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.

In rural sub-Saharan Africa (sSA), the burden of antimicrobial resistance (AMR) remains high. As AMR continues to rise, there is a strong need for practical, implementable surveillance to monitor and mitigate risks, as well as inform timely, evidence-based clinical decision-making. Emerging evidence points to possible community-level drivers, such as transmission between human, animal and environmental reservoirs as contributing factors, yet microbiological surveillance or opportunities for wastewater-based surveillance are often limited and insufficient in these settings. Therefore, alternative sustainable and affordable approaches are needed. We intend to build on the demonstrated potential of metagenomic profiling of pooled faecal material, which accurately predicted population-level AMR prevalence in invasive Enterobacterales infections.

We aim to validate this metagenomic pooled approach on additional populations, and to evaluate whether AMR patterns could be similarly predicted from surveillance of community One Health reservoirs. We will assemble existing data from hospital-based microbiology diagnostic laboratories in rural Burkina Faso and Kenya, and determine to what extent community-level metagenomic data, and/or faecal material of patients on hospital admission, can predict AMR in clinical isolates. We will perform community-level surveys in eight clusters per country, randomly selecting 15 households per cluster. We will systematically sample suspected environmental AMR exposure sites in and around households (soil, drinking water, latrines, chicken faeces) and collect data on community-level antibiotic use, hygiene practices, contact with domestic animals and sanitary facilities. Samples and data will be collected twice: during the dry and during the rainy season.

In addition to evaluating the accuracy of predicting resistance in clinical isolates, we will quantify community-level exposure risks. We will conduct metagenomic profiling on pooled DNA extracts from human stool samples (hospital and community-level) and from household environments. Bayesian statistical models will quantify relationships between AMR gene abundance in the environment and in human stool, and invasive bacteria identified among clinical patients, accounting for geography and seasonality. A cost-utility analysis will determine under what circumstances the use of pooled metagenomic data to inform empirical antibiotic policies would represent an efficient use of resources.

The proposed surveillance protocol is developed in partnership with local communities and local and international researchers and has received ethical approval in Kenya and Burkina Faso. It will assess whether intermittent, pooled-sample metagenomics provides a viable, low-cost and practical approach for population-level AMR surveillance in settings that—like many in rural sSA—lack systematic microbiological diagnostics and where sewage systems for wastewater-based surveillance are absent. By providing an alternative to routine microbiological-based surveillance where this proves challenging to implement, this approach may help improve treatment outcomes, contribute to equity and public health. Findings will be disseminated through peer-reviewed publications and academic conferences and will contribute to the recently proposed WHO AMR surveillance strategy, which combines survey-based approaches with routine AMR surveillance.

Maternal dietary practices are vital for improving maternal and neonatal outcomes. However, comprehensive information about optimal dietary practices among pregnant women is limited in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of optimal dietary practices and its associated factors among pregnant women in Ethiopia.

A systematic review and meta-analysis of observational studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

PubMed, EMBASE, Web of Science, Scopus, African Journals Online and Cochrane Library were searched for studies published in English before 25 March 2024.

Observational studies reporting the prevalence of optimal dietary practices and/or associated factors among pregnant women in Ethiopia were included.

Data were independently extracted by two reviewers, and the quality of the included studies was evaluated using the Newcastle–Ottawa Scale adapted for cross-sectional research. Review Manager V.5.4.1 and STATA V.14 software were used for data synthesis and statistical analysis. A random-effects and/or fixed-effects model was employed to calculate pooled ORs and 95% CIs to determine the correlation between dependent and independent factors. We checked heterogeneity using the I² statistic and conducted subgroup analysis to explore the source of heterogeneity among the included studies. Funnel plots and Egger’s regression test were used to determine publication bias.

A total of 22 studies with 10 915 participants were included in the review. The pooled prevalence of optimal dietary practice was 35.83% (95% CI 28.35 to 43.32). The overall study’s quality was high, and we detected significant publication bias (Egger’s test, p value=0.001). Monthly income ≥5000 ETB/90 US$) (pooled OR (OR=2.56, 95% CI 1.12 to 5.88), formal education (OR=2.74; 95% CI 1.22 to 6.16), good dietary knowledge (OR=4.1; 95% CI 3.19 to 5.25), ownership of radio/television (OR: 5.64, 95% CI 2.05 to 15.52), favourable attitude (OR=3.90, 95% CI 3.05 to 4.99) and food security (OR: 4.48; 95% CI 3.03 to 6.61), urban residency (OR=6.25, 95% CI 4.06 to 9.63), family size

Only one in three pregnant women in Ethiopia practises optimal dietary behaviours. Several modifiable individual and sociodemographic factors influence dietary practices. Interventions focusing on improving nutrition knowledge, enhancing attitudes, expanding access to media-based nutrition information and strengthening antenatal nutrition education, particularly for rural and less educated women, may improve dietary practices and pregnancy outcomes.

CRD42024542652.

To assess patient satisfaction and identify associated factors in plastic and hand reconstructive surgery at ALERT Comprehensive Specialised Hospital in Addis Ababa, Ethiopia.

A hospital-based cross-sectional study was conducted from February to March 2023 using a structured questionnaire that incorporated the Patient Satisfaction Questionnaire Short Form and the Outpatient Assessment of healthcare scales. Patient satisfaction was measured using a five-point Likert scale. Descriptive statistics and multivariable logistic regression were employed using Stata V.17.

ALERT Comprehensive Specialised Hospital, Addis Ababa, Ethiopia.

A total of 391 systematically selected adult patients attended the plastic and hand reconstructive surgery outpatient departments.

Overall patient satisfaction and factors influencing satisfaction with surgical services.

Of the 379 respondents (response rate 96.9%), 51.2% were male. The overall patient satisfaction rate was 75.7%. However, 78.6% experienced long waiting times (mean: 2 hours 15 min), 84.4% reported inadequate information provision, and 90.3% indicated that medical care was unaffordable. Significant factors associated with higher satisfaction included age 30–39 years (AOR=2.7; 95% CI 1.09 to 6.83), having laboratory tests ordered (AOR=2.03; 95% CI 1.03 to 4.03) and X-ray/ultrasound imaging (AOR=2.20; 95% CI 1.19 to 4.06). Patients who received care free of charge were less likely to be satisfied compared with those paying out of pocket (AOR=0.23; 95% CI 0.07 to 0.82).

Although overall satisfaction was moderately high, significant dissatisfaction was reported regarding service accessibility, waiting times, communication and affordability. Targeted interventions in these areas are recommended to improve patient-centred care.

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.

Paternal postpartum depression among fathers of newborns is a new concept in Ethiopia. It is an emerging public health concern because it produces insidious effects on the well-being of newborns as well as on the whole family. However, there is limited evidence on the prevalence of paternal postpartum depression and its associated factors among partners of postpartum women in Ethiopia.

A community-based cross-sectional study was conducted.

This study was conducted in Dessie town, Amhara Regional State, Northeast Ethiopia.

634 partners of postpartum women participated in the study between 10 January and 10 February 2023. The study included fathers whose spouses had given birth in the last 12 months and who had been of the randomly selected kebeles for at least 6 months. Fathers aged

A standardised and validated depression-screening instrument (Edinburgh Postnatal Depression Scale) was used to assess paternal postpartum depression. Variables with a P value

610 fathers were interviewed, with a response rate of 96.2%, and the prevalence of paternal postpartum depression was 19% (95% CI 16.0 to 22.3). This study showed that not being comfortable with income (adjusted OR (AOR)=2.32 (95% CI 1.16 to 4.66)], substance use (AOR=2.48 (95% CI 1.22 to 5.05)), prior parenting experience (AOR=1.89 (95% CI 1.02 to 3.50)), unplanned pregnancy (AOR=2.81 (95% CI 1.50 to 5.25)) and infant sleep problems (AOR=4.59 (95% CI 1.80 to 7.18)) were significantly associated with paternal depression.

This study revealed that nearly one-fifth of fathers had paternal depression. Factors significantly associated with PPD were not being comfortable with family income, substance use, experience of childbirth, unplanned pregnancy and infant sleeping problems. This suggests the need to provide health education to decrease substance use and counselling on the utilisation of family planning to minimise unplanned pregnancy and support offered to multiparous fathers.

Qualitative evidence in ovarian cancer (OC) doctor-patient-caregiver communication is scarce. This study explored the information needs of patients and caregivers, comparing these to healthcare professionals’ (HCPs) perspectives, to uncover why gaps exist.

Qualitative, observational, multicentre and cross-sectional study with OC patients, their caregivers and HCPs. Qualitative data were collected through remote semistructured interviews. Themes were identified using thematic analysis. The EORTC QLQ-C30 and the disease-specific EORTC QLQ-OV28 were collected as quality of life measures and analysed descriptively.

Patients were recruited during their routine visits in five university hospitals in Spain.

Patients were ≥18 years of age in stages III or IV according to FIGO classification, were on first line treatment or recurrent and platinum sensitive with the most complex molecular profiles. 19 patients, 7 caregivers and 10 HCPs participated in the study.

Three main themes emerged: (a) patient information needs about the disease and pharmacological treatments, (b) patient information needs about non-pharmacological support and (c) caregiver information needs. The first theme was viewed through three differing attitudes (the Involved, Trusting and Indecisive), with HCPs’ agreeing with the attitudes but without adjusting transmitted information accordingly. For the second theme, patients expressly desired more information on psychosexual issues, psychological support and patient associations (PAs), and HCPs concurred with a need for more non-pharmacological support. Regarding the third theme, caregivers expressed not being engaged by HCPs, despite HCPs recognising their importance, with nurses being more empathetic than oncologists on this matter.

These results highlight the importance of understanding the information needs of OC patients and their caregivers. This understanding enables HCPs to provide better support, helping patients and caregivers make more informed health decisions.

The objective of this study was to determine the association between viral subtype/clade and disease severity.

Multicentre retrospective cohort study.

This study used data from the Global Influenza Hospital Surveillance Network (GIHSN). The dataset comprised hospitalised influenza patients with viral sequencing data across 14 countries, collected from August 2022 through October 2023.

A total of 761 hospitalised patients were enrolled during the study period, and 745 patients were included in the analysis. We excluded patients with missing data on explanatory or outcome variables, those infected with viral clades represented by fewer than 11 sequences, and those enrolled at study sites contributing fewer than 5 patients.

Disease severity was defined by admission to intensive care unit (ICU), receipt of non-invasive oxygen supplementation, 3-variable definition (ICU, mechanical ventilation or death) or 4-variable definition (3-variable plus oxygen supplementation).

Outcomes were analysed in association with subtype or clade using the mixed-effects logistic regression models, adjusting for age group, sex, underlying medical conditions, influenza vaccination status, antiviral use, country income level and epidemic period, while study site was included as a random effect.

745 patients were included: 263 A(H1N1)pdm09, 380 A(H3N2), 102 B/Victoria. A(H1N1)pdm09 infection was associated with increased odds of ICU admission (adjusted ORs (aORs) 2.5, 95% CI 1.1 to 5.8) compared with A(H3N2). 6B.1A.5a.2a.1 clade of A(H1N1)pdm09 was associated with increased severity compared with 6B.1A.5a.2a clade (aOR 3.0, 95% CI 1.0 to 9.5) and (aOR 5.4, 95% CI 1.6 to 18.3) for the 3-variable and 4-variable definitions respectively. Among A(H3N2), the (3C.2a1b.2a.)2b clade showed a trend toward increased severity using the 4-variable definition compared with the 2a.1b clade (aOR 2.9, 95% CI 0.8 to 10.0).

This analysis highlights the differential impact of influenza subtypes and clades on disease severity in hospitalised patients. Future research should investigate the role of specific viral mutations of these clades in modulating immune evasion or disease severity. These findings reinforce the GIHSN’s critical role in global surveillance. Ongoing genomic surveillance is crucial for understanding the clinical impact of emerging influenza variants and informing public health responses.

This scoping review aims to map evidence or literature on improvement strategies used by health leaders and professionals to strengthen the safety climate in the operating room.

A scoping review was performed on the basis of the method proposed by the Joanna Briggs Institute and applied to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) extension.

16 academic and grey literature data sources were searched using search terms on 17 January 2025, namely, Medical Literature Analysis and Retrieval System Online via Pubmed, Latin American and Caribbean Literature on Health Sciences via the Virtual Health Library, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Embase, PsycINFO, Cochrane Library, WorldCat, Digital Library of Theses and Dissertations, Brazilian Association of Surgical Center Nurses, Center for Material and Sterilization and Anesthetic Recovery, Association of Portuguese Operating Room Nurses, Association of PeriOperative Registered Nurses, Institute for Healthcare Improvement, WHO and Agency for Healthcare Research and Quality.

Study selection, data extraction and synthesis were based on the following eligibility criteria based on the acronym PCC (participants, concept, context): participants (health leaders and professionals), concept (strategies to improve the safety climate) and context (operating room). This scoping review considered studies published from 2009 onwards.

Information on the objective, method and findings addressing improvement strategies employed to strengthen the safety climate in the surgical centre was retrieved. The findings are presented in tables and in a qualitative thematic summary.

A total of 26 studies were analysed, published between 2009 and 2024, with the USA as the country of origin of the publications with the highest number (11 studies). As for the methodological approach, intervention and quasi-experimental studies stand out. When the studies in this review were mapped, strategies that strengthened the safety climate in the operating room were identified and grouped into two main axes that are interrelated: communication tools and training programmes.

It is evident that the implementation of tools that promote communication and training programmes enhances safe surgical care, as they contribute substantially to the domains of the safety culture. The use of communication protocols in the operating room is recommended as a perioperative safety tool.

This scoping review adhered to a protocol previously published in this journal and that is registered on the Open Science Framework website (https://osf.io/zg8nu/).

Strengthening research capacity in Africa is vital for tackling pressing health, educational and socioeconomic challenges facing the continent. At the core of this effort is the cultivation of innovative research leaders through postgraduate training programmes that incorporate mentorship-infused supervision. Such models have demonstrated potential in improving research skills, boosting academic productivity and fostering leadership development among emerging scholars. This systematic review and meta-synthesis protocol aims to examine existing mentorship-infused supervision practices across African higher education institutions. The review seeks to identify effective models, uncover common challenges and barriers, and generate evidence-based recommendations to develop sustainable, contextually relevant strategies. Insights from this work will inform policies and practices to enhance postgraduate research training, advance research leadership and contribute to the broader goal of strengthening research ecosystems across Africa.

A systematic review and thematic meta-synthesis will be undertaken, focusing on qualitative research studies as well as the qualitative components of mixed-methods studies. Relevant studies published in English will be identified through a comprehensive search strategy. The electronic databases, including Medline/PubMed, Scopus, Web of Science, African Journals Online, EMBASE and CINAHL, will be searched to capture a wide range of peer-reviewed articles and grey literature. Databases will be searched from March 2026. Two reviewers will independently perform study selection, data extraction, quality assessment and evaluation of risk of bias, using the Critical Appraisal Skills Programme checklist.

This systematic review and meta-synthesis will analyse publicly available literature and does not require ethical approval, as it involves no primary data collection. It will adhere to established ethical and methodological standards, including proper citation and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The findings will be widely disseminated through open-access journal publication, conference presentations and targeted reports for universities, research institutions and policymakers to inform and support mentorship-based postgraduate research supervision across Africa.

CDR420251049878. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251049878.

Does a simulation-based training intervention with an artificial intelligence (AI) navigation system improve their clinical bronchoscopy performance? And can the AIs outcome measures be used to evaluate clinical performance?

Pre–postintervention study.

Odense University Hospital of Southern Denmark, pulmonary endoscopy suite.

Nine bronchoscopists (4 experienced, >500 bronchoscopies and 5 intermediates, 10–500 bronchoscopies).

Diagnostic completeness (DC), structured progress (SP), procedure time (PT) and procedure efficiency (DC/PT).

The primary outcome measures showed no statistically significant difference between the pre- and postintervention bronchoscopies DC: 53% versus 59%, p=0.16, SP: 29% versus 32%, p=0.35 and PT: 219 s versus 181 s, p=0.22. The experienced outperformed the intermediates regarding DC: 73% versus 43%, p

DC, SP and PT showed no statistically significant difference after a simulation-based training intervention. DC, SP and procedure efficiency differentiated between experienced and intermediate bronchoscopists and can be used to evaluate clinical bronchoscopy performance.

Although care for low-risk births in the Netherlands is primarily conducted by midwives, the use of consultant-led care has been increasing for a variety of indications, leading to a high patient burden for consultants. The induction of labour (IOL) of late-term pregnancies has historically been an indication for consultant-led care. This study by Velthuijs et...

As a result of the mass scale of production of plastics since the 1950s, microplastics, defined as particles 1 Microplastics have been linked to reproductive toxicity in both cell culture...

Although the WHO and the Centers for Disease Control and Prevention (CDC) classify preconception health risks (PCHRs) into biomedical, behavioural and social categories, this classification remains theoretical, mainly inconsistent and lacks a scientifically robust framework. Data-driven clustering techniques may help clarify this complexity for policymakers and healthcare providers. This study aimed to assess the status of PCHRs and identify latent classes of these risks among women preparing for pregnancy.

This community-based cross-sectional study was conducted from 31 July to 16 August 2024 in Tigray, Ethiopia, among 865 married women planning to conceive within the next 6 months. Data were gathered through face-to-face interviews using a structured questionnaire. Risk factor indicators covering lifestyle behaviours, substance use, nutritional risks and related factors were developed based on guidelines from the WHO, the CDC and national recommendations. Latent class analysis (LCA) was employed to identify distinct classes of PCHRs, with the optimal number of classes determined using statistical fit indices, adequacy criteria and interpretability. The study also evaluated the overall distribution of PCHRs among participants.

The study took place in Tigray, Ethiopia, among married women intending to become pregnant within 6 months.

Burden of PCHRs and identified distinct latent classes of these risks within the participants.

All participants were exposed to at least four PCHRs, with 84.2% experiencing between 6 and 12 risk factors. The optimal LCA model identified four distinct classes of PCHRs: lifestyle behavioural risks (n=458, 52.9%), reproductive health risks and chronic medical conditions (n=106, 12.25%), nutritional risks and environmental exposure (n=149, 17.23%) and social determinants of health (n=152, 17.57%).

Our study reveals a high baseline level of PCHRs, with all participants exhibiting multiple risk factors for adverse pregnancy outcomes. The identification of four distinct risk profiles underscores the need for tailored risk-specific interventions, particularly in conflict-affected settings. Our findings point out the need for targeted preconception care and risk stratification in national health strategies to improve maternal and child health outcomes.

The Cohort of Health-Related Outcomes in Chronic Illness Care in General Practice was established using data collected as part of a cluster-randomised trial. This aims to support the trial’s follow-up and enable further examination of the interplay between chronic disease, multimorbidity (MM), polypharmacy (PP) and quality of life (QoL) in a Danish general practice setting.

The cohort comprises 35 977 adult patients from 250 general practices participating in a cluster-randomised trial and had a response rate of 22.4%. Participants were either registered as chronic care patients or had attended an annual chronic disease consultation. They completed a comprehensive questionnaire on self-reported chronic conditions, medication use, QoL, treatment burden and patient-centred care. Additionally, 431 general practitioners (GPs) from the participating practices completed a questionnaire about managing patients with complex MM.

Among participants, 51.9% were female, the mean age was 65.6 (SD 12.9) years, 93.1% had education beyond basic schooling, and half were retired. Conditions from more than one organ system-based disease group were reported by 82.2%, and 94.6% used one or more prescription medications. The main challenges reported by the participating GPs in managing patients with complex MM were keeping time and obtaining an overview of the patient’s health status.

Cohort data will be linked with Danish registries to improve the detection and treatment of chronic conditions and PP in general practice.

The cluster randomised trial (MM600) is registered with ClinicalTrials.gov ID: NCT05676541.

Traumatic musculoskeletal injuries are common and often life changing. The 6-month period following injury is a critical phase in recovery, during which engagement with rehabilitation professionals can be key to achieving positive outcomes. However, there is limited understanding of which aspects of recovery matter most to patients, how they define a successful recovery and what this looks like when captured during the lived recovery process. The aim of this study was to explore patients’ views and perceptions of recovery following musculoskeletal trauma and to understand what constitutes successful recovery at 6 months postinjury.

Qualitative study using interpretative phenomenological analysis through semi-structured interviews.

Major trauma centre in the UK.

13 participants (mean age (SD) 51 (17) years, 69% male) completed the interview. Eligibility criteria: adults >18 years, musculoskeletal injury from a traumatic event and ability to communicate in English. Purposive sampling included age, gender, injury severity and injury type. Interviews were audio recorded and transcribed verbatim.

Three main themes were identified: (1) The recovery journey: participants reflected on their recovery while still processing the accident/injuries. They often drew on other people’s experiences to make sense of their recovery. Recovery was accompanied by a range of negative emotions and personal challenges. (2) The outcome: participants used multiple strategies to work towards recovery, guided by personalised individual goals. A successful recovery was defined as their ‘normal’. (3) Healthcare/clinicians impact recovery: Participants reported confusion and mixed messages from healthcare professionals, leading to uncertainty around injury management. Fragmented care pathway and difficulties accessing healthcare and support were also highlighted.

Recovery at 6 months post injury involves a complex interplay of physical and emotional factors. This period can be particularly challenging to navigate, often with no or limited support. There is a need for a targeted, individualised approach to guide patients through this period of recovery. Participants’ focus was on the outcome following their injury, setting goals for the future, with successful recovery defined as ‘normal’. Further research is needed to support clinicians in developing effective psychologically informed rehabilitation plans.

Adolescent idiopathic scoliosis (AIS) is a common paediatric spinal deformity with large curves surgically managed through spinal fusion. However, postoperative rehabilitation remains inconsistent and varies depending on clinician, hospital or location. Our international e-Delphi consensus established a broad range of statements from preoperative care until 12 months postoperatively. However, rehabilitation and graded return to sport between 3 and 12 months remains vague and further consensus work is needed. This study aims to understand the intermediate and late stages of rehabilitation in order to guide return to sport, exercise and physical activity. The primary objective is to explore content of rehabilitation and milestones between 3 and 12 months postoperatively. This understanding of postoperative care will form the basis for future postoperative guidance.

This protocol for a nominal group technique (NGT) study is written in accordance with the Accurate Consensus Reporting Document guidelines. A national sample of expert surgeons, physiotherapists and nurses in AIS will be recruited. The NGT will take place virtually and will consist of six stages: stage 1: idea generation; stage 2: round robin idea sharing; stage 3: discussion and clarification; stage 4: anonymous voting; stage 5: results feedback; and stage 6: discussion and final voting. This NGT will be preceded by a scoping review which will be disseminated a priori to inform stage 1 idea generation. The population, concept, context framework will be used to explore postoperative rehabilitation towards sports, exercise or physical activities following any kind of spinal surgery. The study steering group and patient and public involvement representative have been involved from conceptualisation and will continue to be involved until final dissemination.

The University of Birmingham has provided ethical approval: ERN_4201-Jun2025. Dissemination will take place through conference presentation and peer-reviewed publications.

Over 777 million COVID-19 infections have occurred globally, with data suggesting that 10%–20% of those infected develop Long COVID. Fatigue is one of the most common and disabling symptoms of Long COVID. We aim to assess the feasibility and safety of a new, remotely delivered, multimodal rehabilitation intervention, paced to prevent post-exertional malaise (PEM), to support the conduct of a future, definitive randomised trial.

We will conduct a randomised, two-arm feasibility trial (COVIDEx intervention vs usual care). Sixty participants with Long COVID will be recruited and randomised prior to giving informed consent under a modified Zelen design using 1:1 allocation with random permuted blocks via central randomisation to receive either the COVIDEx intervention or usual care. The 50-minute, remotely delivered, COVIDEx intervention will occur twice weekly for 8 weeks. All participants will wear a non-invasive device throughout their entire study participation, to track heart rate, blood oxygen saturation, steps, sleep and monitor PEM. The primary feasibility objectives will be recruitment rates, intervention fidelity, adherence, acceptability (intervention and design), retention, blinding success and outcome completeness. Secondary objectives will include refined estimates for the standard deviation and correlation between baseline and follow-up measurements of fatigue. Feasibility and clinical outcomes will be collected at baseline, 4, 8, 12 and 24 weeks. Qualitative interviews with participants and physiotherapists will explore intervention acceptability and barriers/facilitators.

Ethical approval for this study was obtained by the Western University Health Sciences Research Ethics Board (REB# 123902). Dissemination plans include sharing of trial findings at conferences and through open access publications and patient/community channels.

NCT06156176

This study compared the effectiveness of first-time use of faster aspart with rapid-acting insulin analogues in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D).

This retrospective cohort study used data from 1 January 2017 to 8 May 2021 captured in the Clinical Practice Research Datalink Aurum database in the UK.

Patients with T1D or T2D either initiating faster aspart or another rapid-acting insulin analogue (‘new users’) or switching from a rapid-acting insulin analogue to faster aspart or to another rapid-acting insulin analogue (‘switchers’) were included. The index date was the date of first prescription of faster aspart or a rapid-acting insulin analogue, or of switching to a different rapid-acting analogue or to faster aspart.

A total of 9695 and 2170 patients were included in the new users (T1D, 1737; T2D, 7958) and switchers cohorts (T1D, 1764; T2D, 406), respectively.

Glycated haemoglobin (HbA1c) change at 6 months, occurrence of hypoglycaemia from index to 12 months post-index and treatment persistency from index to discontinuation or censoring.

Numerically greater reductions were observed with faster aspart than rapid-acting insulins in T1D switchers and new users in change in HbA1c at 6 months. Patients with T1D who switched to faster aspart experienced a significant reduction in rate of hypoglycaemia (p=0.0021). Treatment persistency was higher with faster aspart than with rapid-acting insulins among T1D switchers. No distinction in treatment persistency was observed between the treatment groups for T1D new users or T2D switchers.

Reductions in HbA1c were numerically larger with faster aspart in three of four subgroups. There was higher treatment persistency with faster aspart vs rapid-acting insulin analogues among T1D switchers.

NN1218-4967.

Gestational trophoblastic disease, characterised by abnormal proliferation of trophoblastic tissue in the placenta during pregnancy, contributes to maternal morbidity and mortality. This study aimed to estimate the pooled prevalence and histopathological patterns of gestational trophoblastic disease in Africa, where previous studies have reported inconsistent findings.

Systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

We searched PubMed, ScienceDirect, Hinari and Google Scholar for studies published between January 2000 and January 2024.

Institution-based observational studies from African countries reporting the prevalence and/or histopathological patterns of gestational trophoblastic disease, using total deliveries as the denominator.

Data were extracted into Excel and analysed using Stata V.17. Pooled estimates were calculated using a random-effects model with Knapp-Hartung adjustment. Heterogeneity was assessed with Cochran’s Q test and the I² statistic, and study quality was evaluated using the Joanna Briggs Institute tool.

Of the 2252 studies identified, 33 were included, comprising 2885 gestational trophoblastic disease cases from eight countries. The pooled prevalence of gestational trophoblastic disease in Africa was 4.35 per 1000 deliveries (95% CI 3.26 to 5.45, I²=99.8%). The pooled prevalence of hydatidiform mole, invasive mole and choriocarcinoma in Africa was 3.49 per 1000 deliveries (95% CI 2.45 to 4.52, I²=99.7%), 0.47 per 1000 deliveries (95% CI 0.14 to 0.79, I²=72.2%) and 0.97 per 1000 deliveries (95% CI 0.54 to 1.40, I²=99.1%), respectively.

This review indicated the prevalence of gestational trophoblastic disease was high. Hydatidiform mole was the predominant histopathological pattern observed. Routine antenatal screening is needed for early detection. Further research should be conducted to identify risk factors and evaluate strategies for the prevention and management of the disease.

CRD42024504268.