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 determine the time intervals between injury and orthopaedic admission, admission and surgery, and postsurgery length of stay and to elucidate factors contributing to delays in accessing orthopaedic services.

Prospective cohort study.

A tertiary hospital in the rural Eastern Cape province of South Africa.

413 adult patients admitted with femur fractures between January 2024 and July 2024.

The primary outcome was the time interval from injury to surgical fixation. Secondary outcomes included time from admission to surgery, length of hospital stay and reasons for delays.

Of 413 patients, only 22% (n=91) received surgical intervention within 48 hours of admission. The median time from injury to admission was 4 days (IQR 0–12), and injury to surgery was 13 days (IQR 0–713). Systemic factors, including limited theatre capacity and bed shortages, were the main reasons for delays. In the multivariate analysis, cardiac disease (adjusted OR, AOR=9.62), diabetes mellitus (AOR=4.36) and a Glasgow Coma Scale score of

Significant delays in femoral fracture fixation were observed, with fewer than 10% receiving surgery within 48 hours of injury. Addressing surgical capacity and referral pathways is essential to improving timely access to care.

This scoping review explores the global context, policies and programmes aimed at achieving universal health coverage (UHC) for maternal health services, focusing on progress within low- and middle-income countries (LMICs). Additionally, it maps methodological approaches and indicators used to evaluate UHC progress for maternal health.

Scoping review methodology.

ProQuest, Scopus, Web of Science and Ovid MEDLINE were searched.

Included were peer-reviewed studies that evaluated UHC policies, programmes and progress towards achieving UHC of maternal health services in LMICs, reported primary research and conducted in all healthcare settings.

Two independent reviewers screened and appraised eligible studies using preset criteria based on a ‘population-concept-context’ framework.

The initial search resulted in 959 studies of 61 articles selected in the final review. Most studies provided international (eg, Sustainable Development Goals, n=35), and national context on health system reforms related to healthcare financing and budgets (n=36). While progress was made on the coverage of maternal health services, the equity in maternal health service access was low for most studies. Both studies evaluating interventions and those not evaluating interventions reported high coverage in maternal health indicators, with antenatal care showing low coverage (n=7, 41%), skilled birth attendance (n=6, 55%) and facility delivery (n=6, 60%), while postnatal care coverage remained variable across studies. Two studies reported high coverage of caesarean section births (n=2, 100%). Studies evaluating intervention found equity improved in access and utilisation of maternal health services; conversely, evaluation without intervention for most studies identified low equity in access and utilisation of maternal health services. High inequity in determinants of maternal health outcomes was reported across studies measuring equity domains.

Countries have many approaches to reaching UHC and tackling the problem of achieving UHC for maternal healthcare. Therefore, policymakers in LMICs must decide how to allocate limited resources to prioritise coverage, equity or quality of maternal healthcare.

To examine the epidemiological patterns and trends of sexual violence against adults and children before and during the COVID-19 pandemic in the Buffalo City and Amathole districts of the Eastern Cape Province, South Africa.

Observational, retrospective, cross-sectional study based on a review of medical records of survivors of sexual violence who reported for healthcare between January–December 2019 and January–December 2020.

The study was conducted in two healthcare facilities in the Buffalo City and Amathole districts of the Eastern Cape Province, South Africa.

A total of 1957 survivors of sexual violence presented for healthcare at the two healthcare facilities during the study period. Inclusion criteria were survivors of all ages with confirmed cases of sexual violence; records with no evidence of sexual violence were excluded.

Primary outcome measures were prevalence and distribution of sexual violence before and during the COVID-19 pandemic. The secondary outcome measures were demographic characteristics of survivors (age, sex and ethnicity), perpetrator identity and location of incidents.

The majority of survivors were female (93.6%), and 49% were under 18 years of age. Most were Black (96.3%) and resided in rural (45.6%) or semiurban (45.6%) areas. Perpetrator identity was unknown in 42.5% of cases. Among known perpetrators, non-partners such as neighbours (22.5%) and family members (13.6%) were most common. More cases were reported pre-pandemic (n=930; 60.5%) compared with during the pandemic (n=608; 39.5%). During the pandemic, 45.0% of cases occurred in the perpetrator’s home, and 53.7% occurred in rural settings. Most pandemic-period cases (63.1%) were reported during alert level 1, when most social and economic activities had resumed.

Overall, there was a high rate of sexual violence, with trends correlating with the extent of COVID-19 restrictions; the highest rates were reported pre-pandemic and during alert level 1. These findings highlight the importance of prioritising the safety of women and children and informing protective strategies in both rural and urban areas during future emergency responses.

Predicting the progression to severe dengue remains a critical yet challenging aspect of patient management. This umbrella review aims to identify biomarkers associated with the development of severe dengue. The primary objective is to determine which biomarkers can predict progression to severe disease in dengue-infected patients. Secondary objectives include identifying (a) early biomarkers (detected on days 1–3 of illness), (b) late biomarkers (detected after day 3), (c) biomarkers requiring further investigation and (d) differences in predictive biomarkers between patients aged

The review questions were formulated based on the Population, Concept and Context (PCC) framework. This review will follow the Joanna Briggs Institute methodology for umbrella reviews and be reported in accordance with the Preferred Reporting Items for Overviews of Systematic Reviews guidelines. The protocol has been registered in PROSPERO (CRD420251058284). MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis and DARE databases will be searched from 1/1/1990 to 1/6/2025. The findings are expected to support early risk stratification and guide future biomarker research in dengue infection. The systematic reviews included in this umbrella review may define severe dengue according to either the WHO 1997 or 2009 guidelines.

Ethical approval is not required since the work involves published documents. The review findings will be communicated to relevant stakeholders through conference presentations and publication in an open-access journal.

PROSPERO 2025 CRD420251058284. Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251058284.

This study aimed to estimate reductions in travel-related carbon dioxide (CO₂) emissions, travel time and distance resulting from a telemedicine service for patients with chronic conditions, and to assess its potential to contribute to more equitable access to specialised care in Northeast Brazil.

Cross-sectional study.

Primary healthcare units in the Northeast region of Brazil.

Patients between birth and 104 years of age with chronic conditions who received video-based teleconsultations between June 2022 and November 2023.

The primary outcome was the reduction in travel-related carbon emissions due to avoided in-person referrals. Secondary outcomes included travel time and travel distance savings. Round-trip distances between primary healthcare units and referral centres were estimated using geolocation data. CO₂ emissions were calculated using the Greenhouse Gas (GHG) Protocol adapted to Brazil (Brazilian GHG Protocol Programme), focusing on Scope 3 emissions from patient travel.

A total of 4642 teleconsultations were conducted with 4106 patients. Of these, 4021 (86.6%) avoided in-person referrals, resulting in estimated savings of 226 900 miles in travel distance and 488 584 min in travel time. The estimated CO₂ emissions avoided totalled 21 593 kg (21 930 kg CO₂ equivalent), with a mean of 5.37 kg (SD±5.5) per teleconsultation (5.4 kg CO₂ equivalent ; SD±5.5). Greater travel distance savings were observed among patients living in municipalities with lower Municipal Human Development Index (mean 92.3±104.2 miles vs 17.3±8.4 miles; p

Telemedicine use in Northeast Brazil significantly reduced patient travel, leading to substantial savings in CO₂ emissions. These savings were more pronounced for patients in smaller, less developed municipalities. By reducing the need for travel, telemedicine can improve access to healthcare for remote or underserved populations, while also supporting environmental sustainability.

To compare the presenting demographic and clinical characteristics of rhegmatogenous retinal detachment (RRD) with other RD types, investigate risk factors of blinding RD and the outcome of surgical intervention.

Prospective, cross-sectional and multicentre.

Four ophthalmic centres in three geographic locations of Nigeria.

264 eyes from 237 patients diagnosed with RRD, tractional retinal detachment (TRD) and exudative retinal detachment (ERD) seen between April 2019 and March 2020.

264 eyes of 237 patients were diagnosed out of 35 641 patients screened. RRD was the most common RD (n=167 (70.5%), TRD 61 (25.7%) and ERD 9 (3.8%) patients). The hospital-based prevalence of all RD is 6.6 per 1000 patients (0.66%), and for RRD alone, 4.7 per 1000 patients (0.47%). The most common symptom was a sudden decline in vision, 100 patients (42.2%); floaters and flashes were uncommon, 5 (2.1%). RRD presented earliest, with a median symptom duration of 2 months, and TRD and ERD at 7.5 months each.

The 46–65-year age group had the highest representation, RRD (n=70, 41.9%), TRD (n=41, 67.3%), ERD (n=4, 44.4%). The mean age was highest in TRD (52.3±12.7 years) and lowest in RRD (44.0±17.5 years) and ERD (45.2±20.4 years). Males dominated (RRD 70.1%, TRD 62.3%, and ERD 66.7%). Ocular trauma was highest in RRD 29.3%, TRD 7.5% and ERD 10%; fellow eye RD was highest in TRD 47.5%, ERD 20%, RRD 8% and myopia was highest in RRD 27.6%.

Two-thirds of eyes were blind (Snellen best-corrected visual acuity

Shorter symptom duration is associated with better preoperative and postoperative vision. In contrast, longer durations are connected to poorer outcomes. Eyes with symptoms lasting less than a week had a 17% rate of postoperative blindness, compared with 30% in cases lasting 1–3 months, and 51% in cases exceeding 6 months.

Delays in diagnosing and treating RD result in high rates of preoperative blindness, which can be reversed with surgery even after several weeks of symptoms. Understanding the associations between RD and the risk of blinding RD in developing countries will benefit early diagnosis, treatment and improve treatment outcomes.

Indigenous Mayan-Yucatecan communities in Mexico have a high prevalence of chronic non-communicable diseases (NCDs) such as diabetes, hypertension, obesity and rheumatic diseases (RMDs). According to the syndemic theory, these diseases combined with social, economic and cultural factors affect the quality of life. The aim of this protocol is to describe the methodological process to create, implement and evaluate a Syndemic-Based Care Model (SCM), using a Community Based-Participatory Research (CBPR) strategy in three Mayan-Yucatecan communities.

This is a convergent mixed-methods protocol. The quantitative component is a before-after study, and the qualitative component is an ethnographic study. The intervention will be a SCM co-constructed with Mayan communities based on their particular needs and aiming for reduction of the negative impact of NCD/RMD through a multidisciplinary approach. We will follow four phases of the CBPR: (1) situational analysis, through community censuses and semistructured interviews to understand the prevalence of NCDs and the syndemics in these communities; (2) co-construction of the elements of a SCM based on the health priorities identified by researchers, community members and healthcare workers; (3) implementation of this SCM and (4) evaluation of the SCM through (1) statistical analyses involving the construction of a syndemic index through stepwise logistic regression of the normalised and standardised key clinical, social and economic variables; interval and ratio variables will be normalised by their z-score and categorical variables will be one-hot encoded; similarity and social networks analysis with clustering to identify syndemic subpopulations; and cost-effectiveness and cost-utility analyses using Markov modelling and (2) narrative and thematic qualitative analysis of the SCM’s implementation and impact on community members’ health, function and quality of life.

Research ethics boards of participant institutions approved this research protocol. This project will be presented to municipal authorities, community meetings and community leaders for observation and acceptance. For people who wish to participate, informed consent will be provided written and verbally in Spanish or Mayan-Yucatecan according to the participant preferences, and it can be signed by either autograph or fingerprint. The results of this research will be disseminated to various groups: (a) local and regional authorities of the Mexican health system and municipal authorities; (b) the participating communities will be informed in an assembly of the results and (c) academic dissemination will be done through publications in public science journals and institutional press releases and will also be presented at national and international congresses or symposia.

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related death globally. Growing evidence links gut microbiota dysbiosis to CRC, with several reviews reporting consistent microbial alterations in CRC patients that may serve as non-invasive biomarkers. However, findings vary across studies, and consensus on key microbial taxa is lacking. This umbrella review aims to clarify: (1) the association between gut microbiome composition and CRC development/progression, (2) specific microbial taxa linked to CRC risk, (3) the role of microbiome diversity in CRC outcomes and (4) potential microbial biomarkers for diagnosis, prognosis and treatment response.

This umbrella review will follow the Joanna Briggs Institute (JBI) Umbrella Review Guidelines and adhere to the Preferred Reporting Items for Overviews of Reviews. A comprehensive search will be conducted across MEDLINE (PubMed), Embase, CINAHL and key systematic review databases, including the Cochrane Database, JBI Evidence Synthesis and Database of Abstracts of Reviews of Effects, without language restrictions. The search strategy will use a combination of Medical Subject Headings terms and free-text keywords with Boolean operators. The review questions were developed using the Population, Concept and Context framework. Only high-quality (as determined by the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses), peer-reviewed quantitative systematic reviews with or without meta-analyses will be included. Overall effect estimates extracted from systematic reviews, with the number of studies that inform the outcome, will be presented.

No ethical approval is required since the work is carried out on published documents. Findings of this review will be disseminated among relevant stakeholders through multiple scientific avenues, including presentations at both national and international forums and manuscript publication in an open-access journal.

PROSPERO 2025 CRD420251035257. Available from:

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251035257.

Despite growing evidence to characterise cancer-associated cognitive decline (CACD) in women with breast cancer, interventions to mitigate CACD are limited. Emerging evidence suggests aerobic exercise may enhance cognition after breast cancer diagnosis and treatment; yet, CACD remains an understudied outcome of exercise, and few high-quality studies have been conducted. In addition to knowledge gaps in effectiveness, the translation of exercise interventions to community settings remains challenging. The Breast cancer Reasoning and Activity INtervention (BRAIN) investigates the effectiveness of aerobic exercise training, delivered in a community-based setting, for improving cognitive function in women with breast cancer and gathers information on the implementation success of the intervention.

This Hybrid Type I effectiveness–implementation study is conducted at an academic medical centre in the southwestern United States in partnership with a non-profit, community health and wellness organisation. The study enrols 160 women diagnosed with stage I–IIIa breast cancer and within 3–36 months of treatment completion into a 1:1 randomised controlled trial. Individuals randomised to the exercise group receive a 6-month, individually tailored aerobic exercise programme delivered by exercise trainers employed at local community fitness centres. The programme is progressive in nature and designed to help participants achieve aerobic exercise levels consistent with guidelines for cancer survivors. Individuals randomise to the control group receive a 6-month health education control intervention delivered virtually by hospital-based health educators. Cognitive performance (primary), self-reported cognition, patient-reported outcomes, physical activity and cardiorespiratory fitness are measured at baseline, 6 months (postintervention) and 12 months (follow-up). Brain structure and function are measured via magnetic resonance imaging (MRI) at baseline and 6 months. Implementation outcomes are defined by the RE-AIM framework, which includes reach, effectiveness, adoption, implementation and maintenance. RE-AIM outcomes are measured at baseline, 6 months, 12 months and ongoing during the study.

This study was approved by the Mayo Clinic Institutional Review Board (#23-000020). All participants provide informed consent prior to participation. Findings will be disseminated to scientific, clinical and community audiences through manuscripts, presentations and newsletters.

NCT04816006.

Cancer and its treatment can negatively impact physical function, general well-being and quality of life. An evidence-based strategy to manage this is to prescribe exercise. One approach is to prescribe exercise prehabilitation to improve pretreatment health and function. However, current exercise prehabilitation programmes are under-researched, and the quality of their reporting has not been systematically assessed.

This review aimed to identify the following: the characteristics of prehabilitation exercise programmes; how intensity, physical function, patient-reported outcomes and treatment-related outcomes were measured; the quality of reporting and programme implementation.

Studies were eligible for inclusion if they reported a cancer prehabilitation exercise intervention, reported outcomes relating to physical function and patient-reported outcomes, and full-text copies were available in English.

PubMed, Mednar and Scopus were screened for studies from inception until 4 of April 2024.

Exercise characteristics were extracted and manually charted in Microsoft Excel using the Template for Intervention Description and Replication. The tool for the assessment of study quality and reporting in exercise (TESTEX) framework was used to assess study quality and intervention reporting.

1495 results were retrieved, 28 of which were included. Exercise sessions lasted a mean of 42.5±21.9 min and were completed 3.7±1.3 times per week. 22 studies implemented concurrent exercise, five prescribed aerobic, and one prescribed resistance. High-intensity exercise was prescribed in four studies, moderate-high in 12, seven prescribed moderate, three prescribed low-moderate, and one was low intensity. 10 studies prescribed exercise intensity using the Borg Rating of Perceived Exertion Scale, five prescribed heart rate (HR) zones, six used a set workload, and seven did not monitor intensity. A mean TESTEX score of 9.3±2.3 out of 15 was achieved. The lowest scoring criterion (n=3) related to the reporting of the exercise dose.

There was heterogeneity among studies regarding exercise intervention characteristics and measures of effectiveness. The overall quality of reporting was satisfactory, yet inconsistencies were apparent regarding quantifying and monitoring exercise dose, which limits the ability of researchers and clinicians to replicate, evaluate or scale cancer prehabilitation exercise interventions, impeding evidence-based practice. As such, to be able to optimise cancer prehabilitation exercise programmes, research must first focus on improving the quality of reporting and standardising outcome measures and methods of monitoring and prescribing exercise.