This study aims to investigate the lived experiences of civilians in Lahore during the 2025 India–Pakistan conflict, focusing on psychological distress, social disruption, coping mechanisms and perceptions of national response and preparedness.

The study employs an exploratory phenomenological approach.

The study has been conducted in Lahore, the capital city of Punjab, the largest by population province of Pakistan. Lahore was selected as a research site due to its historical, strategic and political significance in Indo-Pak conflicts.

Data were collected from 10 participants aged 18 or above years, who lived in Lahore between April and May 2025, and were willing to discuss personal, social or psychological experiences related to the conflict. In-depth, semistructured interviews were conducted in Urdu, transcribed, and were thematically analysed using both manual and NVivo V.12 software-supported coding.

Seven inter-related themes were identified. Participants reported intense anxiety, hypervigilance and insomnia driven by hybrid warfare tactics, including misinformation, drone sightings and media sensationalism. Social life was disrupted through withdrawal from public, religious and communal activities. Coping strategies included religious faith, family cohesion, humour and expressions of national solidarity. Notably, many participants experienced psychosomatic symptoms such as palpitations, gastrointestinal distress and stress-induced fever. A prominent finding was the absence of civilian preparedness guidance, which amplified fear and uncertainty during the escalation.

The conflicts, although short lived and geographical restrained, casts a long psychological and social on civilians, marked by fear, uncertainty, social disruption and dissatisfaction with institutional preparedness. While some coping and resilience were evident, the findings highlight the need to strengthen civilian-focused public health responses during periods of conflict escalation, including mental health awareness, media literacy and community-level support within Pakistan’s emergency response frameworks.

Paediatric kidney transplantation, while life-saving, presents significant academic challenges for children. Frequent hospitalisations, medical treatments and the psychosocial impact of chronic illness can severely disrupt educational trajectories. This study aimed to explore the post-transplant academic experiences of children from the perspective of their parents.

A qualitative phenomenological study. Data were collected through in-depth, semistructured interviews and analysed using inductive thematic analysis.

The study was conducted in Lahore, Pakistan, with participants recruited from the registry of the Punjab Human Organ Transplantation Authority (PHOTA).

Thirteen parents of children who had undergone a kidney transplant and were enrolled in a formal school.

Five major themes emerged from the analysis: (1) academic disruption and coping, detailing declines in performance and motivation alongside efforts to maintain engagement; (2) cognitive fatigue and emotional strain, encompassing reduced focus, memory difficulties and psychological distress; (3) school attendance, participation and support, highlighting frequent absenteeism, limited engagement in activities, and the critical role of institutional flexibility; (4) social identity and peer exclusion, revealing fears of stigma, self-isolation and misunderstanding from peers and (5) navigating the future, reflecting parental anxieties about long-term educational and career prospects alongside adaptive hope. The findings underscore that formal support systems in schools and healthcare settings are currently underdeveloped to meet these children’s complex needs.

This study illuminates the profound and multifaceted academic challenges faced by children after kidney transplantation. The results emphasise that a transplant is not merely a medical event but a life-altering experience with significant educational consequences. There is a critical need for integrated, targeted interventions that provide robust psychological support, flexible educational policies and comprehensive school reintegration programmes to ensure these children can achieve their full academic and personal potential.

To understand the experiences of burnout and coping strategies among healthcare professionals working in the emergency department of tertiary care public and private hospitals in Karachi.

A qualitative exploratory design was employed.

One public-sector and one private-sector tertiary care hospital located in Karachi, Pakistan were selected for this study. Audio-recorded in-depth interviews were conducted with a total of 15 healthcare professionals working in the emergency department, which were later transcribed verbatim and analysed inductively.

The findings of the study identified two major themes contributing to burnout: individual and organisational themes, along with coping strategies used by healthcare professionals. Individual-level subthemes included emotional distress, arising from ethical dilemmas and constraints within the work environment, and work-life imbalance, where participants experienced difficulty maintaining personal well-being due to professional demands. Organisational-level subthemes included lack of leadership support and recognition, role conflict, inadequate resources, excessive workloads and exposure to workplace violence, all of which contributed significantly to burnout. Healthcare professionals reported both adaptive and maladaptive coping strategies. Adaptive strategies included positive reframing, peer support and relaxation techniques, whereas maladaptive strategies involved venting frustration and, in some cases, substance use to manage prolonged stress.

The findings revealed that the experience of burnout is caused by a range of interdependent factors at the individual and organisational levels. Multifaceted interventions are needed to address these issues such as national and emergency department staffing policies, mental health support, resilience training, workload management, flexible scheduling and the promotion of work-life balance.

There is a recognised need to provide equity in healthcare through inclusion of ethnic minorities in research. South Asians, the largest ethnic minority group in the UK, experience high levels of mental illness, often against the backdrop of socioeconomic deprivation and discrimination. The research community recognises that South Asian communities are often excluded from health research. Efforts have been made to understand the barriers and facilitators to their participation. However, the participation of individuals at the intersection of mental ill health and South Asian ethnicity remains understudied. This is a protocol for the synthesis of qualitative evidence from mental health research studies about participation, motivation and barriers to recruitment of South Asians in high-income countries.

We will search 10 databases for qualitative evidence on participation of South Asian individuals in mental health research studies in high-income countries: MEDLINE, EMBASE, PsycINFO, Health Management Information Consortium, Social Policy and Practice, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Social Sciences Citation Index, Science Citation Index Expanded and ProQuest Dissertations and Theses Citation Index. Search terms for the following five concepts will be used: (1) South Asia, (2) ethnic minority, (3) mental health conditions, (4) barriers and facilitators to participation and (5) high-income countries. No date restriction will be applied to the search. Searches will be limited to studies in the English language. Study selection and data extraction will be performed by two researchers independently, using Covidence. Demographic data, thematic outputs and salient discussion points will be extracted from final full-text inclusions and entered into NVivo for coding. Meta-ethnographic approaches using first and second-order constructs from included studies will be used to form third-order constructs. This synthesis will generate new knowledge regarding the intersectionality of mental health and South Asian ethnicity.

Ethical approval is not required as this study is a synthesis of published data. This review will provide new knowledge regarding the requirements for researchers and practitioners to advance the involvement of South Asian populations in mental health research. This will undoubtedly enhance equity in the long term, reduce the burden of mental disorders and enable the provision of more effective mental health care for South Asian communities.

CRD42025626382.

Cutaneous T cell lymphoma (CTCL) is a group of non-Hodgkin lymphomas that primarily affects the skin and can mimic inflammatory dermatoses. Unlike many skin diseases, CTCL can lead to disabling symptoms, and advanced CTCL can even be fatal. Early studies investigating health-related quality of life (HRQOL) in patients with mycosis fungoides (MF) and Sézary syndrome (SS), common subtypes of CTCL, demonstrated significant impairment across numerous domains. The aim of this current study is to develop a core domain set (CDS) to identify the essential aspects of MF/SS that influence HRQOL that should be measured in therapeutic clinical trials. In the future, this set of core concepts will be used to identify the best patient- reported outcome measure(s) (PROM) for HRQOL for MF/SS clinical research.

Multiple strategies will be used to generate candidate concepts: systematic review of the literature, qualitative study and a survey study of healthcare providers. A Delphi consensus process including a comprehensive group of stakeholders (patients, caregivers/care partners, a multidisciplinary group of healthcare professionals, patient advocacy groups, pharmaceutical industry representatives, methodologists and government agencies) will be used to achieve consensus. Statistical corrections for multiple significance testing and false positive findings will be undertaken.

The study was submitted for and received institutional review board approval at the University of Washington (IRB# STUDY00018890 and STUDY00019407). Informed consent will be obtained from all participants where necessary. We will disseminate our findings through peer-reviewed, open access publications and presentations at national/international conferences. We will provide a plain language summary in lay terms for patients and families to patient advocacy groups for distribution to their network.

The protocol is registered in the Core Outcome Measures in Effectiveness Trials (COMET) database.

Socioeconomic inequalities significantly impact access to healthcare services for individuals with type 2 diabetes mellitus (T2DM). This study investigates these inequalities in Iran, focusing on factors such as asset, sex, urban–rural residence, age, education, employment status, and marital status.

Cross-sectional study.

This study used data from the national ‘Diabetes Care (DiaCare)’ study, a population-based survey conducted from 2018 to 2020 in Iran.

Socioeconomic status (SES) was assessed using Principal Component Analysis (PCA) based on assets. Socioeconomic inequalities in access to physicians, pharmacies and laboratories were measured using the Concentration Index (CI) and Erreygers Corrected Concentration Index (ECI). Decomposition analysis was performed using a probit regression model to assess the contributions of various factors to the observed inequalities.

Among 13 315 patients with T2DM, 5.8% lacked access to physicians, 6.8% to pharmacies and 8.7% to laboratories. The CI was positive and statistically significant for access to physicians (0.0614), pharmacies (0.0787) and laboratories (0.0875), indicating better access concentrated among higher SES individuals. Urban residents had the largest positive marginal effects on access to physicians (0.032), pharmacies (0.078) and laboratories (0.053), with percentage contributions of 13.21%, 23.23% and 17.39%, respectively. Higher asset quintiles showed substantial contributions to inequalities, with the highest quintile contributing 10.5% to physician access inequality, 9.68% to pharmacy access and 9.16% to laboratory access. Education level also positively impacted access, with high school education contributing 0.64% and college education 0.52% to access inequalities. Sex differences showed a negative marginal effect for women, indicating slightly lower access.

Socioeconomic factors, particularly asset, residence and education, significantly impact access to healthcare services for patients with T2DM in Iran. Policies should focus on reducing barriers to healthcare access, especially for lower SES and rural populations.

To examine the associations between the inflammatory potentials of diet and lifestyle, as measured by the Dietary Inflammation Score (DIS) and Lifestyle Inflammation Score (LIS), with the risk of type 2 diabetes mellitus (T2DM), hypertension and chronic kidney disease (CKD).

This retrospective cohort study used data collected between 2000 and 2012 from the Multi-Ethnic Study of Atherosclerosis cohort, which was conducted across six US communities.

The study sample included 4736 participants for the analysis of T2DM, 2149 participants for hypertension and 4631 participants for CKD.

The primary outcomes were the incidence of T2DM, hypertension and CKD during follow-up.

During a median follow-up of 9.0 years, 537 participants developed T2DM, 1019 developed hypertension and 1067 developed CKD. DIS was not associated with T2DM in the overall population; however, women in the third quartile of DIS had a 52% higher risk of developing T2DM (HR 1.52; 95% CI 1.07 to 2.15). Also, individuals in the third quartile of DIS had a 22% higher risk of hypertension (1.22; 95% CI 1.02 to 1.47) in the overall population; however, no significant linear trend was observed across the quartiles (P-trend=0.397). Individuals in the fourth quartile of LIS had over twice the risk of developing T2DM (2.15; 95% CI 1.57 to 2.95), although no significant linear trend was observed across quartiles (P-trend

This study highlights the role of diet and lifestyle-related inflammation in the development of hypertension and T2DM risk, providing novel evidence from a large, multiethnic US cohort. The findings underscore the potential of dietary and lifestyle strategies that target inflammation to reduce cardiometabolic disease risk.

This research aims to explore the factors that hinder professionals in delivering integrated care for children under 5 in temporary accommodation (TA) and understand their experiences of collaboration during the pandemic to inform recommendations.

Semistructured qualitative interviews.

England, UK.

45 professionals working across health, housing, education and non-profit sectors in England. Purposive and snowball sampling was employed to recruit a representation of key professionals across England. Those not eligible to take part in the study included people who did not work with families and/or children in TA settings.

To explore cross-sector learnings that are applicable to improving integrated care and to tailor recommendations to the needs of families and children under 5 experiencing homelessness in the UK today.

This study highlights the complex, multilevel barriers that professionals face when delivering integrated care to children under 5 in TA. Findings are organised using a framework that distinguishes between practice-level, organisational and systemic challenges. From siloed working practices and limited training to staffing shortages and restrictive data-sharing policies, these challenges collectively hinder service continuity and collaboration.

Although this project was conducted during the COVID-19 pandemic, the challenges identified reflect deeper, long-standing issues in service delivery. As services continue to recover and prepare for future crises, these insights remain highly relevant and can inform more resilient, integrated recovery plans to support children in TA beyond the pandemic context. Addressing these barriers, through improved collaboration, training and data-sharing, is key to strengthening care for this vulnerable population.

Administering supplemental oxygen to prevent hypoxaemia is a fundamental treatment for patients hospitalised with acute injury or illness. However, the amount of oxygen administered frequently exceeds that needed to maintain normoxaemia, causing patients to experience hyperoxaemia and wasting supplemental oxygen. Closed-loop, autonomous oxygen titration systems are designed to optimise oxygen delivery by administering the lowest possible oxygen flow that maintains peripheral oxygen saturation (SpO₂) within a predefined range. For adults hospitalised with an acute injury or illness, it remains uncertain whether the use of a closed-loop, autonomous oxygen titration system safely increases the proportion of time spent in normoxaemia (SpO₂ 90%–96%) compared with usual care.

The Strategy to Avoid Excessive Oxygen using Autonomous Oxygen Titration Intervention trial is a multicentre, unblinded, parallel-group, randomised trial being conducted at four level 1 trauma centres in the USA. The trial compares an autonomous oxygen titration system versus usual care among 300 adults hospitalised for major trauma, burn, acute care surgery or acute respiratory illness. The primary outcome is the proportion of patient-time spent within the targeted normoxaemia range (SpO₂ 90%–96%) as measured by continuous non-invasive pulse oximetry, during the first 72 hours after randomisation. Secondary outcomes include the amount of supplemental oxygen administered and the proportion of time spent in hypoxaemia (SpO₂2 >96%). Specifying the protocol and statistical analysis plan before the conclusion of enrolment increases the rigour, reproducibility and interpretability of the trial. Enrolment began on 6 May 2024.

The trial protocol was approved by the single institutional review board at the University of Colorado School of Medicine and the Office of Human Research Oversight at the Department of Defense. We will present the results at scientific conferences and submit them for publication in a peer-reviewed journal.

NCT06374225.

Waiting for cardiac surgery is a stressful life event for most patients. Exploring what people experience while waiting and understanding their preferences and views on how waiting time could be improved will help to inform new strategies for more efficacious waiting list management. In this study, we explored experiences and views of people waiting for elective cardiac surgery across four major London hospitals.

Mixed-methods cross-sectional survey, with explanatory concurrent design.

Four cardiac surgery services across two National Health Service Trusts in London.

Patients on waiting lists for elective cardiac surgery at Royal Brompton, Harefield, St Thomas and King’s College hospitals between October 2023 and March 2024.

Experience of waiting for surgery, and preferences about how waiting time could be improved.

554 out of 1041 invited participants agreed to participate (recruitment rate 53.2%). Among them, 274 fully completed the survey (completion rate 49.5%). Most participants (from 52.2% to 70.9%) reported their daily and social activities were impacted by their cardiac condition, and worrying was an ubiquitous feeling (reported by 86%). Psychological distress was reported differently across women and men (higher in women). Eight themes were identified: worrying, daily activities, family/friends and social activities, sexual life, waiting list experience and feelings, communication, most important factors for surgery and suggested improvements. Communication with the surgeon and clinical team, and regular updates on waiting list progress are suggested as crucial factors to alleviate stress, thus potentially improving the experience of waiting for the surgery.

This study highlights the importance of emotional support, clear communication, regular updates on waiting list progress and building trust with the clinical team to improve patient-centred care while waiting for elective cardiac surgery. This finding can offer valuable insights for managing waiting lists in other surgery waiting list contexts.

NCT05996640.

Maternal and child mortality has markedly decreased worldwide over the past few decades. Despite this success, the decline remains unequal across countries and is overall insufficient to meet the Sustainable Development Goals. South Asia and sub-Saharan Africa bear most of the burden of maternal and child morbidity and mortality. Major gaps persist in our understanding of the causes, timing, diagnostic thresholds and risk factors for adverse outcomes in these regions. Addressing these gaps requires new ways to prevent and treat disease, from novel diagnostics to precision public health strategies, all of which rely on high-quality clinical data from diverse populations. The Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRISMA) Maternal and Newborn Health Study aims to estimate population-level prevalence of morbidities and mortality and to assess biological, clinical and sociodemographic risk among mother–infant pairs in India, Pakistan, Kenya, Ghana and Zambia.

This study is a prospective, open cohort study with a planned recruitment of about 6000 women annually across six research sites in five countries. Participants are pregnant women enrolled less than 20 weeks gestation, as determined by ultrasound, identified through active house-to-house and facility-based surveillance. Robust clinical data will be collected at 12 scheduled study visits during antenatal care, labour and delivery, and through 1 year postpartum. A total of 34 outcomes will be captured. The primary analysis will estimate the burden of adverse outcomes and examine associated risk factors to inform future intervention strategies. Data will also be used to develop normative values for pregnant and postpartum women, as well as predictive models to assess pregnancy risk.

PRISMA received institutional and national ethical approvals. Findings will be published in peer-reviewed open-access journals and disseminated at national and international forums to inform clinical guidelines and public health practice.

NCT05904145.

Application of artificial intelligence (AI) tools in the healthcare setting gains importance especially in the domain of disease diagnosis. Numerous studies have tried to explore AI in the diagnosis of various diseases, including tropical fevers such as dengue and malaria. However, there is a lack of standard guidelines to develop the AI models, the gap between clinical and engineering expertise and clinical validation of the models, and hence there is a critical need for the development of an integrated diagnostic tool which uses demographical, laboratory variables and epidemiological parameters of patient and provides early prediction.

The present study aimed to develop and evaluate a machine-learning (ML) prediction tool for differential diagnosis of tropical fevers for adult patients (>18 years) using a three-phase approach in a tertiary care centre in South India by January 2026. Phase involves identification of the prevalent tropical fevers and associated clinical parameters to develop the AI model through a retrospective audit and qualitative interview. Phase Ⅱ involves retrospective data collection from hospital medical records for finalised diseases (1000 cases per disease) and clinical parameters, with data being used for model development using the Python language. Support vector machine, logistic regression, K-Nearest Neighbors, Naïve Bayes and ensemble models such as decision tree and Random Forest will be employed along with explainable AI techniques. They are used as they are easy to understand and interpret, well established, most effective for structured data, enhancing the transparency and interpretability of the predictive machine learning models, and their use has been widely supported in previous studies across various contexts. Suitable statistical parameters like specificity, sensitivity and area under receiver operating characteristic (AUROC) will be applied to evaluate model performance. In phase , the developed model will be implemented prospectively to assess the feasibility of model implementation. Model performance such as specificity, sensitivity and AUROC will be calculated, and the finally developed model will be implemented in a single tertiary care hospital to evaluate its overall performance.

Ethical approval for the study has been obtained from the institutional ethics committee of the Kasturba Medical College and Kasturba Hospital, Manipal (IEC number: 6/2024). Informed consent will be taken for obtaining the data of the patient for the evaluation of the model in the third phase of the study, and data will be kept confidential. The study results will be disseminated by publishing them in a peer-reviewed journal.

The protocol has been registered with the Clinical Trial Registry of India (CTRI) (CTRI/2024/04/065866) and approved on 16 April 2024.

The COmmunity HEalth System InnovatiON (COHESION) project (2016–2019) was a 4-year collaboration between research teams from Mozambique, Nepal, Peru and Switzerland. It conducted formative health system research using tracer chronic conditions, non-communicable diseases (diabetes and hypertension) and one neglected tropical disease per country (schistosomiasis in Mozambique, leprosy in Nepal and neurocysticercosis in Peru).

Findings guided the co-creation of interventions to improve diagnosis and management through a participatory approach with communities, primary healthcare workers and regional health authorities.

As a continuation of this effort, the research team initiated the COHESION Implementation project (COHESION-I) with two objectives: (1) implement and evaluate the context-specific co-created interventions in Mozambique, Nepal and Peru (Component 1) and (2) adapt the COHESION approach to India, a country that did not benefit from a formative phase previously (Component 2). This protocol manuscript focuses on Component 1.

A mixed-methods, pre–post quasi-experimental design will be used, including quantitative, qualitative, economic and process evaluations. Each country will have three arms: (1) co-created and co-designed interventions; (2) only co-designed intervention and (3) the usual care arm. Data will be collected longitudinally over 18 months to assess the effect of the interventions. The main outcomes include patient satisfaction (Patient Satisfaction Questionnaire Short Form), health system responsiveness (WHO responsiveness domains) and quality of life (EuroQol 5 dimensions 5 levels). The qualitative evaluation will explore how satisfaction is perceived among service users with chronic conditions and healthcare workers. Other outcomes per type of evaluation will be considered such as perceived value of health services, cost estimation and acceptability of the intervention components, among others.

Approvals were obtained from Ethics Committees of Universidad Peruana Cayetano Heredia (Peru), Universidade Eduardo Mondale (Mozambique) and Nepal Health Research Council (Nepal). Results will be disseminated through peer-reviewed publications and scientific conferences.

NCT06989502.

In the constantly advancing, dynamic and competitive fields of residency programmes, continuous professional development is crucial for fostering competent and well-rounded health professionals. Multisource (MS) (360°) feedback is widely adopted internationally as a comprehensive tool to assess residents’ performance, yet it is not commonly practised in the Kingdom of Saudi Arabia (KSA). Therefore, this study aims to explore awareness and readiness among residents in KSA to receive 360° feedback.

A qualitative exploratory study using in-depth semistructured interviews.

Secondary and tertiary care hospitals in major cities, recognised for postgraduate training by the Saudi Commission for Health Specialties of KSA.

For the study, medical residents of diverse specialties were recruited by the convenience sampling method. Informed written consent for participation was taken. Audio recorded interviews data were transcribed, and a thematic analysis technique was used to extract the themes.

A total of 7 female and 2 male residents participated. The study extracted four major themes with 31 subthemes accordingly. The subthemes were categorised under the following major themes: lack of awareness of the concept, acknowledging the value of multisource feedback (MSF), receptivity/readiness and challenges.

The study underscores the significant potential of MS (360°) feedback in fostering the personal and professional development of medical residents in KSA. The participants initially lacked a clear understanding of MSF, including its goals, key stakeholders and the competencies it assesses. However, many residents swiftly acknowledged its benefits in offering holistic and equitable evaluation. They demonstrated a strong desire for its implementation across all residency programmes to foster their personal and professional development.

This study aims to explore the impact of financial toxicity (FT) faced by cancer patients in Bahawalpur, Pakistan, identify their coping strategies and provide patient-driven recommendations to mitigate the FT.

A qualitative study design was used, and thematic analysis was employed to analyse the data.

Patients were selected from two tertiary care hospitals located in Bahawalpur, Pakistan.

Thirty patients were selected using a purposive and convenience sampling method. Data were collected between April and June 2024. Patients who provided consent, were 18 years or older and were receiving cancer treatment were included in the study.

Most participants were between 40 and 60 years old, and 66.6% were male. The study highlights severe FT, characterised by financial instability, psychological distress and family lifestyle disruptions. Patients employed various strategies, such as adjusting healthcare decisions, mobilising financial resources and seeking financial aid to cover treatment costs. Novel insights revealed the inadequacy of existing government health card programmes, which focus on direct medical expenses but fail to cover indirect costs, further exacerbating FT. Patients reported significant challenges in accessing government aid programmes due to administrative barriers. Participants highlighted the need for additional support mechanisms to address these gaps effectively, including enhanced accessibility, broadening financial assistance and integrated financial counselling.

This study is the first to explore FT in Pakistan’s healthcare system. It reveals gaps in support mechanisms and highlights the need for comprehensive policy interventions. Addressing these challenges holistically can improve patient outcomes and quality of life.

The impact of poor nutritional health on maternal and infant morbidity and mortality remains high in low- and middle-income countries (LMICs), exacerbated by climate change-linked disasters. Maternal nutritional health, as a modifiable factor, is influenced by various social, political, economic and environmental factors, as well as cultural practices. Identifying climate change-related interventions, adaptive strategies and best practices targeting maternal nutritional health and well-being in LMICs within a cultural context helps inform the co-production of sustainable, culturally sensitive interventions to improve health outcomes for mothers and babies.

We will undertake a systematic review of the literature employing the six steps of the Protocol, Search, Appraisal, Synthesis, Analysis and Report (PSALSAR) framework, including both peer-reviewed and grey literature. The Population, Concept and Context approach will be used to formulate the review question and the inclusion and exclusion criteria. We will include primary research comprising all study designs published in English from 2007 onwards. We will conduct searches in online academic databases, including CINAHL, MEDLINE, Global Health (CABI), AGRIS (FAO) and SCOPUS, as well as defined grey literature sources (ie, Google Scholar). Titles, abstracts and later full-text articles will be independently accessed and screened for eligibility criteria by four researchers. Following the integrative review methodology, we will present findings narratively, organised around the components of the PSALSAR framework to provide a comprehensive synthesis of the available evidence.

As no primary data will be collected, the systematic review does not require formal ethics approval. However, we will give attention to ethical considerations within the identified studies. Findings will be published in a peer-reviewed journal and presented at relevant conferences. The findings of our systematic review and the ethnographic component of our research project will inform the development of appropriate maternal nutritional health interventions using co-production methodology in Pakistan.

CRD420251080897.

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

The study aimed to assess the prevalence of financial catastrophe and explore patients’ perceived effectiveness of the government support programme related to chronic kidney disease.

Cross-sectional mixed-method study.

A total of 120 patients receiving free regular haemodialysis under the government’s Deprived Citizen Support Programme for at least 6 months were included in the quantitative study, and 9 patients participated in the qualitative study.

Prevalence of financial catastrophe and factors associated with financial catastrophe among chronic kidney disease patients undergoing haemodialysis.

A convergent parallel mixed-method approach was carried out from 15 June to 15 December 2024, among chronic kidney disease patients undergoing haemodialysis at the National Kidney Center. Quantitative data were collected through face-to-face interviews using a semi-structured questionnaire. Financial catastrophe was defined as out-of-pocket (OOP) healthcare payments ≥40% of a household’s disposable income, following the WHO-recommended threshold for severe financial burden. OOP expenditures were assessed over 6 months, and associations were tested using ² and binary logistic regression at a 95% CI in SPSS V.25.0. For the qualitative arm, in-depth interviews were conducted with nine purposively selected patients, and inductive thematic analysis was applied to explore the perceived effectiveness of the government support programme. The quantitative and qualitative findings were then integrated to achieve convergence and divergence, allowing for a comprehensive understanding of the extent and context of financial hardship among patients.

The prevalence of financial catastrophe was 72.5%. The factors associated with financial catastrophe were the presence of complications (adjusted OR (AOR): 3.67, 95% CI 1.019 to 13.27), patients without financial support (AOR: 2.77, 95% CI 1.016 to 7.56) and reduction in food expenses (AOR: 0.313, 95% CI 0.109 to 0.896). Qualitative findings on awareness regarding government subsidies, financial strain, barriers to receiving treatment and perceived effectiveness of the programme revealed key aspects of utilisation and effectiveness of the government support programme.

The prevalence of financial catastrophe was substantially high, which highlights the importance of addressing economic challenges in chronic kidney disease care. The study emphasised the need to strengthen financial protection through the expansion of government subsidies and improved insurance coverage.

To assess the feasibility of conducting a cluster randomised controlled trial comparing the effects of Advanced Trauma Life Support (ATLS) and Primary Trauma Care (PTC) with standard care on patient outcomes.

This was a pilot pragmatic three-armed parallel, cluster randomised, controlled trial conducted between April 2022 and February 2023. Patients were followed up for 30 days.

Tertiary care hospitals across metropolitan areas in India.

Adult trauma patients and residents managing these patients were included.

ATLS or PTC training was provided for residents in the intervention arms.

The outcomes were the consent rate, loss to follow-up rate, missing data rates, differences in the distribution between observed data and data extracted from medical records, and the resident pass rate.

Two hospitals were randomised to the ATLS arm, two to the PTC arm and three to the standard care arm. We included 376 patients and 22 residents. The percentage of patients who consented to follow-up was 77% and the percentage of residents who consented to receive training was 100%. The loss to follow-up rate was 14%. The pass rate was 100%. Overall, the amount of missing data for key variables was low. The data collected through observations were similar to data extracted from medical records, but there were more missing values in the extracted data.

Conducting a full-scale cluster randomised controlled trial comparing the effects of ATLS, PTC and standard care on patient outcomes appears feasible, especially if such a trial would use data and outcomes available in medical records.

NCT05417243.

Poor medication adherence is associated with poor clinical outcomes, an increase in hospitalisations and increased mortality. This is a multicentre randomised study that evaluates the effectiveness of using a manual pill organiser (MPO) and a custom-developed pill reminder app (PRA) on medication adherence, morbidity, as well as health economic outcomes among Indian elderly individuals taking multiple medications.

The primary objective of this study is to evaluate the impact of MPO and PRA alone or in combination in improving medication adherence among elderly individuals on multiple medications. The secondary objectives include the impact of interventions on the morbidity profile and health-related quality of life. The study also plans to assess the cost-effectiveness and cost-utility of improving medication adherence.

This is a community-based, open-label, factorial-design randomised controlled trial to be conducted across rural and urban populations at two geographically distinct sites in India. The study will enrol 752 elderly individuals aged 60–80 years, receiving three or more medications for at least 6 months and having access to smartphones. The participants will be randomised to receive one of the following interventions for 12 months: control group, PRA, MPO and MPO+PRA. All study groups would receive patient education about the importance of medication adherence. The study outcomes include the proportion of improvement in medication adherence (using Medication Adherence Rating System-5, 7-day point prevalence of medication non-adherence and pill count); adverse clinical outcomes; healthcare utilisation; health-related quality of life; cost-effectiveness and cost-utility outcomes.

The study protocol has been approved by institutional ethics committees at all three institutes. The study results for primary and secondary outcomes will be published in peer-reviewed journals.

CTRI/2024/01/061975 (Registered on: 29 January 2024).