Multimorbidity, characterised by the coexistence of two or more chronic conditions, represents a growing challenge for health systems, adversely affecting quality of life, self-care, treatment adherence and service utilisation. Within the context of self-regulation in health, the Common-Sense Model of Self-Regulation of Health and Illness (CSM) proposes that illness perceptions—such as beliefs about causes, control, consequences, timeline and illness identity—influence health behaviours. Despite consolidated evidence in single-disease contexts, little is known about how these perceptions operate when multiple conditions coexist, particularly due to the need to integrate potentially conflicting representations. To date, no systematic reviews have synthesised these relationships specifically in populations with multimorbidity. This protocol describes the methods for a systematic review aimed at examining how illness perceptions are associated with treatment adherence, self-care and indicators of chronic condition management in adults with multimorbidity.

This systematic review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Observational studies involving adults (≥18 years) with multimorbidity, which assess illness perceptions using validated instruments and report outcomes related to treatment adherence, self-care or self-management behaviours, will be included. The search will be conducted in the PubMed, Scopus, Web of Science, Embase, CINAHL, PsycINFO and LILACS databases, using combinations of descriptors related to illness perception, multimorbidity and health behaviours. Two independent reviewers will conduct study selection, data extraction and methodological quality assessment. The risk of bias will be assessed using the Newcastle-Ottawa Scale, and the overall quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Where appropriate, meta-analysis will be conducted using measures of association (eg, ORs, relative risk or HRs); otherwise, a structured narrative synthesis will be performed. Subgroup analyses will be conducted when data are available.

As it uses exclusively secondary and published data, this review does not require approval by a research ethics committee. The results will be submitted for publication in a peer-reviewed journal and disseminated at relevant scientific conferences.

CRD420251266292.

Gastric cancer is the fifth most common cancer globally and the fourth leading cause of cancer-related mortality. While gender and sex differences in gastric cancer care are underexplored in Germany, international studies have revealed disparities in aspects such as histology, comorbidities, treatment approaches and survival outcomes. This study aims to explore gender/sex-specific variations in clinical management and their impact on mortality, complications and survival rates in gastric carcinoma patients in Germany. The findings may inform revisions to clinical guidelines and support the development of more personalised treatment strategies. This study aims to improve the quality of care for gastric cancer patients and promote more individualised, sex-sensitive medical practices.

This nationwide, retrospective cohort study will analyse data from the German Diagnosis-Related Groups statistic and regional clinical cancer registries from 2017 to 2021. The study will evaluate both datasets separately, providing a comprehensive view of sex differences in gastric cancer care. Primary outcomes include hospital mortality and survival rates, while secondary endpoints include surgical complications, treatment modalities and postoperative outcomes. The analysis will investigate whether sex influences tumour characteristics, access to treatment and therapy effectiveness. Statistical methods such as descriptive analysis, regression models and survival analysis will be applied to identify sex-related variations in diagnosis, treatment and outcomes.

This study uses anonymised secondary data; thus, ethics approval is not necessary. Findings will be submitted to a peer-reviewed journal, reported to the Innovation Fund of the Federal Joint Committee of Germany, and a patient leaflet for the involved self-help groups will be made.

NCT06902337.

Vaccines are our best defence against infectious diseases, yet uptake of childhood immunisation programmes has consistently declined in the UK, with growing concerns around socioeconomic inequalities. Liverpool, in particular, demonstrated some of the lowest uptake rates in England since 2019. In response, the Health Equity Liverpool Project (HELP) implemented a hyper-localised community-led initiative between September 2023 and June 2024 to tackle vaccine hesitancy. Activities included outreach events and school-based engagement across nine sites within Liverpool. Despite promising qualitative evidence, the intervention’s impact on childhood vaccine uptake has not yet been quantified. We aim to evaluate the population level impact of the HELP intervention on the uptake of five childhood vaccines (first and second doses of the measles, mumps and rubella vaccine (MMR1, MMR2), 6-in-1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b and hepatitis B), pneumococcal conjugate vaccine booster dose (PCV) and rotavirus vaccine) using synthetic control methods.

We will analyse publicly available quarterly vaccine uptake data (between April 2019 and March 2025) from the Cover of Vaccination Evaluated Rapidly programme for general practices (GPs) in England. The intervention group will be defined as practices located within a 1 km radius of the intervention sites. A synthetic control group will be constructed using non-intervention GPs matched on pre-intervention vaccine uptake, and linked demographic, socioeconomic and healthcare capacity covariates. Primary outcomes are the uptake of MMR1 and MMR2 vaccines. Secondary outcomes include the uptake of 6-in-1, PCV and rotavirus vaccines. Average treatment effects will be estimated as the post-intervention difference in uptake between intervention and synthetic control groups. Sensitivity analyses will examine spillover effects, alternative spatial definitions of exposure, the biasing effect of concurrent interventions and the feasibility of analysis at small area neighbourhood level.

This study will be conducted as part of the ReCITE project, which has received ethical approval from the Liverpool School of Tropical Medicine Research Ethics Committee (Reference: 24–018) and is funded by the UK Arts and Humanities Research Council (Project Number: AH/Z505341/1). Findings will be shared with the project funder and submitted for publication in a peer-reviewed journal.

To understand how reductions in resource allocation affect food safety services in England.

This longitudinal ecological study analysed secondary observational data.

England, data at the local authority level.

Ecological study, without human participants.

The primary outcome measures were the number of staff, represented by the number of full-time equivalents per capita, number of interventions per establishment, and proportion of hygiene-compliant establishments.

A £1 decrease in food safety expenditure per capita was associated with a 2% (–3.3 to –0.7) decrease in staffing levels and a 1.6% (–3.2 to –0.1) decrease in the number of interventions achieved per establishment. A one-unit reduction in staff was associated with a 42.2% (–80.5 to –11.9) decrease in the number of interventions achieved. No evidence of an association was found between expenditure or staff levels and the proportion of compliant establishments.

Spending reductions negatively affected the capacity of food safety teams to provide key services. Reductions in food safety expenditure significantly affected food hygiene staff levels and service provision. This finding raises concerns about the capacity of food safety teams to operate and the potential for increased public risk of gastrointestinal infections.

To translate and validate the HLS-Child-Q15, a relatively short questionnaire for assessing health literacy in children originally validated in German, into English to make it accessible to a large population of English-speaking children.

We translated the HLS-Child-Q15 into English following established methods, including forward and backward translation, using multiple translators. We incorporated clinician and consumer input into the translation process. We conducted a qualitative pre-test to assess comprehension and a validation to assess psychometric properties and test-retest reliability.

Perth Children’s Hospital, Perth, Western Australia

We recruited English-speaking children aged 8 to 15 years.

Qualitative analysis of pre-test interviews, Cronbach’s α coefficient for internal consistency and intraclass correlation coefficient for test-retest reliability.

The translation process yielded an acceptable translation. A qualitative pre-test conducted with 10 children demonstrated good comprehension of questionnaire items and resulted in small changes to increase item clarity. Validation with 207 participants demonstrated that questionnaire output score increased with age, school year, self-efficacy score, parental educational level and home literacy environment score. Internal consistency was assessed, with a Cronbach’s α coefficient of 0.854 (95% CI 0.812 to 0.887). Test-retest reliability was moderate, with an intraclass correlation coefficient of 0.612 (95% CI 0.402 to 0.761).

The translated HLS-Child-Q15 was well understood by children. Validation of the translated questionnaire demonstrated adequate psychometric properties, consistent with the original German questionnaire. The translated HLS-Child-Q15 is suitable for use with English-speaking children.

Data are available on reasonable request and in compliance with institutional ethics and governance requirements.

ACTRN12622001499774

Traditional oncology outcome measures, such as survival rates and disease progression, fail to fully capture the complex lived experiences of persons and patients with cancer, including psychological distress, financial burdens and changes in social roles. While person- and patient-centred outcomes have emerged as essential components of quality cancer care, ambiguities persist regarding their definitions and measurement methodologies in clinical trials.

This scoping review aims to explore how person-centred and patient-centred outcomes are defined and measured in cancer clinical trials and to identify trends, gaps and methodological approaches for their assessment. Comprehensive searches will be conducted across PubMed, SCOPUS, Sci-Elo, EMBASE, PsycINFO and Google Scholar for grey literature sources, encompassing articles from August 2020 to August 2025. Eligible studies include primary research that reports patient- or person-centred outcomes in cancer clinical trials. Studies focusing solely on preventative care or lacking assessment of patient- or person-centred outcomes will be excluded. Studies will be independently screened and selected by two reviewers in duplicate, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Data extraction will also be conducted independently and in duplicate using a standardised extraction tool, with disagreements resolved through consensus to ensure consistency and accuracy. Results will be synthesised qualitatively and quantitatively, with narrative and thematic analysis used to identify trends and gaps in the literature.

Ethical approval is not required. Results will be published in a peer-reviewed journal and presented at conferences.

https://doi.org/10.17605/OSF.IO/EYZPK

To meet the elevated nutritional requirements of very low birthweight (

This is a three-arm, pragmatic, multicentre, double-blind, randomised clinical trial of 615 human milk–fed infants born either (1) ≤1250 g or (2)

Ethical approval was obtained from Clinical Trials Ontario (CTO) and local research ethics boards that are not CTO members. Study findings will be disseminated to clinicians at seminars and conferences and in peer-reviewed publications.

NCT05308134.

Delirium is a critical and complex neuropsychiatric syndrome that significantly affects older adults in general hospital wards. Although multicomponent interventions have been shown to be effective in preventing delirium, the consistent implementation remains a challenge. Also, to manage the complex pathway of patients from admission to discharge in hospital, the involvement of the nursing staff is essential. Developing a nurse-led clinical pathway for delirium prevention could provide a structured approach to improving care quality. For intervention development taking account of the complexity of the clinical environment, the UK Medical Research Council framework is frequently used. A core element of this framework is mapping a programme theory that explains how, for whom and in what circumstances an intervention may work. The realist review methodology is well suited to uncovering the underlying mechanisms, contexts and outcomes of interventions, translating these into a programme theory.

The aim of this realist review is to develop a programme theory for a nurse-led clinical pathway to prevent delirium in older adults aged 65 years or older in general hospital wards and to identify strategies to support its effective implementation.

The realist review is based on the methodical framework developed by Pawson et al and further adapted by Rycroft-Malone et al and the reporting will follow the Realist And MEta-narrative Evidence Syntheses: Evolving Standards guidelines. The process comprises four steps: (1) defining the review scope; (2) systematically searching for and appraising the evidence; (3) extracting and synthesising findings and (4) developing a narrative synthesis. Interest holders, including clinical and academic experts, will be actively involved as an expert reference group to inform and refine the programme theory. The final programme theory will be presented in Context-Mechanism-Outcome configurations and the Implementation Research Logic Model.

Since no data are collected as part of the review, ethical approval is not required. Findings will be disseminated through academic conferences and publication in a peer-reviewed journal.

This protocol has been registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/7EPTF).

Children with upper limb loss or difference (ULLD) require individualised and developmentally appropriate clinical care. To guide this specialised care, outcome measures can be used to assess important constructs, such as physical function, health-related quality of life (HRQoL) and satisfaction with medical treatments and services. However, there is limited research available on which outcome measures are used to assess these constructs and whether they have been psychometrically assessed in children with ULLD who may or may not use a prosthesis. Thus, the purpose of this scoping review is (1) to determine which outcome measures are used to assess physical function, HRQoL and satisfaction in paediatric patients with ULLD and (2) to identify articles that include children with ULLD in psychometric assessments of these outcome measures. Findings of these studies will be reported. This review will inform healthcare professionals on which outcome measures assessing function, HRQoL and satisfaction have been psychometrically tested for use in children with ULLD. It will also inform future research on outcome measurement in this population.

A two-phase scoping review will be conducted in which PubMed, Web of Science and CINAHL will be searched: first, to identify which outcome measures are used to assess physical function, HRQoL and satisfaction in children with ULLD and, second, to determine whether those measures have been psychometrically assessed for use in this population. Teams of two reviewers will review articles for eligibility and extract information from eligible articles. Tie-breaking will be conducted by a third reviewer. Narrative summaries will be used to describe the findings of this scoping review.

No ethical approval is needed. The results of the review will be submitted for publication in a peer-reviewed journal and presented at relevant conferences.

The scoping review that applies this protocol has been registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/7UGWB).