Cycling can be beneficial for health, well-being and the environment; however, cycling participation in the UK remains low. Effective and cost-effective strategies are needed to support people in the community to increase cycling. The Cycle Nation Communities randomised controlled trial (RCT) will evaluate whether a 9 week multi-component cycling programme (Cycle Nation) is more effective and cost-effective than an existing national cycle training session on cycling participation, transport use and health and well-being.

This pragmatic, single-blinded, two-arm RCT will recruit ≥268 adults who cycle infrequently. Participants will be randomised to the 9 week multi-component individual/social-level group-based Cycle Nation programme or an existing national standard single group-based cycle training session. Both arms will be delivered by community-based cycling organisations in Glasgow. Participants will complete self-reported measurements at baseline, 12 weeks and 12 months. The primary outcome is the proportion of participants cycling at least weekly at 12 months. Secondary outcomes include proportion of participants cycling at least weekly at 12 weeks; change in weekly number of rides and minutes of cycling and use of private car, taxi, public transport and walking at 12 weeks and 12 months; change in motivation, perceptions of cycling safety, confidence to cycle, self-esteem, vitality, health-related quality of life and perceived general physical health at 12 weeks and 12 months. A within-trial economic evaluation from a National Health Service/personal social service and a broader societal perspective will be undertaken. Pending within-trial results, a long-term model may be developed. An embedded process evaluation will use participant and facilitator interviews, participant acceptability questionnaires, facilitator delivery proforma and session observations.

Ethical approval has been obtained from the University of Glasgow Medical, Veterinary and Life Sciences Ethics Committee (11 April 25). Findings will be published in peer-reviewed journals and communicated to stakeholders and the public.

NCT07005674.

Non-communicable diseases (NCDs) are rapidly escalating in developing countries and social factors such as the dynamics of the family play an important part in the lifestyle choices that lead to the onset and maintenance of chronic illness. There remains a gap in Malaysia as the majority of the studies were focused on the normal population rather than directly towards persons having NCDs. This study aimed to examine emerging risk factors such as family functionality and its association with NCD.

A cross-sectional survey was conducted using a multistage random sampling method.

Urban residential areas in Selangor, Malaysia.

A total of 2542 adults residing in urban areas of Selangor were recruited.

Family functionality was measured using the APGAR (Adaptation, Participation, Gain or Growth, Affection and Resources) scale and multiple logistic regression was performed to measure the association between emerging risk factors and NCD.

The prevalence of diabetes mellitus and hypertension was 10.8% and 6.1%, respectively. Widowed/separated status (adjusted OR (AOR) 41.53, 95% CI 19.06 to 90.48, p value=0.001) was reported to be a predictor of diabetes. As for hypertension, familial functionality (AOR 4.2, 95% CI 1.11 to 14.50, p value

There is a growing concern that family functionality is an emerging risk factor for NCDs. Future family-centred health promotion programmes should be incorporated to improve self-management behaviours and health outcomes.

A significant proportion of adults in England and Wales report experiencing childhood trauma, which is often associated with poor health and negative social outcomes including a significant increase in the risk of poor mental health outcomes in adulthood. This proposed scoping review adopts a broad definition of childhood trauma and applies both a salutogenic framework and ecological systems theory to explore how protective factors at five ecological levels can support mental well-being. The review will also examine how protective factors vary across different population groups and contexts.

The scoping review will follow the Joanna Briggs Institute (JBI) protocol for scoping reviews. The databases that will be searched are Embase, PubMed, Web of Science, PsycINFO, CINAHL and Medline. Studies will be included if they include protective factors and involve adults aged 18 and over who have experienced childhood trauma, whether self-identified, retrospectively self-reported or measured using a validated instrument. Studies will be excluded if they focus on participants under the age of 18.

All search results will be uploaded to Covidence, duplicates removed, and titles/abstracts screened by at least two reviewers based on inclusion criteria. Full texts of potentially relevant sources will be imported into EndNote 21. Reasons for exclusions will be documented and disagreements resolved through discussion or a third reviewer. The full process will be reported using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Data will be extracted by at least two reviewers using a tool developed by the team based on the JBI guidance. A best-fit framework analysis will be used, using a matrix developed by the researchers including the four salutogenic domains and the five levels of the ecological framework.

Formal ethical approval is not necessary for this scoping review as it does not involve the collection of primary data. The outcomes of this study will be disseminated through peer-reviewed journal articles, conference/seminar presentations, and developed into resources for stakeholders and collaborators.

Open Science Framework (DOI 10.17605/OSF.IO/CJRUY).

We investigated symptoms reported before and after heart failure (HF) diagnosis and their associations with 3-month hospitalisation and mortality.

To examine associations between symptoms recorded in primary care and short-term hospitalisation and mortality in HF patients.

Landmark analysis using Royston-Parmar survival models at baseline (diagnosis), 6 and 12 months post-diagnosis.

Primary care database (Clinical Practice Research Datalink) linked to hospital and mortality data (1998–2020).

Adults (>40 years) with a first HF diagnosis.

Shortness of breath, ankle swelling, oedema, fatigue, chest pain, depression and anxiety in the 3 months before diagnosis and at 6 and 12 months.

3-month all-cause hospitalisation and mortality; secondary outcomes included HF and non-cardiovascular hospitalisation.

Among 86 882 HF patients (62 742 and 54 555 surviving to 6 and 12 months, respectively), the magnitude of symptom risk varied by timepoint. Specifically, the symptoms with the strongest associations with adverse outcomes were: depression for all-cause hospitalisation at diagnosis (HR: 1.26; 95% CI 1.15 to 1.39) and 6 months (1.46; 1.25 to 1.70); ankle swelling for mortality (1.49; 1.14 to 1.94) at 6 months and SOB for HF hospitalisation (1.18; 1.12 to 1.26) at diagnosis and 12 months (1.99; 1.68 to 2.35).

Symptoms persisted and were more prominent at 6 and 12 months post-diagnosis than at diagnosis.

Persistent postsurgical pain (PPSP) affects up to 15% of patients after major surgery, impairing physical function, quality of life and increasing risk for long-term opioid use. Current PPSP prediction models rely on static or retrospective data and fail to incorporate dynamic perioperative factors. The Personalised Prediction of Persistent Postsurgical Pain (P5) study aims to develop individualised, multimodal prediction models by integrating preoperative behavioural, psychophysical and neurocognitive assessments and high-frequency symptom monitoring.

P5 is a prospective, single-centre cohort study enrolling 2500 adults aged 18–75 undergoing major surgery at a tertiary academic hospital. Participants complete baseline surveys, cognitive testing and quantitative sensory testing preoperatively. Ecological momentary assessments (EMAs) are collected via smartphone three times per day through 30 days postoperatively, capturing pain, mood, catastrophising and medication use. Participants are assessed on postoperative day 1 and complete online surveys at 3 and 6 months, evaluating pain persistence, interference, neuropathic symptoms and related outcomes. Clinical and perioperative data are extracted from the electronic health record. The primary outcome is PPSP at 3 months. Predictive models will be developed using supervised machine learning and dynamic structural equation modelling to extract latent features from EMA data. Model performance will be assessed using area under the receiver operating characteristic curve, area under the precision-recall curve and SHapley Additive exPlanations for interpretability.

This study has received ethics approval from the Washington University School of Medicine Institutional Review Board #202101123. Informed consent is required. Results will be submitted for publication in peer-reviewed journals and presented at research conferences.

NCT04864275.

All children in England should receive a health review at 2–21/2 years, with the Ages and Stages Questionnaire third edition (ASQ-3) used to collect public health surveillance data on child development. However, practitioners also value tools that assess individual children’s development—consistent with ASQ-3’s original purpose. Concerns about licensing costs and barriers to digitalisation have prompted interest in alternative tools to the ASQ-3 in England.

To inform policy, we conducted a rapid scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to identify tools that can measure or assess early child development.

Searched PubMed, PsycINFO and Web of Science from January 2012 to November 2022, with targeted search update November 2024.

We included English-language studies published after January 2012 that described or evaluated tools in English which could measure or assess early child development in children

We extracted key features and reliability, validity, sensitivity and specificity of tools which could feasibly be implemented at the 2–21/2-year review (eg, including multiple age versions and

We identified 112 unique publications describing 34 tools; six met our feasibility criteria for the 2–21/2-year review (reported in 53 studies). Only ASQ-3 and CREDI offer domain-specific scoring—a government priority. ASQ-3 moderately detects mild delays and performs better for severe delays in at-risk groups. Caregiver Reported Early Development Instruments (CREDI) was designed for public health surveillance, and we do not yet know how it performs for individual assessment.

ASQ-3 and CREDI are most promising for use at the 2–21/2-year review. However, we lack UK-based validation and norming studies, even for ASQ-3. Ultimately, careful implementation and integration into existing systems will determine a tool’s value for identifying developmental needs, supporting families and producing high quality data for public health surveillance.

Digital technology in primary healthcare service delivery can enhance accessibility, service delivery and health outcomes in rural populations. The objective of this systematic review is to review and synthesise the scope and impact of digital health technology innovations within rural primary healthcare settings.

Systematic review.

Articles published on PubMed, PsycINFO, Cochrane Central, SCOPUS, Web of Science, EMBASE and CINAHL between January 2013 and October 2025 were searched using key search terms.

Patient, intervention, context, outcome model criteria guided article eligibility. Included articles were undertaken in rural populations, used digital health technology for treatment or management, explored the impact of digital health technology on rural primary healthcare and reported on healthcare outcomes. Included articles were in the English language and presented peer-reviewed primary research.

Extraction was performed using a bespoke standardised template by multiple reviewers. Quality assessment was undertaken using the Mixed Methods Appraisal Tool. Descriptive analysis and conventional inductive content analysis were applied to quantitative and qualitative data, respectively. The review is written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement guidelines.

66 studies were included in the review. Most studies were conducted in the USA (n=26). Most studies focused on adult patient populations, with limited representation of Indigenous (In=3) and paediatric populations (n=2). Telemedicine/telehealth interventions using audio, video or both were the most common (n=36). Remote patient monitoring or point-of-care testing was integrated into 21 studies. Physical health conditions, particularly diabetes (n=17), cardiovascular diseases (n=11) and general primary healthcare concerns (n=13) were commonly reported. Others reported on areas including mental health, hypertension, obesity and pregnancy care.

Conventional inductive content analysis identified key themes: cost and time effectiveness, quality healthcare provision, consumer acceptance from both patients and practitioners, and healthcare service provider perspectives. Uptake barriers included staff workload and patient non-compliance, while facilitators encompassed process standardisation and practitioner acceptance and endorsement. Consumer acceptance was linked to satisfaction, willingness to engage and improved health outcomes and well-being.

Digital health interventions in rural primary healthcare offer significant potential to improve healthcare delivery, reduce costs and enhance patient access, satisfaction and health outcomes. However, careful consideration of factors such as feasibility, consumer and practitioner acceptance, and recognition of limitations is crucial for successful implementation. The review underscores the importance of flexible policies to support emerging digital healthcare solutions, including the integration of artificial intelligence. Overall, digital health interventions offer a promising avenue to improve healthcare outcomes in rural areas and should be prioritised for government funding and investment.

CRD42023477233.

To examine the distribution and frequency of International Classification of Diseases, 10th Revision (ICD-10), codes in emergency departments (EDs) across Malaysia, providing insights into the most common diagnoses. The aim is to support the development of a principal diagnosis short list for implementing ED-specific diagnosis-related groups (DRGs) to enhance resource allocation and healthcare efficiency.

A cross-sectional study conducted as part of a functional exercise by the Ministry of Health Malaysia, with systematic retrospective data collection over a 6-week period in 2022.

13 public emergency hospitals across Malaysia, representing state, major specialist, minor specialist and non-specialist hospitals, including facilities from Sabah and Sarawak for geographical diversity.

10 247 ED visit records were collected through systematic random sampling, of which 9942 complete and valid records were retained for analysis after the exclusion of incomplete or erroneous entries.

The study included 9942 ED patient records from 13 public hospitals across Malaysia over a 6-week period. Of these, 54.4% were male, and 45.5% were female. Malaysian citizens comprised 96.1% of the study population. The most frequently reported diagnoses were respiratory diseases (21.2%), followed by injuries and poisoning (13.2%) and digestive system disorders (8.4%). A total of 946 unique ICD-10 codes were identified, with 73.7% used fewer than five times. The top 20 diagnoses accounted for 42.9% of all records. Acute upper respiratory infection (J06.9) was the most commonly reported diagnosis (961 cases), followed by COVID-19 (U07.1, 608 cases) and gastroenteritis of unspecified origin (A09.9, 313 cases). The data demonstrated variation in the distribution of ICD-10 diagnoses across participating hospitals, highlighting key diagnostic categories relevant for future DRG development.

This study highlights the diversity of diagnoses in Malaysian EDs and underscores the need for tailored DRGs to optimise healthcare resource allocation. The findings suggest that a principal diagnosis short list may support future efforts to improve classification consistency and inform resource planning, although its effect warrants empirical evaluation. Given the concentration of diagnoses within a limited number of ICD-10 codes, implementing DRGs in emergency care is both feasible and necessary. Future research should expand data collection to capture seasonal trends and refine the principal diagnosis list to further support DRG categorisation and ensure its applicability across varying healthcare demands.

Yoga has been shown to improve pain and function compared with no exercise in people with chronic low back pain (LBP), but treatment effects are small. Given that yoga is a mind–body intervention that addresses physical as well as psychological factors, it may be more effective for patients with chronic LBP who are at high risk of poor prognosis. The study aims to investigate the efficacy of a 12-week yoga programme combined with education in reducing pain and disability for individuals with chronic LBP at high risk of poor prognosis at short (12 weeks) and intermediate (24 weeks) terms, compared with a control group receiving education only.

A randomised controlled trial will include 110 adults with chronic non-specific LBP reporting an average pain intensity of 3 points or more on a 0–10 scale over the past week and classified as high risk of poor prognosis (ie, scoring 50 points or above) on the Orebro Musculoskeletal Pain Questionnaire short-form. Participants in the control group will receive an educational booklet and attend three face-to-face lectures over a 3-month period. In the intervention group, in addition to the booklet and lectures, participants will attend group yoga sessions twice a week for 12 weeks, totalling 24 yoga sessions. The primary outcome is disability assessed at 12 weeks, measured using the Roland-Morris Disability Questionnaire.

The study was approved by the Human Research Ethics Committee of Universidade Federal de Minas Gerais (Protocol number CAAE: 57028022.0.0000.5149). Findings will be disseminated to trial participants, clinicians and the broader public and scientific community.

NCT05953155.

Global discussions surrounding the medical use of marijuana have gained momentum; yet in Malaysia, cannabis remains strictly prohibited under the Dangerous Drugs Act 1952. Despite its legal status, there is growing public discourse on its potential therapeutic benefits. Understanding public acceptance is critical for informing future health policies and public education efforts.

This study used a cross-sectional design, web-based survey among Malaysians aged 18 years and above using convenience and snowball sampling methods. The survey collected data on sociodemographic characteristics, lifestyle factors (eg, smoking and drug use), awareness of medical marijuana and perceived risk. Multivariable logistic regression analysis was performed to identify factors associated with acceptance of medical marijuana decriminalisation.

Out of 2047 respondents, 88.4% supported medical marijuana decriminalisation based on clinical evidence. Key predictors of acceptance included male gender (adjusted OR (AOR) 1.71; 95% CI 1.29 to 2.26), higher education (Bachelor’s degree AOR 1.56; 95% CI 1.09 to 2.23 and Master’s/PhD AOR 2.04; 95% CI 1.34 to 3.10), self-employment (AOR 1.84; 95% CI 1.22 to 2.77) and private sector employment (AOR 1.40; 95% CI 1.03 to 1.89). Behavioural factors, such as smoking (AOR 1.58; 95% CI 1.10 to 2.27), prior drug use (AOR 1.86; 95% CI 1.30 to 2.67) and low perceived risk (AOR 5.82; 95% CI 3.48 to 9.73), were also significantly associated with acceptance.

A large proportion of Malaysian adults supported the clinical use of medical marijuana. Acceptance was strongly associated with demographic and behavioural factors, particularly gender, education and perceived risk. These findings may guide the development of targeted public health education and inform future discussions on regulatory approaches in Malaysia.

Long-term healthcare utilisation (HCU) among mothers of infants with neonatal, invasive group B Streptococcus disease (iGBS) remains understudied; identifying these patterns could provide better support for affected families and address the iGBS public health burden.

Cohort study.

Population of Denmark.

1565 mothers of infants with iGBS and 44 976 matched comparators from 1997 through 2021, with follow-up until 2022, using national health and social registry data.

HCU including primary, inpatient, outpatient, psychiatric and surgical care was evaluated as period prevalence ratio (PPR) and rate ratios compared across three time periods (0–6 years, 7–13 years and 14–20 years) using a modified Poisson regression model and negative binomial regression with 95% CIs.

Mothers of newborns with iGBS had higher PPRs of psychiatric care contacts in the first 0–6 years and 14–20 years following iGBS compared with the comparison cohort (RR_0–61.12 (95% CI 0.93 to 1.35), RR_14–201.24 (95% CI 0.97 to 1.58)). Exposed mothers had similar PPRs of primary, inpatient and outpatient care use as comparators, except for a slightly higher inpatient care use 7–13 years following iGBS. Exposed mothers had higher RRs for primary, inpatient, outpatient and psychiatric care contacts than mothers in the comparison cohort.

Mothers of iGBS-exposed infants had elevated psychiatric healthcare use and increased primary, and outpatient care visits compared with matched comparators, suggesting heightened healthcare needs and psychosocial burden of caregiving up to 20 years post-iGBS.

To identify stakeholder perceived challenges and facilitators for implementing a clean fuel and clean stove intervention to reduce household air pollution and hypertension in Lagos, Nigeria.

Qualitative study guided by the Exploration and Preparation phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, using focus group discussions and in-depth semi-structured interviews with inductive and deductive thematic analysis.

Peri-urban communities across the five administrative divisions of Lagos State, Nigeria.

128 stakeholders from 32 communities, including community, religious, market and youth leaders, primary healthcare staff, and household decision makers. Approximately half were female.

This was a pre-implementation needs assessment that included demonstrations of the clean stove and fuel.

Thematic domains describing barriers and enablers to adoption and implementation, mapped to EPIS inner, outer, and bridging factors.

Stakeholders reported barriers that included stove stacking, upfront stove cost, concerns about long-term fuel price and availability, equipment durability and maintenance, safety, mistrust of new technology, and uncertainty about stove performance for dishes requiring high heat and long cooking times. Reported facilitators included payment flexibility and subsidies, opportunities to test the stove, perceived benefits of cleaner and faster cooking with less soot, endorsement by community leaders, and interest in local retail and distribution to improve access.

Implementation planning for clean fuel and clean stove programmes should address affordability, reliable fuel supply chains, durability and service, culturally relevant cooking needs, and trust building through community leadership. These findings inform adaptation strategies for scale-up in similar low-resource settings.

NCT05048147.

To compare elective surgeries rates and waiting times between Indigenous and non-Indigenous patients in Queensland.

Aggregated annual data analysis from July 2013 to December 2022 on elective surgeries and waiting times.

Public hospitals across Queensland.

All patients who had elective surgery in Queensland public hospitals between 2013 and 2022.

Rates and clinically recommended timeframes for elective surgeries.

Between 2013 and 2022, the overall estimated average rate of elective surgeries for Indigenous patients was 286 per 100 000 population, compared with 221 per 100 000 for non-Indigenous patients. Indigenous patients had higher rates of most elective surgeries except plastic and urological surgeries, where non-Indigenous patients had higher rates. Across all urgency categories, the percentages of elective surgery performed within clinically recommended timeframes were similar between Indigenous and non-Indigenous patients.

Our findings may point to the efficacy of specific policy and service delivery innovations undertaken in Queensland. Due to the limitations of our aggregated data, this inference warrants careful interpretation. More studies with disaggregated data are needed.

To characterise the reporting practices of sequential multiple assignment randomised trials (SMARTs) in human health research.

Scoping review of protocol and primary analysis papers describing SMARTs published between January 2009 and February 2024.

SMARTs are innovative trial designs that allow for multiple stages of randomisation to treatment, with randomization potentially based on a patient’s response(s) to previous treatment(s). They are uniquely designed to develop sequential adaptive interventions (dynamic treatment regimes (DTRs)) to support personalized clinical decision-making over time. Previous reviews have identified inconsistencies in how the design, implementation and results of SMARTs have been reported in published studies. A comprehensive assessment of SMART reporting practices is lacking and necessary for developing standardised SMART-specific reporting guidelines.

We systematically searched multiple databases for SMART-related protocol and primary analysis papers published between January 2009 and February 2024. Title, abstract and full-text screenings were performed by pairs of reviewers, with disagreements resolved by consensus. Data extraction included study characteristics, design elements and analytical approaches for embedded or tailored DTRs. Results were synthesised qualitatively and presented descriptively.

From 5486 screened studies, 103 (59 protocol papers, 16 primary analysis papers, 14 protocol papers with corresponding primary analysis papers) met the inclusion criteria. Most studies targeted adults (62.7% protocols, 62.5% primary analyses, 42.9% protocol+primary analyses) and were primarily conducted in the USA. Behavioural and mental health constituted the most frequent therapeutic domain. While intervention descriptions and re-randomisation criteria were consistently reported, operational characteristics such as blinding (protocols: 64.4%, primary analyses: 62.5%, protocols+primary analyses: 71.4%) and randomisation details (protocols: 55.9%, primary analyses: 37.5%, protocols+primary analyses: 50.0%) were inconsistently documented. Only 46.7% of primary analyses evaluated embedded DTRs, and none explored deeply tailored DTRs.

Despite the increased adoption of SMART designs, substantial reporting variability persists. Most primary analyses underuse the capability of SMARTs to generate data for developing DTRs. SMART-specific standardised reporting guidelines can help accelerate the scientific and clinical impact of SMARTs.

The WHO Safe Childbirth Checklist (SCC) has been implemented in diverse settings to improve the quality and safety of intrapartum care, but implementation strategies and their relationship with adoption and fidelity remain heterogeneous and incompletely described.

To describe the landscape of SCC implementation, map the implementation strategies used and explore how these strategies were reported in relation to adoption and fidelity.

We included primary studies reporting SCC implementation in healthcare settings that described at least one implementation strategy, with no restrictions on country or language. Studies that did not report implementation strategies or did not involve SCC use in real-world care settings were excluded.

We searched PubMed, Embase, CINAHL, Global Health and Global Index Medicus (June 2024), screened reference lists and consulted grey literature for the period 2009–2024.

This scoping review followed JBI methodology (Peters et al) and was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We extracted study characteristics and implementation findings, coded strategies using the Expert Recommendations for Implementing Change (ERIC) taxonomy and grouped them by clusters. Adoption (initial uptake) and fidelity (adherence to core components) were categorised following Proctor’s implementation outcomes. We created a descriptive implementation intensity score and conducted exploratory analyses (tertiles, boxplot).

34 studies described 19 SCC implementation projects across 16 countries. We identified 24 distinct ERIC strategies, with most projects using 5–11 strategies. Frequently reported strategies included educational meetings, audit and feedback, supervision, contextual adaptation and leadership or champions. Exploratory analyses did not show consistent associations between implementation intensity and adoption or fidelity. ‘Change infrastructure’ strategies (such as record system or equipment changes) were variably defined and warrant cautious interpretation. Adaptations (eg, translation and alignment with national guidelines) were common and aimed at improving local fit, but heterogeneous reporting limited cross-study comparability.

SCC implementation has relied on diverse, multicomponent strategies, yet reporting—especially of strategy content and adaptations—remains insufficient, constraining comparison and synthesis across settings. As a pragmatic bundle, implementers may prioritise brief team training, unit-level champions and leadership signals, point-of-care audit and feedback, light-touch SCC adaptation that preserves core content and structured supervision or peer coaching, combined with systematic inclusion of women and families through codesign and companion-mediated prompting. Using theory-informed frameworks (such as Exploration, Preparation, Implementation, and Sustainment and Consolidated Framework for Implementation Research [CFIR]) and standardised reporting tools (eg, Proctor’s outcomes; Template for Intervention Description and Replication / Standards for Reporting Implementation Studies [TIDieR/StaRI]) can make SCC implementation strategies more transparent, comparable and scalable.

Open Science Framework: https://doi.org/10.17605/OSF.IO/RWY27.

To evaluate the association between asthma-related emergency department (ED) visits and weather, air quality, monsoons, haze and cultural festivals in Singapore.

Retrospective cohort study.

A public healthcare cluster that covers 20% of the nation’s adult asthma population.

2617 adult patients accounting for 5337 asthma ED visits between 2016 and 2024.

Temperature, rainfall, wet bulb temperature (WBT), wind speed and Pollution Standards Index (PSI) were correlated with asthma ED counts at 0–7 day lags. Associations between ED visits and monsoons, transboundary haze and cultural festivals were evaluated using one-way analysis of variance. Weekly seasonal ARIMA models with exogenous regressors were fitted, incorporating PSI as a covariate and adjusting for demographic, clinical and socioeconomic factors.

Asthma ED visits were positively correlated with PSI (lag 0: r=0.142; 95% CI 0.107 to 0.178) and inversely correlated with rainfall (lag 3: r=–0.062; 95% CI –0.099 to –0.026) and WBT (lag 1: r=–0.067; 95% CI –0.104 to –0.031). Wind speed (lag 2: r=–0.049; 95% CI –0.086 to –0.013) and ambient temperature (lag 6: r=–0.045; 95% CI –0.081 to –0.008) showed weaker inverse associations. Mean PSI was higher during haze (82.67 vs 51.46, p

PSI–ED association peaked on the same day of exposure but was no longer significant after adjusting for demographic and clinical factors. Pollution-linked festivals, transboundary haze and the Northeast monsoon were associated with increased asthma ED visits

Sexual violence (SV) remains a critical issue affecting mental health globally, defined as coerced sexual acts, unwanted advances or trafficking. Research indicates that an estimated 81% of women and 48% of men in Belgium have experienced SV in their lifetime.1 Actual rates might be higher among older adults due to under-reporting.2 While extensive research focuses on younger victims, there is growing...

Postictal agitation (PIA) is a common adverse effect following electroconvulsive therapy (ECT). Current pharmacological treatments for PIA have undesirable side effects, and interventions to prevent PIA are unsatisfactory. The aim of this study is to assess the effect of peri-interventional music on PIA for patients undergoing ECT. Additionally, the study will assess the impact of music on pretreatment anxiety and post-treatment cognitive impairment.

This multicentre, open-label, parallel randomised controlled trial (RCT) aims to include 92 patients from two centres in Rotterdam, the Netherlands. Participants will be randomised into two groups: a music intervention group and a control group. The music group listens to recorded music 30 min before and 12 min after each of the first six ECT sessions of the full ECT course, while the control group will receive standard care. The primary outcome is the presence of PIA, measured using the Richmond Agitation-Sedation Scale (RASS). Secondary outcomes include the severity and duration of PIA, pretreatment anxiety, recovery duration, peri-treatment medication requirements, cognitive impairment and depression severity. Data will be analysed according to an intention-to-treat principle.

This study protocol has been approved by the Medical Ethical Review Committee of the Erasmus Medical Centre on 28 January 2025 (MEC-2024–0467) and subsequently received local approval at Antes Parnassia group. The trial will be carried out following the Declaration of Helsinki principles. Study results will be reported in a peer-reviewed journal according to the Consolidated Standards of Reporting Trials guidelines.

NCT06817330.

Gender gaps in healthy life expectancy are frequently used as indicators of health inequality between women and men. However, total gaps can be misleading—masking critical disparities such as women living longer yet spending more years with disability or illness, or men experiencing premature mortality. We therefore critically evaluate whether these gaps accurately capture gender-based health.

We estimate gender gaps in disability- and chronic disease-free life expectancy using the Sullivan method and decompose those gaps via the continuous-change approach to distinguish mortality from morbidity contributions. Data are drawn from the harmonised Gateway to Global Aging Data and the UN life tables from the 2022 Revision of World Population Prospects for all countries, except England, where the life tables are from the UK Office for National Statistics.

The analysis is performed on 24 countries and regions, including the USA, England, South Korea, China, India, Mexico and 19 European Union countries for the years 2014–2015 and 2017–2019 (N=201 723).

The main outcomes are gender gaps in disability- and chronic disease-free life expectancy and the contribution of mortality and health in explaining the gender gap.

Gender gaps in disability-free life expectancy ranged from –0.37 years (Portugal) to almost 5 years (South Korea), with most European countries showing female advantages of 3.0–3.5 years, while minimal gaps were observed in China, Mexico and India (0.4–0.9 years). Decomposition revealed striking inconsistencies between total gaps and underlying components—South Korea’s 4.9-year gap reflected a survival advantage outweighing disability disadvantage by 13-fold, while Portugal’s –0.37-year gap masked opposing contributions (mortality: +2.3; disability: –2.7). Chronic disease-free life expectancy showed female disadvantage in most countries, especially Portugal (–2.3), Korea (–1.6) and Mexico (–1.9).

Using gender gaps in healthy life expectancy as a metric for gender inequality in health is misleading. Countries with very different levels of development, healthcare systems and gender roles can have similar gender gaps, but substantial differences in the levels of mortality and health. Because these gaps mask important underlying differences in health and mortality between women and men, caution is warranted when using them.

To construct a data-driven composite from (a subset of) currently used quality indicators for oesophagogastric cancer surgery and to evaluate whether this approach enhances the reliability of between-hospital comparisons on outcome relative to the expert-driven composite indicator ‘textbook outcome (TO)’.

In this retrospective cohort study, we applied Item Response Theory (IRT) to construct a data-driven continuous composite indicator reflecting a single latent variable—the quality of surgical care—and estimated latent variable scores for all individual patients. Reliability was compared between the expert-driven (TO) and data-driven (IRT) composite indicators.

All Dutch hospitals providing oesophagogastric cancer surgery.

All patients who underwent oesophagectomy (n=3588) or gastrectomy (n=1782) between 2018 and 2022 as registered in the Dutch Upper GI Cancer Audit (DUCA).

We evaluated the reliability of between-hospital comparisons using ‘rankability’, which quantifies the proportion of observed variation in indicator scores between hospitals not attributable to chance.

Seven out of 15 quality indicators were included in the IRT composite indicator. Most of the patients were assigned the artificial maximum of the continuous quality score (ie, ceiling effect), resulting in similar average hospital scores. Relative to TO, rankability increased when using the IRT composite for oesophagectomy (57% vs 41%) but declined for gastrectomy (38% vs 47%).

The selected seven quality indicators for oesophageal and gastric cancer surgery represent a single latent variable but are not yet optimal for differentiating surgical care quality due to ceiling effects. Despite using fewer indicators, the continuous IRT score showed a promising increase in rankability for oesophagectomy, suggesting that data-driven composite indicators may enhance hospital benchmarking reliability.