To examine whether Indigenous Peoples’ and Local Communities’ (IPLC) ontologies are associated with knowledge, attitudes and practices (KAP) related to wildlife cohabitation and zoonotic disease transmission in biodiversity-rich areas of Latin America.

Cross-sectional household survey using a standardised KAP questionnaire. Ontologies were classified using latent class analysis. Associations between ontology classes and outcomes were assessed using multivariable logistic regression models.

Urban, rural and protected areas in biodiversity-rich regions of Bolivia, Brazil, Chile and Guatemala.

A total of 2903 individuals aged ≥10 years were recruited through random household sampling (response rate 85%).

Primary outcomes were defined according to the KAP framework. Knowledge outcomes comprised combined knowledge of zoonotic disease transmission from wildlife to humans and knowledge of zoonotic risks associated with wildlife trade. Perceived training needs related to zoonotic disease prevention were analysed as a secondary knowledge outcome measure. Attitudes were measured through risk perception, operationalised as concern about zoonotic disease transmission. Practices included self-reported hunting and slaughtering of wildlife.

The analysis identified three distinct ontology classes: Relational environmentalism (52% of the population), characterised by strong spiritual connections to animals and a tendency to protect wildlife; Dualistic environmentalism (28%), with a weaker spiritual connection to animals but a commitment to wildlife conservation; and Neutral (20%), demonstrating little spiritual connection to animals and a neutral attitude towards wildlife conservation. In the logistic regression analyses, both environmentalism groups exhibited greater knowledge of zoonotic transmission and concern about outbreaks, with members of the Relational class demonstrating higher levels of these attributes. Furthermore, members of the Dualistic environmentalism class were less likely to have close contact with animals.

In Latin America’s biodiversity-rich regions, individuals whose ontology aligns with environmentalism appear to demonstrate a heightened awareness of zoonoses, particularly those who adhere to a Relational environmentalism perspective. Consequently, the integration of IPLC cultural knowledge holds potential to enhance wildlife conservation measures and contribute to the mitigation of disease transmission. Further research is needed to explore causal pathways and the integration of culturally grounded approaches into public health interventions.

Intimate partner violence (IPV) is a major public health concern in Bangladesh, where approximately two-thirds of women report experiencing partner violence and over half of young men admit to perpetrating it. While adverse childhood experiences (ACEs) are among the strongest predictors of IPV, existing research has relied on cumulative ACE scores, overlooking how distinct dimensions of childhood adversity may differentially predict violence. This study examines the relationship between two dimensions of ACEs, threat (eg, exposure to violence) and deprivation (eg, lack of emotional or cognitive support) and IPV perpetration among Bangladeshi young adults.

Cross-sectional survey.

Bangladeshi youths aged 18–35 years across the eight divisions who participated in the national Gender Norms Attitude Study in 2022.

Of the 2790 participants, 2016 (mean age 28.27, SD 5.11) were included in this study as they were either married or in a committed relationship.

The primary outcome measures were IPV perpetration, assessed using the Hurt, Insult, Threaten, Scream scale. The primary exposures were two dimensions of childhood adversity (ACE): threat and deprivation, derived from the nine items commonly used in public health research.

Overall, 59.88% of men and 41.53% of women reported having perpetrated IPV. Both threat (adjusted OR (aOR)=2.57; 95% CI 2.03 to 3.23) and deprivation (aOR=1.75; 95% CI 1.39 to 2.20) ACEs significantly associated higher odds of IPV perpetration. Women had lower odds of perpetration than men (aOR=0.41; 95% CI 0.32 to 0.52), as did those with higher socioeconomic status (aOR=0.83), whereas the odds varied by region (eg, highest in Barisal, aOR=4.40).

Conclusions

The findings highlight the importance of adopting a dimensional approach to ACEs and considering regional and socioeconomic factors in IPV prevention efforts. By integrating these findings into public health interventions and policy frameworks, Bangladesh and other low- and middle-income countries can develop more effective, culturally sensitive strategies to reduce IPV and its devastating consequences.

Mental health problems among undergraduate medical students are a major global public health concern that emerge early during training and are shaped by demanding educational environments, emotional stressors and organisational pressures. Although research has expanded rapidly, the literature remains fragmented across themes, regions and methods. This scoping review aims to map the global quantitative literature on medical students’ mental health and identify gaps in scope, geography, methodology and equity.

This scoping review will be conducted in accordance with the Joanna Briggs Institute methodological guidance and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We will include quantitative studies assessing mental health among undergraduate medical students. MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library (Wiley) and PsycINFO (Ovid) will be searched without date or language restrictions using a keyword-based search strategy. Two reviewers will independently screen titles, abstracts and full texts and extract data using a standardised form. Data will include publication year, country, study design, sample size, mental health measures, thematic domains and patterns of collaboration. Mental health domains will be classified using an a priori thematic framework encompassing psychological symptoms and distress, psychological resources, academic environment, social support and physical health and lifestyle factors. Equity-related variables (sex, gender identity, sexual orientation, race/ethnicity, socioeconomic status) will be operationalised based on analytical use. Results will be synthesised descriptively using tables and visualisations.

Ethical approval is not required. Findings will be disseminated through publication and presentations. The dataset and code will be openly available on publication.

Protocol registration will be made available online via the Open Science Framework (doi:10.17605/OSF.IO/2EHNU).

Climate change poses significant public health challenges globally, particularly in vulnerable regions such as The Gambia. Despite growing recognition of environmental impacts, limited research has examined community-level awareness of climate change health effects in West African settings. This study aimed to assess household awareness and perceptions of climate change impacts on public health among vulnerable communities in the North Bank Region, The Gambia and identify socio-demographic determinants of climate change awareness.

In this study, we conducted a community-based cross-sectional study. Using multistage sampling, we selected 35 communities across seven districts. Data were collected via structured questionnaires administered in local languages (Mandinka, Wolof, Fula) using KoboToolbox.

This study was conducted among 868 residents aged ≥18 years in the North Bank Region between January and February 2024.

Overall, 85.7% (n=744) of respondents had heard about climate change, with radio (53.6%) being the primary information source. Participants demonstrated high awareness of certain climate hazards, such as excessive heat (76.4%) and altered rainfall patterns (55.2%), but less so for other hazards, such as flooding (30.3%). Respondents correctly identified multiple health impacts to health and livelihoods, including heat stress (65.8%), dehydration (57.3%), respiratory diseases (73.6%), waterborne diseases (59.0%) and crop failure (86.4%). Multivariable analysis revealed that older age (>39 years: adjusted OR (aOR)=2.50, 95% CI 1.49 to 4.21) and tertiary education (aOR=3.93, 95% CI 1.50 to 10.30) were independent predictors of climate change awareness. Approximately 77% of participants reported experiencing climate change effects in their communities within the past 5 years.

This first comprehensive assessment of climate-health awareness in the North Bank Region of The Gambia reveals substantial community recognition of climate change and its health consequences. Significant disparities in awareness by age and educational attainment indicate that targeted educational interventions focused on younger populations and those with limited formal education are warranted.

In 2023, cholera caused over 95 000 deaths globally, predominantly in low-income and conflict settings, and contributed to the wasting, stunting and malnutrition of millions in countries where the disease is endemic. Moreover, the frequency and magnitude of cholera outbreaks are rising. As a result, the demand for outbreak control interventions is quickly outpacing existing resources. Oral cholera vaccination (OCV) is one intervention among many used to limit further transmission. Since 2022, one-dose OCV (OCV1) has replaced the standard two-dose OCV due to limited global supply. However, only a handful of on-the-ground surveys of OCV1 effectiveness presently exist.

This study aims to assess the transmission of cholera in outbreak settings using digital public health approaches and quantify OCV1 effectiveness in complement to on-the-ground surveys.

Using Haiti and Cameroon as natural case studies representing two disparate geographical and sociodemographic contexts, we employed computational digitisation techniques to extract weekly case counts from non–machine-readable images of outbreak epidemic curves. We then leveraged the R package EpiEstim to derive estimates of the effective reproduction number (R_t). To assess OCV1 effectiveness in the two considered countries, we applied VaxEstim, an extension of EpiEstim requiring three inputs: the basic reproduction number (R₀), R_t, and vaccine coverage. Notably, our work provides the first known real-world application of VaxEstim in low-resource settings.

Early in either outbreak, weekly estimates of R_t were elevated (Haiti, 2.60 (95% credible interval (CrI) 2.42 to 2.79); Cameroon, 1.90 (95% CrI 1.14 to 2.95)). Thereafter, R_t estimates oscillated around the critical threshold of 1 in both settings. Haiti exhibited marginally higher OCV1 effectiveness than Cameroon (75.3% (95% CrI 54.0 to 86.4%) versus 54.9% (95% CrI 18.9 to 84.9%)).

This study underscores the value of combining digitised case data with computational techniques and the utility of VaxEstim for rapid, inexpensive estimation of vaccine effectiveness in data-poor outbreak settings.

Transcranial pulse stimulation (TPS) is a novel technology with therapeutic promise for Alzheimer’s disease. Given its novelty and the rapidly evolving research in neurology and mental health using this technology, large randomised controlled trials are expected. Therefore, an independent and up-to-date synthesis of the available evidence is needed. In our effort to create a living systematic review of the clinical efficacy of TPS across various conditions, we aim to describe its methodology to ensure its transparency and scientific rigour. This protocol details the predefined methods related to search frequencies, updates to the review and quantitative synthesis.

We will only include randomised controlled trials involving clinically diagnosed populations and comparing active TPS to sham TPS. We will search MEDLINE, CENTRAL and Web of Science, as well as trial registries and grey literature. The principal searches in databases and trial registries will be rerun monthly, and new evidence will be integrated. Study selection, data extraction and risk-of-bias assessments will be performed independently and in duplicate. All relevant clinical outcomes measured with validated psychometric scales and tests will be collected. The relevance of a quantitative synthesis, the studies to be included in pairwise meta-analysis, appropriate scales, questionnaires and time points will be discussed by the research team annually. If a meta-analysis is conducted, we will use the standardised mean difference as the measure of effect size. We will assess our confidence in the cumulative evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

For this systematic review and meta-analysis, we will collect existing data without generating new datasets. Therefore, ethics approval or consent to participate is not required.

We will publish our initial systematic review when a total of four randomised controlled trials across different health conditions using active TPS compared with sham TPS are available. At this stage of our project, we anticipate updating the living systematic review annually following the publication of the baseline review. We will conclude the living phase of the review when high certainty of evidence is achieved or if the topic loses its relevance.

CRD42024595947.

In the first 2 years of the COVID-19 pandemic, Hong Kong adopted strict public health and social measures to stop community transmission of SARS-CoV-2. These include border screening and control, isolation of cases and quarantine of their contacts and universal masking. During this period, attack rates in Hong Kong were among the lowest globally.

To estimate the seroprevalence of COVID-19 among healthcare workers (HCWs) in Hong Kong in 2020 and 2021.

We reviewed contact tracing data from the Hong Kong Department of Health to identify COVID-19 cases reported among HCWs. Between June 2020 and December 2021, we conducted a longitudinal cohort study to estimate the seroprevalence of COVID-19 among HCWs working in hospitals and clinics in Hong Kong during the first 2 years of the COVID-19 pandemic.

Overall seropositivity of COVID-19 by plaque reduction neutralisation test during the first (May–October 2020) and second round (November 2020–April 2021) of the study was 0% (95% CI 0.00% to 0.49%) and 0.52% (95% CI 0.14% to 1.33%). After COVID-19 vaccines were offered to HCWs in February 2021, seroprevalence by surrogate virus neutralisation assay among cohort participants who provided biannual blood samples rose to 68.7% (95% CI 65.9%, 71.3%) and 80.2% (95% CI 76.8%, 83.2%) in round 3 (May–October 2021) and the first 2 months of round 4 (November–December 2021).

Seroprevalence in Hong Kong HCWs in our study was low despite considerable exposure to confirmed COVID-19 cases in some study participants. However, the low rate of community transmission may have also contributed to the observed low seroprevalence among HCWs in our cohort.

Simulation-based interprofessional education (Sim-IPE) enables health professions students to collaborate in a realistic, safe, simulated clinical environment. Debriefing is a critical component of simulation, facilitating reflective learning and improvement in team performance. Instructor-led (IL) debriefing is considered the gold standard but is resource-intensive and may not be feasible in settings with limited faculty availability. Peer-led (PL) debriefing offers a potentially cost-effective alternative; however, its impact on debriefing quality, interprofessional competencies and professional identity in Sim-IPE remains underexplored. This study aims to compare PL and IL debriefing in terms of perceived quality and impact on interprofessional outcomes.

This manuscript reports a prospectively registered protocol for a single-centre, parallel-group, non-inferiority randomised controlled trial to be conducted at Qatar University Simulation Centre (Tamayuz). The trial consists of two arms: an IL debriefing arm (control) and a PL debriefing arm (intervention). A total of 120 students will undergo a comprehensive simulation experience, including pre-briefing and simulation, followed by random assignment to one of the debriefing arms. Outcome measures will include the Debriefing Assessment for Simulation in Healthcare Scale, Satisfaction with Simulation Experience tool, Modified McMaster Ottawa Scale for Teams and Extended Professional Identity Scale. At the time of the original submission, participant recruitment had not yet commenced.

This study was approved by the Institutional Review Board of Qatar University (QU-IRB 237/2025-EA). All participants in this study will provide informed consent prior to participation in the study. Findings of this study will be submitted to peer-reviewed journals and may be presented at conferences.

This study is prospectively registered on the International Standard Randomised Controlled Trial Number registry, a recognised clinical trial registry, prior to participant enrolment.

ISRCTN52780669.

Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are heterogeneous conditions with a high multimorbidity burden. However, existing risk assessment instruments prioritise physiological measures while overlooking systemic comorbidities. We aim to develop and validate an electronic health record (EHR)-embedded artificial intelligence (AI) model—AiRES (AI in patients with RESpiratory disease)—to predict the 30-day, 90-day and 180-day risks of all-cause and index-disease hospitalisations. This model represents a first step towards a clinical decision support tool for personalised multimorbidity management in patients with CRD.

Patients aged ≥18 years with a validated case definition of asthma and COPD will be identified from Singapore health administrative data (2012–2020). Candidate predictors will include age, sex, ethnicity, housing type, and comorbidities, measured across multiple care settings as visit frequency, grouped at quarterly intervals in Year 1 and annually for Years 2 and 3 over a 3-year lookback window. We will predict 30-day, 90-day, and 180-day risks of (1) all-cause and (2) asthma/COPD-specific hospital admissions using up to five randomly selected index dates per individual. Three machine learning algorithms—logistic regression (LR) with Lasso regularisation, eXtreme Gradient Boosting, and Categorical Boosting—will be trained using 10-fold cross-validation (CV) with an ensemble feature selection strategy. The optimal model, selected based on performance and feature importance, will be benchmarked against two reference models: a full LR and a Zero-Inflated Negative Binomial regression with hospitalisation history as the sole predictor. Discrimination and calibration will be assessed using internal-external cluster-based and temporal CV. Clinical utility will be evaluated using decision curve analysis.

This study obtained ethics approval from the National University of Singapore (NUS-IRB-2024-849). Results will be published in international peer-reviewed journals.

Scabies is a common skin condition and poses a substantial disease burden in resource-poor tropical settings. The Rohingya refugee camps in Cox’s Bazar, Bangladesh represent one of the world’s largest and most protracted humanitarian crises. Using 3 years of data from 2021 to 2023, this study analysed the seasonality of scabies and examined its association with climatic factors.

This is a retrospective observational study conducted in the Rohingya refugee camps and adjacent host communities in Ukhiya and Teknaf, Cox’s Bazar. All patients clinically diagnosed with scabies and who received treatment at 35 International Organization for Migration (IOM)-supported health facilities between 1 January 2021 and 31 December 2023 were included. Climate data, including daily mean, minimum and maximum temperature and total and maximum rainfall, were obtained from the Bangladesh Meteorological Department. Seasonal–Trend decomposition using LOESS (locally estimated scatterplot smoothing) (STL) was applied. Associations between climatic variables and the decomposed seasonal component of scabies cases and corresponding attack rate, as well as overall scabies case counts and overall attack rate, were assessed using Pearson’s correlation tests.

A total of 323 106 new scabies cases were reported from IOM-supported health facilities between January 2021 and December 2023. Children aged under 5 years and 6–18 years accounted for the highest proportion of cases (32.08% and 38.95%, respectively). The average monthly number of scabies cases was highest in November (12 625) and lowest in May (5862). Case numbers increased from November to February (high season), with a peak between October and November, and declined between April and June (low season). An inverse relationship was observed between temperature and scabies incidence, with higher case numbers during cooler months and lower numbers during warmer months. Pearson’s correlation analysis demonstrated a strong and significant negative correlation between the seasonal components of both scabies cases and attack rate and temperature variables, including maximum (cases: r=–0.492, p=0.002; attack rate: r=–0.484, p=0.003), minimum (cases: r=–0.506, p=0.002; attack rate: r=–0.489, p=0.002) and mean temperature (cases: r=–0.525, p=0.001; attack rate: r=–0.511, p=0.001). No significant association was observed between the seasonal component of scabies cases or attack rate and humidity or rainfall.

This study identified a distinct seasonal pattern of scabies, with higher caseloads and attack rate during late autumn and winter (October to February) and lower caseloads and attack rate during summer months (April to June). Temperature showed a strong negative association with the seasonal component of scabies burden. These findings may inform the timing of public health strategies, including mass drug administration, intensified case management and social and behavioural change communication, in humanitarian settings.

Adhesive capsulitis (frozen shoulder) is a common condition characterised by pain, stiffness and reduced function. While conventional physiotherapy (typically comprising joint mobilisation, stretching, strengthening and electrotherapy) is widely used, there is limited evidence for the effectiveness of advanced neuromuscular techniques such as the reciprocal inhibition technique (RIT). This study aims to evaluate the impact of incorporating RIT into standard physiotherapy compared with standard physiotherapy alone in individuals with adhesive capsulitis.

This is a double-blind, randomised controlled trial. 30 adults aged 30–70 years with clinically confirmed adhesive capsulitis will be recruited from a tertiary rehabilitation centre in Dhaka, Bangladesh. Participants will be randomly allocated to receive either RIT combined with conventional physiotherapy or conventional physiotherapy alone, with both groups undergoing 12 treatment sessions over 4 weeks. The primary outcome is pain intensity at 4 weeks post-randomisation, measured by the Numeric Pain Rating Scale. Secondary outcomes include shoulder range of motion (abduction, internal and external rotation, assessed with a universal goniometer), functional ability (Shoulder Pain and Disability Index) and muscle strength (abduction, internal and external rotation, measured by hand-held dynamometry). Blinded assessors will conduct evaluations at baseline and after the intervention. Data will be analysed using intention-to-treat principles. Between-group comparisons will be made using linear mixed models with fixed effects for group, time and group-by-time interaction, and a random intercept for participants to account for repeated measurements. Within-group changes will be estimated from the models.

This trial has received ethical clearance from the Institutional Review Board of the Institute of Physiotherapy, Rehabilitation & Research (approval number BPA-IPRR/IRB/18/02/2025/32). Results will be disseminated through peer-reviewed publications and international conferences in accordance with Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. By addressing a significant evidence gap, this study may establish RIT as an effective and affordable adjunct to standard physiotherapy for managing adhesive capsulitis.

CTRI/2025/06/089288 [Registered on: 23/06/2025]

This study applied a socio-material practice lens to examine health professionals’ responses to methanol poisoning in Bangladesh and to compare these practices with established guidelines.

This study employed a rapid ethnographic design.

Data were generated in primary-level, secondary-level and tertiary-level health facilities in six districts of western Bangladesh between September 2024 and May 2025.

We carried out semi-structured interviews with 50 health professionals with responsibilities for managing patients experiencing alcohol-related or poisoning-related conditions.

Among health professionals, the meanings of methanol poisoning as a diagnostic category, its symptoms and treatments are obscured by moral concerns about alcohol. Materials, including antidotes, for managing methanol poisoning were scarce, and health professionals reported using readily available medical supplies for supportive treatment, though not specifically adapted for methanol poisoning. Health professionals’ care practices for responding to methanol poisoning were often structured by these meanings and materials, with guidelines remaining largely invisible.

Socio-material practices of health professionals in response to methanol poisoning in Bangladesh are characterised by missed opportunities. Improving responses requires shifting the meanings of methanol poisoning as a diagnostic category, ensuring that materials such as treatment guidelines and appropriate antidotes, such as ethanol and fomepizole, are available and supporting providers to enact care practices that reflect these guidelines.

Cadmium is a metal that poses significant health risks, particularly in occupational environments where exposure can happen. The main objective of this scoping review is to review the cadmium exposure levels in the different occupational settings in the European Union (EU), considering the regulatory measures currently in place. The secondary objectives, depending on the availability of data, are (a) to identify the occupational settings where higher exposure levels occur, (b) to identify any geographical and temporal differences and trends within the EU and (c) to identify the most relevant co-exposures reported.

A scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. Studies reporting quantitative occupational data on cadmium exposure obtained through human biomonitoring and/or air monitoring will be included. A descriptive analysis of the findings will be performed.

This protocol for a scoping review does not require ethical approval as it is based on secondary data. The dissemination plan of the scoping review includes its publication in a scientific journal of reference, as it is expected that it will provide important knowledge to support ongoing and future occupational health interventions in the EU, at the technical and regulatory levels.

This study is registered at the Open Science Framework (OSF), 7 April osf.f2w3h.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of morbidity and mortality due to chronic liver disease. There is an extensive body of evidence focusing on pharmacotherapy for MASLD. Reviews on the topic have been largely limited to the efficacy of select agents, subgroups or outcomes. The current is a protocol for a comprehensive systematic review and network meta-analysis (NMA) evaluating the efficacy of examined pharmaceutical interventions in improving hepatic outcomes of MASLD.

MEDLINE, Scopus, Web of Science, the Cochrane Library database and multiple trial registries will be searched for clinical trials on MASLD pharmacotherapy. Histological, radiological and paraclinical outcomes will be considered along with safety and tolerability. Screening and data extraction will be conducted by pairs of independent reviewers. Risk of bias (RoB) will be assessed using the Cochrane RoB 2 tool. Pairwise random-effects meta-analyses will be conducted followed by random-effects frequentist NMAs—according to the length of intervention—for each outcome in clinically distinct MASLD subgroups. Other effect moderators will be examined in subgroup analyses and meta-regression. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation and Confidence in Network Meta-Analysis approaches.

Ethics approval was waived (Alborz University of Medical Sciences; approval ID: IR.ABZUMS.REC.1404.121) as no new data will be generated. Information from published records will be used in compliance with their Copyright agreements. Results will be submitted for peer review and publication in a scientific journal.

CRD420251125615.

Inappropriate complementary feeding contributes to child undernutrition, even in food-secure areas. This paradox highlights the need to look beyond food availability and examine the household-level mechanisms that shape everyday feeding decisions in the farming and food-secure settings. The objective of this study was to explore the household dynamics of maternal caregiving and agricultural labour in complementary feeding practices in rural farming communities in Geita.

Phenomenology study design was employed to explore the lived experiences and perceptions of mothers regarding complementary feeding practices.

Rural farming communities in Geita Region, Tanzania.

Mothers of children aged 6–23 months were purposively selected to participate in seven in-depth interviews and two focus group discussions.

In these farming communities, four household-level factors were found to influence complementary feeding practices: maternal responsibility and farming obligations, carrying children and porridge to the farms, limited paternal involvement, fatigue due to prolonged farm work, reliance on elder siblings for childcare and fear of judgement or sanctions for late arrival at the farm. Farming emerged as a cross-cutting theme that intersected all these sub-themes.

Mothers described complementary feeding practices as closely linked to household division of labour, caregiving arrangements and the demands of farming activities that shaped daily routines. These findings suggest the need for context-sensitive strategies that consider intra-household roles and the time constraints associated with subsistence farming.

Well-being of healthcare professionals (HCPs) is vital for care quality, staff retention and overall healthcare system effectiveness. This study aims to identify the organisational and workplace variables associated with sick leave and measures of engagement of HCPs on department level within a single Dutch academic hospital.

Cross-sectional study using routinely collected organisational data.

A tertiary-care academic hospital in the Netherlands.

25 clinical departments were included. Department level variables were derived from routinely collected hospital databases. Availability of data varied across variables. Analysis included information on patient population, human resources, care processes, quality of care and employee and patient experiences to assess differences, correlations and predictors for sick leave and engagement.

Primary outcome measures were (1) sick leave (%) and (2) engagement, assessed through two staff-survey items (vitality and connectedness; 0–10 Numeric Rating Scale). Both outcomes were analysed at department level.

Employee population data showed the most consistent patterns across analyses. Departments with higher staffing capacity had higher sick leave and lower engagement in group comparisons (p=0.009, p=0.030, respectively). In multivariable models, higher staffing capacity remained associated with increased sick leave (B=1.38, 95% CI 0.53 to 2.23, p=0.003). Engagement was positively associated with higher inflow (B=0.92, 95% CI 0.06 to 1.77, p=0.037) and negatively associated with outflow (B = –1.36, 95% CI –2.08 to –0.63, p=0.001). No consistent associations were found with patient population and patient experience measures.

Workforce-related factors, particularly staffing capacity and inflow and outflow, are strongly linked to sick leave and engagement. Routinely collected hospital data can be used to identify at-risk departments and inform targeted strategies for improving workforce sustainability. Future studies should explore more granular, team-level data to better support staff well-being and care quality.

In Guinea, around 17 new cases of HIV occurred each day and it was responsible for 10 deaths a day in 2022. In addition to this burden, regional disparities have emerged over the years. This study aimed to describe and explain the uneven distribution of HIV infection in Guinea using spatial analysis.

This is a retrospective cross-sectional secondary analysis using data from the 2012 and 2018 Guinea Demographic and Health Survey (DHS).

This study was conducted in Guinea.

We conducted a secondary analysis of data from 300 and 400 enumeration areas, respectively, included in the 2012 and 2018 DHS Program for participants aged 15 to 49 who underwent HIV testing. Spatial analysis methods, including Moran I, interpolation and Kulldorff’s scan statistic, were applied to examine variation and identify high-risk spatial clusters of HIV prevalence rate. The potential relationship between HIV status and socio-demographic, biological, behavioural and socio-environmental explanatory variables was explored using logistic regression at individual level.

In total, 7922 individuals in 2012 and 8539 in 2018 participated in the study. HIV prevalence rate in 2012 and 2018 was 1.9% and 1.5%, respectively. Across Guinea’s 33 prefectures, HIV prevalence rate varied from 0% to 3.9% in 2012 and from 0% to 3.5% in 2018. Spatial analysis identified four significant high-risk spatial clusters in 2012 and one high-risk cluster in 2018. The high-risk clusters in 2012 were in Kissidougou (relative risk (RR)=3.97; p value=0.037), Matam (RR=2.80; p value=0.019), Pita (RR=3.46; p value=0.035) and N’zerekore prefectures (RR=6.08; p value=0.027), the high-risk cluster in 2018 was located in Boffa prefecture (RR=3.95; p value=0.022). Factors significantly and positively associated with HIV infection in 2012 included age class 25–34 (aOR: 2.20; 95% CI 1.40 to 3.47), age class 35–49 (aOR: 2.43; 95% CI 1.51 to 3.92), number of HIV healthcare facilities>30 (aOR: 2.14; 95% CI 1.34 to 3.43). HIV infection was significantly lower in men (aOR: 0.52; 95% CI 0.35 to 0.77). In 2018, in addition to age groups 25–34 years (aOR=1.90; 95% CI 1.18 to 3.04) and 35–49 years (aOR=2.25; 95% CI 1.40 to 3.64), the Soussou ethnicity group (aOR=1.73; 95% CI 1.04 to 2.87) was also positively associated with HIV infection.

This study describes the spatial distribution of HIV prevalence rate and identified high-risk clusters in Guinea. In addition, risk factors associated with HIV status were identified. The information can help prioritise surveillance and response efforts to control HIV in Guinea.

The over 14 million African children who are HIV-exposed but uninfected (CHEU) are at risk for poor health outcomes, including neurodevelopmental conditions such as autism; however, no study to date has examined autism in CHEU in Africa, where the vast majority of these children live. Scalable diagnostic and neurobehavioural tools, including powerful, low-cost approaches such as eye-tracking, for detection and study of mechanistic neural processes are necessary to advance autism research in these settings. The objective of this study is to examine autism diagnostic outcomes and eye-tracking biomarkers in relation to CHEU while at the same time building capacity for neuro-health research in Kenya.

This study will leverage a longitudinally assessed cohort of CHEU and children who are HIV-unexposed and uninfected (CHUU) with well characterised HIV-related and contextual exposures. We will first determine and compare autism diagnostic outcomes between young CHEU and CHUU across a large cohort (n=850) of Kenyan children using research-grade autism assessment tools, and, second, determine whether neurobehavioural eye-tracking markers predict autism outcomes across this cohort.

Human subjects approvals have been obtained from Moi University Institutional Review and Ethics Committee (IREC; IREC/909/2024; Approval #0004835), Kenya’s National Commission for Science, Technology and Innovation (NACOSTI; Reference #NACOSTI/P/25/415028), the Institutional Review Board of the Indiana University School of Medicine (Protocol #23171), with reliance agreements executed with Purdue University and Boston University. Dissemination of findings will occur through multiple channels within the research and clinical community, including peer-reviewed journal publications and conference abstracts and presentations. As part of capacity building efforts, the research team will also communicate study results to policy makers, the lay public and other health systems involved in the care of young children with disabilities via study-hosted workshops and conferences.

To investigate the association between longitudinal trajectories of metabolic risk clusters and the risk of progression to end-stage kidney disease (ESKD) and major adverse kidney events (MAKEs) in patients with chronic kidney disease (CKD).

Prospective registry-based cohort study.

Secondary and tertiary care settings in Taiwan, using data from a multidisciplinary pre-ESKD care programme.

A total of 1494 adult patients with CKD stages 3b–5 enrolled in a structured pre-ESKD care programme.

Time to initiation of dialysis (primary outcome) and time to MAKE, defined as a composite of dialysis initiation or all-cause mortality (secondary outcome). Group-based multitrajectory modelling was used to categorise longitudinal trajectories of metabolic risk clusters, including systolic blood pressure, fasting blood glucose and low-density lipoprotein (LDL) cholesterol.

Four trajectory groups were identified: Group I had controlled blood pressure and glucose but elevated LDL (dialysis incidence: 19.5 per 1000 person-years); Group II had borderline-high blood pressure and elevated glucose (33.6 per 1000 person-years); Group III had controlled glucose and low LDL but borderline-high blood pressure (38.8 per 1000 person-years) and Group IV had controlled glucose but elevated blood pressure and LDL (46.7 per 1000 person-years). Compared with the other groups, Group I exhibited significantly longer dialysis-free and MAKE-free survival (log-rank test, p

Longitudinal trajectories of metabolic risk cluster are associated with differential risks of CKD progression to ESKD and death. Our findings provide valuable insights into the monitoring of metabolic risk profiles over time in patients with CKD.

National cross-sectional survey.

Hospitals delivering orthopaedic and trauma services across all levels of care and ownership categories in Tanzania.

Licensed orthopaedic and trauma surgeons practising in Tanzania served as key informants for their respective hospitals. A total of 171 surgeons provided data on 92 unique hospitals nationwide.

Primary outcomes included orthopaedic departmental structural capacity, availability of multidisciplinary specialist support, external support mechanisms and in-hospital orthopaedic training activities.

A response rate of 77.7% yielded data on 92 hospitals delivering orthopaedic and trauma services nationwide. Structural capacity varied widely, with only 19.6% of hospitals reporting more than 50 orthopaedic beds, 43.5% relying on a single orthopaedic surgeon, and 47.8% operating with one or two functional theatres. Access to specialist support was limited, with vascular trauma surgeons available in 9.8% of hospitals and plastic and reconstructive surgeons in 8.7%. Intensivists were available in 41.3% of facilities and anaesthesiologists in 57.6%, while physiotherapists were present in 90.2% of hospitals but occupational therapists in only 28.3%. External dependence was common, with 41.3% of hospitals relying on donated implants and 29.3% participating in outreach programmes. In-hospital orthopaedic training opportunities were limited, with seminars or workshops available in 25.0% of hospitals. Across domains, higher-tier hospitals demonstrated significantly greater structural capacity and specialist availability.

Orthopaedic and trauma services in Tanzania are available across multiple levels of the health system but are characterised by inequitable workforce distribution, limited capacity at lower-tier hospitals and substantial reliance on external assistance. Integrated strategies linking infrastructure development, multidisciplinary workforce expansion, sustainable procurement and decentralised training are essential to strengthen the organisation and resilience of orthopaedic and trauma services nationwide.