Postoperative sleep disturbance (PSD) is a common complication following major surgery, occurring in 15%–72% of patients. PSD poses a significant threat to both postoperative recovery and long-term outcome, leading to elevated risks of cognitive decline, pain sensitivity and cardiovascular events in patients. The current pharmacological treatments for PSD are typically reactive, administered only after symptoms have manifested, highlighting a critical unmet need for effective prophylactic strategies during the perioperative period. Recently, an increasing number of studies have demonstrated the effect of esketamine on preventing PSD, but their findings are inconsistent. This protocol outlines a systematic review and meta-analysis to examine the effect of perioperative esketamine on the prevention of PSD.

A comprehensive search will be conducted in MEDLINE (via Ovid), EMBASE (via Ovid), the Cochrane Central Register of Controlled Trials (via Ovid), PubMed and Web of Science by two authors independently. The search terms will comprise indexed and free-text terms to encompass the concepts of esketamine and PSD. The primary outcome is the incidence of PSD at postoperative days 1, 3 and 7. Two authors will independently conduct study screening, data extraction and risk of bias assessment with the Cochrane Collaboration’s tool. RevMan V.5.4.1 and Stata V.17.0 software will be used to conduct the statistical analysis. Subgroup analysis, sensitivity analysis and assessment of publication bias will be performed to verify the strength of our conclusions. Finally, the Grading of Recommendations Assessment, Development and Evaluation approach will be used to recommend evidence quality.

Ethical approval is not required for this study. The findings will be presented at national or international conferences and submitted to a peer-reviewed journal.

CRD420251232636.

To assess the levels of knowledge, attitudes and practices (KAP) toward skin cancer prevention among Malaysian adults and to examine differences in KAP across socio-demographic groups.

Cross-sectional online survey.

Community-based study conducted in Malaysia using social media recruitment.

A total of 386 adults aged ≥18 years residing in Malaysia. Most participants were young adults (86.3%), female (55.4%) and of Chinese ethnicity (65.5%). Healthcare professionals were excluded.

Primary outcomes were levels of knowledge, attitude and preventive practices toward skin cancer, measured using the validated KAP-SC-Q (Knowledge, Attitude and Practice of Skin Cancer Questionnaire) and categorised as poor, moderate or good. Secondary outcomes included differences in KAP across socio-demographic and clinical characteristics, analysed using independent t-tests and ² tests.

Over half of participants demonstrated poor knowledge of skin cancer (56.0%) and the vast majority showed inadequate preventive practices (84.2%), while attitudes toward skin cancer were predominantly positive (62.4%). Significant differences in mean KAP scores and categorical levels were observed across several socio-demographic variables. Participants with tertiary education had higher knowledge (14.32 vs 12.61) and attitude scores (20.01 vs 15.95; p

Malaysian adults exhibited limited knowledge and very poor preventive practices toward skin cancer despite generally positive attitudes. These findings highlight substantial gaps between awareness and behaviour and support the need for targeted public health interventions to correct misconceptions, improve risk perception especially in high-risk groups and promote effective ultraviolet protection behaviours.

Despite international efforts to address women’s long-term health and well-being, significant gaps in sexual and reproductive health (SRH) services and non-communicable diseases (NCDs) prevention remain, particularly in low-and-middle-income countries (LMICs).

We analysed data from 726 278 women aged 15–49 from six national surveys (2017–2021, Benin, Cameroon, Gabon, India, Madagascar and Mauritania) on unmet needs for NCD prevention (blood pressure, glucose, cervical cancer screening) and SRH services (contraception, antenatal, postnatal care). Unmet needs prevalence was calculated as the percentage of participants with specific unmet needs and estimated across demographics and socioeconomic groups using multivariable logistic regression models.

Unmet needs were strikingly high for NCD prevention: 36.6% for blood pressure, 70.0% for blood glucose and 98.5% for cervical cancer screening. In contrast, unmet needs for contraception, antenatal care and postnatal care were relatively lower: 7.5%, 14.5% and 14.5%, respectively. Significant variations were observed across countries. India had the lowest unmet needs for SRH services: 6.7% for contraception, 13.1% for antenatal care and 13.1% for postnatal care. Gabon had lower unmet needs for prenatal (16.8%) and postnatal care (14.8%) compared with other African countries and the lowest unmet need for cervical screening at 84.7% (95% confidential interval 83.1% to 86.2%), over 10 percentage points lower than others. Furthermore, socioeconomic factors like higher education, better economic status, healthcare access, insurance and internet use significantly lowered unmet needs, especially for antenatal and postnatal care. Employed women had higher unmet needs for antenatal (35.7%) and postnatal (37.3%) care than unemployed women (28.1%, 27.8%) but lower for NCDs prevention (98.9%, 71.8%) under two definitions than unemployed women (99.3%, 79.2%).

This study highlights the urgent need to address high unmet needs for NCD prevention among women in LMICs, particularly cervical cancer screening. Unmet SRH needs are also a major concern, given significant disparities across countries. Especially, governments should prioritise measures to focus on vulnerable groups.

Although female smoking prevalence in China remains low, emerging evidence suggests that social acceptance may be increasing, with tobacco marketing increasingly targeting women. This study explored women’s smoking behaviours, motivations and societal perceptions toward this in urban China.

Between May and October 2019, 28 semistructured focus groups were conducted in Beijing, Changsha and Shenzhen with 288 participants: 12 groups of female smokers, 6 of female former smokers, 6 of female never-smokers and 4 of men. Participants were recruited both online and offline, and smoking status was verified with a carbon monoxide monitor. Discussions were transcribed verbatim and analysed thematically using dual coding.

Four themes emerged. First, while stigma against female smoking persisted, social acceptance is growing, especially among younger generation. Second, three initiation stages were identified: adolescence, early career and post-retirement, often triggered by peer influence, occupational stress and life transitions. Third, many female smokers concealed their behaviour, reflecting tension between shifting descriptive norms and enduring injunctive norms, which may contribute to underreporting in surveillance data. Fourth, misconceptions about smoking harms and quitting were common, with most women who smoke relying on willpower and showing limited interest in cessation support; pregnancy was one of the few strong motivators for quitting.

Findings suggest gradual normalisation of female smoking in urban China, driven by evolving gender roles and targeted marketing. Public health responses should prioritise gender-specific health education, strengthen promotion of cessation services and tighten restrictions on tobacco marketing towards women to prevent future increases in female smoking.

The objective of this study was to determine the association between viral subtype/clade and disease severity.

Multicentre retrospective cohort study.

This study used data from the Global Influenza Hospital Surveillance Network (GIHSN). The dataset comprised hospitalised influenza patients with viral sequencing data across 14 countries, collected from August 2022 through October 2023.

A total of 761 hospitalised patients were enrolled during the study period, and 745 patients were included in the analysis. We excluded patients with missing data on explanatory or outcome variables, those infected with viral clades represented by fewer than 11 sequences, and those enrolled at study sites contributing fewer than 5 patients.

Disease severity was defined by admission to intensive care unit (ICU), receipt of non-invasive oxygen supplementation, 3-variable definition (ICU, mechanical ventilation or death) or 4-variable definition (3-variable plus oxygen supplementation).

Outcomes were analysed in association with subtype or clade using the mixed-effects logistic regression models, adjusting for age group, sex, underlying medical conditions, influenza vaccination status, antiviral use, country income level and epidemic period, while study site was included as a random effect.

745 patients were included: 263 A(H1N1)pdm09, 380 A(H3N2), 102 B/Victoria. A(H1N1)pdm09 infection was associated with increased odds of ICU admission (adjusted ORs (aORs) 2.5, 95% CI 1.1 to 5.8) compared with A(H3N2). 6B.1A.5a.2a.1 clade of A(H1N1)pdm09 was associated with increased severity compared with 6B.1A.5a.2a clade (aOR 3.0, 95% CI 1.0 to 9.5) and (aOR 5.4, 95% CI 1.6 to 18.3) for the 3-variable and 4-variable definitions respectively. Among A(H3N2), the (3C.2a1b.2a.)2b clade showed a trend toward increased severity using the 4-variable definition compared with the 2a.1b clade (aOR 2.9, 95% CI 0.8 to 10.0).

This analysis highlights the differential impact of influenza subtypes and clades on disease severity in hospitalised patients. Future research should investigate the role of specific viral mutations of these clades in modulating immune evasion or disease severity. These findings reinforce the GIHSN’s critical role in global surveillance. Ongoing genomic surveillance is crucial for understanding the clinical impact of emerging influenza variants and informing public health responses.

Early detection of carotid plaque prevents stroke and myocardial infarction. Individuals with fatty liver might be at an increased risk of developing carotid plaque, yet limited access to carotid artery ultrasound underscores the need for predictive models.

We aimed to construct six predictive models for males and females separately to predict carotid plaque among individuals with fatty liver disease.

A cross-sectional study.

We included 8361 participants aged ≥40 years (4871 males; 3490 females) with fatty liver who underwent at least one health check-up between 1 January 2020 and 31 December 2023.

The sex-stratified dataset was randomly divided into 70% training and 30% internal testing datasets. With 24 potential predictors, we applied four machine learning (ML) algorithms and two conventional logistic regression (LR) models: stepwise LR and LR based on ML-selected features (LR-ML) to develop sex-specific carotid plaque prediction models. The performances were evaluated by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score, accuracy, calibration curve and decision curve analysis.

Carotid plaque was determined when the local carotid intima-media thickness was ≥1.5 mm in any of the arterial segments.

Four predictors (age, hypertension, total bilirubin, total cholesterol and white blood cell count) in males and three (age, systolic blood pressure and fasting blood glucose) in females were identified by consensus across the four ML algorithms and subsequently used to construct LR models. Among all 4 ML and two LR models, the gradient boosting machine model demonstrated the best overall performance in males (AUC=0.773, 95% CI 0.749 to 0.797), while the LR-ML model was optimal in females (AUC=0.817, 95% CI 0.791 to 0.843). Calibration and decision curve analyses further demonstrated satisfactory agreement and higher net benefit across sexes. Risk stratification identified distinct low-, intermediate- and high-risk groups with progressively higher observed prevalence of carotid plaque (20.25%, 48.58% and 69.41% in males; 15.28%, 50.89% and 66.56% in females).

Our findings highlight significant sex differences in practical carotid plaque prediction, providing crucial insights for public health implications in the early identification and risk assessment of carotid plaque among individuals with fatty liver.

Health cadres, who assist midwives in supporting pregnant women in community settings, need to enhance their competencies in identifying risk factors and referring high-risk pregnant women to midwives for further care. Since the capabilities of these health cadres are influenced by maternal complications, an educational programme was implemented to strengthen their skills. Therefore, this study aimed to evaluate the competency of health cadres by providing a researcher-developed educational programme.

An open-label, cluster non-randomised controlled trial.

Health cadres with at least 1 year of work experience were recruited at six public health centres (PHCs) in Banjarnegara Regency, Indonesia.

Six PHCs were selected and allocated into intervention group (IG=3 PHCs) and control group (CG=3 PHCs) groups. A total of 133 female health cadres were enrolled across the selected PHCs. At each PHC, a systematic random sampling method was used to select the participants. The researchers and health professionals provided a 3-week period of theoretical and scenario-based simulations to the IG, while the CG received no education.

Researcher-developed questionnaires and checklists were used to assess the knowledge, skills (health assessment, communication, attitude) and confidence. The primary endpoint was competency, a total score of knowledge and skills. The outcome domains were compared between the two groups, and a linear mixed-effect model was used to account for cluster-level variation.

A total of 130 (97.7%) completed the study (IG:64, CG:66). The competency score showed significant improvement at endline (CG=49.5 and IG=52.5; p=0.002). The median scores for health assessment skills (CG=12 vs IG=14; p

Education effectively increased the competency of health cadres. A well-structured education programme is necessary for health cadres to improve and maintain their competencies in monitoring high-risk pregnant women.

NCT06134518.

To develop and validate a simple risk score for predicting major adverse cardiovascular events (MACE) in coronary artery disease (CAD) patients using routinely available clinical variables.

This was a cohort study with retrospective analysis of prospectively collected data.

This study was conducted at a tertiary care centre in China.

This cohort study included 7182 CAD patients, randomly divided into training dataset and testing dataset in a ratio of 3:1.

The primary outcome was a composite of MACE (cardiovascular death, non-fatal MI, stroke and revascularisation). A Cox regression model was developed on a training set to identify independent predictors. Variables were assigned points based on their β-coefficients to construct a risk score. The model was validated on a testing set. Discrimination was assessed using the concordance index (C-index) and area under the receiver operating characteristic (ROC) curve (AUC). Risk groups were defined according to the total score.

Over a median follow-up of 27.3 months, 487 (6.8%) MACE events occurred. Six independent predictors were identified and included in the score: age ≥65 years (three points), NT-proBNP ≥125 pg/mL (four points), HbA1c ≥7% (3 points), elevated serum creatinine (>106 µmol/L for male or >97 µmol/L for female, 4 points), low-density lipoprotein-cholesterol (LDL-C) ≥1.8 mmol/L (two points), and cardiac troponin T (cTnT) ≥0.15 ng/mL (four points). The score stratified patients into low- (0–4 points), middle- (5–9 points), and high-risk (10–14 points) groups. In the testing set, the middle- and high-risk groups had significantly increased MACE risk compared with the low-risk group (HR 1.54, 95% CI 1.03 to 2.29; HR 2.70, 95% CI 1.78 to 4.08, respectively). The model showed consistent discrimination in both training (C-index = 0.726, AUC = 0.728) and testing sets (C-index = 0.702, AUC = 0.705).

A simple risk score comprising six clinical variables effectively stratified CAD patients into distinct MACE risk categories. This tool may aid in clinical decision-making and resource prioritisation in secondary prevention, pending external validation.

This nationwide, community-based, multicentre epidemiological survey seeks to evaluate the status, distribution and determinants of health literacy among Chinese adults aged 60 years and older. It addresses the limited representativeness of previous local studies and scarcity of data on advanced-age populations, thereby providing an evidence base for policies to improve health literacy in this demographic.

Led by the National Centre for Chronic and Non-communicable Disease Control and Prevention (NCNCD), this survey uses a multi-stage complex sampling design across 124 districts in all 31 provinces of China. Launched in 2022, the survey is conducted annually, recruiting 24 800 participants each year. Data collection includes demographic information, health literacy assessment (knowledge, attitudes and skills), health information channels, health behaviours and health status. Statistical analyses will assess health literacy levels, influencing factors and urban-rural/gender disparities.

Ethical approval was obtained from the NCNCD Ethical Review Committee (Approval No. 202110;12 July 2021). Ongoing reviews are conducted on an annual basis, and three ethical reviews have been completed. Findings will be disseminated through peer-reviewed publications and conference presentations, ensuring participant confidentiality.

To systematically summarise and evaluate the existing evidence of the associations between diverse folate exposures and the risk of colorectal cancer (CRC), while identifying evidence quality.

Umbrella review of meta-analyses.

PubMed, Web of Science, Cochrane and Embase were searched from the database inception to March 2024, with an update to 12 October 2025.

We included meta-analyses of randomised controlled trials or observational studies that investigated the associations between folate exposures and CRC or precancerous lesions (ie, adenoma and polyps).

For each association, we recalculated the summary effect size with 95% CI using the DerSimonian and Laird random-effects model, heterogeneity (I² statistic), 95% prediction interval, small-study effect (Egger’s test) and excess significance bias (² test).

This umbrella review included five meta-analyses describing 10 associations between folate exposures and CRC risk. In the general population, moderate-quality evidence supported an inverse association between total folate intake (from foods and supplements) and CRC risk (RR 0.84; 95% CI 0.80 to 0.90), while low-quality evidence suggested inverse associations of dietary folate intake (from foods alone) (RR 0.88; 95% CI 0.81 to 0.96) and folic acid supplement intake (RR 0.83; 95% CI 0.77 to 0.90) with CRC risk. Among patients with inflammatory bowel disease, low-quality evidence suggested an inverse association between folic acid supplement intake and CRC incidence (HR 0.71; 95% CI 0.53 to 0.96). Additionally, elevated circulating folate levels were observed to have a provoking effect on advanced-stage tumours (OR 1.95; 95% CI 1.18 to 3.22; Grading of Recommendations Assessment, Development and Evaluation (GRADE): very low). Sensitivity analysis revealed a potential increased risk of adenoma recurrence associated with folic acid supplement use among patients with a history of adenoma (RR 1.05; 95% CI 0.86 to 1.29; GRADE: high).

These findings suggest that consuming dietary folate and total folate intake may be beneficial in CRC primary prevention. Specifically, folic acid supplements may inhibit colorectal carcinogenesis in normal tissues while promoting cancer in the established neoplastic foci.

CRD42024537550.

Sense organ diseases (SODs) are among the leading causes of disability worldwide. They severely impact communication, mobility and quality of life, with rising prevalence and widening inequalities across populations. This study aims to provide an updated, comprehensive assessment of the global, regional and national burden and trends of SODs, and to inform strategies for prevention, treatment and health policy development.

This is a population-based observational study using secondary data from the Global Burden of Disease (GBD) 2021 study. SODs, defined in the GBD framework as age-related and other hearing loss (AHL), blindness and vision loss (BVL), and other sensory impairments, were analysed in terms of prevalence and disability-adjusted life years (DALYs). We focused on SODs overall and conducted specific analyses for AHL and BVL, stratified by age, sex and sociodemographic index (SDI).

Global dataset covering 204 countries and territories across all regions and sociodemographic strata from 1990 to 2021.

This study covered the global population represented in the GBD 2021 dataset, using aggregated population-level estimates with no direct individual recruitment.

Not applicable.

Primary outcomes were prevalence (cases and age-standardised prevalence rates) and DALYs (number and age-standardised DALY rates). Secondary outcomes included age–period–cohort effects, decomposition of contributors (population growth, ageing and epidemiological change), inequality metrics and burden projections to 2030.

Between 1990 and 2021, the global age-standardised rate (ASR) of DALYs for SODs increased from 884.07 to 912.8 per 100 000 population. The ASR of prevalence rose from 25 297.36 to 28 050.29 per 100 000. The disease burden increased across all age groups, with females experiencing a higher prevalence of SODs, and population growth and ageing as the leading contributors. AHL emerged as the predominant category of SODs. Socioeconomic disparities widened, with the slope index of inequality for DALYs rising from 128.82 in 1990 to 418.62 in 2021. In 2021, China reported the highest DALYs and case numbers. Predictive analysis showed a stable ASR of DALYs and prevalence, but a continued rise in cases through 2030, with COVID-19 further exacerbating the burden.

The global burden of SODs continues to rise, driven primarily by population ageing and growth, with widening disparities across sociodemographic levels. These findings emphasise the need for targeted prevention strategies, improved early detection and equitable access to sensory healthcare services. Monitoring the long-term impact of COVID-19 and demographic shifts remains a priority.

Not applicable. This study is a secondary analysis of GBD data and is not linked to a clinical trial.

We aimed to investigate the effect of first visit to different levels of medical institutions on diagnostic and treatment delays of pulmonary tuberculosis (PTB) patients, assess the current situation and potential problems of different-level medical institutions, and put forward constructive recommendations for policy-making to reduce the delayed behaviours among PTB patients in the Ningxia Hui Autonomous Region (NHAR).

NHAR, China.

We collected information on all PTB patients in the NHAR identified through China’s National Tuberculosis Information Management System (TBIMS) between 2015 and 2019. Propensity score matching (PSM) was used to create balanced data excluding the effects of covariates. The inverse probability of treatment weight was used to verify the robustness of the PSM results. Binary logistic regression was used to assess the correlation between first-visit medical institution levels and diagnostic and treatment delays.

Diagnostic and treatment delays of PTB patients.

We collected 11 202 confirmed PTB cases from TBIMS during 2015–2019.

Among 11 202 confirmed PTB cases, 1497 (13.4%) had diagnostic delays, with a median diagnostic delay of 1 day (IQR: 0–7 days). Among 7593 PTB cases, 1056 (13.9%) had treatment delays, with a median treatment delay of 0 days (IQR: 0–1 days). After adjustment by propensity value matching, the possibility of diagnostic delay (OR=0.84, 95% CI 0.72 to 0.99) and treatment delay (OR 0.37, 95% CI 0.32 to 0.44) of county medical institutions was significantly higher than that of above-municipal medical institutions.

More effective measures should be implemented to improve rapid diagnosis and treatment technology and the capacity of county medical institutions, clarify the referral process and reduce the occurrence of delayed behaviours.

This study aimed to investigate the knowledge, attitude and practice (KAP) of patients living with functional gastrointestinal disorders (FGIDs) toward their diseases.

A web-based cross-sectional study was conducted.

The gastroenterology outpatient department of Zhejiang Hospital of Traditional Chinese Medicine, Zhejiang, China.

The study enrolled 503 patients with FGIDs from the Gastroenterology Outpatient Department of our hospital between September and October 2023.

Not applicable for cross-sectional study.

Participants completed a self-designed questionnaire that collected sociodemographic information and assessed KAP scores. The primary outcome measures were KAP scores.

The mean KAP scores were 6.57±2.76 (possible range: 0–10) for knowledge, 30.00±4.08 (possible range: 7–35) for attitude and 30.16±4.92 (possible range: 8–40) for practice. Pearson’s correlation analysis indicated a positive and moderate correlation between knowledge and attitude (r=0.330, p

Patients with FGIDs demonstrated moderate knowledge, positive attitudes and moderate practices regarding their disease. Drinking habits and household income reportedly influenced their KAP outcomes. Targeted educational interventions are warranted to enhance practice behaviours among patients with FGIDs.

The study aims to calculate the curative care expenditure (CCE) from different comorbidity states of chronic hepatitis B (CHB), to provide a reference for the relevant government departments to optimise health insurance protection measures for this disease.

A prevalence-based retrospective study.

This study included 1600 medical institutions, covering general hospitals, traditional Chinese medicine hospitals, specialised hospitals and maternal and child health hospitals.

The cohort included 238,617 CHB outpatients and 4312 inpatients.

CCE for CHB was estimated based on System of Health Accounts 2011.

The total CCE of CHB in Sichuan Province in 2019 was USD 85.49 million. The majority of CCE was spent by outpatient services (USD 67.16 million), the main source of financing schemes was household out-of-pocket payment (75.71%). Conversely, the CCE for inpatient services (USD 18.33 million) was mainly financed by public financing schemes (46.38%). More than 70% of the CCE flowed to general hospitals, and less than 20% flowed to primary healthcare institutions. The CCE varied significantly across different comorbidity groups. The CCE for patients with no additional comorbidities and those in the low comorbidity group was mainly spent by patients aged 30–39 years and those aged 40–49 years, respectively. The CCE in the high comorbidity group was mainly spent by patients aged 50–54 years.

The present study shows that a high proportion of the CCE allotted to CHB is financed by household out-of-pocket payment. This situation poses a heavy medical burden not only on individuals, but also on society. Therefore, the financing structure needs to be optimised urgently. Potential policy directions may improve the outpatient mutual aid protection mechanism.

Disease activity assessment is important for Crohn’s disease (CD) management, since it involves the initial and subsequent therapeutic schedule. The purpose of this study is to identify a portable and reliable indicator for assessing and predicting activity and severity of CD.

A multicentre, cross-sectional, diagnosis-based study. Data were obtained retrospectively from clinical records.

Patient data for the development cohort and internal validation cohort were collected from the Department of Gastroenterology, Xiangya Hospital, Central South University between January 2017 and June 2021. Patient data for the external validation cohort were collected from the Department of Gastroenterology, Xiangtan Central Hospital between January 2022 and April 2024.

Inpatients diagnosed with CD were potential participants, and those with CD who also had other autoimmune diseases, malignant tumours, pregnancy or lactation were excluded. We identified 224 patients in the development cohort, 96 patients in the internal validation cohort and 80 patients in the external validation cohort.

Demographic data and laboratory examination results were collected and seven integrated indices were established. Mann-Whitney U test, Kruskal-Wallis K test, ² test and multivariate logistic regression analysis were used to identify independent predictors. Receiver operating characteristics curve analysis was used to evaluate the performance of integrated indices in CD activity and severity staging, and Delong’s test was used for comparison.

In the development cohort, platelet-to-albumin ratio (PAR) had the largest area under the curve (AUC) in prediction of activity (AUC of 0.753 (0.687–0.819), sensitivity 73.0%, specificity 68.4%, cut-off value 8.02) and was the only possible alternative in prediction of severity (AUC of 0.770 (0.693–0.848), sensitivity 81.2%, specificity 68.4%, cut-off value 9.71). Moreover, PAR demonstrated coherence in the internal validation cohort, effectively predicting activity (AUC 0.737 (0.639–0.835), sensitivity 65.7%, specificity 79.3%, positive predictive value (PPV) 88.0%, negative predictive value (NPV) 50.0%) and severity (AUC 0.720 (0.591–0.848), sensitivity 88.5%, specificity 77.4%, PPV 76.7%, NPV 64.9%). Furthermore, it showed generalisability in the external validation cohort for predicting activity (AUC 0.661 (0.536–0.785), sensitivity 61.9%, specificity 70.6%, PPV 88.6%, NPV 33.3%) and severity (AUC 0.752 (0.619–0.884), sensitivity 73.1%, specificity 64.9%, PPV 59.4%, NPV 77.4%).

PAR could be a portable index to assess the activity and severity of CD. Several limitations of this study, such as the limited sample size and potential biases, should be overcome in the future via more extensive validation.

Lumbar back myofasciitis (LBM) is a common condition caused by cold exposure, lumbar injuries or poor posture, leading to aseptic inflammation, fibrosis and chronic pain. While acupuncture stimulation of trigger points is widely used, clinical evidence supporting its efficacy remains limited. This study aims to evaluate the effectiveness and safety of acupuncture stimulation of trigger points in the treatment of LBM and to explore the underlying analgesic mechanisms.

This single-centre randomised controlled trial will be conducted at Acupuncture and Moxibustion Hospital of China Academy of Chinese Medical Sciences. A total of 60 participants will be randomly assigned to either the experimental group or the control group in a 1:1 ratio. The primary outcome measure will be the Visual Analogue Scale for pain, while secondary outcomes will include pressure pain threshold, ultrasound, infrared thermography and Roland-Morris Disability Questionnaire.

Ethics approval was obtained from the Ethics Committee of Xiyuan Hospital, China Academy of Chinese Medical Sciences (Approval No. 2024XLW007-2). The findings of this study will be published in peer-reviewed journals. Prior to participation, all eligible participants will be given informed consent.

ITMCTR2025000258.

This study aimed to explore the challenges encountered during dietary decision-making among Chinese adults with inflammatory bowel disease (IBD) and provide a theoretical basis for developing targeted strategies to improve dietary decision-making ability.

A descriptive qualitative interview study.

This study was conducted in four hospitals in Nanjing, China.

From June 2023 to July 2024, semi-structured interviews were held with 24 patients diagnosed with IBD across four hospitals in Nanjing through purposive sampling.

Five themes and twelve sub-themes were identified. The five themes were as follows: (1) challenges in problem identification (insufficient perception of disease threat and excessive fear of flare-ups); (2) challenges in information integration (absence of individualised professional guidance and decision-making burden due to overwhelming information); (3) challenges in decision implementation (conflicts between dietary preferences and diet management, socialising and diet management, and limited choices and diet management); (4) challenges in post-decision reflection (disappointment and regret over decision outcomes and self-regulatory fatigue); and (5) other factors influencing dietary decisions (dietary decision dilemmas under inappropriate social support, avoidance of decisions under emotional influence, and Chinese cultural influences on dietary decision-making).

The results of this study showed that patients with IBD encountered various challenges that impeded healthy dietary decisions. Our findings provide a foundation for the future development of dietary decision-making support strategies. This study may provide a framework to guide the development of dietary decision-making aids tailored to the dietary challenges encountered at various decision-making stages, thereby promoting patients’ healthy eating behaviours.

The purpose of the study is to construct a postoperative nausea and vomiting (PONV) risk prediction model for day-case laparoscopic cholecystectomy (LC) using a machine learning combination algorithm and evaluate its performance.

A retrospective cohort study.

The Hospital Information System (HIS) and the Surgical Anaesthesia Information Management System (SAIMS).

Patient data are collected from the day surgery ward of Sichuan Provincial People’s Hospital from February 2023 to April 2024. The research subjects are adult patients (18–75) who underwent day-case LC, excluding patients with unexpected termination of the day surgery plan, such as the patient who was transferred to hepatobiliary surgery due to intraoperative conversion to laparotomy.

The study employed two data filling methods, two data sampling methods, two variable screening methods and six machine learning algorithms to construct 48 predictive models. Area under curve (AUC), accuracy, precision, recall rate and F1 value were used to evaluate the predictive performance of the model. The AUC of the test set is mainly used to evaluate the prediction performance, and the Shapley weighted explanatory value is used to determine the weight of the variable’s prediction contribution. We will collect patient data from this unit in July 2025 to evaluate the model’s performance.

A total of 2709 patients were selected for model construction in the study. 20 input variables were retained for developing the predictive model. The combined model of KNN, BSMOTE, RFEL and GBM shows the best AUC performance (0.9600). The five most important variables in the prediction model were postoperative pain, LESS method, citraturia dosage, gender and sufentanil dosage. An additional 211 patients were collected to validate the model performance with an AUC of 0.79.

The study finds that postoperative pain, LESS method and cisatracurium dosage are closely related to the occurrence of PONV in day-case LC. However, these three variables have rarely been reported in the previous literature and worth further research. The prediction model obtained in this study provides a meaningful reference for the perioperative prevention and treatment of PONV in day surgery.

Data on health inequalities in inflammatory bowel disease (IBD) among women of childbearing age (WCBA, 15–49 years) across different countries are lacking. We aimed to assess the global incidence, disability-adjusted life year (DALY) burden and cross-country inequalities of IBD in WCBA from 1990 to 2021.

Observational study.

Data were extracted from the Global Burden of Disease Study 2021.

Women aged 15–49 years diagnosed with IBD.

The primary outcomes were the total numbers and age-standardised rates of incidence and DALYs. Secondary outcomes included (1) temporal trends, assessed using estimated annual percentage change (EAPC); (2) periods of significant change identified through joinpoint regression analysis and (3) health inequalities by sociodemographic index (SDI), assessed using the slope index of inequality (SII) and the concentration index.

Globally, from 1990 to 2021, the number of incident IBD cases among WCBA increased from 60 926 (95% uncertainty interval (UI) 50 342 to 74 910) to 98 975 (95% UI 80 568 to 124 089), and DALYs increased from 193 091 (95% UI 145 850 to 245 244) to 281 580 (95% UI 223 989 to 349 966). During the same period, the age-standardised incidence rate (ASIR) increased significantly (EAPC 0.22, 95% UI 0.1 to 0.34), whereas the age-standardised DALY rate (ASDR) decreased significantly (EAPC –0.28, 95% UI –0.35 to –0.21). In 2021, the highest ASIR (14.93 per 100 000, 95% UI 11.52 to 18.97) and ASDR (27.94 per 100 000, 95% UI 19.97 to 37.87) were observed in high-SDI regions. In contrast, the fastest increase in ASIR (EAPC 1.69, 95% UI 1.48 to 1.90) occurred in middle-SDI regions. High-middle-SDI regions exhibited the most pronounced decrease in ASDR (EAPC –0.8, 95% UI –0.92 to –0.67), whereas a notable upward trend in ASDR was found solely in low-SDI regions (EAPC 0.14, 95% UI 0.07 to 0.21). The SII for ASIR increased from 4.83 (95% CI 3.63 to 6.03) in 1990 to 6.26 (95% CI 4.90 to 7.63) in 2021, whereas the concentration index decreased from 0.35 (95% CI 0.25 to 0.44) to 0.24 (95% CI 0.16 to 0.33). The SII for ASDR decreased from 7.37 (95% CI 2.07 to 12.67) in 1990 to 5.97 (95% CI 1.38 to 10.56) in 2021, and the concentration index shifted from 0.13 (95% CI 0.06 to 0.2) in 1990 to –0.03 (95% CI –0.1 to 0.05) in 2021.

In 2021, the global incidence and ASDR burden remained concentrated in high-SDI countries, with significant regional disparities. From 1990 to 2021, health inequality in DALYs gradually shifted from high-income to low-income countries.

Diabetic foot ulcers (DFUs) are highly prevalent and recurrent complications of diabetes mellitus that have significant health and cost implications. Self-care is critical for preventing or delaying DFU and promoting healing, yet adherence to self-care recommendations is low. Interventions using motivational interviewing (MI) have been effective in supporting behaviour change and emotional adjustment, but evidence for DFU is scarce. This study will assess the acceptability, feasibility and preliminary efficacy of an MI-guided programme, Healing DFU through Empowerment and Active Listening (HEALing), and its integration in usual wound care practice.

This single-arm pilot study adopts a mixed-methods approach to assess the feasibility and acceptability of the HEALing intervention. HEALing is a practical, low-intensity, clinic-integrated personalised self-care support intervention, comprising three 30 min face-to-face sessions delivered over 6 weeks by trained wound care nurses, aiming to enhance self-care behaviours and support emotional adjustment in patients with DFU. Data will be collected from a battery of questionnaire-based surveys with patients (n=30), and in-depth individual interviews with both patients (n=30) and wound care nurse facilitators (n=10) from nurse-led wound clinics in a large primary care sector in Singapore.

The primary feasibility outcomes will include enrolment, retention (≥80%), data completion (≥80% of surveys) and participant satisfaction. Secondary outcomes will include self-report measures of illness perceptions, foot care confidence, diabetes distress, foot self-care behaviour, DFU knowledge, autonomy support and health-related quality of life, taken at baseline and post-intervention. Post-intervention interviews with patients and wound care nurse facilitators will be conducted to collect feedback on the programme and its implementation feasibility.

The study protocol has been approved by the local ethics committee, and written informed consent will be obtained from all participants. Findings will be disseminated through the first author’s PhD thesis, peer-reviewed journals, national and international conferences and public events.

NCT06540170; Pre-results.