International guidelines on breast cancer (BC) screening have differing recommendations leading to uncertainty on best practices for primary care providers. The purpose of this study was to create a Canadian best practices document on BC health and screening for primary healthcare providers through multidisciplinary consensus using Nominal Group Technique and Delphi method.

A 9-member multidisciplinary expert group and a patient advocate participated in the consensus methods and voting. Experts included those involved in BC management and two primary care physicians. Twenty-nine experts across BC disciplines participated in external review.

Two study objectives included (1) building consensus on key ‘best practice’ behaviours related to BC-related health and screening and (2) building consensus on specific definitions related to BC screening.

The final consensus document consists of 65 statements grouped in five categories with companion resources to support uptake of all best practices. Categories include identification and work-up for diagnostic imaging, risk factors and identifying individuals eligible for high-risk screening, shared decision-making, decisions and referrals for BC screening and screening outcomes. Special areas of focus were shared decision-making, age to initiate screening, and BC screening in special populations.

We created a comprehensive consensus document distilling the latest evidence to provide practical Canadian consensus-based advice on specific ‘best practice behaviours’ related to BC health and screening to serve as a resource for providers.

Alcohol is causally related to more than 200 diseases and injuries. Alcohol health warning labels are a promising intervention to address alcohol-related harm with multiple possible roles, but research on its real-world impacts is lacking. This study aims to experimentally evaluate the impact of exposure to two types of content (responsibility and cancer message) and positioning of the message (front or back) on knowledge of alcohol causing cancer as the primary outcome and alcohol consumption behaviour, intentions, risk perception, emotional response, product appeal and policy support as secondary outcomes. The study also aims to assess the potential testing effect of pre-measurement on the primary outcome.

Participants (of the legal drinking age in Spain (18 years or older), purchased at least one alcoholic beverage (with alcohol by volume (ABV) ≥ 1.2% for their own consumption and speaking Catalan or Spanish) will be recruited outside of supermarkets in Barcelona after purchasing alcohol, randomly assigned into one of the eight experimental groups, complete a baseline questionnaire (with half of the sample answering baseline questions measuring knowledge) and receive label stickers displaying either responsibility or cancer message, and applied to either front or back of every alcohol container they have purchased. They will complete follow-up surveys measuring the primary and secondary outcomes 1 week and 1 month after the intervention, either online or via telephone. The key hypotheses are that the label containing a cancer message will have a greater impact on the primary and secondary outcomes compared with the responsibility label. To evaluate the impact of health warning labels on knowledge of alcohol causing cancer, logistic regression will be employed to model the probability of a correct response as a function of the key independent variables, with results reported as ORs. Secondary outcomes will be modelled through linear regressions for continuous variables, and through logistic regressions for dichotomic variables or categorical variables that will be dichotomised a priori. The target sample size is 1300 participants.

The study has been approved by the Ethical Committee for Research with Medicines (CEIm) IDIAP Jordi Gol (24/228-P) and the Ethical Research Committee of the WHO (ERC.0004213). The results will be disseminated in peer-reviewed journals, on social media and policy fora in national, European and global context, and will inform WHO and European Union-level policy recommendations.

European Commission, Directorate General for Health and Food Safety, SANTE/2022/SI2.883729.

NCT06915298. https://clinicaltrials.gov/study/NCT06915298

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.

Perineal warm compresses in the second stage of labour have been demonstrated by clinical guidelines as an effective intervention for improving perineal outcomes and mothers’ psychological well-being, yet their adoption in clinical practice remains suboptimal. Therefore, this study aims to bridge the evidence-practice gap through the application of implementation science models and frameworks to facilitate clinical adoption. The investigation will systematically explore the barriers and facilitators to the application of perineal warm compresses in the second stage of labour and subsequently develop a corresponding implementation strategy addressing identified barriers.

This study was guided by the PEDALs model. Using a scoping review and a parallel mixed-methods study to systematically investigate the barriers and facilitators to the application of perineal warm compresses in the second stage of labour. The identified barriers and facilitators were mapped to the domains of the Consolidated Framework for Implementation Research (CFIR). Then we will use a modified nominal group technique to determine seven priority barriers that need to be addressed. These barriers will be input into the CFIR-ERIC implementation strategy matching tool to obtain expert-recommended implementation strategies. Finally, the Delphi method will be employed to select and refine the implementation strategies into a clear and actionable implementation strategy bundle.

This study has been approved by the Ethics Committee of Hebei Medical University, with approval number 2024043. Written informed consent will be obtained from all participants. Study findings will be disseminated through articles in scientific, peer-reviewed journals, and at national and international conferences. This study will begin in August 2025 and be completed in June 2026.

Diabetes mellitus is a significant global health challenge, requiring innovative strategies to improve management and mitigate complications. Digital health technologies offer promising solutions to enhance diabetes self-care by providing real-time feedback, improving communication and supporting data-driven decision-making. Despite the increasing adoption of digital self-care interventions, there is a lack of comprehensive synthesis of evidence on their impact, accessibility and integration into healthcare systems. This scoping review aims to map existing research on digital self-care solutions for diabetes management, identify knowledge gaps and highlight best practices and key factors influencing adoption.

The review will follow Arksey and O’Malley’s framework and adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search will be conducted in Medline, Scopus, Embase, CINAHL and Google Scholar, focusing on studies published from January 2004 to December 2024 in English, French, Arabic, Portuguese, Spanish, Italian, Czech, Slovak and Chinese. Studies reporting on digital self-care solutions for diabetes management will be included, covering experimental and quasi-experimental study designs. Data extraction will cover study and participant characteristics, digital solution features, and barriers and facilitators to adoption. Ethical and equity considerations will also be analysed using established frameworks. Two reviewers will independently screen studies, with discrepancies resolved by a third reviewer.

This scoping review will provide a comprehensive understanding of digital self-care solutions for diabetes management, offering insights to inform future research and enhance self-care practices globally. Findings will be disseminated through peer-reviewed publications, conferences and interest holder engagements to inform clinical practice and policy development. As this study involves the review of existing literature, ethical approval is not required.

Improving outcomes from sepsis in children is a WHO Global Health Priority, yet mortality from sepsis remains high, particularly in low- and middle-income countries (LMICs). This database from children with community-acquired childhood sepsis in LMICs and some high-income countries will allow analysis of the burden of disease, including incidence, severity and outcomes. Understanding these aspects of sepsis care is fundamental for the design and conduct of future international interventional trials to improve childhood sepsis outcomes.

This multicountry retrospective observational study will include children up to 18 years of age presenting to emergency departments with suspected sepsis, defined as admission to hospital for treatment with intravenous antibiotics plus (1) a provisional diagnosis of sepsis and/or (2) treatment for suspected sepsis (operationalised as the administration of one or more fluid bolus to treat impaired perfusion or vasoactive infusion). Presenting characteristics, management and outcomes will be collected. These will include vital signs, serum biomarkers, intravenous fluid administration for the first 24 hours of hospitalisation, organ support therapies delivered, antimicrobial use, microbiological diagnoses, hospital and intensive care unit length of stay, and mortality censored at hospital discharge or 30 days from enrolment (whichever occurs first).

Central ethics approval was received from the Royal Children’s Hospital of Melbourne, Australia Human Research Ethics Committee (HREC/100648/RCHM-2023). Each international site will be required to obtain local Institutional Research Ethics Board approval. The findings will be disseminated in peer-reviewed journals, at academic conferences and through lay media. A cleaned study database and individual site-level data will be made available to site investigators upon completion of the study.

This study was registered with the Australian and New Zealand Clinical Trials Registry on 23 January 2024 prior to commencement of recruitment (ACTRN12624000052538).

Eating disorders are complex mental health conditions characterised by pathological behaviours related to food intake, often accompanied by a chronic obsession with weight control. Their prevalence is increasing, with an earlier onset and greater severity among young people. Universal prevention, through multicomponent strategies that tackle modifiable risk factors, has emerged as a promising tool. This paper reports the study protocol designed to assess the effectiveness and cost-effectiveness of the PRETA (Prevención de los Trastornos de la Alimentación) programme in reducing the risk of eating disorders and related modifiable risk factors among preadolescents in the school setting.

The PRETA programme will be assessed by means of an open, community-based, multicentre, controlled trial using 1:1 matched-pairs cluster randomisation at the school level. Schools in Tenerife (Spain) will be assigned to the PRETA programme or a waitlist control group. Participants include 5th- or 6th-grade students (10–13 years old), their parents and teachers. The PRETA programme is a universal, school-based, multicomponent programme designed to reduce eating-disorder risk and modifiable risk factors. Its main component is an interactive online platform called e-PRETA, complemented by training sessions for families and teachers. e-PRETA includes nine 45-minute sessions addressing risk factors, such as dietary habits, beauty standards, media literacy, self-esteem, emotional regulation and social skills. A total of 1068 children from 12 schools will participate. The primary outcome will be the risk of developing eating disorders (Children’s Eating Attitudes Test-26 item version). Secondary outcome measures are body dissatisfaction (Adapted Contour Drawing Rating Scale), eating disorder traits (Eating Disorder Inventory-2), internalisation of appearance ideals (Sociocultural Attitudes Towards Appearance Questionnaire-4) and self-esteem (Rosenberg Self-Esteem Scale). Outcomes will be assessed at baseline and postintervention (3 months). Additional baseline covariates such as electronic device use, parental feeding attitudes, physical activity, sleep duration and screen time will also be collected. Programme effectiveness will be analysed using generalised mixed models. Cost-effectiveness will be assessed by comparing the incremental costs associated with the implementation of the PRETA programme with its estimated effectiveness.

Ethics approval has been obtained from the Ethics Committee for Research with Medicines at the University Hospital of the Canary Islands (CHUC_2021_78). Written informed consent will be obtained from the parents or legal guardians of all participants. Results will be disseminated through scientific publications and conferences.

NCT06792981.

To explore how learner transformation manifests in a communal arts and humanities (AH) educational activity for medical students.

Mixed methods explorative study.

UK-based medical school that follows a 5-year case-based learning curricular model.

A group of 105 first-year medical students attended a group viewing of a TV documentary titled, ‘Life on the List’ as part of their core curriculum. The documentary explores the humanistic aspects of kidney disease, organ donation and transplantation by portraying the personal stories of transplant recipients, donors and healthcare professionals. Following the screening, attendees engaged in a question-and-answer session with an expert panel.

Perceived transformation of learning was measured using a quantitative Likert-scale paired pre-screening and post-screening questionnaire. Additionally, the qualitative study used facilitated focus groups (FGs) to explore how learners may or may not have transformed their learning based on the AH educational activity.

Inclusion criteria were: (a) first-year medical students and (b) those who attended the screening. Those not meeting these criteria were excluded. The quantitative questionnaire was completed by 94 participants, while 19 attended FG interviews.

Paired t-tests were conducted to compare pre-screening and post-screening responses across five questions. All results demonstrated statistical significance (phow learning was transformed: (1) an absorbing experience; (2) confronting and challenging: different ways of seeing the world; (3) collective reflection: the power and safety of the crowd; (4) ‘everything just came into perspective’: accepting the world in a new way; and (5) willing to change the world: advocacy and agency. By this collective experience focusing on real patient stories and providing an opportunity for discussion and reflection, participants were offered a holistic view on kidney medicine and transplantation. Overwhelmingly, participants were inspired to strive for person-centred care, with many being motivated to explore kidney medicine and transplantation as career options.

Couched in pedagogy, an AH educational activity for medical students can leverage learner transformation and promote person-centred care. With respect to kidney medicine, organ donation and transplantation, such activities can provide early career exposure to these fields. Students may be inspired to act as positive ambassadors for organ donation and transplantation and further explore these areas as future career options. Further research should investigate AH interventions in diverse groups from a longitudinal perspective to consider long-term effects in promoting holistic and empathetic patient care.

Non-communicable diseases (NCDs) are a leading cause of global mortality, disproportionately affecting low and middle-income countries (LMICs). Physical inactivity, a key contributor to NCDs, is prevalent worldwide despite evidence supporting the health benefits of physical activity (PA). Cities, while often associated with barriers to PA, also present unique opportunities to enhance PA through systemic, context-sensitive interventions or so-called actions. However, evidence on effective city-level PA strategies, particularly in LMICs, remains limited. The CITY based interventions to stimulate active MOVEment for health (CITY-MOVE) project aims to accelerate, support and evaluate the implementation of PA actions at the city level by adapting the WHO Global Action Plan on Physical Activity into locally relevant strategies across six cities worldwide, accompanied by a cross-contextual evaluation framework to ensure transferability and scalability.

This multicase study examines 13 PA actions in six cities (Bogotá, Lima, Kampala, Antwerp, Rotterdam and Ljubljana) across three continents, addressing both early (design and implementation) and late (evaluation) action stages. Early-stage actions employ action research in Living Labs to codesign and implement PA initiatives with local stakeholders, while late-stage interventions focus on retrospective evaluations of implementation outcomes. The framework integrates the Medical Research Council guidance on complex interventions with the Context and Implementation of Complex Interventions. Mixed methods are employed, including document review, interviews, participatory workshops and quantitative analysis of PA and NCD indicators. A cross-contextual Multi-Criteria Decision Analysis (MCDA) framework will synthesise findings to inform scalability and transferability of actions.

Ethics approvals were obtained from local review boards in the participating cities.

Dissemination will occur at three levels: local, regional and global. Locally, findings will be shared with city authorities, non-governmental organisations (NGOs) and healthcare providers through Living Labs and policy dialogues. At the regional level, knowledge will be spread across cities in Europe, Latin America and East Africa through Communities of Practice and the use of tools like the MCDA framework. Globally, the project will contribute to the scientific community and international organisations such as the WHO and UN-Habitat, by sharing results through open access publications, conferences and global networks to ensure widespread dissemination and sustainability of the project’s impacts.

This study and its outcomes are publicly accessible on OSF (https://osf.io/mn8zd/) and ZENODO (https://zenodo.org/communities/citymove/).

Our aim is to develop a Framework of Measurement for people living with Long COVID and their caregivers for use in Long COVID research and clinical practice. Specifically, we will characterise evidence pertaining to outcome measurement and identify implementation considerations for use of outcome measures among adults and children living with Long COVID and their caregivers.

We will conduct a scoping study involving: (1) an evidence review and (2) a two-phased consultation, using methodological steps outlined by the Arksey and O’Malley Framework and Joanna Briggs Institute. We will answer the following question: What is known about outcome measures used to describe, evaluate or predict health outcomes among adults and children living with Long COVID and their caregivers? Evidence review: we will review peer review published and grey literature to identify existing outcome measures and their reported measurement properties with people living with Long COVID and their caregivers. We will search databases including MEDLINE, Embase, CINAHL, PsycINFO and Scopus for articles published since 2020. Two authors will independently review titles and abstracts, followed by full text to select articles that discuss or use outcome measures for Long COVID health outcomes, pertain to adults or children living with Long COVID and/or their caregivers and are based in research or clinical settings. We will extract data including article characteristics, terminology and definition of Long COVID, health outcomes assessed, characteristics of outcome measures, measurement properties and implementation considerations. We will collate and summarise data to establish a preliminary Framework of Measurement. Consultation phase 1: we will conduct an environmental scan involving a cross-sectional web-based questionnaire among individuals with experience using or completing outcome measures for Long COVID, to identify outcome measures not found in the evidence review and explore implementation considerations for outcome measurement in the context of Long COVID. Consultation phase 2: we will conduct focus groups to review the preliminary Framework of Measurement and to highlight implementation considerations for outcome measurement in Long COVID. We will analyse questionnaire and focus group data using descriptive and content analytical approaches. We will refine the Framework of Measurement based on the focus group consultation using community-engaged approaches with the research team.

Protocol approved by the University of Toronto Health Sciences Research Ethics Board (protocol #46503) for the consultation phases of the study. Outcomes will include a Framework of Measurement, to enhance measurement of health outcomes in Long COVID research and clinical practice. Knowledge translation will also occur in the form of publications and presentations.

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

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

A representative statewide sample population of NSW, Australia.

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

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

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

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

The COVID-19 pandemic’s unprecedented nature has exposed significant vulnerabilities in most public health systems and highlighted the importance of coordinated responses across various levels of government. A global debate emerged on the types of health measures necessary to curb the rapid spread of contagious and/or lethal diseases. However, some of these measures involved restricting individual rights, raising significant ethical, legal and public health questions. The protocol of this systematic review aims to address a critical gap in the literature by analysing how Public Health Surveillance services worldwide implemented compulsory right-restricting measures during the COVID-19 pandemic, and what impacts these measures had on public health outcomes and individual rights.

This protocol focuses on studies about right-restricting measures enacted by Public Health Surveillance services during the COVID-19 pandemic. It will be unrestrictive as to period (starting in 2019, when the outbreak was identified), language or publication status in a preliminary stage. It will include only peer-reviewed publications, discarding opinion articles, editorials, conference papers and non-peer-reviewed publications. Considering the PICo strategy, the research question of this systematic review can be formulated as follows: Problem—right-restricting measures enacted by Public Health Surveillance services; Interest—implementation modalities and impacts on individual rights and public health outcomes; Context—COVID-19 pandemic. This protocol will use the following databases: Pubmed, Cochrane/CENTRAL, Embase, Scopus and Web of Science. Considering the various measures that may have been adopted, the following categories of analysis will be used: (i) Public Health Surveillance as a field, (ii) the various specific areas of Health Surveillance, (iii) law enforcement, (iv) right-restricting measures and consent, (v) interactions between right-restricting measures and routine Public Health Surveillance functions, (vi) differences between countries and (vii) Health Surveillance lessons learnt from the COVID-19 pandemic. These categories are not strictly mutually exclusive; however, each study will be assigned to the category most aligned with its primary focus. To ensure the validity and reliability of findings, each study will have its risk of bias assessed at both the study and outcome levels.

Patients and the public were not involved in the design, conduct, reporting or dissemination plans of this systematic review. The results will be presented in one or more articles to be submitted to scientific journals and may also be presented at scientific conferences and to public policy makers.

This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 20 November 2024 (registration number CRD42024613039).