance, resource allocation and care delivery for this public health problem.
Countries face challenges in maternal and newborn care (MNC) regarding costs, workforce and sustainability. Organising integrated care is increasingly seen as a way to address these challenges. The evidence on the optimal organisation of integrated MNC in order to improve outcomes is limited.
(1) To study associations between organisational elements of integrated care and maternal and neonatal health outcomes, experiences of women and professionals, healthcare costs and care processes and (2) to examine how the different dimensions of integrated care, as defined by the Rainbow Model of Integrated Care, are reflected in the literature addressing these organisational elements.
We included 288 papers and identified 23 organisational elements, grouped into 6 categories: personal continuity of care; interventions to improve interdisciplinary collaboration and coordination; care by a midwife; alternative payment models (non-fee-for-service); place of birth outside the obstetric unit and woman-centred care. Personal continuity, care by a midwife and births outside obstetric units were most consistently associated with improved maternal and newborn outcomes, positive experiences for women and professionals and potential cost savings, particularly where well-coordinated multidisciplinary care was established. Positive professional experiences of collaboration depended on clear roles, mutual trust and respectful interdisciplinary behaviour. Evidence on collaboration interventions and alternative payment models was inconclusive. Most studies emphasised clinical and professional aspects rather than organisational integration, with implementation barriers linked to prevailing biomedical system orientations.
Although the literature provides substantial evidence of organisational elements that contribute to improved outcomes, a significant gap remains in understanding how to overcome the barriers in sustainable implementation of these elements within healthcare systems. Interpreted through a systems and transition science lens, these findings suggest that strengthening integrated maternity care requires system-level changes aligning with WHO policy directions towards midwifery models of person-centred care.
A healthy diet is a crucial component for adolescents’ health and wellbeing. Current literature surrounding dietary intake and its effect on cognition, mental health and wellbeing has mainly focused on children, not adolescents. This review aims to synthesise findings from studies that explore the relationship between dietary intake and cognition, mental health and wellbeing in the adolescent population.
Electronic searches will date from 1 January 2000 to 7 October 2024 and will be conducted in CENTRAL, MEDLINE/PubMed, CINAHL via EBSCOHOST, ERIC, British Education Index, Child and Adolescent Studies, Education research complete, Psychology and Behavioural Sciences Collection, Social Policy and Practice Embase, and APAPsychINFO via OvidSP. Articles will be screened using defined inclusion and exclusion criteria and assessed for eligibility by five independent reviewers. Discrepancies will be reviewed by a third reviewer. The selection process of included articles will be reported by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. A narrative summary will be used to report and synopsise the extracted data.
This systematic review does not require ethical approval. The dissemination strategy for this review comprises peer-reviewed publications, public health conference presentations and providing a valuable reference for healthy-food interventions in school and community-based settings as well as identifying gaps in the current literature and informing policy and practice.
CRD42025633083.
Chronic subdural haematoma (CSDH) is a common neurosurgical condition in older adults, with a recurrence rate of approximately 7.1–13% after burr-hole drainage. Although surgical adjuncts such as subdural drains and middle meningeal artery embolisation may reduce recurrence, these are not suitable for all patients. Pharmacological strategies, including tranexamic acid, Goreisan and carbazochrome sodium sulfonate hydrate, have shown potential, but high-level evidence remains lacking. A prior retrospective study suggested that a triple oral regimen combining these agents may reduce recurrence. This randomised controlled trial aims to evaluate its efficacy and safety.
This is a prospective, multicentre, open-label, randomised controlled trial conducted across six hospitals in Ibaraki, Japan. A total of 180 patients undergoing first-time burr-hole surgery for CSDH will be randomised 1:1 to receive either triple therapy (Goreisan 7.5 g/day, carbazochrome sodium sulfonate hydrate 90 mg/day and tranexamic acid 750 mg/day for up to 90 days) or standard postoperative care. The primary outcome is recurrence requiring reoperation within 90 days. Secondary outcomes include time to recurrence and haematoma volume reduction on serial CT imaging. All analyses will follow the intention-to-treat principle, using logistic regression, Cox proportional hazards models and mixed-effects models.
Written, informed consent will be obtained from all participants at each participating hospital by trained staff from that hospital. The trial protocol has been approved by the ethics committee of the University of Tsukuba Hospital (approval no. TCRB23-025) and the Institutional Review Boards of all participating centres. Study findings will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals. A summary of the results will also be provided to participating institutions and made publicly available in accordance with the BMJ Open data sharing policy.
jRCTs031240007.
by Omar Fitian Rashid, Saba A. Tuama, Humam Al-Shahwani
In modern digital communication, Confidentiality of text transmission is remains a concern in the current online communication as cyber threats and intrusion. To address these challenges, this paper proposes a dual-layered security system that integrates cryptography and multi-image steganography to strengthen text protection during transmission. The cryptography layer is done based eight steps; in the first one, the message is converted to ASCII format, then convert the ASCII values into their equivalent binary numbers and make a complement to the binary values where each 0’s becomes 1’s and vice versa. In the next step, it needs to enter a key that includes a combination of characters, numbers, and special characters. This key is also converted to binary, and then the XOR operation is made between the message of the binary values and the key. In the fifth step, switching the values of each two adjacent binary values are together and converted to decimal values. While the second layer embeds the ciphertext in several cover images using a randomized codebook along with the Least Significant Bit (LSB) substitution, thus enhancing undetectability. Experimental evaluation demonstrates fast execution times for both the encryption/decryption processes and the multi-image hiding/extraction procedures. The achieved results validate that the proposed system provides an efficient and highly secure framework for protecting sensitive information.by Nailya Ibragimova, Arailym Aitynova, Seitzhan Turganbay, Marina Lyu, Alexandr Ilin, Tamari Gapurkhaeva, Galina Ponomareva, Karina Vassilyeva, Diana Issayeva, Amirkan Azembayev, Serzhan Mombekov, Aralbek Rsaliyev, Nurgul Sikhayeva, Yergali Abduraimov, Saki Raheem
Iodine-based antiseptics are essential in wound care but are often limited by cytotoxicity, instability, and rapid iodine release. Novostron is a novel polymer–iodine complex incorporating dextrin, polyvinyl alcohol, and metal ions, designed to enable controlled iodine release. Structural integrity and composition were confirmed by ¹H and 13C NMR spectroscopy and physicochemical analysis, indicating a molecular weight of ~9500 g/mol, a pH of 4.23, and an iodine content of 8.13%. Pharmacokinetic analysis in rabbits demonstrated that following a single dermal application, systemic iodine absorption was minimal, with peak blood iodine concentrations remaining within physiological limits and rapid elimination within 24 hours. Evaluation of thyroid function revealed no significant changes in serum T₃, T₄, or TSH levels compared with those of the controls, confirming that topical application of Novostron does not disrupt thyroid homeostasis. In compliance with OECD guidelines in rabbits, guinea pigs, and rats, Novostron showed no signs of dermal irritation, skin sensitization, or systemic toxicity (LD₅₀ > 2000 mg/kg). In a rat cotton pellet granuloma model, Novostron significantly reduced the inflammatory mass (23.65% inhibition), supporting its anti-inflammatory potential. In a murine burn model, Novostron accelerated wound contraction (25.95% at day 10), increased epidermal thickness, and enhanced collagen deposition (~44%), outperforming controls and matching or exceeding betadine. These findings suggest that Novostron promotes tissue repair by modulating inflammation. Overall, Novostron demonstrated a favourable preclinical safety and efficacy profile, and its polymer–iodine composition, which enables controlled release and localized activity highlights its potential as a promising topical therapeutic. However, the study was limited to animal models and short-term observation; further long-term and clinical investigations are needed to confirm its translational potential in human wound healing.In Canada, many families want to breastfeed, but there are several common challenges they may encounter. Currently, 91% of Canadian families initiate breastfeeding after giving birth, yet only 38% of babies are breastfed exclusively to 6 months. In 1991, the Breastfeeding Committee for Canada (BCC) was established to implement the World Health Organization’s Ten-Step Baby-Friendly Hospital Initiative, a series of evidence-based in-hospital practices to support families to breastfeed. Then, in recognition of the need to support breastfeeding beyond the hospital setting, the BCC expanded the Baby-Friendly Initiative (BFI) to apply the Ten Steps to both hospitals and community health settings. However, uptake of the BFI Ten Steps in community settings has been low and methodology on how to optimise implementation of the Ten Steps in community is not well developed. Therefore, the objective of this project is to develop and evaluate a quality improvement collaborative with 25 community health services from across Canada to learn how to best support the implementation of the BFI Ten Steps in community, with the ultimate goal of improving breastfeeding outcomes.
This protocol describes the activities of the Community Baby-Friendly Initiative Collaborative (CBFI-C) and the methods used to evaluate its effectiveness. We will use the Institute for Healthcare Information Breakthrough Series (IHI-BTS) model, a proven quality improvement model that has been widely used in clinical settings, but is not yet widely used in community settings. The IHI-BTS combines three virtual learning sessions with action cycles that allow the participating sites time to test and track small practice changes. Sites will be asked to track care indicator and breastfeeding outcome data, engage in monthly webinars, receive coaching from trained mentors, participate in focus groups and participate in a final summative workshop. We will use a multi-site case study approach, combining aggregate care indicator data and qualitative data from webinars, focus groups and workshops to evaluate how the CBFI-C model supports community sites in the process of implementing the BFI Ten Steps.
Ethics approval for this evaluation was obtained from the CHIPER Health Research Ethics Board (Number HS26947-H2025:157)). The results of the CBFI-C evaluation will be shared in a report, peer-reviewed publications and presentations to government and academic audiences. The findings will inform effective quality improvement strategies to enhance uptake of the BFI in community health settings.
The purpose of this article is to present the Gothenland Millennium Cohort, describe the data collection process, present key measures used and summarise some of the key findings to date in order to stimulate collaboration and use of the cohort data. This research programme was originally established to study pathways to alcohol and drug use, behavioural problems, mental health issues, and the factors that promote or prevent these outcomes. The Cohort aims to support scientific research and doctoral education through a longitudinal study that tracks individuals from early adolescence through adulthood. This programme is multidisciplinary (social work, psychology, disability research) with the goal of producing high-quality research that deepens our understanding of how early-life vulnerabilities, risks and protective factors influence long-term wellbeing, including health and welfare, in diverse populations.
In 2013, all school-registered adolescents, in grades 6 and 7 (aged 12 and 13), in four municipalities in Gothenland region (ie, southern Sweden) born in year 2000 or 2001, were invited to participate. Of 2150 invited adolescents, 1885 (88%) accepted participation in the programme and 1760 (93.4%) participated in at least one of the annual data collection waves up to grade 9 (Wave 4), with participation rates ranging from 70% to 85% per wave. Wave 5 questionnaires were collected during the second year of upper secondary school (grade 11). In Wave 5, half (50.4 %; n = 949) of the adolescents participated. In Wave 6, interviews were conducted with a selection of participants in their last year of upper secondary school (grade 12). Parents were surveyed in Waves 1 and 2 by self-report questionnaires (response rate = 32%; 41%). Data were also gathered from teachers (attrition
Over 240 publications have been produced as of September 2025 in the areas of disability and everyday functioning, child-parent relationships, child welfare, substance use and criminal behaviour, mental health, trauma, harassment, and sexuality.
These include continued investigation of wellbeing and its related indicators during adolescence as well as in emerging adulthood, continued efforts to secure funding and an age 25 expansion of the cohort data.
Although the WHO and the Centers for Disease Control and Prevention (CDC) classify preconception health risks (PCHRs) into biomedical, behavioural and social categories, this classification remains theoretical, mainly inconsistent and lacks a scientifically robust framework. Data-driven clustering techniques may help clarify this complexity for policymakers and healthcare providers. This study aimed to assess the status of PCHRs and identify latent classes of these risks among women preparing for pregnancy.
This community-based cross-sectional study was conducted from 31 July to 16 August 2024 in Tigray, Ethiopia, among 865 married women planning to conceive within the next 6 months. Data were gathered through face-to-face interviews using a structured questionnaire. Risk factor indicators covering lifestyle behaviours, substance use, nutritional risks and related factors were developed based on guidelines from the WHO, the CDC and national recommendations. Latent class analysis (LCA) was employed to identify distinct classes of PCHRs, with the optimal number of classes determined using statistical fit indices, adequacy criteria and interpretability. The study also evaluated the overall distribution of PCHRs among participants.
The study took place in Tigray, Ethiopia, among married women intending to become pregnant within 6 months.
Burden of PCHRs and identified distinct latent classes of these risks within the participants.
All participants were exposed to at least four PCHRs, with 84.2% experiencing between 6 and 12 risk factors. The optimal LCA model identified four distinct classes of PCHRs: lifestyle behavioural risks (n=458, 52.9%), reproductive health risks and chronic medical conditions (n=106, 12.25%), nutritional risks and environmental exposure (n=149, 17.23%) and social determinants of health (n=152, 17.57%).
Our study reveals a high baseline level of PCHRs, with all participants exhibiting multiple risk factors for adverse pregnancy outcomes. The identification of four distinct risk profiles underscores the need for tailored risk-specific interventions, particularly in conflict-affected settings. Our findings point out the need for targeted preconception care and risk stratification in national health strategies to improve maternal and child health outcomes.
Immunisation is one of the most valuable, impactful and cost-effective public health interventions which delivers positive health, social and economic benefits. Globally, 4 million deaths worldwide are prevented by childhood vaccination every year. In Ethiopia, despite huge progress being made, the routine immunisation coverage has never reached the targeted figures and planned goals. Pastoralist communities are often disproportionately under-vaccinated, and there is often a confluence of interrelated factors that drive this outcome. This study enables us to identify factors affecting immunisation service utilisation in the pastoralist communities of Ethiopia, which helps to design effective and context-specific interventions.
This study aims to explore the behavioural and social drivers (BeSDs) of routine immunisation among the communities with high numbers of zero-dose and under-immunised children in Afar, Somali and Gambella regions of Ethiopia.
A qualitative exploratory study was conducted in three selected regions of Ethiopia (Gambella, Somali and Afar) from 9 November 2023 to 30 December 2023. Purposive sampling was used. A total of 33 interviews were conducted in the three regions. Sample size was determined based on idea saturation. Data was collected using interview guides. The interview guide was developed after reviewing relevant literature, desk review and using the journey to health and immunisation framework. A separate interview guide was developed for the journey mapping exercise, in-depth interview, healthcare workers discussion guide, focus group discussion and observation. Data was analysed thematically.
Behavioural (lack of awareness, lack of reminder/forgetting, misperception about vaccines, negative previous experience, lost card and fear of post-vaccination adverse events).
Structural (language barrier, long distance from home to facility, high cost of transportation, long waiting time, limited training of healthcare professionals and incentives, inconvenient service hours, shortage of health professionals, disrespect by the healthcare provider), Socio-cultural (competing priorities, low community engagement, lack of decision-making autonomy, limited husband involvement, workload, rural residence and larger family size were the commonly mentioned barriers to routine immunisation uptake. On the other hand, structural (house to house visit by health extension workers, counselling about adverse events, presence of outreach service, affordability (free of charge)), behavioural and socio-cultural (knowledge of adverse event management, and respect from community) were enablers to routine immunisation service uptake in pastoralist communities.
The study found several individual and contextual factors affecting routine immunisation uptake in pastoralist communities. Context-specific and tailored interventions which address zero dose drivers should be designed so as to enhance vaccine uptake. The findings suggested the need to design context-specific interventions to address the aforementioned barriers to immunisation.
by Sabrina Lessard, Annie Bernatchez, Houda Garrach, Mélanie Couture, Claire Godard-Sebillotte, Sarita Israel, Rym Zakaria
ObjectiveThis project aims to gain a thoroughly understanding of the characteristics and experiences of psychological mistreatment among older adults, acknowledging the diversity within this population. It also seeks to identify clinical tools and practices for its detection and intervention. While there is extensive literature on mistreatment of older adults, specific studies focusing on psychological aspects and intersecting social and identity dimensions are scarce. The findings will provide valuable insights for policymakers and healthcare professionals, helping to shape interventions and policies aimed at countering mistreatment in the ageing population.
IntroductionPsychological mistreatment involves a range of behaviors, expressions, and gestures—or the lack of appropriate actions—that negatively impact an individual's health and dignity. Often subtle and difficult to detect, this type of mistreatment is prevalent and can coexist with other types of abuse. Examination of psychological mistreatment, shaped by various social and identity dimensions, is lacking in current research, particularly regarding how it is experienced by older adults. This scoping review seeks to map the current knowledge on psychological mistreatment of older adults, while highlighting gaps and future directions for research.
Inclusion criteriaThis scoping review will encompass studies that explore the characteristics and experiences of psychological mistreatment among older adults, including their experiences and those of perpetrators and witnesses. It will also identify clinical tools and practices for the detection and intervention of psychological mistreatment in this population.
MethodA scoping review will be undertaken by a multidisciplinary team, examining studies from post-2010, sourced from both bibliographic databases and grey literature, available in English or French. Employing an intersectional framework, the review will use Gender-Based Analysis Plus (GBA+) to examine how different forms of discrimination intersect and shape experiences of mistreatment. That is, this approach will help explore how social and identity dimensions—including gender, age, sexual orientation, ethnicity, socioeconomic status, and health conditions—shape the experiences and manifestations of psychological mistreatment.
by Hoda Abbasizanjani, Stuart Bedston, Ashley Akbari
ObjectivesWe developed an efficient Research-Ready Data Asset (RRDA) for the Welsh Longitudinal General Practice (WLGP) data within the Secure Anonymised Information Linkage Databank to standardise curation, enhance reproducibility, and facilitate research on primary care trends. Using this, we investigated primary care activity trends during and after the COVID-19 pandemic.
MethodsThe RRDA involves cleaning, curation using GP-registration history, and transforming data into a structured, normalised format to support efficient large-scale queries. A comprehensive clinical code look-up was developed, incorporating official, local, and supplementary categories to enhance event classification. To enable patient-practice interaction analysis, a four-layer approach was developed to capture healthcare providers, access mode, interaction type, and event details. We assessed RRDA coverage, defined as the proportion of residents with shared primary care records, stratified by demographic and geographic factors, using longitudinal binomial Generalised Additive Mixed Models (GAMMs). We categorised GP events into key activity types and summarised averaged daily rates per month per 100,000 people (2000–2024), with trends analysed using negative binomial GAMMs.
ResultsCurating 4.6 billion records for 5.1 million people (1990–2024) revealed significant improvements in data quality and completeness over time, with data retention increased from 40% to 94%, and patient inclusion from 43% to 98%. Use of SNOMED-CT and local codes increased after Read-V2 discontinuation in 2018, while invalid codes declined—reflecting evolving coding practices and improved data quality. WLGP RRDA coverage rose from 35% in 1990 to 86% in 2024, with regional variation but modest demographic differences. From 2000 to 2024, consultation rates rose by 1.9 times, with post-COVID-19 pandemic levels 8% above 2019. Prescription-only activity doubled with little variation associated with the pandemic. Vaccination rates spiked during the pandemic, and remain 1.8 times above pre-pandemic levels. Other less frequent activities were significantly disrupted during the COVID-19 pandemic but recovered to 2019 levels.
ConclusionsThe WLGP RRDA improves the usability of primary care data, supporting timely, scalable analysis of healthcare delivery and system-level trends.
by Berihun Agegn Mengistie, Getie Mihret Aragaw, Tazeb Alemu Anteneh, Kindu Yinges Wondie, Alemneh Tadesse Kassie, Alemken Eyayu Abuhay, Wondimnew Mersha Biset, Gebrye Gizaw Mulatu, Nuhamin Tesfa Tsega
BackgroundPrecancerous cervical lesions, or cervical intraepithelial neoplasia (CIN), represent a significant precursor to cervical cancer, posing a considerable threat to women’s health globally, particularly in developing countries. In Africa, the burden of premalignant cervical lesions is not well studied. Therefore, the main purpose of this systematic review and meta-analysis was to determine the overall prevalence of precancerous cervical lesions and identifying determinants among women who underwent cervical cancer screening in Africa.
MethodsThis study followed the Preferred Reporting Item Review and Meta-analysis (PRISMA) guidelines. The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42025645427). We carried out a systematic and comprehensive search on electronic databases such as PubMed and Hinari. In addition, Google Scholar and ScienceDirect were utilized to find relevant studies related to precancerous cervical lesions. Data from the included studies were extracted using an Excel spreadsheet and analyzed using STATA version 17. The methodological quality of the eligible studies was examined using the Joanna Briggs Institute (JBI) assessment tool. Publication bias was checked by using the funnel plot and Egger’s tests. A random-effects model using the Der Simonian Laird method was used to estimate the pooled prevalence of pre-cancerous cervical lesions in Africa. The I-squared and Cochrane Q statistics were used to assess the level of statistical heterogeneity among the included studies.
ResultsA total of 112 eligible articles conducted in Africa, encompassing 212,984 study participants, were included in the quantitative meta-analysis. Thus, the pooled prevalence of pre-cancerous cervical lesions in Africa was 17.06% (95% confidence interval: 15.47%−18.68%). In this review, having no formal education (AOR = 4.07, 95% CI: 1.74, 9.53), being rural dweller(AOR = 2.38, 95% CI: 1.64, 3.46), history of STIs (AOR = 3.94, 95% CI: 2.97, 5.23), history of having multiple partners (AOR = 2.73, 95% CI: 2.28, 3.28), early initiation of coitus (AOR = 2.77, 95% CI: 2.11, 3.62), being HIV-seropositive women (AOR = 3.33, 95% CI: 2.32, 4.78), a CD4 count Conclusions
In Africa, the overall prevalence of pre-cancerous cervical lesions is high (17%). The findings of this review highlight that health professionals, health administrators, and all other concerned bodies need to work in collaboration to expand comprehensive cervical cancer screening methods in healthcare facilities for early detection and treatment of cervical lesions. In addition, increasing community awareness and health education, expanding visual inspection of the cervix with acetic acid in rural areas, offering special attention to high-risk groups (HIV-positive women), encouraging adherence to antiretroviral therapy for HIV-positive women, overcoming risky sexual behaviors and practices, and advocating early detection and treatment of precancerous cervical lesions.
To offer a comprehensive overview of the individual and organisational factors related to inclusive leadership among healthcare professionals.
Systematic review and meta-analysis.
The review was conducted following the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Findings were synthesised using meta-analysis, a random effects model and narrative synthesis.
In January 2025, a systematic search was conducted with no time or geographical limits in the CINAHL, MEDLINE (PubMed), Mednar, ProQuest and Scopus databases. Studies in English, Swedish and Finnish were included.
A total of 34 studies were included. The meta-analysis revealed a statistically significant positive relationship between inclusive leadership and psychological safety among healthcare professionals (n = 10). The narrative synthesis further identified individual and organisational factors related to inclusive leadership. Individual factors consisted of well-being at work, performance and productivity, social behaviour, innovativeness and creativity and psychological capacity. Organisational factors revealed work community cohesion and citizenship, as well as organisational fairness and appreciation.
Inclusive leadership is a promising leadership behaviour, with positive outcomes for healthcare professionals and organisations. By enhancing psychological safety, inclusive leadership offers broader benefits for individuals and organisations. As such, it could improve the retention of professionals and the attractiveness of organisations in the healthcare sector.
To strengthen the functioning of healthcare organisations, leaders should be educated in inclusive leadership and its practical benefits. Training should focus on developing inclusive leadership behaviours that foster belonging, value individual uniqueness and encourage participation across all professional groups, creating an environment where both individuals and organisations can thrive.
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to report the results.
No patient or public contribution.
The protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (ID: CRD42024503861)
Although some research supports the maintenance of positive outcomes from cardiac rehabilitation Phase II (CR II) up to 12 months, the barriers to maintaining physical activity and risk factor management during CR maintenance (CR III) are well known.
To investigate participants' ability to sustain clinical, quality-of-life (QOL), and behavioral outcomes and share their experiences 6 months after CR II completion.
Longitudinal explanatory sequential pre-CR/post-CR study in a community hospital within a large health system. A convenience sample of 155 participants completed a reassessment of health outcomes. Participants also completed an online survey about barriers and facilitators during and after CR II. Analysis methods included MANOVA and summative content analysis.
The sample was mostly male, white, non-Hispanic, and college educated, with a mean age of 67.9 years. CR II participants sustained most behavioral outcomes, but not all clinical outcomes. Outcomes that improved/maintained were physical activity, tobacco status, diet, and QOL. Outcomes that worsened/returned to pre-CR II were weight, blood pressure, and depression. Participants described their motivation for staying healthy, top concerns, goals, barriers, and strengths/resources. Common responses included exercise, weight, diet, quality of life, family, and friends.
Our findings suggest the need for the implementation of innovative strategies during CR II that may extend past discharge into CR III. These include the introduction of digital technology and eHealth to provide value-added service to patients and a solid foundation for future maintenance and a structured, behavioral weight loss intervention. Establishing these tools, in addition to developing a support system will help patients to initiate maintenance care before program completion.
by Birtukan Gizachew Ayal, Abebe Kassa Geto, Sefineh Fenta Feleke, Ali Yimer, Atitegeb Abera Kidie, Natnael Amare Tesfa, Esuyawkal Mislu, Molla Hailu, Hassen Ahmed Yesuf
BackgroundSugar-sweetened beverages or snacks are limited in nutritional value. Excess consumption of sugar-sweetened beverages or snacks in early childhood is associated with inadequate micronutrient intake, being overweight or obese, and developing chronic diseases later in life. There is scarcity of information specific to sugar-sweetened beverages or snacks consumption prevalence and its determinants in Sub-Saharan Africa Countries. This study aimed to determine the pooled prevalence of sugar-sweetened beverage or snack consumption and its determinants among infants and young children aged 6–23 months.
MethodsA cross-sectional study design was conducted using demographic and health survey data conducted from 2019 to 2023 from twelve Sub-Saharan African countries. A weighted sample of 23,145 children aged 6–23 months was included in the study. Multilevel mixed-effects logistic regression analysis was used to determine the factors associated with the dependent variable. The level of statistical significance was declared with a p-value Results
The pooled prevalence of Sugar-sweetened beverage or snack consumption was 25.40% (95% CI: 24.84% − 25.96%). In multilevel multivariable logistic regression analysis, children aged between 9−11(AOR = 1.95 95% CI: 1.62, 2.35), 12–17(AOR = 2.83; 95% CI: 2.26, 3.54), and 18−23 months (AOR = 3.77;95% CI: 3.07, 4.63), media exposure (AOR = 1.59; 95% CI:1.28, 1.98), children from households with middle (AOR = 1.39; 95% CI: 1.11, 1.73) and rich (AOR = 2.31; 95% CI: 1.87, 2.85) wealth status, post natal checkup (AOR = 1.18; 95%CI:1.05,1.33), maternal ANC visit (AOR = 1.60; 95% CI: 1.15, 2.22), and high community media exposure ((AOR = 2.22;95%CI:1.65,5.81) were positively associated significant factors whereas currently breast feeding children (AOR = 0.70; 95% CI: 0.59,0.82), older age at first birth (AOR = 0.88,95% CI: 0.81, 0.96), presences of more than one under-5 children in the household (AOR = 0.89, 95% CI: 0.80, 0.99), mothers don’t perceive distance to health facility as big problem (AOR = 0.86; 95% CI:0.76, 0.98), and children reside in rural (AOR = 0.83;95%CI:0.68,0.95) were negatively associated with sugar sweetened beverage or snack consumption.
ConclusionIn this study, one out of four children consumed sugar-sweetened beverages or snacks. Current age of child, current breastfeeding status of child, media exposure, wealth index, maternal age at first birth, post natal checkup, maternal ANC visit, number of under-five children in the household, distance to health facility, place of residence, and community level media exposure were significant factors with sugar-sweetened beverage or snack consumption. Therefore, it is recommended to raise awareness about the health risks of sugar-sweetened beverage and snack consumption, enforce restrictions on their advertisement, strengthen nutrition-focused counseling within maternal and child health services with special attention for older age children, promote breastfeeding, and give special attention to challenges related to health facility accessibility, and support for young mothers.
This study aims to synthesise evidence on users' experiences of telephone cancer information and support services (CISS) to identify important service features and inform service development.
A qualitative evidence synthesis.
OVID MEDLINE, EMBASE, CINAHL, PsycINFO and SocINDEX databases were searched for peer-reviewed qualitative literature fitting the inclusion criteria from database inception to 30 March 2023. The included articles were double-screened, and quality appraised using the CASP checklist. GRADE-CERQual was used as a tool to assess the confidence of review findings. Content synthesis combined the qualitative data with the Loiselle cancer experience measurement framework guiding analysis. This paper is reported as per the equator network recommended SRQR checklist.
Of the 607 articles screened, seven studies were included. Four main themes and 14 sub-themes about CISS aspects were identified: psychological well-being (managing emotions/coping, hope/reassurance, supporting close others and a reluctance to call the CISS); knowledge is power (information seeking, the burden of knowledge and empowerment); truth and clarity (adjunct support, credible source and improved understanding and confidence); and service adequacy (operators' ability to connect with users, convenience, service provision and awareness, and the cancer journey).
Findings suggest people with cancer and their carers accessing a CISS value emotional support combined with trusted information, topic expertise and a connection with the service operator. future service provision should address the lack of awareness regarding the range of services and the convenience extended operating hours may offer.
The results add to our understanding of CISS service provision. However, knowledge gaps remain regarding preferences among service features and the hierarchy of CISS characteristics to be prioritised to enhance services.
Focused CISS awareness campaigns will inform communities and healthcare professionals of the available resources to improve the lives of those affected by cancer. Ongoing service review will enable resources to be tailored to callers' needs, potentially easing the burden on existing services that are overwhelmed and under-resourced.
This qualitative evidence synthesis did not directly involve patient or public contribution to the manuscript.
Systematic Review Registration Number (PROSPERO): CRD42023413897
by Thomas Buyinza, Edward Buzigi, Joshua Kitimbo, Gabriel Ssabika, Mary Mbuliro, Julius Kiwanuka, Justine Bukenya, David Guwatudde, Rawlance Ndejjo
IntroductionAdolescents and young adults (AYAs) worldwide display poor dietary behaviors, including high consumption of sugar-sweetened beverages and insufficient intake of fruits and vegetables. These issues are more pronounced in Sub-Saharan Africa, such as rural Eastern Uganda, where 45.3% of adolescents eat low-diversity diets high in refined grains and fats. Such diets raise the risk of malnutrition and diet-related non-communicable diseases (NCDs). However, there is limited contextual evidence on the multi-level factors influencing AYAs’ dietary behaviors in rural Uganda. This study examined socio-ecological factors shaping dietary behaviors among AYAs in this setting.
MethodsA qualitative study guided by the socio-ecological model (SEM) was conducted in Mayuge District, Eastern Uganda. Focus group discussions (FGDs) were held with AYAs, including male and female, aged 10–14, 15–19, and 20–24 years. To have a nuanced understanding of how AYAs’ dietary behaviours are shaped, additional FGDs were conducted with parents or guardians and teachers, and key informant interviews with the district education officer, nutrition focal person, civil society staff, and food vendors. Data were analyzed in ATLAS.ti using both inductive and deductive thematic approaches: data-driven sub-themes were first identified inductively, then deductively mapped onto pre-determined themes of the SEM.
ResultsDietary behaviors were shaped by satiety, energy needs, sensory appeal, and nutrition knowledge at the individual level. Peer influence, parental control, and food’s perceived link to attractiveness acted interpersonally, while community factors included gendered cultural taboos, norms, and health worker advice. At the societal level, cultural identity, ancestral restrictions, and media exposure strongly influenced choices.
ConclusionsThis study contributes novel rural-specific evidence from rural Uganda, where AYAs’ diets are uniquely constrained by satiety demands, parental dominance, cultural taboos, and seasonal scarcity; contrasting with urban contexts where convenience, autonomy, and wider food environments prevail. Multi-level interventions integrating nutrition education, family and peer engagement, cultural dialogue, and household food security support are essential for promoting healthier diets in resource-limited rural settings.
FreshRSS 