To identify the factors associated with low psychological resilience among university students in the Grand Est region of France at the end of the first national COVID-19 lockdown.

A cross-sectional online survey was conducted (May 2020) among students at the University of Lorraine using the LimeSurvey platform and institutional mailing lists.

Higher education setting in north-eastern France, involving students from the University of Lorraine (multicampus public university) and Sciences Po Nancy, a political science institute in the same region.

A total of 3708 students fully completed the online questionnaire, including the Brief Resilience Scale (BRS), resulting in an estimated response rate of 7.1%. All students enrolled at the University of Lorraine and Sciences Po Nancy during the 2019–2020 academic year were eligible to participate.

The primary outcome was psychological resilience, measured using the BRS. Secondary measures included perceived social support assessed with the Multidimensional Scale of Perceived Social Support, quality of interpersonal relationships evaluated using the Quality of Interpersonal Relationships Scale (Échelle de la Qualité des Relations Interpersonnelles, EQRI) and frequency of positive and negative thoughts measured with the Thermometer of Thoughts Tool. Factors associated with low resilience were analysed using bivariable and multivariable logistic regression.

Among 3708 students included in the sample, corresponding to a response rate of approximately 7.1%, 50.6% had normal resilience, while 37.3% reported low resilience. Female gender (OR=2.1, 95% CI: 1.8 to 2.6) and low social support (OR=1.7, 95% CI: 1.1 to 2.6) were the factors associated most strongly with low resilience. Negative thoughts (OR=1.4, 95% CI: 1.4 to 1.5), lower quality of relationships with people in general (OR=1.5, 95% CI: 1.3 to 1.8) and studying arts, humanities or languages (OR=1.4, 95% CI: 1.0 to 1.8) were identified as factors associated with low resilience. Increased age (OR=0.9, 95% CI: 0.9 to 1.0) and flat sharing (OR=0.6, 95% CI: 0.4 to 0.9) were inversely associated with low resilience levels.

Resilience seems to be impacted primarily by internal and micro-environmental factors. Consolidating levels of individual resilience of at-risk populations by acting on these factors could be the key to improving their mental health.

To understand how public health practitioners (PHPs) are using parental guidance on talking to children in their work with parents. In 2021, evidence-based guidance was produced for parents of young children to facilitate these conversations, but it is unclear how this guidance is being promoted to parents or used by PHPs.

Qualitative study, consisting of in-depth, semistructured interviews.

Local authority, National Health Service or other healthy weight service providers in the UK.

Participants were PHPs working on children’s healthier lifestyles programmes in the UK as part of the UK’s National Child Measurement Programme (NCMP). Invitations to participate were distributed via the Department of Health and Social Care and regional and national networks.

24 participants were interviewed. Practice varied between organisations with the guidance being used in NCMP letters to parents, in follow-up phone calls with parents and in training NCMP staff and other health or education professionals. Participants valued the evidence-based guidance and its compassionate tone, feeling it gave them and parents, confidence in addressing a sensitive topic. Some felt it was too lengthy for parents with learning disabilities or low literacy levels. Others identified a need for similar guidance for older children. Though helpful, participants acknowledged the guidance was only one small part of a necessary systems-wide approach to promoting healthy weight.

The guidance is a useful tool but needs systematic promotion to increase use and effectiveness. Further work is warranted to develop adapted versions for other populations.

India had an estimated three to five million excess deaths from causes attributable to SARS-CoV-2 during 2020–2021, far exceeding official government statistics. Most deaths in India occur in rural areas, where medical certification of deaths is limited. Yet, the effects of the pandemic in rural settings remain largely undocumented. We estimated the cause-specific excess mortality in rural areas of selected states of India.

Longitudinal analyses of hospital mortality data.

India’s Health Management Information System (HMIS) reports the number of deaths by cause for adolescents or adults aged 10 years or more. We examined eight states with high coverage of the expected number of deaths in rural areas.

We analysed monthly death reports from the HMIS, which covered approximately 0.2 million health facilities during 2018–2023. We compared excess deaths during the peak COVID-19 months in rural health facilities to pre-COVID-19 and non-peak periods of 2021, and categorised reported causes by their probable association with COVID-19.

Excesses of cause-specific and total mortality.

During the April–June 2021 SARS-CoV-2 wave, predominantly driven by the Delta variant, monthly deaths in rural health facilities across India surged from approximately 200 000 to 500 000. In eight states with high-quality reporting, rural facility deaths increased by 270% (95% CI 267% to 272%) compared with the same months in 2018–2019, prior to the COVID-19 pandemic. Notably, this surge occurred despite a sharp decline in hospital admissions following the national lockdown in March 2020. The largest relative increase was for fever-related and respiratory diseases, and these deaths were markedly elevated even when compared to non-peak months of 2021. Generalising these findings from eight states to all of rural India yields an estimate of approximately 2.6 million excess rural deaths in April–June 2021. In contrast, there were few excess deaths during the Omicron viral waves in 2022–2023.

COVID-19 substantially increased deaths in rural India during April–June 2021, but reassuringly, no significant excess mortality was observed in subsequent years. The HMIS provides an important opportunity to strengthen routine mortality surveillance in rural India.

To investigate the associations of oxidative balance score (OBS) with all-cause mortality, cardiovascular mortality and cardiovascular disease (CVD) incidence in two large, population-based cohorts.

Cohort study and cross-sectional study were used.

The US National Health and Nutrition Examination Survey (NHANES) and the UK Biobank.

A total of 33 566 adults from NHANES (1998–2018) and 55 760 adults from the UK Biobank were included.

All-cause mortality, cardiovascular mortality and CVD. Mortality outcomes were ascertained through national death registries. Prevalent CVD was identified in NHANES through questionnaire, and incident CVD events were identified in the UK Biobank using linked hospital admission and death registry data.

Higher OBS was consistently associated with lower all-cause and cardiovascular mortality in both cohorts. In NHANES, participants in the highest OBS quartile (Q4) had a 39% lower risk of all-cause mortality (adjusted HR: 0.61, 95% CI 0.52 to 0.72) and a 45% lower risk of cardiovascular mortality (adjusted HR: 0.55, 95% CI 0.41 to 0.74) compared with those in Q1. Similarly, in the UK Biobank, Q4 was associated with an 18% lower risk of all-cause mortality (adjusted HR: 0.82, 95% CI 0.74 to 0.91) and a 41% lower risk of cardiovascular mortality (adjusted HR: 0.59, 95% CI 0.4 to 0.87). In NHANES, Q4 was associated with lower odds of prevalent CVD (adjusted OR: 0.56, 95% CI 0.46 to 0.67), whereas in the UK Biobank, Q4 was associated with a 19% lower risk of incident CVD during follow-up (adjusted HR: 0.81, 95% CI 0.74 to 0.9). Subgroup analyses in NHANES indicated heterogeneity by ethnicity and socioeconomic status, whereas associations in the UK Biobank followed an L-shaped pattern with a flattening of estimated risk at moderate OBS levels.

Higher OBS was associated with more favourable mortality and cardiovascular outcomes. These findings indicate that OBS is a composite indicator associated with cardiovascular health at the population level.

To examine differences in physical health conditions among female veterans compared with male veterans and female civilians.

Cohort analysis using data from the UK Biobank, incorporating self-reported and hospital-derived health information.

Veteran status was identified using Standard Occupational Classification codes. The study included female veterans (n=546), male veterans (n=2722) and female civilians (n=66 305).

Physical health conditions were identified through self-report and hospital records. Multivariable logistic regression models estimated associations between veteran status and selected health conditions, adjusting for age, sociodemographic factors, time in service, body mass index and current smoking status.

Compared with female civilians, female veterans had increased odds of chronic obstructive pulmonary disease (adjusted OR (aOR) 1.79, 95% CI 1.04 to 3.08) and lower odds of hypertension (aOR 0.74, 95% CI 0.59 to 0.93), with no significant difference in musculoskeletal conditions or osteoarthritis. Compared with male veterans, female veterans had significantly higher odds of osteoarthritis (aOR 1.61, 95% CI 1.25 to 2.08), migraine (aOR 2.63, 95% CI 1.66 to 4.19) and thyroid disorders (aOR 4.42, 95% CI 2.83 to 6.89).

Female veterans have distinct physical health profiles, including a greater burden of musculoskeletal and respiratory conditions compared with male veterans and female civilians. These findings highlight the need for targeted prevention and clinical interventions for women with a history of military service.

To develop and validate a mortality-risk prediction model for patients with advanced splenomegaly-subtype schistosomiasis, enabling accurate prognosis assessment and informed resource allocation.

Retrospective, population-based cohort study using clinical data from a single-centre registry.

Endemic regions of Hubei Province, China.

The study includes 628 patients with advanced splenomegaly-subtype schistosomiasis from the Hubei Provincial Advanced Schistosomiasis Registry between September 2014 and January 2015. The splenomegaly subtype is defined as splenomegaly extending below the umbilical line or with a transverse diameter exceeding the mid-abdominal line. We divided the study population into two cohorts. The derivation cohort included 452 patients selected from several counties within the registry. These patients had a confirmed diagnosis of advanced splenomegaly-subtype schistosomiasis. Only those with complete data were retained. The external validation cohort comprised 176 patients from geographically distinct counties in the same registry, and the same inclusion and exclusion criteria were applied. 10-fold cross-validation was employed to evaluate the model’s generalisation on the derivation cohort.

6-year all-cause mortality was the outcome measure. Baseline variables, included age, serum aspartate aminotransferase, albumin, splenectomy history and frequency of ascites ≥5 episodes were analysed using Cox proportional hazards regression. Model performance was assessed via C-statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Five predictors were integrated into the mortality risk model. The C-statistic for predicting 6-year mortality was 0.79 (95% CI 0.74 to 0.83) in the derivation cohort, with robust validation in the external validation cohort (0.78, 95% CI 0.70 to 0.86). Simplified models using subsets of predictors showed slight reductions in discrimination (NRI and IDI). Patients with a frequency of ascites ≥5 episodes had significantly lower survival rates and should be given special attention in clinical practice.

The validated prediction model identifies high-risk patients using accessible clinical variables. The approach may optimise prognostication and prioritisation of healthcare resources for advanced schistosomiasis. The model’s performance remains to be confirmed in a prospectively enrolled cohort.

Studies on ageing trajectories typically foreground intrinsic capacities and focus on frailty and mortality outcomes. Instead, research capturing aspects of people’s living environment alongside individuals’ capacities is limited. This study aimed to identify qualitatively distinctive ageing profiles among deceased older adults in China using individual-based and environment-based indicators. It further examined sociodemographic correlates of profile membership and investigated associations between these profiles and end-of-life and death-related outcomes.

This is a retrospective cohort study.

Individual level, longitudinal data from the Chinese Longitudinal Healthy Longevity Study (CLHLS) between 2008 and 2018 were analysed.

The study included older participants of the CLHLS (2008–2018) who died between survey waves (N=9755).

Ageing profiles were categorised using latent class modelling based on individuals’ intrinsic capacity (functional, physical, cognitive, mental and social dimensions; 20 indicators) and environment characteristics (healthcare-related, financial and social aspects; 10 items). Sociodemographic correlates of profile membership included age, sex, education, marital status, living arrangement and residence location. End-of-life and death experiences were assessed by length of survival and functional status measured at the wave prior to death, pain at death and terminal delirium.

Within the study sample, four profiles emerged: healthy-and-supported (57%), cognitively-competent-but-functionally-dependent (12%), functionally-capable-but-cognitively-challenged (18%) and frail-and-support-lacking (13%). While profiles were primarily distinguished by functional and cognitive capacities and financial status, social participation was insufficient across all groups. Sociodemographic disparities (sex, education, marital status, living arrangement and residence) were associated with profile membership. The first and third profiles enjoyed a better quality of life in their final months. The healthy-and-supported adults were most prone to painful deaths in hospitals. The functionally capable participants most often died at home. The frail-and-support-lacking individuals were at the highest risk of terminal delirium.

The heterogeneity of ageing revolved around functional and cognitive capacities and economic/financial characteristics, the latter particularly salient for the frail-and-support-lacking group. The uniformly low social engagement observed across profiles highlighted the need for boosting overall social participation and developing community-level social services. Distinct end-of-life patterns emphasise the importance of targeted care strategies for rural and urban residents and interventions for delirium prevention.

To explore the current context in which maternal influenza vaccination (MIV) is delivered in Kuwait and to identify determinants influencing its provision and uptake from the perspectives of preventive medicine professionals (PMPs), including policymakers.

Qualitative semistructured interviews were conducted with purposely selected PMPs including policymakers. Interview questions were obtained from the Tailoring Immunization Programme for improving MIV in Europe.

PMPs from six governmental regions of Kuwait, including hospitals and associated polyclinics. Data collection was conducted between March and June 2022.

A total of 10 participants reflected diverse professional and population contexts, including Kuwaiti and non-Kuwaiti professionals working in rural and urban settings. Cell sampling was used to ensure representation across key roles involved in MIV delivery, including policymakers, vaccination campaign managers and campaign implementers.

Thematic analysis identified four overarching themes: barriers, facilitators, influences on MIV uptake and suggested interventions. Key barriers included limited knowledge among pregnant women and healthcare providers (HCPs), lack of prioritisation of pregnant women within vaccination programmes, shortage of vaccine supply and the COVID-19 pandemic. Facilitators and influential factors included the presence of vaccination champions, targeted health promotion activities and the availability of a Ministry of Health (MoH) hotline for addressing concerns and system-level accessibility and digital facilitation of MIV uptake. Suggested interventions emphasised strengthening HCP education through continuous training aligned with clear national policies and guidelines.

This study highlights the need for clear national policies and clinical guidelines to support consistent MIV provision, alongside ongoing education for HCPs in Kuwait to strengthen MIV recommendation. Future research should include obstetricians, given their central role in antenatal care, to ensure MIV strategies are clinically grounded and integrated into routine maternity services.

This study aims to investigate the lived experiences of civilians in Lahore during the 2025 India–Pakistan conflict, focusing on psychological distress, social disruption, coping mechanisms and perceptions of national response and preparedness.

The study employs an exploratory phenomenological approach.

The study has been conducted in Lahore, the capital city of Punjab, the largest by population province of Pakistan. Lahore was selected as a research site due to its historical, strategic and political significance in Indo-Pak conflicts.

Data were collected from 10 participants aged 18 or above years, who lived in Lahore between April and May 2025, and were willing to discuss personal, social or psychological experiences related to the conflict. In-depth, semistructured interviews were conducted in Urdu, transcribed, and were thematically analysed using both manual and NVivo V.12 software-supported coding.

Seven inter-related themes were identified. Participants reported intense anxiety, hypervigilance and insomnia driven by hybrid warfare tactics, including misinformation, drone sightings and media sensationalism. Social life was disrupted through withdrawal from public, religious and communal activities. Coping strategies included religious faith, family cohesion, humour and expressions of national solidarity. Notably, many participants experienced psychosomatic symptoms such as palpitations, gastrointestinal distress and stress-induced fever. A prominent finding was the absence of civilian preparedness guidance, which amplified fear and uncertainty during the escalation.

The conflicts, although short lived and geographical restrained, casts a long psychological and social on civilians, marked by fear, uncertainty, social disruption and dissatisfaction with institutional preparedness. While some coping and resilience were evident, the findings highlight the need to strengthen civilian-focused public health responses during periods of conflict escalation, including mental health awareness, media literacy and community-level support within Pakistan’s emergency response frameworks.

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

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

Urban residential areas in Selangor, Malaysia.

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

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

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

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

Since 1985, the international healthcare community has recommended the ideal rate of caesarean section (CS) to be 10%–15% at the national level. The literature has reported that overused CS without necessary medical indications can be harmful to both maternal and child health. To generate evidence to support policy on CS, this study evaluated the trend over time of CS in Thailand during January 2016 to October 2021 (which included the COVID-19 pandemic period) and explored predictors of CS use.

This study was a retrospective secondary data analysis of de-identified hospitalisation data under the Universal Coverage Scheme (UCS) from the National Health Security Office’s e-Claims database. Descriptive analyses were conducted to explore the number and rate of CS over time and across different characteristics (ie, age, hospital type, COVID-19 status and delivery day) including a multivariable logistic analysis to explore predictors of CS. Interrupted time series analysis was adopted to investigate the effect of the COVID-19 pandemic on CS rate.

569 321 CS cases under UCS from 2016 to 2021.

The results showed an increasing trend of CS rate, from 30% in January 2016 to 35% in October 2021. Both clinical (eg, medical indication and age) and non-clinical (eg, region and day of delivery) factors were significantly associated with CS. Furthermore, the COVID-19 pandemic had no significant effect on CS rate (level: –0.0016, 95% CI –0.0085 to 0.0053, p=0.66).

This study highlighted an increasing trend of CS in Thailand and could present supportive evidence that Thailand might have been facing an overuse of CS. More awareness and actions are warranted to ensure the movement towards reduction of unnecessary CS in Thailand.

Teenagers widely use digital devices for information sharing and other daily activities. Their heavy reliance on smartphones and tablets may contribute to repetitive-use injuries of the thumb.

This study aimed to investigate the prevalence of texting thumb (TT) among medical students and to identify the potential associations between TT and behavioural patterns during digital device use.

This cross-sectional study employed an online, self-developed questionnaire to assess demographic and behavioural patterns associated with smartphone use. Data on thumb pain and its features were evaluated for diagnostic purposes. This study comprised medical students from six medical schools in Jordan. Data were collected from 482 medical students, excluding those who did not meet the inclusion criteria.

The prevalence of TT was 34%, predominantly on the right side (53%) and at the thumb base (69%). The findings suggest that TT was significantly associated with specific behavioural patterns, including supporting the forearm (p=0.026, adjusted OR: 1.611; 95% CI 1.059 to 2.449), number of texting per day (p=0.005, adjusted OR: 1.319; 95% CI 1.086 to 1.603) and studying hours per day using a digital device (p=0.002, adjusted OR: 1.586; 95% CI 1.193 to 2.109). Also, students’ attitudes toward thumb pain were significantly associated with the TT (p=0.005, adjusted OR: 1.351; 95% CI 1.094 to 1.668).

Students’ attention to behavioural patterns is crucial when using digital devices. Supporting the forearm, limiting text message use, avoiding prolonged use of digital devices, never ignoring hand pain and resting the hand significantly reduce the risk of thumb overuse injury.

Paternal incarceration represents a significant stressor that disrupts family cohesion, undermines paternal identity and adversely affects children’s psychosocial well-being. While family-focused programmes show promise in improving outcomes for incarcerated parents and their children, culturally attuned prison-based parenting interventions remain underdeveloped and scarce, particularly in Asian contexts. To address this gap, a local parenting intervention grounded in the Double ABCX model of family resilience, the ‘Be My Hero’ programme, was designed for incarcerated fathers in Hong Kong, China.

A concurrent mixed-methods design will be used to evaluate the intervention. A convenience sample of 20–30 incarcerated fathers of children aged 3–11 will be recruited from three correctional facilities. Quantitative measures assessing paternal competence, father–child attachment, communication and resilience will be collected preintervention and postintervention. Qualitative data will be triangulated through semistructured interviews with participants, their children and social workers, supplemented by session logs documenting perceived shifts in paternal identity and programme feasibility. The intervention is expected to mitigate disruptions in paternal identity and strengthen father–child bonds. This may, in turn, reduce intergenerational disadvantage and improve overall family well-being.

This study has received ethical approval from The University of Hong Kong. Informed consent and assent will be obtained from the participants, their children and current guardians. Findings will be disseminated through peer-reviewed journals or conferences to inform correctional rehabilitation practices, encouraging the integration of family-focused and resilience-based approaches. Stakeholders, including practitioners and policymakers, may adopt similar interventions to promote healthier re-entry outcomes and reduce intergenerational disadvantage.

To assess the prevalence and determinants of essential newborn care (ENC) practices among Ethiopian mothers using the 2023 Performance Monitoring for Action (PMA) dataset.

A cross-sectional analysis of the nationally representative 2023 PMA Ethiopia survey.

A total of 1933 mothers with complete data on ENC practices were included.

Ethiopia, using a multi-stage stratified cluster sample.

ENC, defined as the adoption of at least four of five WHO-recommended practices: immediate drying, delayed bathing, skin-to-skin contact, clean cord care and early initiation of breastfeeding.

Overall, 32.1% (95% CI 28.1% to 36.0%) of mothers practised at least four ENC components. Coverage was highest for immediate drying (95.4%) and delayed bathing (87.3%), but lower for skin-to-skin contact (53.6%) and clean cord care (64.5%). Health facility delivery showed a strong association with higher ENC practice (adjusted OR (AOR)=106.00; 95% CI 46.14 to 243.54). Mothers who were spouses, rather than household heads, had higher odds of practising ENC (AOR=2.88; 95% CI 1.20 to 6.89) and those mothers with parity two or three had higher odds of practising ENC compared with first-time mothers (AOR=2.00; 95% CI 1.33 to 3.02 and AOR=3.39; 95% CI 1.76 to 6.53, respectively). Lack of postnatal care attendance was negatively associated with ENC (AOR=0.56; 95% CI 0.37 to 0.85). Regional disparities were observed, with mothers in the Southern Nations, Nationalities and Peoples’ region being significantly less likely to practise ENC compared with those in Addis Ababa (AOR=0.31; 95% CI 0.15 to 0.64). All results are based on weighted data to ensure national representativeness.

The prevalence of ENC practices remains low in Ethiopia. Health facility delivery, maternal role in the household, parity and region of residence were significant predictors of ENC practice. Strengthening facility-based delivery, promoting maternal empowerment and addressing regional disparities are essential to improving newborn health outcomes in the country and achieving Sustainable Development Goal 3.

There is a recognised need to provide equity in healthcare through inclusion of ethnic minorities in research. South Asians, the largest ethnic minority group in the UK, experience high levels of mental illness, often against the backdrop of socioeconomic deprivation and discrimination. The research community recognises that South Asian communities are often excluded from health research. Efforts have been made to understand the barriers and facilitators to their participation. However, the participation of individuals at the intersection of mental ill health and South Asian ethnicity remains understudied. This is a protocol for the synthesis of qualitative evidence from mental health research studies about participation, motivation and barriers to recruitment of South Asians in high-income countries.

We will search 10 databases for qualitative evidence on participation of South Asian individuals in mental health research studies in high-income countries: MEDLINE, EMBASE, PsycINFO, Health Management Information Consortium, Social Policy and Practice, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Social Sciences Citation Index, Science Citation Index Expanded and ProQuest Dissertations and Theses Citation Index. Search terms for the following five concepts will be used: (1) South Asia, (2) ethnic minority, (3) mental health conditions, (4) barriers and facilitators to participation and (5) high-income countries. No date restriction will be applied to the search. Searches will be limited to studies in the English language. Study selection and data extraction will be performed by two researchers independently, using Covidence. Demographic data, thematic outputs and salient discussion points will be extracted from final full-text inclusions and entered into NVivo for coding. Meta-ethnographic approaches using first and second-order constructs from included studies will be used to form third-order constructs. This synthesis will generate new knowledge regarding the intersectionality of mental health and South Asian ethnicity.

Ethical approval is not required as this study is a synthesis of published data. This review will provide new knowledge regarding the requirements for researchers and practitioners to advance the involvement of South Asian populations in mental health research. This will undoubtedly enhance equity in the long term, reduce the burden of mental disorders and enable the provision of more effective mental health care for South Asian communities.

CRD42025626382.

Recent research indicates that around 8% of older people living in prison have signs or symptoms of dementia or mild cognitive impairment (MCI), yet the care they receive is not equivalent to care in the community and this means their needs may not be met. We co-developed an intervention specifically for older people living in prison with dementia/MCI (Dementia and Mild Cognitive Impairment in prison care pathway and training package–DECISION). To date, this has not been implemented or evaluated. This paper presents our protocol for a study to assess the feasibility and acceptability of DECISION.

This is a non-randomised, realist-informed mixed-methods feasibility study with integrated process evaluation, which will take place in two prisons in England. The intervention was codeveloped with experts with lived experience. Participants will include older people living in prison, staff working in prison and peer supporters. We will assess the feasibility and acceptability of the intervention (eg, numbers eligible; rates of recruitment and retention), and the evaluation design (eg, completion rates of standardised outcome measures). Methods will include semistructured, realist-informed interviews; an audit to assess implementation fidelity; focused ethnography; training questionnaires; and collection of resource use data. We will refine the DECISION programme theory using realist-informed methods to examine and refine how contexts and mechanisms interact to produce the intervention’s outcomes.

This study received a favourable ethical opinion from the Wales REC 3 Research Ethics Committee in January 2025 (reference number 24/WA/0323). HMPPS National Research Committee approval was also granted in January 2025 (reference number 2024-1451). Findings will be disseminated through a range of avenues, including stakeholder engagement events, open-access papers, conference presentations, evidence briefings for commissioners, providers and practitioners, and newsletters for service users.

To describe disability severity transitions in the ageing population in Switzerland using an overall functioning score to define four disability severity states (no, mild, moderate and severe) and death, and to investigate the association of multimorbidity and further predictors with these transitions.

Secondary analysis of the Swiss version of the Survey of Health, Ageing and Retirement in Europe (SHARE).

Switzerland.

Community-dwelling population aged 50+ with at least two interviews in SHARE (N=3505).

Not applicable.

Primary outcome measures are the disability severity as assessed by a previously developed overall functioning score, and death status as assessed by the SHARE end-of-life interview. Transition analysis between disability severity states and death was conducted using multistate Markov models. The association between predictor variables and transition intensities was quantified using the proportional hazards assumption. Two distinct operationalisations of multimorbidity (count, burden) were used and analysed according to two separate models (A, B).

The findings for both models were similar: Estimated HRs for transition intensities suggest that being multimorbid or having a higher disease burden score increases the risk of transitioning to higher disability severity states and death for most transitions (HRs between 0.90 and 2.34 for model A compared with not being multimorbid; HRs between 0.95 and 1.46 for model B for a one-point increase in the disease burden score). In addition, most transitions to higher disability severity states and death are more likely for higher age (HRs between 1.00 and 1.14 for model A, and between 1.00 and 1.15 for model B for a 1 year increase in age), and transitions to death are less likely for women, compared with men (HRs between 0.34 and 0.88 for model A, and between 0.38 and 0.71 for model B).

This study is a first attempt to understand disability severity transitions in the older population in Switzerland. Although we believe that such an approach is suitable to inform resource allocation to LTC, rehabilitation and prevention, more detailed information on contextual factors will be important to consider for future research. Moreover, our study contributes to the discussion on how to operationalise multimorbidity in healthy ageing research.

To assess whether transgender women who have sex with men (TGWSM) sampled in men who have sex with men (MSM) biobehavioural surveys in Ukraine experience different levels of sexual risk, stigma, HIV prevalence and engagement in the HIV care than cisgender MSM (CMSM).

Analysis of secondary data from three population-level cross-sectional surveys.

The analysis was conducted on data from three rounds of integrated biobehavioural surveys of MSM in 27 cities of Ukraine from 2013 to 2018.

Data from n=18 621 MSM with n=18 102 CMSM and n=503 TGWSM.

The primary outcomes were differences in sexual risk behaviours, HIV testing and treatment uptake, and the secondary outcomes were differences in lifetime experiences of stigma, coercive sex and physical assault (in the 2018 survey only) between CMSM and TGWSM.

Compared with CMSM, TGWSM were more likely to be clients of non-governmental organisations (adjusted OR, aOR: 1.39, 95% CI 1.15 to 1.67), engage in commercial sex (last month; aOR: 1.28, 95% CI 1.01 to 1.61), have group sex (aOR: 1.31, 95% CI 1.06 to 1.61), more long-term sex partners (last month; adjusted incidence rate ratio: 1.14, 95% CI 1.03 to 1.27), history of imprisonment (aOR: 1.51, 95% CI 1.00 to 2.31) and engage in chemsex (last month, aOR: 1.58, 95% CI 1.12 to 2.23). We found no difference in HIV prevalence (5.17% in TGWSM vs 5.43% in CMSM, p=0.065). In 2018, more TGWSM reported lifetime experience of stigma from family and friends (aOR: 3.58, 95% CI 2.54 to 5.04), general social stigma (aOR: 3.13, 95% CI 2.22 to 4.41), anticipated healthcare stigma (aOR: 3.63, 95% CI 2.53 to 5.16), physical assault (aOR: 2.73, 95% CI 1.85 to 4.03) and coercive sex (aOR: 3.01, 95% CI 1.99 to 4.55) than CMSM.

TGWSM in Ukraine may be at increased risk of HIV acquisition compared to CMSM due to many factors including elevated levels of stigma and violence. Services specifically tailored for transgender people are needed to help reduce these high-risk behaviours.

Social support is an important factor for psychosocial well-being and motivation to follow the treatment strictly in people with drug-resistant tuberculosis (DR-TB). Thus, this study aimed to determine the availability of social support and its association factors in people with DR-TB in selected hospitals in Ethiopia.

A cross-sectional study was conducted in Addis Ababa (at Saint Peter and ALERT hospitals) and Bishoftu Hospital in Ethiopia. The study involved 130 people with DR-TB from January to May 2023.

All adult people on DR-TB treatment for at least 2 months were enrolled consecutively from the registration book. A structured questionnaire was used to collect data. Data were entered to Open Data Kit and analysed with SPSS V.22. Descriptive statistics were used to describe the characteristics of the participants. A linear regression model was used to assess factors associated with social support.

Availability of social support from different sources.

The overall proportion of availability of social support obtained from different sources was 97.7% with 95% CI of (93.1% to 99.5%). Sex (β=0.61, 95% CI (0.28 to 0.94); p

A considerable proportion of people with DR-TB were obtaining social support from different sources. Interventions targeted female sex, single marital status and perceived social stigma are required to enhance social support conditions in people with DR-TB.

Studies of determinants of adverse birth outcomes (ABOs) were conducted in Ethiopia; however, there is a lack of a single study considering the factors operating at multiple levels (individual, interpersonal, organisational, environmental and policy levels). Therefore, this study identified combined determinants of ABOs at all levels in Ethiopia by analysing the Demographic and Health Survey data guided by the Ecological model, considering that birth outcomes are shaped by the interaction between a mother’s environment and her biological and psychological health.

This study aims to identify combined determinants of ABOs at all levels in Ethiopia by analysing the Demographic and Health Survey data guided by the Ecological model.

A cross-sectional study design based on interviewer-administered questionnaires was used for the respective Demographic and Health Surveys.

We used data from the 2016 Ethiopian and Demographic Health Survey, a stochastically national representative study with inclusive information on ABOs, to examine how various levels of influence from individual behaviours to environmental-level factors are affecting birth outcomes.

An effective number of 11 023 live births within the 5 years preceding the survey.

ABOs, including low birth weight and preterm birth. Multivariable multilevel mixed-effects logistic regression was used to identify determinants of ABOs through five hierarchical models in Stata V.14. Model I was the null model; models II, III, IV and V sequentially included intrapersonal, interpersonal, organisational and environmental variables, respectively. Statistical significance was determined using ORs with 95% CIs at p

The weighted prevalence of ABOs in Ethiopia is 27.0% (95% CI 25.7% to 28.3%). The final model of the multivariable multilevel mixed-effects logistic regression identified several predictors of ABOs at the intrapersonal or individual level, including maternal age of 15–24 completed years (adjusted OR (AOR)=1.24, 95% CI 1.02 to 1.51); poorest (AOR=1.41, 95% CI 1.01 to 2.00), poorer (AOR=1.42, 95% CI 1.02 to 2.01) and middle wealth quintiles (AOR=1.45, 95% CI 1.02 to 2.06); first-born twin (AOR=2.61, 95% CI 1.31 to 5.21) and second-born twin (AOR=4.05, 95% CI 2.16 to 7.61); and female childbirth (AOR=1.41, 95% CI 1.22 to 1.63). On the other hand, intimate partner physical violence (AOR=1.19, 95% CI 1.07 to 1.34) was the only factor associated with ABOs at the interpersonal level; cluster altitudes of 180–1500 m (AOR=1.28, 95% CI 1.05 to 1.55) and 2501–3455 m (AOR=1.51, 95% CI 1.15 to 1.99) were found to be an exposure of ABOs at the environmental level.

The prevalence of ABOs in Ethiopia is high. Factors associated with ABOs at the individual level include maternal age, wealth quintile, twin birth and female birth. In contrast, exposure variables at the interpersonal level comprise intimate partner violence, and those at the environmental level include cluster altitude. To improve ABOs and consequently reduce neonatal mortality, maternal and child health investment and future studies should act at all levels.