To investigate the association between a Composite Lifestyle Index (CLI) and glucose management among Iranian adults with diabetes and to assess the geographic distribution of lifestyle behaviours.

Cross-sectional.

A population-based nationally representative survey conducted across all 31 provinces of Iran based on data from the 2021, the latest, WHO STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance (STEPS) survey.

Adults aged ≥25 who completed the third step of the STEPS study and met one or more of the following criteria—fasting blood sugar (FBS) of 126 mg/dL or higher, haemoglobin A1c (HbA1c) of 6.5% or higher or current use of glucose-lowering medications. Finally, 3042 adults with diabetes were included in the analysis.

A CLI was derived from diet, physical activity, smoking and alcohol consumption and categorised into tertiles representing the lowest, moderate and highest engagement in healthy lifestyle behaviours. Diabetes awareness was assessed by self-report, and suitable glucose management was defined as HbA1c

In fully adjusted models, moderate lifestyle engagement was significantly associated with lower FBS (aß=–7.36, 95% CI –13.35 to –1.38, p=0.01) and lower HbA1c (aß=–0.27, 95% CI –0.46 to –0.07, p=0.00) compared with the lowest tertile. Additionally, improving the CLI from the first to second tertile was associated with 1.37 times higher odds of achieving suitable glucose management (p=0.01). Restricted cubic spline analysis confirmed a significant non-linear relationship between continuous CLI and both FBS (P_{non-linearity}=0.002) and HbA1c (P_{non-linearity}=0.005), with maximal glycaemic benefits observed at moderate CLI values.

The relationship between healthy lifestyle behaviours and glycaemic outcomes among Iranian adults with diabetes was non-linear, a U-shaped pattern. Glycaemic benefits peaked at moderate engagement levels, and diminished at the highest levels of engagement. These exploratory findings suggest that moderate lifestyle engagement may be associated with improved glycaemic outcomes, highlighting the need for prospective studies to evaluate whether integrating tailored lifestyle promotion into diabetes management can effectively benefit underserved regions.

Potentially inappropriate prescribing (PIP) in the elderly is associated with adverse outcomes and increased healthcare use. We aimed to estimate its prevalence and pattern among the elderly population of Iran using the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria.

Retrospective, population-based observational study.

Nationwide data of Iran Health Insurance Organization (IHIO) prescription claims from 24 provinces (21 March 2014 to 19 March 2017).

Adults aged ≥60 years with at least one prescription in the dataset were included. The study comprised 2 696 300 older adults who received 28 575 400 prescriptions.

Not applicable.

Using a two-stage curation process, we selected STOPP version 3 criteria that could be operationalised from dispensing data alone (age, Anatomical Therapeutic Chemical code, dose, duration and concurrent use). For each criterion, we calculated prescription and patient level PIP prevalence overall and among at-risk prescriptions.

Across the curated STOPP criteria, 313 315 prescriptions issued to 131 012 patients met at least one PIP criterion. The most frequent PIPs were concurrent beta blocker and diltiazem use (99 027 prescriptions; 1.26% of patients), benzodiazepine therapy ≥4 weeks (89 240 prescriptions; 1.60% of patients), ≥2 anticholinergic drugs (47 079 prescriptions; 0.78% of patients) and concomitant non-steroidal anti-inflammatory drug plus anticoagulant (25 685 prescriptions; 0.38% of patients). PIPs involving acetylcholinesterase inhibitors, ticlopidine, clonidine and methyldopa were rare.

In this nationwide claims-based study, about 5% of elderly Iranians were exposed to PIPs, particularly chronic benzodiazepine use, excessive anticholinergic burden and high-risk cardiovascular and antithrombotic combinations. Our findings provide concrete targets for claims-based surveillance and interventions to improve prescribing safety in Iran’s ageing population.

User involvement is important for improving accessibility, quality and equity in health and social care research. However, the specific mechanisms by which it contributes to, or detracts from intervention outcomes are unclear, particularly for populations experiencing exclusion and health and social inequities in high-income countries. This realist review aims to understand and describe key mechanisms of user involvement in complex interventions in health and social care research among populations experiencing exclusion in high-income countries. Specifically, we will explore how, why, for whom and under what circumstances user involvement contributes to complex interventions in health and social care research among populations experiencing exclusion.

We will conduct a six-step realist review: (1) clarifying the scope, (2) searching for evidence, (3) selecting and appraising sources, (4) extracting and organising data, (5) synthesising data and (6) refining the synthesis. We will systematically review and synthesise relevant sources from academic databases and grey literature. Workshops will be held with experts who have lived experience of exclusion and/or professionals working in inclusion health to gather feedback and refine the findings. A group of external academic experts in the field will also be consulted. Following Pawson and Tilley’s iterative approach, data will be extracted, analysed and synthesised into explanatory theoretical findings and reported in accordance with the Realist And Meta-narrative Evidence Syntheses Evolving Standards.

Formal ethical approval is not required for this study as it is a review of published literature. Our overall dissemination strategy will be developed in collaboration with the experts who have lived experience of exclusion, as well as three professionals working in inclusion health. Findings will be shared with these expert contributors and disseminated through various channels, including a peer-reviewed publication, lay summary report and conference presentations.

CRD420251046835.

This study aimed to investigate the relationship between perceived social support and domestic violence with maternal postpartum stress in an Iranian context.

This cross-sectional study was conducted in 2023 in Tabriz, Iran.

A total of 349 mothers, 2–6 months post partum, who were living with a spouse and had no history of mental health disorders, were selected from municipal health centres using a cluster sampling method.

Data were collected using the Maternal Postpartum Stress Scale, the Perceived Social Support Questionnaire (Personal Resource Questionnaire-85 (PRQ-85)), and the Hurt, Insult, Threaten, Scream tool for domestic violence. Data were analysed using descriptive statistics, bivariate tests (independent samples t-tests, one-way analysis of variance and Pearson’s correlation coefficient) and generalised linear model.

Maternal postpartum stress showed a significant negative correlation with perceived social support (r=–0.16, p=0.002) and a significant positive correlation with domestic violence (r=0.14, p=0.006) in the initial analysis. In the final adjusted general linear model with robust standard errors, perceived social support was significantly associated with lower stress (B=–0.1, p

This study reveals a complex web of associations where perceived social support, domestic violence, economic stability and the model of birth care are linked to maternal postpartum stress. These findings highlight the urgent need for systemic support structures that empower the family unit and prioritise the emotional health in the postpartum period.

The soluble FMS-like tyrosine kinase-1 and placental growth factor (sFlt-1/PlGF) ratio has demonstrated impressive predictive test characteristics in women with suspected pre-eclampsia. However, it remains a matter of debate whether the introduction of this novel test can indeed translate to a reduction in pre-eclampsia-related hospital admissions, outpatient visits and can consequently lower overall healthcare costs. The PREPARE II study aims to investigate whether the sFlt-1/PlGF ratio, along with digital self-monitoring, can reduce pre-eclampsia-related healthcare utilisation in the first week following the test for women with suspected pre-eclampsia.

This is a randomised controlled trial across six centres which includes women (≥16 years old) between 20 and 37 weeks of gestation with suspected pre-eclampsia due to one or more identified symptoms. For power calculation, we assumed that the sFlt-1/PlGF ratio including a telemonitoring strategy leads to a de-escalation of care by cumulatively reducing the frequency of pre-eclampsia-related hospital admissions and/or outpatient visits in the first week from 50% in the control group to 35% in the intervention group. Considering a loss to follow-up of 5%, a sample size of approximately 470 women is required with 235 women per arm (α=5%; power=90%). The intervention is an algorithm based on the urine protein/creatinine ratio (PCr)+sFlt-1/PlGF ratio, along with a telemonitoring strategy. The algorithm incorporates a PCr cut-off of 30 (mg/mmol) and a sFlt-1/PlGF ratio cut-off of 38 for risk classification. Subsequent clinical follow-up recommendations are stratified based on this classification: low risk entails no additional follow-up, returning to routine antenatal care; intermediate risk includes telemonitoring; high risk necessitates immediate admission. The primary outcome is the occurrence of pre-eclampsia-related healthcare utilisation in the first week after testing. Secondary outcomes are maternal/perinatal adverse events, total healthcare usage, pre-eclampsia diagnosis, quality of life and productivity losses. A cost-effectiveness analysis from a societal perspective will be performed.

Ethical approval was obtained from the Medical Ethics Committee of Leiden University Medical Centre (METC LDD) on 21 July 2025 (reference NL-009295). The results will be disseminated through peer-reviewed publications and presentations at international conferences.

NL88527.058.24.

Cancer literacy (CL) is essential for enabling informed decision-making, prevention, early detection and adherence to treatment. However, disparities in CL across Europe, coupled with the spread of disinformation, limit equitable access to cancer care. This protocol describes a collection of scoping reviews to document the state of CL, misinformation narratives and education and training initiatives and identify barriers and facilitators. This work is embedded within the activities of the Beating Cancer Inequalities through Literacy in Europe project and encompasses nine consortium countries across Europe: Romania, Portugal, Belgium, Bulgaria, Montenegro, Ukraine, Italy, Ireland and Moldova.

The protocol follows the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR) checklist, guided by the Population, Concept, Context framework. Searches will be conducted in PubMed, supplemented by grey literature, capturing results from January 2015 to December 2025. Eligible records will undergo full-text review. Data will be extracted into predefined categories reflecting the topics of interest, developed by the research team before extraction to include key study information. Then, sources in local languages are provided by the partners, included and validated by native-speaking team members, adding to the results found by the researchers.

No ethical approval is required. Findings will be disseminated via peer-reviewed publications, project reports and stakeholder workshops.

Open Science Framework (10.17605/OSF.IO/9AQSX).

The first year after childbirth is a critical yet insufficiently monitored period for parental health. Postpartum mental and physical morbidity can affect both mothers and co-parents, but national longitudinal data remain scarce. The Stress Of Co-parents Related to A Traumatic Experience of birth across Switzerland (SOCRATES) cohort study aims to describe maternal and co-parental health and well-being trajectories during the first year after childbirth.

SOCRATES is a prospective, population-based cohort study conducted in all linguistic regions of Switzerland. Eligible participants include women aged 14 and above who gave birth to a live or stillborn infant (≥22⁺⁰ weeks’ gestation and ≥500 g) and their cohabiting co-parents, provided they speak German, French, Italian or English. Recruitment was conducted in 81 of the 112 Swiss maternity units, birth centres and organisations of midwives over 6 weeks in spring 2025. Clinical data on pregnancy, childbirth and the early postpartum period are extracted from medical records. Postpartum hospitalisation data are obtained through linkage with national medico-administrative databases. Participants complete online questionnaires shortly after birth and at 2, 6 and 12 months post partum, including sociodemographic characteristics and patient-reported outcomes. The primary outcome is the prevalence of childbirth-related post-traumatic stress disorder at 2 months, assessed using the City Birth Trauma Scale. Secondary outcomes include depression, physical recovery, sexual health, quality of life, healthcare use, perceived care quality and overall well-being. A weighting procedure will be used to ensure representativeness and to account for attrition.

Ethical approval was granted by all seven Swiss ethics committees (number 2024-02262). All participants provided informed consent. Findings will be disseminated through national and international conferences, peer-reviewed publications, policy briefs, social media and stakeholder engagement activities.

NCT06886841.

‘Spin’ refers to reporting practices that distort the interpretation of results and mislead readers’ impression of the research findings so that the results are viewed in a more favourable light. This systematic review aims to assess the impact of spin on the impressions and/or interpretation of research findings among healthcare professionals and decision makers involved in health-related decision-making and to evaluate interventions/strategies designed to reduce the influence of spin.

This systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE (via Ovid), EMBASE, the Cochrane Library (CENTRAL) and the Education Resources Information Center (ERIC) will be searched from their inceptions to 27 January 2026. Randomised controlled trials evaluating the impact of spin on participants’ impressions and/or interpretation of research findings, as well as trials assessing the effect of interventions/strategies on the recognition and interpretation of spin, will be considered. Study selection, data extraction and risk of bias (RoB) assessment with the Cochrane RoB2 tool will be performed independently by multiple reviewers. Where sufficient data are available, meta-analyses will be conducted.

As this study is based on a review of publicly available literature, ethical approval is not required. The findings will be disseminated through publication in peer-reviewed journals, presentations at international conferences and press releases.

INPLASY202620006.

Adnexal surgery is one of the most common surgeries performed in women. Minimally invasive methods are on the rise globally as they have been shown to decrease surgical morbidity compared with abdominal surgery. Adnexal surgery by vaginal natural orifice transluminal endoscopic surgery (vNOTES) is the latest innovation. It combines the vaginal approach and endoscopy via the vagina. Large pragmatic randomised controlled trials (RCTs) are lacking comparing outcomes after vNOTES and conventional laparoscopy.

A multicentre pragmatic RCT aiming to recruit 200 women aged 18 years and above undergoing adnexal surgery for benign disease or prophylactic reasons. Patients will be randomised to vNOTES or laparoscopy. Recruitment will start Q4 2025, and the study is estimated to end 2028.

The primary outcome is postoperative pain. Secondary outcomes are units of postoperative opioid and non-opioid analgesics used, perioperative complications, operation time, postoperative complications, readmission, conversion rate and the surgeon’s experience.

The national Swedish ethical board at the main centre, Helsingborg Hospital, Sweden, has given ethical agreement (dated 20 March 2025). Before including patients, all centres will require local or national ethical approval. The results of the study will be published in international peer-reviewed journals.

NCT06964594.

Biomarkers related to the diagnosis, prognosis and treatment of dementia will play a key role in future clinical practice. The overarching aim of the ODIN (blood and cerebrospinal fluid) Biobank is to study biomarkers for dementia and contribute to the transition from cerebrospinal fluid to blood-based biomarkers.

ODIN recruited 451 patients (median age 74 years, 53% females) referred to the Department of Neurology at Aarhus University Hospital, Denmark, for diagnostic assessment of dementia. Enrolment started in March 2020 and ended in July 2025. Patients referred for a lumbar puncture were eligible for inclusion. Cerebrospinal fluid and blood samples (plasma, serum and buffy coat) were stored at –80°C. Information about sociodemographic, educational level, dementia subtype, cognitive test scores, neuroimaging results, hypertension, diabetes, height, weight, alcohol consumption and smoking was collected.

The most frequent diagnoses were Alzheimer’s disease (n=268, 59%), frontotemporal dementia (n=26, 5.8%) and mixed Alzheimer’s and vascular disease (n=23, 5.1%). N=82 (18%) were cognitively unimpaired or had mild cognitive impairment but not dementia. The median Mini–Mental State Examination score was 23 (IQR: 20–26) and the median Addenbrooke’s Cognitive Examination score was 68 (IQR: 58–77).

ODIN will contribute to the development, validation and implementation of new biomarkers related to diagnosis, prognosis and treatment of dementia. Furthermore, the cohort will assist the transition from cerebrospinal fluid to blood-based biomarkers.

To investigate how patients with sarcoma present prior to diagnosis—through a general practitioner (GP) or another healthcare professional (HCP)—and describe presenting symptoms.

International observational cohort study.

Data were obtained from the longitudinal ‘QUality of life and Experiences of Sarcoma Trajectories’ (QUEST) cohort study, conducted across the Netherlands, the United Kingdom (UK), Australia and New Zealand.

Among 572 patients, 487 (85.1%) started their diagnostic trajectory at the GP (subcohort 1) and 85 (14.9%) with another HCP (subcohort 2)—mainly medical specialists treating unrelated conditions (36/85; 42.4%). Soft tissue sarcoma patients most often reported swelling, whereas bone sarcoma patients reported unexplained pain. Notably, 31/85 (36.5%) of subcohort 2 were asymptomatic. Reasons for delaying GP visits included assuming symptoms were minor and expecting them to resolve. Patients sought care when, among others, symptoms persisted and worsened.

Most patients first consulted a GP, underlining the role of primary care in sarcoma diagnosis internationally. Due to rarity and nonspecific symptoms, faster diagnosis remains challenging, requiring improvements in both primary and specialist care.

NCT03441906; Results.