To investigate associations between body composition indices and metabolic status among normal-weight adults.

Cross-sectional study using data from the Tehran Lipid and Glucose Study (phaseVII: 2019–2021).

Primary care and community health services in an urban Tehran population.

1298 adults (40.5% men, 59.5% women), aged 18–80years, body mass index (BMI) 18.5–24.9 kg/m². Exclusions: known diabetes, cardiovascular disease, kidney failure, malignancy, pregnancy or lactation, diuretic or glucocorticoid use. Participants were classified as metabolically healthy normal weight (MHNW) or unhealthy (MUHNW).

The primary outcome was the association between body composition and anthropometric indices with metabolic status. The secondary outcome was identification of the strongest predictors of MUHNW. Body composition was assessed by bioelectrical impedance analysis to obtain fat mass (FM), body fat percentage (BFP), skeletal muscle mass percentage (SMM%), fat mass index (FMI), fat-free mass index, skeletal muscle indices and the fat-to-muscle mass ratio (FMR). Anthropometric measures included waist circumference (WC) and waist-to-hip ratio (WHR). Associations were examined using logistic regression adjusted for age, smoking and physical activity.

Mean age: 37.5±12.8 y; MUHNW participants were older than MHNW (44.5±13.2 vs 35.8±12.1 years, p

BMI, WC, WHR and body fat indices were positively associated with metabolically unhealthy status among normal-weight adults of both sexes. WHR was the strongest predictor, highlighting its value for identifying at-risk individuals where advanced body composition tools are unavailable.

Child mortality continues to pose a major public health challenge across Asia. This study examines trends in under-5, infant and neonatal mortality and identifies key determinants, spatial risk patterns and projections through 2030 using spatiotemporal modelling.

We used national-level data from 41 Asian countries, representing over 80% of Asia’s population, between 2000 and 2022, incorporating 26 health, environmental and sociodemographic indicators. A hierarchical Bayesian model using Integrated Nested Laplace Approximation, incorporating fixed effects, spatially structured and unstructured random effects, and temporal smoothing, was used. Model performance was assessed via the Deviance Information Criterion, Watanabe-Akaike Information Criterion, coefficient of determination (R²), root mean squared error (RMSE) and mean absolute error metrics.

Under-5 mortality decreased significantly (p

The study highlights the critical role of immunisation and maternal education in reducing mortality, and the need for more targeted neonatal interventions. The white-box modelling framework enables both interpretability and reliable forecasting, supporting data-driven policy planning toward achieving advanced, equitable child survival, as outlined in Sustainable Development Goal 3.2.

This study aims to investigate the association between physical fitness and markers of cognitive function in adults aged 40 and above in Qatar.

A cross-sectional study.

The Qatar Biobank, data of 1000 adults aged 40 and above.

A population of 1000 adults aged 40 years and older was included. Available data comprised measures of physical fitness including cardiorespiratory fitness, muscular strength, body composition and physical fitness capacity, as well as cognitive function assessed through tests of short-term visual memory and psychomotor coordination.

This paper investigated the physical fitness effect on cognitive functioning through short-term visual memory and psychomotor coordination testing. Logistic regression was used to measure the association between physical fitness and cognitive functioning tests.

Our study showed that lower physical fitness capacity was significantly associated with lower psychomotor coordination in females (OR=1.57, p=0.040) and showed no significant association in males (OR=1.65, p=0.062). For short-term visual memory, the association was significant in females (OR=1.68, p=0.042) unlike in males (OR=1.58, p=0.062). Males with greater muscle strength were about half as likely to have lower psychomotor coordination (OR=0.48, p=0.04). In females, a higher body fat percentage was associated with poorer cognitive function, with each 1% increase in body fat being linked to 6% higher odds of low short-term visual memory (p=0.02) and low psychomotor coordination (p=0.006). Cardiorespiratory fitness showed no statistically significant association with short-term visual memory and psychomotor coordination level in either sex.

Our findings suggest that overall physical fitness capacity is associated with better cognitive function in Qatari adults. The relationship between specific fitness measures and cognitive function varied by sex, with muscle strength having a stronger effect for males and body composition for females. These results highlight the potential importance of maintaining physical fitness for cognitive health in adulthood.

The study aimed to determine the prevalence and identify the associated factors of undernutrition among children under 5 years of age living in riverbank erosion areas in Bangladesh.

A community-based cross-sectional study.

The study was carried out in riverbank erosion-prone areas of the Tangail and Kushtia districts of Bangladesh, which were selected because they are highly vulnerable to riverbank erosion and related livelihood disruptions.

Participants were selected using a two-stage cluster sampling technique based on the criterion that mothers had at least one child under the age of 5 years.

Stunting, wasting and underweight were considered independently as outcome variables to assess nutritional status.

Descriptive analysis was performed to determine the prevalence of undernutrition, while the ² test and multivariable Poisson regression model were used to identify significantly associated factors with undernutrition among children under 5 years of age in riverbank erosion areas.

The average prevalence of stunting, wasting and underweight was 37.74%, 22.64% and 9.81%, respectively. Results from the Poisson regression model showed that children who were average or large in size at birth had a much lower prevalence of all forms of undernutrition compared with those born very small. Female children had a 30% lower prevalence of stunting compared with male children. In addition, having educated parents, receiving four or more antenatal care visits and household livestock ownership were each associated with a lower prevalence of undernutrition.

The prevalence of stunting in this study was higher than that reported in the most recent Bangladesh Demographic and Health Survey 2022. Child size at birth, sex, parental education, antenatal care visits and household livestock ownership were identified as significantly associated factors with undernutrition in riverbank erosion areas of Bangladesh.

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.

The increasing incidence of type 2 diabetes mellitus (T2DM) among women of reproductive age poses significant health risks for both mothers and their fetuses. Optimising blood glucose levels during pregnancy is particularly challenging, even with a combination of oral antidiabetic agents and insulin therapy. Hydroxychloroquine (HCQ) has been shown to lower glucose levels in non-pregnant populations and has demonstrated safety in pregnant women with systemic lupus erythematosus and rheumatoid diseases. In addition to its glucose-lowering effects, HCQ also exhibits immunomodulatory, antioxidant and anti-inflammatory properties. Given that both T2DM and pregnancy are pro-inflammatory states, inadequate glycaemic control may exacerbate adverse pregnancy outcomes. We hypothesise that adjunctive treatment with HCQ in this cohort could improve glycaemic control, reduce systemic inflammation and subsequently lower the risk of adverse pregnancy outcomes.

This is a prospective, open-label, randomised controlled trial involving 56 pregnant women diagnosed with T2DM. Participants will be randomly allocated, using computerised randomisation software, into either a control group receiving standard care or an intervention group receiving standard care with HCQ 200 mg daily. The primary outcomes will be the difference in glycaemic parameters and inflammatory markers. Secondary outcomes include the assessment of pregnancy outcomes between the groups, such as gestational age at delivery, postpartum haemorrhage, fetal macrosomia and shoulder dystocia.

This protocol has been approved by the National University of Malaysia Ethics Committee (JEP-2023–866). Study findings will be disseminated via presentations at academic conferences, publications in peer-reviewed journals and professional training and meetings to healthcare professionals.

This study was registered in ClinicalTrials.gov (NCT06319560) on 23 January 2024.

Diabetes is highly prevalent in older women worldwide. This study explores the associations of psychosocial factors with both health service utilisation and self-management in older women aged 68 to 73 years with type 2 diabetes (T2D) or pre-diabetes.

This cross-sectional study used data from the Australian Longitudinal Study on Women’s Health (ALSWH), which is a national population-based cohort study that has collected information on factors related to women’s health and well-being over 20 years.

Women aged 68–73, born between 1946 and 1951, participated in ALSWH and self-reported their diagnosis of T2D or pre-diabetes.

Resilience, dispositional optimism and perceived control were the measures of psychosocial factors. The associations between these factors and diabetes self-management behaviours, healthcare visits and preventive service use were examined by numerous regression models.

There were 939 women aged 68–73 years with T2D or pre-diabetes. Women with T2D who exhibited higher dispositional optimism had significantly higher odds of participating in moderate/vigorous physical activity (OR: 1.06), visiting a dentist (OR: 1.07) and a lower rate of general practitioner (GP) visits (rate ratio (RR): 0.99). Women with T2D with greater resilience were likely to have a lower rate of consulting with mental health professionals (RR: 0.63) and higher odds of blood sugar level checks (OR: 1.68). The rate of GP visits within a year decreased by 16% for women with pre-diabetes who had a higher resilience score (RR: 0.84), and women with pre-diabetes with greater resilience had a 13% lower rate of visits to a nurse (RR: 0.87).

Psychosocial aspects of diabetes care may be important for supporting the physical and mental well-being of older women with T2D or pre-diabetes. Healthcare providers may consider whether integrating assessments of resilience and optimism into routine diabetes management might help identify older women who could benefit from targeted psychosocial support.

This study aims to identify factors associated with early antenatal care (ANC) initiation using a survival analysis approach applied to nationally representative data.

This study used a cross-sectional design based on data from the nationally representative 2022 Bangladesh Demographic and Health Survey. The survey was conducted at the community level across all administrative divisions of Bangladesh. A total of 5128 ever-married women aged 15–49 years who had a live birth within 5 years prior to the survey were included in the analysis. Women with missing or incomplete information regarding the timing of their first ANC visit were excluded from the study.

The primary outcome was early initiation of ANC, defined as the first ANC contact within the first trimester.

The study applied survival analysis methods, including Kaplan-Meier survival curves, log-rank tests and an Accelerated Failure Time model, to assess the determinants of early ANC initiation.

Only 37.9% (95% CI 36.0% to 39.9%) of women in Bangladesh initiated ANC within the first trimester. Early ANC initiation was associated with higher maternal age, education, skilled employment, wealthier households, media exposure, higher decision-making autonomy, higher husband’s education and urban residence. Women who reported that distance to a health facility was not a big problem had initiated ANC earlier than those who considered distance a major barrier. Regional disparities were also evident, with women from Barishal, Chattogram, Rajshahi, Khulna and Rangpur accessing ANC later than those in Dhaka.

Persistent inequalities in early ANC initiation highlight the need for targeted policies to reduce financial barriers, improve healthcare accessibility and strengthen awareness campaigns to ensure equitable maternal healthcare in Bangladesh.

Antimicrobial resistance (AMR) is a critical public health issue in Bangladesh, exacerbated by the widespread practice of non-prescribed antibiotic dispensing. This study seeks to assess their knowledge and attitudes, particularly how these factors influence non-prescribed antibiotic dispensing practices in Bangladesh.

A total of 287 pharmacy staff across four regions of Bangladesh were included in the study. Data were collected using a structured questionnaire assessing knowledge, attitudes and practices regarding non-prescribed antibiotic dispensing.

The study found that 92.4% of respondents dispensed antibiotics without prescriptions. The practice was significantly more prevalent among those with poor knowledge (99.28% in below-average vs 86.09% in above-average knowledge groups, p

These findings highlight knowledge and attitude towards antibiotic dispensing play a vital role where weak regulation, education and economic incentives further worsen the situation. Urgent interventions, including improved pharmacist training, prescription monitoring and public awareness campaigns, are essential to reduce non-prescribed antibiotic dispensing and align practices with Bangladesh’s National Action Plan on AMR.

To quantify, compare and analyse the carbon emissions of biologic treatments for severe asthma.

Cradle-to-gate carbon emissions (from raw materials to finished product) for six monoclonal antibody therapies, benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab and tezepelumab, were estimated using Medicine Carbon Footprint Classifier, a standardised, mass-based method for medicine carbon footprinting. A representative patient, eligible for all therapies, was defined to enable comparisons. Sensitivity, scenario and pairwise analyses were conducted to explore variations in emissions and opportunities for reduction.

The primary outcome was first-year carbon emissions of biologic treatments for a representative patient with severe asthma, expressed in kg CO₂e. Additional outcome measures were the effect of varying the electricity source on treatment emissions and emissions associated with alternative biologic choices.

First-year treatment emissions for the representative patient ranged from 1.1 kg CO₂e with benralizumab to 188.9 kg CO₂e with dupilumab, a 172-fold difference. Variation was driven by the active pharmaceutical ingredient per preparation (30–300 mg), number of preparations required for first-year treatment (8–52) and manufacturer’s proportion of non-fossil fuel electricity (NFFE) (22%–91%). Sensitivity analysis showed that increasing NFFE to 100% could reduce emissions by 29%–90% and the difference between the highest and lowest emission treatments by 91%. Pairwise comparison showed that selecting any biologic instead of dupilumab could reduce emissions by 134–188 kg CO₂e per patient-year, equivalent to 340–478 car miles. The emission differences between treatment with benralizumab, mepolizumab and tezepelumab were minimal.

The carbon footprints of biologic treatments for severe asthma vary widely, driven primarily by differences in dose and manufacturer electricity sources. Our analyses highlight near-term opportunities to reduce emissions, including replacing fossil fuel electricity with renewable or nuclear sources (NFFE) and optimising dosing practices. The approach can be applied across other therapeutic areas to support carbon-informed prescribing and healthcare decarbonisation.

The global need for developing comprehensive mental healthcare systems for children and adolescents has been increasingly evident. The system-of-care (SOC) model in the USA is among the most studied cases for such a system, which demonstrates how integrated services, encompassing psychiatric care, can effectively support children and adolescents with severe emotional disturbance. Over the past decades, the SOC framework has been widely expanded, with nearly every state in the USA receiving federal funding to implement or expand the SOC initiatives. The number of studies investigating the efficacy of the SOC is increasing, but no systematic review of the instruments for the evaluation of the implementation of the SOC exists today. This protocol paper documents the plan of a systematic review, which aims to identify and synthesise the existing instruments, which are designed and used to evaluate the implementation of the SOC.

This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocol guidelines. To identify relevant studies, we will perform a comprehensive search in five databases: PubMed, PsycINFO, ERIC, Social Work Abstracts and Web of Science. The title and abstracts of all searched articles will be screened independently by two reviewers according to the eligible criteria. Full-text screening of potentially relevant articles will be performed by at least two independent reviewers. A summary of included articles will describe the availability, progress and cultural adaptability of instruments.

The current systematic review will be solely based on previously reported data and will not involve new data collection. There are no concerns that require ethical vetting. Findings of the review will be disseminated through conference presentations and publication in a peer-reviewed journal.

1065693.

The study aims to present recommendations for a revised Doctor of Pharmacy (Pharm-D) curriculum that aligns with regional needs and international standards of pharmacy education.

An exploratory qualitative study involving individual semistructured interviews. Data were collected and reported in accordance with Consolidated Criteria for Reporting of Qualitative Studies.

Face-to-face interviews were conducted in the respective offices of the experts and online interviews were conducted on Zoom and Google Meet.

Purposive and snowball sampling was used to recruit experts due to the eligibility criteria of including associate professors with a PhD, and snowball sampling facilitated the recruitment of experts from all provinces and internationally. Interviews were transcribed verbatim and data were analysed using an inductive thematic approach using NVivo V.15. All interviews were conducted in English.

The study engaged 49 experts from national and international settings with an age range of 25–60 years (median=43 years). The researchers came out with six themes and their subthemes from the data including: (a) understanding current Pharm-D curriculum in Pakistan, (b) inevitable changes required in the Pharm-D curriculum, (c) specific-subject based changes, (d) foundational steps to achieve the required changes, (e) barriers to the implementation of these changes and (f) impact of Pharm-D curriculum change.

The findings highlighted a clear need to revise the curriculum by incorporating enhanced clinical pharmacy content, integrated learning approaches, elective courses, interprofessional education, mandatory hospital and clinical placements, experiential learning through simulation-based methods and research components through a collaborative approach from policy makers and academic stakeholders.

This study aimed to determine the prevalence of cervical high-risk human papillomavirus (hrHPV) in a community-based setting and its risk factors association in women living in hard-to-reach areas in Bangladesh.

A cross-sectional study

The study was carried out in six subdistricts, located in hard-to-reach and climate-impacted regions of Bangladesh.

A total of 8000 married women aged 30–60 years were invited for screening. Women who were unable to give consent, were pregnant or had a hysterectomy with removal of the cervix, previous screening less than 5 years, or treatment of the cervix or had symptoms of potential cervical cancer were excluded.

A community-based hrHPV self-collected screening for cervical cancer was conducted from June 2022 to July 2023.

Prevalence of cervical hrHPV and risk factor association.

11 127 women were eligible for screening; 7850 women submitted hrHPV self-swabs, 7828 valid HPV test results were reported and 164 women (2.1%) tested hrHPV positive. Women living in the North were 2.1 times more likely to be hrHPV positive compared with women living in the South (adjusted OR (AOR)=2.1, 95% CI: 1.5 to 3.8, p=0.023) and widowed women were 3.0 times more likely to be hrHPV positive than married women (AOR=3.0, 95% CI: 1.7 to 5.3, p=0.001). Another risk factor associated with testing hrHPV positive was the use of hormonal contraceptives for 5 years and above (AOR=7.0, 95% CI: 2.0 to 24.4, p=0.002).

The study identified a low overall prevalence of hrHPV infection (2.1%) among women in hard-to-reach areas in Bangladesh, with some regional variations. Higher prevalence was observed in widowed compared with married women and among women reporting more than 5 years of hormonal contraceptive use. This study shows no evidence of particularly high-risk groups in hard-to-reach areas in Bangladesh. The findings support the feasibility of implementing a nationwide hr-HPV-based self-sampling strategy as a viable approach to reach WHO targets for reducing the burden of cervical cancer. Recommendation for policymakers to support future research to identify hrHPV prevalence among women in comparable groups in other geographically remote areas in Bangladesh.

NCT05234112.

We explored how key sociodemographic characteristics were associated with correct knowledge about antibiotics and antibiotic resistance (ABR) and appropriate usage of antibiotics from a One Health perspective among rural community members in Bangladesh.

Cross-sectional single-period survey.

Rural villages in Cumilla district, Bangladesh.

Eligibility criteria: aged ≥18. Across 50 clusters of villages, we approached 2160 community members and 2187 (98.8%) agreed to participate.

Primary outcomes: we collected two knowledge outcomes measuring the number of correctly answered binary/multiple-choice questions about (1) antibiotics and ABR and appropriate usage of antibiotics in relation to human illness and (2) antibiotics and ABR and appropriate usage of antibiotics in relation to animal health and the environment. Secondary outcomes: self-reported awareness of (1) antibiotics and (2) ABR.

Several sociodemographic characteristics were associated with variation in both knowledge outcomes. Education showed the strongest associations, with higher education levels associated with higher knowledge scores. For example, compared with having no formal/incomplete primary education, having higher education was associated with 10 percentage points (95% CI 8 to 12) and 6 percentage points (95% CI 3 to 8) higher mean knowledge scores for the knowledge outcomes 1 and 2, respectively. Having worked in the last month compared with not having worked was also weakly positively associated with both knowledge outcomes, and being female compared with being male was also weakly negatively associated with both knowledge outcomes.

Better public education is required to tackle ABR in Bangladesh but correct knowledge about antibiotics and ABR and appropriate usage of antibiotics in relation to humans, animals and the environment varies in relation to individuals’ education level, sex and working status. To maximise their effectiveness, interventions to tackle ABR must be flexible given recipients’ sociodemographic characteristics and pre-existing knowledge levels.

People with autism, particularly those experiencing moderate-to-severe intellectual impairments, face an increased likelihood of developing anxiety disorders.1 2 Although anxiety is common among this group, there is limited research demonstrating the effectiveness of psychological treatments for...