Malaria remains a serious public health issue, and sub-Saharan Africa (SSA) is still disproportionately burdened with the disease. Efficient disease tracking in both public and private healthcare points is required to consolidate elimination efforts. Considerable amounts of malaria cases in the private sector, especially community pharmacies, are not captured into routine surveillance systems. This scoping review aims to systematically collate the existing evidence on the facilitators and barriers to malaria surveillance in community pharmacies (CPs) and over-the-counter medicine sellers (OTCMS) in SSA.

We will retrieve all relevant studies (published and completed but unpublished) through searches in PubMed, CINAHL, Scopus, Web of Science and Hinari from inception to 15 June 2026. Searches will be conducted without language restrictions; however, full-text inclusion will be limited to English-language publications due to resource constraints. Titles and abstracts of non-English articles will be thoroughly screened using online-assisted translation tools such as Google Translate to assess their potential eligibility. Potentially relevant non-English studies will be documented and reported in the appendices to allow for an evaluation of possible language bias, in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines. All the articles retrieved from the searches will be collated and deduplicated using EndNote. The deduplicated studies will then be screened and selected. Two reviewers will independently screen studies using a study selection flow chart developed from the pre-specified eligibility criteria. The data synthesis for this scoping review will be conducted using a narrative synthesis approach. The extracted data will be organised into a structured format, categorising information based on study characteristics, malaria surveillance activities, facilitators and barriers.

Formal ethical approval is not required as the review uses publicly available data. Findings will be published in an open-access peer-reviewed journal, presented at relevant conferences and disseminated through policy briefs and infographics to the WHO, national malaria programmes and pharmacy councils.

Open Science Framework (registration link: https://osf.io/udwpn/overview?view_only=6e42bea8abb94f9cbc535b161ea329a6).

Geriatric patients often face issues related to polypharmacy and adverse drug events. Re-evaluating prescribed medications and considering deprescribing is critical. Medication discrepancies (MDs) during care transitions can compromise patient safety, as over 60% of medication errors occur at these points. This study aimed to assess the magnitude of MDs and their contributing factors through the medication reconciliation (MedRec) process among geriatric patients in emergency departments of comprehensive specialised hospitals in northwest Ethiopia, as well as to determine the acceptance of pharmaceutical interventions.

In this multicentre prospective observational study, the best possible medication history (BPMH) was obtained within 24 hours of emergency department admission from at least two sources. A comparison of the BPMH list with medication orders from treating physicians revealed discrepancies. Data were analysed using STATA V.17.0, using multivariable logistic regression to assess variable associations.

Adult emergency departments of comprehensive specialised hospitals in northwest Ethiopia.

Overall, 384 geriatric patients with chronic conditions and current medication use who visited the adult emergency department of the hospital from 10 January 2025 to 30 March 2025 were involved in this study.

Magnitude and types of MDs, acceptance of pharmacist interventions, and factors associated with MDs.

In total, 384 patients with chronic diseases visiting the hospital emergency department were recruited in the present study. Out of 384 patients involved in the study, 218 (56.77%) had encountered at least one MD. Omission error 190 (45.24%) was the most common type of MD, followed by wrong dose 82 (19.50%). Among 420 interventions, 80.48% of the total cases were accepted. Number of previous/home medications (≥5 medicines; adjusted OR (AOR)=3.12; 95% CI 1.190 to 8.151), older age (≥75 years; AOR=1.62; 95% CI 1.054 to 2.495), and number of comorbidities (≥3; AOR=1.65; 95% CI 1.066 to 2.546) were associated factors with MDs.

This study revealed a high prevalence of MDs in the emergency department. Polypharmacy, comorbidities and older age were factors associated with MDs. The study findings show the need for a clinical pharmacist-led MedRec implementation to enhance patient safety.

To determine the prevalence of potentially inappropriate prescribing (PIP), potentially inappropriate medication (PIM), potential prescription omission (PPO), potentially harmful drug–drug interactions (PDDI) and identify associated factors among older Ethiopians.

Systematic review and meta-analysis

We searched PubMed, HINARI, Scopus and Web of Science databases to identify eligible studies published up to 31 October 2025.

Observational studies reported the prevalence of PIP, PIM, PPO and PDDI among older adults from any healthcare settings were screened.

Two independent reviewers selected studies, extracted data and assessed the risk of bias. The quality and risk of bias of the studies were assessed using the Newcastle-Ottawa scale and Hoy risk of bias tool, respectively, while the certainty of evidence of outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation based on Cochrane recommendations. We used a random-effects model for analyses to estimate the pooled prevalence and associated factors. All data analyses were done using Stata V.17 software.

The national prevalence of PIP, PIM, PPO and PDDI was estimated as main outcomes. Variations were estimated based on regions, age groups, outcome evaluation tool, disease type and healthcare setting.

The review included 25 studies (n=5662 participants) for PIP or PIM, 14 studies (n=2706 participants) for PDDI and 6 studies (n=1342 participants) for PPO. The pooled prevalence estimate was 41% (95% CI 33% to 48%), I²=96.87% for PIP, 37% (95% CI 31% to 44%), I²=96.33% for PIM, 55% (95% CI 36% to 73%), I²=99.00% for PDDI and 14% (95% CI 6% to 24%), I²=95.07% for PPO. The majority of the studies have very good quality (very good=13, good=1, satisfactory=11 for PIP and PIM; very good=11, satisfactory=3 for PDDI; very good=6 for PPO) and low risk of bias (low risk=18, moderate risk=7 for PIP and PIM; low risk=12, moderate risk=2 for PDDI and low risk=6 for PPO), while all studies for each outcome have low certainty of evidence. Subgroup analyses revealed significant regional and contextual variations. Polypharmacy was significantly associated with PIP (OR=3.72, 95% CI 2.53 to 5.46, p2=69.56%), PIM (OR=4.20, 95% CI 2.91 to 6.06, p2=57.83%) and PDDI (OR=4.51, 95% CI 3.05 to 6.69, p2=0.00%), while hypertension (OR=2.46, 95% CI 1.38 to 4.36, p2=0.00%) was associated with PIP.

This review found a high prevalence of PIP, PIM, PDDI and PPO among older adults in Ethiopia, with notable heterogeneity across regions. Polypharmacy was associated with PIP, PIM and PDDI, while hypertension showed association with PIP. Despite generally good study quality, the certainty of evidence was low for the included studies due to the cross-sectional design nature, with high heterogeneity. Therefore, these findings should be interpreted cautiously. This study indicates a high burden of inappropriate medication prescribing and its associated factors, underscoring the importance of further robust studies to clarify prescribing practices and associated factors.

CRD42024556744.

To assess health-related quality of life (HRQoL), treatment satisfaction and associated factors among older adults with acute heart failure in Northwest Ethiopia.

Prospective, multicentre observational study.

Three tertiary hospitals in Northwest Ethiopia provide secondary and tertiary care services.

A total of 422 patients aged ≥60 years with a confirmed diagnosis of acute heart failure were consecutively enrolled between December 2024 and April 2025. Patients with unstable psychiatric conditions or advanced kidney disease were excluded.

HRQoL was assessed using the WHO Quality of Life – Brief Version questionnaire, and treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). Multiple linear regression identified factors associated with HRQoL and treatment satisfaction.

95% of participants reported moderate HRQoL, and 3% reported poor HRQoL. Weight loss was positively associated with HRQoL (β=1.52; 95% CI 0.04 to 3.07; p=0.021), whereas asthma was negatively associated with HRQoL (β = –3.28; 95% CI 6.94 to 0.37; p=0.001). Regarding treatment satisfaction, 65% of patients were moderately satisfied, with notable concerns regarding medication safety and overall experience. Rural residents reported lower satisfaction than urban residents (β = –0.20; 95% CI 0.34 to 0.05; p=0.007). Patients with New York Heart Association (NYHA) class III had higher satisfaction (β=0.25; 95% CI 0.05 to 0.45; p=0.016). Effective hypertension management was linked to increased satisfaction (β=0.20; 95% CI 0.02 to 0.37; p=0.026), whereas coronary heart disease was associated with lower satisfaction (β = –0.40; 95% CI 0.64 to 0.88; p=0.012).

Among older adults with heart failure in Northwest Ethiopia, 98% reported moderate to low HRQoL. Asthma and polypharmacy negatively affected HRQoL, whereas weight loss was positively associated with HRQoL. An NYHA class III status and well-managed hypertension improved treatment satisfaction, whereas rural residency and coronary heart disease were associated with lower satisfaction. These findings underscore the need for targeted interventions to enhance outcomes and QoL in this vulnerable population.

Mobile health (mHealth) technologies have become increasingly popular for monitoring mental health symptoms and lifestyle behaviours, and are largely reported to be feasible and acceptable to users. However, to date, the efficacy of such technologies to improve perinatal mental health outcomes has been mixed. Within the perinatal context, much of this work has been done in the context of postpartum depression, stemming from electronic health records as well as cohort studies. There is, however, a dearth of studies focusing on depression in pregnancy, and machine learning-based clinical decision support systems remain underexplored. The HappyMums application has been developed to meet this need, and its use across Europe will be tested in this study.

A total of 1000 pregnant people currently suffering from, or at risk of, antenatal depression will be recruited across six countries. All participants will be between 13 and 28 weeks’ gestation and will be given access to the new purposefully developed HappyMums mobile application, to use from enrolment until 2 months postpartum. The application leverages passively collected data from smartphone sensors relating to physical activity and behaviour, as well as requiring active engagement from the user to complete mental health questionnaires and ‘game-like’ activities. Digital data types will be combined with traditional mental health measurement methods, such as standardised questionnaires and interviews, to develop novel predictive models capable of identifying mental health trajectories in women at risk of developing antenatal depression and to test the app’s utility for use as personalised risk prediction and depression identification tool. The primary outcome of this study is to determine what proportion of users will continue to use the mobile application and engage with its tasks and activities at least weekly, while secondary exploratory outcomes include assessing usability of the app and testing the predictive ability of a novel machine learning-based model. These outcomes will, for the first time, be assessed by integrating active as well as passive data.

Ethical approval has been granted by local research ethics committees in each recruiting centre. At King’s College London (leading the clinical study), the study was reviewed by the East of England—Essex Research Ethics Committee and granted favourable opinion (REC reference 24/EE/0129). All other sites collecting participant data have the study approved for local delivery. Findings relating to the primary and secondary outcomes will be submitted for publication in open access, peer-reviewed journals, as well as presentations at conferences as symposia or posters. Findings will be made available to a non-specialist audience through open access digital mental health magazines and promotion on social media.

NCT06578845.

To identify enablers and barriers for scaling up non-communicable disease (NCD) interventions across diverse global contexts and to map these factors to the WHO’s health system building blocks.

A multi-method qualitative study applying the Consolidated Framework for Implementation Research to analyse data from multiple projects nearing or completing scale-up.

Global Alliance for Chronic Diseases-funded implementation research projects conducted across 18 low- and middle-income countries and high-income settings.

Data was derived from documents (n=77) including peer-reviewed publications, policy briefs, and reports and interviews with stakeholders (n=18) (eg, principal investigators, medical professionals, public health workers).

Various context-specific interventions targeting sustainable scale-up of NCD (eg, diabetes, hypertension, cardiovascular disease) interventions at the community, primary care or policy levels.

The primary outcome was identifying contextual enablers and barriers to intervention scale-up. Secondary outcomes included exploring how these factors aligned with health system building blocks (eg, leadership/governance, healthcare workforce).

Twenty enablers (eg, intervention adaptability, strong stakeholder engagement, local empowerment) and 25 barriers (eg, resource limitations, intervention complexity, stakeholder burnout) were identified. Contextual alignment, supportive governance and capacity building were critical for sustainability, while cultural misalignment and socio-political instability frequently hampered scaling efforts.

Tailoring interventions to local health systems, ensuring stakeholder co-ownership and incorporating strategies to mitigate stakeholder burn-out are essential to achieving sustainable, scalable NCD solutions. Future research should focus on integrating systematic cultural adaptation, sustainable financing and workforce capacity building into scale-up planning.

To assess the magnitude and associated factors of suicidal behaviour and non-suicidal self-injury (NSSI) among youth of the Gurage Zone, Southern Nations, Nationalities, and Peoples Regional, Ethiopia, 2024.

A community-based cross-sectional study was conducted.

This research was carried out in the Gurage Zone.

This study was conducted among 719 Gurage Zone youths from 1 January 2024 to 1 February 2024.

Suicidal behaviours and non-suicidal self-injury were assessed using a pretested, interviewer-administered, structured questionnaire. Data were entered in EpiData V,3.1 and exported to SPSS V.25 for analysis. A binary logistic regression model was used to identify significant factors associated with suicidal behaviours and NSSI. Variables with a p-value less than 0.05 and adjusted ORs with 95% CI were used to declare association with the outcome variable in the final model.

Out of the total 820 study participants, 719 participants participated in the study, giving a response rate of 88%. Among 719 respondents 465 (64.7%) were males. The prevalence of high risk of suicidal behaviours was 11.7% (95% CI 8.14 to 14.30) and it is significantly associated with substance use in the last 3 months (adjusted OR (AOR)=6.84; 95% CI 3.48 to 13.47), having moderate insomnia (AOR=3.09; 95% CI 1.30 to 7.31) and having depression (AOR=6.84; 95% CI 3.48 to 13.47).

The prevalence of NSSI among youths was 38% (95% CI 34.52 to 41.86). Substance use in the last 3 months (AOR=2.459; 95% CI 1.59 to 3.81), youths having depression (AOR=3.348; 95% CI 2.29 to 4.91), youths who were exposed to stressful life events (AOR=9.86; 95% CI 6.46 to 15.07) were significantly associated with NSSI.

Nearly 1 in 10 youths in the Gurage Zone exhibited high-risk suicidal behaviour, and over one-third reported NSSI. Suicidal behaviour was significantly associated with substance use, depression and moderate insomnia, while NSSI was significantly associated with substance use, depression and exposure to stressful life events. These findings highlight the prevalence of self-harm and the key factors associated with these behaviours among youth in this region.

Cervical cancer (CaCx) is a leading cause of cancer-related deaths among women in South Africa, often presenting at advanced stages and requiring chemoradiotherapy. In South Africa, the burden is disproportionately high among women living with HIV, with limited access to radiotherapy further compounding treatment challenges. Despite this documented disparity, limited data exist on patients in a South African context. This protocol describes the research methodology to assess patterns of care, treatment delays, interruptions and survival outcomes in patients with advanced CaCx, addressing an urgent need for local data in low-income and middle-income countries to provide evidence-based improvements in care.

The Cervical Cancer Cohort at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH-CCC), initiated in 2023, is a mixed retrospective and prospective single-centre study investigating the characteristics, challenges and outcomes of patients with advanced CaCx. It includes women aged ≥18 years with a histopathological diagnosis of stage IB3–IVA CaCx treated at CMJAH Radiation Oncology. The retrospective component covers data from September 2018 to August 2023. Data collection is complete and the team is currently conducting quality control. The prospective component began in October 2023 and aims to enrol participants over 2 years, with follow-up for up to 3 years. The study is ongoing, and an extension for continued enrolment beyond September 2025 is being sought. Participants provide baseline data on demographics, socioeconomic status, cultural influences and healthcare access, with updates every 3 months. When necessary, the next of kin provides follow-up information. The study aims to inform strategies to improve outcomes and reduce the CaCx burden in South Africa.

Ethics approval for this study was obtained from the Human Research Ethics Committee (Medical) at the University of the Witwatersrand in Johannesburg, South Africa, with an ethical clearance certificate (MM221001 MED22-09-085). The results will be widely distributed through presentations at national and international conferences and published in peer-reviewed open-access journals, ensuring wide access to the results.

Gestational trophoblastic disease, characterised by abnormal proliferation of trophoblastic tissue in the placenta during pregnancy, contributes to maternal morbidity and mortality. This study aimed to estimate the pooled prevalence and histopathological patterns of gestational trophoblastic disease in Africa, where previous studies have reported inconsistent findings.

Systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

We searched PubMed, ScienceDirect, Hinari and Google Scholar for studies published between January 2000 and January 2024.

Institution-based observational studies from African countries reporting the prevalence and/or histopathological patterns of gestational trophoblastic disease, using total deliveries as the denominator.

Data were extracted into Excel and analysed using Stata V.17. Pooled estimates were calculated using a random-effects model with Knapp-Hartung adjustment. Heterogeneity was assessed with Cochran’s Q test and the I² statistic, and study quality was evaluated using the Joanna Briggs Institute tool.

Of the 2252 studies identified, 33 were included, comprising 2885 gestational trophoblastic disease cases from eight countries. The pooled prevalence of gestational trophoblastic disease in Africa was 4.35 per 1000 deliveries (95% CI 3.26 to 5.45, I²=99.8%). The pooled prevalence of hydatidiform mole, invasive mole and choriocarcinoma in Africa was 3.49 per 1000 deliveries (95% CI 2.45 to 4.52, I²=99.7%), 0.47 per 1000 deliveries (95% CI 0.14 to 0.79, I²=72.2%) and 0.97 per 1000 deliveries (95% CI 0.54 to 1.40, I²=99.1%), respectively.

This review indicated the prevalence of gestational trophoblastic disease was high. Hydatidiform mole was the predominant histopathological pattern observed. Routine antenatal screening is needed for early detection. Further research should be conducted to identify risk factors and evaluate strategies for the prevention and management of the disease.

CRD42024504268.

Out-of-hospital cardiac arrest (OHCA) has low survival rates with worse outcomes at night due to delayed emergency medical services (EMS) response, resource limitations and workforce fatigue. Since randomised trials are unfeasible, all-comers registries provide essential data to bridge evidence gaps and improve EMS protocols.

Retrospective observational study using propensity score matching.

National EMS registry and death registry data from Poland, cases from September to November 2022.

Of 2388 eligible patients, cases were grouped by time of cardiac arrest (on-hours: 7:00–18:59; off-hours: 7:00–18:59 AM) and matched 1:1 using propensity scores, yielding 1194 pairs.

Primary: return of spontaneous circulation (ROSC) and 30-day survival.

Secondary: EMS response time.

Our findings revealed significant disparities in OHCA outcomes between day and night shifts. ROSC rates were notably lower at night (20.9% vs 34.8%; p=0.01); however, no difference in 30-day survival was observed (8.3% vs 8.1%; p=0.94). Furthermore, EMS response times were significantly longer during nighttime hours (median and IQR): 12.4 (7.4–14.6) versus 11.2 (6.2–13.5) (minutes); p=0.01.

Patients with OHCA during off-hours experienced longer EMS response times and significantly lower rates of ROSC as compared with daytime hours. No difference in 30-day survival was observed between groups. Potential contributors include reduced staffing, fatigue and logistical delays. System-level changes in EMS scheduling and workforce planning might help to reduce time-of-day-related disparities in OHCA outcomes.

Clinical Trials ID: NCT03130088; Post results

The aim of this study was to analyse associations between crowded housing and children’s indoor living environment, respiratory and allergic disorders and general health.

A cross-sectional study.

Sweden, using data from the Swedish National Environmental Health Survey 2019.

The study sample included 48 512 children (aged 6–10 months, 4 years and 12 years). We also investigated associations in vulnerable subgroups, such as children with asthma and those living under unfavourable socioeconomic conditions.

Primary outcomes in the living environment were at least one sign of mould, poor indoor air quality, unpleasant odours, too warm indoors in summer and too cold indoors in winter. Primary outcomes for children’s health were asthma, airway problems, breathing difficulties, rhinitis symptoms, mould and mites allergy, pollen allergy, furred pet allergy and good general health.

About one in five children lived in an overcrowded home. Factors from the indoor living environment such as perceived poor indoor air quality and mould were significantly associated with crowded housing. Moreover, children who lived in overcrowded conditions were less likely to report good general health than children in non-crowded households (OR 0.64, 95% CI 0.54 to 0.76). This association was even stronger in children with asthma (OR 0.51, 95% CI 0.34 to 0.77). Few significant associations were, however, observed with the respiratory and allergic health outcomes.

Crowded housing is associated both with a poor indoor environment and with poorer general health in children. Children with asthma may experience even poorer general health.

Loneliness and adverse childhood experiences (ACEs) constitute significant risk factors for mental disorders, with loneliness emerging as a serious global public health concern. Recent research highlights the role of loneliness as a potential link between early life adversities and current psychopathology. However, most studies have been conducted in high-income, highly individualistic countries. This cross-sectional study explores the interplay between loneliness, social network size, recalled ACEs and depressive symptoms in Ethiopia—a low-income and collectivistic cultural context.

The study included 125 psychiatric outpatients at Jimma University Medical Center in Southwest Ethiopia diagnosed with major depressive disorder, bipolar disorder or psychotic disorders, as well as 131 non-clinical participants. Trained interviewers administered the University of California, Los Angeles (UCLA) Loneliness Scale, the Childhood Trauma Questionnaire, the Social Network Index and the WHO-5 Well-Being Index. We used Mann-Whitney U tests, partial correlation and mediation analysis for data analysis.

We found mild-to-moderate correlations between loneliness and ACEs (clinical group: rho=0.29, p1b₁=0.07, 95% CI (0.02 to 0.13); non-clinical group: indirect effect a₁b₁=0.03, 95% CI (0.01 to 0.07)). In contrast, social network size was neither correlated with ACEs nor did it mediate the association between ACEs and depressive symptoms in either group.

This study replicates previous findings that loneliness—rather than social network size—is associated with ACEs and mediates their impact on depressive symptoms. These results support the transcultural and transdiagnostic relevance of loneliness as a universal psychological mechanism, independent of societal structure.

To examine the association between individual social capital and depression in older adults in Iran and to test the hypothesis that higher levels of social capital are inversely associated with depressive symptoms.

Cross-sectional study using baseline data from a longitudinal cohort.

Community-based study conducted in primary care settings across urban and rural areas of Birjand County, Eastern Iran.

A total of 1348 community-dwelling individuals aged 60 years and older were recruited through multistage stratified cluster random sampling. Participants who were bedridden or had end-stage disease (life expectancy

The primary outcome was depression status, measured using the Patient Health Questionnaire 9 items, with a score≥10 indicating depression. The main explanatory variable was social capital, assessed using a validated 69-item questionnaire capturing domains such as collective activity, social trust and network structure. Univariable and multivariable logistic regression analyses were conducted to estimate adjusted ORs and 95% CIs for associations between depression and social capital dimensions. Statistical analyses were performed using Stata V.12.0

Of the total participants, 268 (19.94%) were identified as having depressive symptoms, with a significantly higher prevalence among women (27.44%) compared with men (11.88%). Depression was more prevalent among those in the lowest wealth quintile (32.09%) and individuals with low literacy levels (28.10%). Participation in collective activities was inversely associated with depression in the second (OR=0.62, 95% CI (0.42 to 0.93)), third (OR=0.45, 95% CI (0.29 to 0.71)), fourth (OR=0.59, 95% CI (0.37 to 0.93)) and fifth (OR=0.37, 95% CI (0.22 to 0.61)) quintiles. Social trust was also associated with lower odds of depression in the third (OR=0.62, 95% CI (0.39 to 0.99)) and fourth (OR=0.64, 95% CI (0.42 to 0.97)) quintiles. Furthermore, the second (OR=0.63, 95% CI (0.40 to 0.99)) and fifth (OR=0.38, 95% CI (0.23 to 0.63)) quintiles of social network structure were inversely related to depression. These findings suggest that higher levels of social capital, particularly in terms of collective participation, trust and social networks, are associated with a reduced likelihood of depressive symptoms in older adults.

Higher levels of social capital, particularly collective engagement, interpersonal trust and diverse social networks, are associated with lower odds of depression in older adults. These findings support the need for community-based interventions to strengthen social capital as a strategy for mental health promotion among the elderly in low-income and middle-income settings.

Prostate cancer (PCa) is the second most common cancer in men worldwide and genetic factors and family history significantly increase the risk of PCa. Men at increased risk for PCa often experience higher PCa-specific anxiety and distress. Comprehensive prevention strategies for men with familial or genetic PCa predisposition are lacking. Consequently, the psychological impact, facilitators and barriers for risk-adapted PCa prevention lack comprehensive study. The novel prospective registry and prevention clinic ‘ProFam-Risk’ (prevention clinic for familial PCa risk) at the University Hospital Düsseldorf offers personalised risk assessment and risk-adapted prevention recommendations for men with familial or genetic PCa predisposition. As part of this research project, this study (‘ProFam-Psych’ - risk-adapted prevention clinic for familial and genetic prostate cancer: psychosocial effects; funded by German Cancer Aid) aims to evaluate the longitudinal psychosocial trajectories associated with this novel prevention clinic.

In a longitudinal observational mixed-methods design, psychosocial outcomes will be assessed in participants of the prevention clinic (case group, CAG) and compared with urology patients without increased risk for PCa (control group, COG). Psychosocial outcomes will be collected at four time points in the CAG (T0: baseline; T1: after first visit; T2: after risk stratification consultation; T3: follow-up 6 months after T2) and at two time points in the COG (T0: baseline during inpatient stay; T1: post-inpatient stay). Recruitment started in 2023, and the recruitment target is n=225 participants (CAG) and n=118 participants (COG). Primary endpoint is the longitudinal course of PCa-specific anxiety (Memorial Anxiety Questionnaire for Prostate Cancer) in the CAG. Secondary endpoints include the comparison of T0 and T1 outcomes between the CAG and COG and the assessment of changes in perceived PCa risk and perceived personal control in the CAG. To assess facilitators and barriers to participation in the risk-adapted PCa prevention clinic, a minimum of n=12 semi-structured qualitative interviews will be conducted, with recruitment continuing until data saturation is reached. Qualitative data will be analysed using qualitative content analysis.

Ethics approval from the Medical Faculty of the Heinrich Heine University Düsseldorf was obtained (2023-2551). Results of the main objective and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal.

DRKS.de, DRKS00032350. Prospectively registered with the German Clinical Trials Register (DRKS) on 14 September 2023.

Urban green and blue space (UGBS) interventions, such as the development of an urban greenway, have the potential to provide public health benefits and multiple co-benefits in the realms of the environment, economy and society. This paper presents the protocol for a 5-year follow-up evaluation of the public health benefits and co-benefits of an urban greenway in Belfast, UK.

The natural experiment evaluation uses a range of systems-oriented and mixed-method approaches. First, using group model building methods, we codeveloped a causal loop diagram with stakeholders to inform the evaluation framework. We will use other systems methods including viable systems modelling and soft systems methodology to understand the context of the system (ie, the intervention) and the stakeholders involved in the development, implementation and maintenance phases. The effectiveness evaluation includes a repeat cross-sectional household survey with a random sample of 1200 local residents (adults aged ≥16 years old) who live within 1 mile of the greenway. The survey is complemented with administrative data from the National Health Service. For the household survey, outcomes include physical activity, mental well-being, quality of life, social capital, perceptions of environment and biodiversity. From the administrative data, outcomes include prescription medications for a range of non-communicable diseases such as cardiovascular disease, type II diabetes mellitus, chronic respiratory and mental health conditions. We also investigate changes in infectious disease rates, including COVID-19, and maternal and child health outcomes such as birth weight and gestational diabetes. A range of economic evaluation methods, including a cost-effectiveness analysis and social return on investment (SROI), will be employed. Findings from the household survey and administrative data analysis will be further explored in focus groups with a subsample of those who complete the household survey and the local community to explore possible mechanistic pathways and other impacts beyond those measured. Process evaluation methods include intercept surveys and direct observation of the number and type of greenway visitors using the Systems for Observing Play and Recreation in Communities tool. Finally, we will use methods such as weight of evidence, simulation and group model building, each embedding participatory engagement with stakeholders to help us interpret, triangulate and synthesise the findings.

To our knowledge, this is one of the first natural experiments with a 5-year follow-up evaluation of an UGBS intervention. The findings will help inform future policy and practice on UGBS interventions intended to bring a range of public health benefits and co-benefits. Ethics approval was obtained from the Medicine, Health and Life Sciences Research Ethics Committee prior to the commencement of the study. All participants in the household survey and focus group workshops will provide written informed consent before taking part in the study. Findings will be reported to (1) participants and stakeholders; (2) funding bodies supporting the research; (3) local, regional and national governments to inform policy; (4) presented at local, national and international conferences and (5) disseminated by peer-review publications.