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.

To examine national trends and determinants of hypertension diagnosis, treatment and control in Indonesia, and to identify factors influencing the performance of hypertension care across three waves of national health surveys.

Repeated cross-sectional analysis of three nationally representative health surveys (2013, 2018 and 2023).

Household-based, population-level surveys conducted across all provinces of Indonesia, representing primary healthcare settings.

Adults aged ≥18 years included in the 2013, 2018 and 2023 Indonesian National Health Research surveys (Riset Kesehatan Dasar and Survei Kesehatan Indonesia). Participants with complete blood pressure measurements and information on diagnosis and treatment were included; those with missing data were excluded. The weighted sample sizes were representative of Indonesia’s adult population by sex, age group and urban–rural residence.

Primary outcomes were hypertension prevalence, diagnosis, treatment and control rates. Secondary analyses assessed sociodemographic, economic and health system factors associated with each stage of the hypertension care cascade using multivariate logistic regression. All estimates were adjusted for survey design and population weights.

Hypertension crude prevalence increased from 27.9% (95% CI 27.7% to 28.2%) in 2013 to 31.6% (95% CI 31.4% to 31.8%) in 2023. Diagnosis rates declined from 33.0% in 2013 to 24.1% in 2018, then slightly rose to 26.9% in 2023. Treatment rates doubled from 10.4% to 22.4% over the decade, corresponding to an estimated 10 million additional adults receiving antihypertensive therapy. However, control rates improved only modestly, from 2.3% to 4.2%, leaving over 95% of hypertensive adults with uncontrolled blood pressure. Women, urban residents and individuals in higher wealth quintiles had consistently better outcomes across all stages of care.

Indonesia faces a growing hypertension burden, with most cases being undiagnosed. Although treatment coverage has doubled over the past decade, control rates have remained stagnant, and disparities between wealth groups persist. Strengthening long-term management, follow-up and equitable care is essential to improve outcomes.

Harms due to methamphetamine use disorder (MAUD) are rising globally. Untreated withdrawal symptoms perpetuate the cycle of dependence and are a barrier to treatment. There is no pharmacotherapy approved for methamphetamine withdrawal. Lisdexamfetamine (LDX) dimesylate has potential as an agonist therapy to ameliorate symptom severity during acute methamphetamine withdrawal and increase duration of initial abstinence and retention in treatment.

We will conduct a double-blind, randomised, controlled trial to evaluate the efficacy of LDX in reducing symptom severity during acute methamphetamine (MA) withdrawal. One hundred eighty-four adults with moderate to severe MAUD presenting to a health service requesting MA withdrawal treatment who report use of MA within the last 72 hours will be recruited. Participants will be randomised 1:1 to receive a tapering dose of lisdexamfetamine (250 mg on day 1, reducing by 50 mg per day to 50 mg on day 5, followed by 2 days of placebo washout on days 6 and 7), or placebo for 7 days. The study will be conducted over 7 days in an inpatient unit, and all participants will also receive standard inpatient withdrawal care. Participants will be followed up in the community to day 84. The primary outcome is efficacy, defined as the between-group difference in average withdrawal severity measured over the 7-day admission by the Amphetamine Withdrawal Questionnaire. Secondary outcomes are retention in treatment, treatment satisfaction, sleep and concomitant medication use (symptomatic medications and medications for other indications to day 7); safety, craving for MA, post-treatment withdrawal symptoms, depression, anxiety and stress, insomnia and cost effectiveness (to day 28) and MA use, mental, physical and social health and post-withdrawal treatment utilisation (to day 84). A First Nations qualitative substudy will assess the experiences of Aboriginal and Torres Strait Islander participants, ensuring the treatment meets the needs of First Nations people.

This protocol was first approved by the St Vincent’s Hospital Human Research Ethics Committee on 15/05/2024 (2024/ETH00788). All participants will be provided with a participant information sheet and consent form, be fully informed about the study and given ample time to consider participation. Results will be published in peer-reviewed journals and presented at national and international conferences. Findings will be presented such that individual participants will not be identifiable.

ACTRN12624001061527.

To investigate the occurrence of depression and mental health disorders other than depression among Brazilian people with intellectual disabilities, analysing data from a national household survey.

Cross-sectional epidemiological study using data from the 2019 National Health Survey (PNS).

Brazil, nationwide data collection in urban and rural private households.

272 499 individuals, among whom 1.2% (n=3198) reported intellectual disabilities.

Self-reported depression and mental health disorders other than depression (anxiety, panic, schizophrenia, bipolar disorder, psychosis or obsessive–compulsive disorder (OCD)), either isolated or comorbid.

Among people with intellectual disabilities, 43.2% reported at least one mental health disorder versus 13.7% without disabilities. In adults aged 0–59 years, intellectual disability was associated with higher odds of depression (adjusted OR (aOR) 3.25, 95% CI 1.76 to 6.00), mental health disorders other than depression (aOR 12.23, 95% CI 7.52 to 19.90) and depression associated with other mental health disorders (aOR 14.34, 95% CI 7.92 to 25.96). In older adults (≥60 years), risks also remained elevated: depression (aOR 1.71, 95% CI 1.04 to 2.79), mental health disorders other than depression (aOR 4.33, 95% CI 2.09 to 8.94) and depression associated with other mental health disorders (aOR 2.98, 95% CI 1.49 to 5.95). Women with intellectual disabilities were more likely to report depression and multimorbidity, while men more often reported non-depressive disorders. Poorer self-perceived health was consistently linked to worse outcomes across age groups.

Mental health disorders and their comorbidities are significantly more prevalent among people with intellectual disabilities in Brazil. These findings highlight the urgent need for inclusive, equitable and specialised mental healthcare policies.

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 examine trends in the prevalence of diabetes and pre-diabetes in Indonesia from 2013 to 2023 and to explore demographic and socioeconomic factors associated with these changes.

Secondary data analysis on multiseries cross-sectional study.

Three waves of the Indonesian National Health Survey (2013, 2018 and 2023), each employing nationally representative, stratified multistage sampling.

Nationally representative respondents aged 15 years and older who completed fasting plasma glucose (FPG) and oral glucose tolerance tests (OGTT).

Diabetes and pre-diabetes were defined based on FPG and OGTT tests and self-reported diagnosis. Multivariable and ordinal logistic regression models assessed associations between glycaemic status and demographic, socioeconomic and health-related factors.

From 2013 to 2023, the prevalence of diabetes rose from 10.7% (95% CI: 10.2% to 11.2%) in 2013 to 11.8% (11.3% to 12.3%) in 2018, before declining to 11.3% (10.7% to 11.9%) in 2023. Meanwhile, pre-diabetes prevalence decreased from 44.5% (43.6% to 45.3%) in 2013 to 39.2% (38.0% to 40.3%) in 2023. Age-standardised and synthetic cohort analysis revealed that younger birth cohorts had lower diabetes prevalence at the same age compared with older generations. In contrast, diabetes prevalence remained high and stable among older adults, suggesting that an increase in diabetes prevalence was due to the increase in older population size rather than increased risk. Multivariable regression confirms that higher age and BMI were strong predictors for diabetes, pre-diabetes and abnormal glycaemic states. Wealth quintiles showed different associations: higher wealth was linked to lower pre-diabetes odds, but not consistently to diabetes.

The ageing population drives the rise of diabetes prevalence in Indonesia. Generational improvements were shown among younger adults, while persistent high diabetes prevalence in older adults underscores ongoing challenges. These findings highlight the importance of age-targeted and cohort-targeted screening and prevention strategies.

This study aimed to (1) assess Lumos data quality, a New South Wales (NSW) statewide linked health data asset; and (2) determine sociodemographic variation in health service utilisation of general practice, emergency department and admitted services.

A retrospective cohort study using Lumos, a linked health data asset.

A representative statewide sample population of NSW, Australia.

People residing within NSW with an electronic health record at a Lumos participating general practice between January 2010 and June 2023.

Data quality indicators of Lumos including completeness, representativeness against NSW population data, consistency and timeliness. Furthermore, variation in general practice visits, emergency department presentations and hospital admission rates stratified by age, sex, rurality and Index of Relative Socio-economic Disadvantage (IRSD)—a measure of socioeconomic status used in Australia, where lower values represent greater relative disadvantage across a range of metrics such as education and income.

At the time of analysis, Lumos included records from 5.2 million unique patients, representing half (49.7%) of the NSW resident population. Limiting data to 2022, the Lumos population distribution broadly aligned with the 2021 Census except for IRSD quintile four and five which were under-represented (15.0% vs 20.4% (standardised difference –0.14)), and over-represented (29.7% vs 19.9% (standardised difference 0.23)), respectively. Age and greater relative disadvantage were associated with higher rates of general practice visits and hospital admissions. Greater relative disadvantage was also associated with higher rates of emergency department presentations.

Lumos’s ability to overcome historical limitations of separately managed health data in Australia and its demonstrated data quality present an opportunity to enhance health system policy and planning in NSW. The variation in service utilisation across primary and tertiary care by population and geography apparent in Lumos reinforces the need for tailored service planning.

Women with severe mental illness (SMI) face barriers to cervical cancer screening, leading to lower participation and poorer outcomes. This research aimed to develop and test an informed-choice tool to help women with SMI make informed decisions about screening attendance.

The tool was developed using a realist review of physical health interventions and a systematic review of informed-choice tools for people with SMI. A mixed-methods approach informed its development. Usability and acceptability were assessed through semistructured interviews and the think-aloud method with service users (n=18), clinicians (n=16) and key informants. A preliminary proof-of-concept (n=25) evaluated the impact on decisional conflict—the uncertainty around making value-sensitive choices.

Conducted in two National Health Service (NHS) Mental Health Trusts (urban and rural). Participants included women with SMI accessing secondary mental healthcare, clinicians and service user groups. A key informants’ group guided clinical content.

A cervical screening informed-choice leaflet and an accompanying video.

The tool was usable and acceptable, especially for women overdue or never screened. It may reduce decisional conflict and increase screening uptake, potentially improving survival. An National Institute for Health and Care Research (NIHR)-funded feasibility trial (Improving uptake of cervical screening in people with severe mental illness (OPTMISE)) is underway. The current UK government guidance on Support for people who find it hard to attend cervical screening due to having a mental health condition or having experienced trauma or abuse is based on this research.

Future research may involve further assessments of the real-world impact of the tool and its adaptation to other health-related decisions.