Environmental enteropathy (EE) is a syndrome affecting the gut characterised by villus blunting, reduced nutrient absorption and microbial translocation in children and adults experiencing a high burden of enteric infection due to inadequate access to clean water and sanitation.

We will conduct coordinated randomised controlled trials in six countries to determine if supplementation with indispensable amino acids (IAAs) can improve intestinal barrier dysfunction in six geographically diverse populations of 18–36 months old children with stunting or severe stunting. All trials will measure the same primary outcomes while secondary outcomes will be measured on a per-trial basis using standardised protocols across the project. The primary endpoint will be change in gut permeability as assessed by the lactulose/rhamnose ratio. Secondary endpoints include changes in amino acid and carbohydrate absorption using novel, isotope tracer tests. Other prespecified outcome measures include changes in EE biomarkers and child weight. IAA supplementation will be given daily for 28 days and evaluation of the major endpoints will be at baseline and after 28 days of supplementation.

Ethical approval will be obtained from the Research Ethics Committee at each participating site. Caregivers will provide written informed consent for each participant. Findings will be disseminated through peer-reviewed journals, conference presentations and face-to-face meetings with participant caregivers.

CTRI: CTRI/2024/06/069187 (India); ClinicalTrials.gov (NCT06617130, Malawi; NCT06676215, Philippines and NCT07256028, Morocco); Ongoing (Zambia); Ongoing (Morocco); PACTR: (PACTR202311714091884, Ghana).

Treatment for high-risk locally advanced prostate cancer typically includes radiation or radical prostatectomy plus androgen deprivation therapy (ADT), but the optimal use of neoadjuvant and adjuvant ADT in practice remains unclear. Relugolix and enzalutamide have demonstrated strong efficacy independently in the setting of advanced disease, but their combined use in neoadjuvant/adjuvant therapy has not been studied. This trial investigates their safety and efficacy as neoadjuvant/adjuvant therapy in patients undergoing definitive local treatment.

Relugolix and Enzalutamide as Neoadjuvant/Adjuvant to Local-regional treatment in Patients with High-risk, Locally Advanced Prostate Cancer (RENAPCA) is a prospective, single-arm, open-label phase Ib trial with blinded outcome assessment. The study is conducted across four tertiary oncology centres within the United States. Eligible participants are adult men with pathologically confirmed locally advanced high-risk prostate cancer who are candidates for definitive local therapy. Patients with significant comorbidities or a life expectancy of less than 6 months are excluded. The trial includes a 3+3 dose-escalation safety lead-in cohort (up to 12 patients) to determine dose-limiting toxicities and recommended phase 2 dose, followed by a dose expansion cohort (up to 46 patients). Interventions consist of 6 months of neoadjuvant therapy with relugolix plus enzalutamide, definitive local therapy (radical prostatectomy or radiation therapy), and 18 months of adjuvant therapy with relugolix plus enzalutamide. Primary outcomes include pathologic CR rate and minimal residual disease rate. Secondary outcomes include prostate-specific antigen response, progression-free survival, objective response rate, frequency and severity of adverse events, and positive margin/pathologic downgrade rate. Exploratory objectives include patient-reported outcomes and quality of life measures. RENAPCA will assess the safety and efficacy of neoadjuvant/adjuvant relugolix+enzalutamide in high-risk, locally advanced prostate cancer to support future larger-scale studies and potentially improve treatment outcomes.

This research protocol has been approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center (7 March 2024). The study is based on voluntary participation with informed written consent.

NCT06130995.

Research on psychosocial interventions for dementia demonstrates increased rigour and robustness. However, if we are to influence practice, beyond results from randomised controlled trials, a variety of types and sources of evidence is needed. The Medical Research Council (MRC) framework offers a valuable guide for developing, evaluating and implementing complex interventions, to facilitate integration of research into practice. There is limited knowledge of how researchers design, evaluate and implement psychosocial intervention studies in dementia, using the MRC framework. This scoping review aims to: (1) identify the methodological and methods trends, use and gaps in the development, evaluation and implementation of psychosocial interventions for dementia, and (2) determine if and how the MRC six core elements were considered and applied in studies.

Six databases (Ovid MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library) will be searched for studies published from 2015 (when MRC process guidance was published) to 2025. Identified deduplicated citations will be imported into Covidence software, where up to 40% of title/abstracts will be double screened by independent reviewers. ASReview will be used to rank articles by relevance, with a stopping criterion of 250 consecutive irrelevant articles. Full texts will be reviewed by a single reviewer and those excluded will be checked by a second reviewer. Data extraction will include study aim/objective (ie, to develop/adapt; test feasibility/pilot; evaluate; implement); methodology and methods applied; information on which MRC six core elements were considered (yes/no), and if so, how they were addressed (ie, qualitative details). A narrative synthesis, alongside graphical representations (eg, table/bar charts/histograms), will be used to synthesise findings on methodologies and methods mapped onto the MRC framework.

This secondary analysis scoping review does not require ethics approval. Results will be disseminated through peer-reviewed publication(s), seminars, webinars, conferences, postgraduate dementia programmes, blogs, commissioner briefings and social media. The findings will provide a state-of-the-art overview of current practices; advance methods/methodology such as informing a Delphi consensus study on appropriate research approaches; and guide researchers in application of the MRC framework to widen the scope of dementia care evidence for practice improvements.

Submitted to Open Science Framework https://doi.org/10.17605/OSF.IO/S56NQ.

Hepatocellular carcinoma (HCC) recurs in most patients after curative treatment. Late recurrence (>2 years after curative treatment) typically indicates de novo tumours in the residual liver. Although contrast-enhanced computed tomography (CECT) and MRI are widely used for post-treatment follow-up, they each have limitations including radiation exposure, high cost and limited access. The abbreviated MRI using gadoxetic acid versus multiphasic CECT for detection of late recurrent HCC after curative treatment (AMRICT) trial aims to compare gadoxetic acid-enhanced abbreviated MRI using hepatobiliary phase imaging (HBP-AMRI) and multiphasic CECT for detecting late recurrent HCC after curative treatment.

This prospective multicentre intra-individual comparison trial will enrol 455 participants who have undergone surgical resection or local ablation for HCC and remained recurrence-free for over 2 years. Each participant will undergo two imaging sessions at 6±2 month intervals, using both HBP-AMRI and multiphasic CECT. The primary endpoint is the detection rate of all-stage HCC. The secondary endpoints include the false referral rate of all-stage HCC and detection and false referral rates of Barcelona Clinic Liver Cancer stage 0–A HCC and of stage 0 HCC. Structured imaging protocols and quality assessments will be implemented for both modalities.

This study was approved by the Institutional Review Boards of the three participating institutions (approval number: 2023–1630 (Asan Medical Center), H-2407-146-1556 (Seoul National University Hospital) and B-2410-929-401 (Seoul National University Bundang Hospital)) and registered at ClinicalTrials.gov (NCT06537193). Findings will be disseminated through peer-reviewed journals, scientific meetings, public forums and guideline updates.

ClinicalTrials.gov: NCT06537193. Participant enrolment began on 12 December 2024, and is ongoing.

This study applied a socio-material practice lens to examine health professionals’ responses to methanol poisoning in Bangladesh and to compare these practices with established guidelines.

This study employed a rapid ethnographic design.

Data were generated in primary-level, secondary-level and tertiary-level health facilities in six districts of western Bangladesh between September 2024 and May 2025.

We carried out semi-structured interviews with 50 health professionals with responsibilities for managing patients experiencing alcohol-related or poisoning-related conditions.

Among health professionals, the meanings of methanol poisoning as a diagnostic category, its symptoms and treatments are obscured by moral concerns about alcohol. Materials, including antidotes, for managing methanol poisoning were scarce, and health professionals reported using readily available medical supplies for supportive treatment, though not specifically adapted for methanol poisoning. Health professionals’ care practices for responding to methanol poisoning were often structured by these meanings and materials, with guidelines remaining largely invisible.

Socio-material practices of health professionals in response to methanol poisoning in Bangladesh are characterised by missed opportunities. Improving responses requires shifting the meanings of methanol poisoning as a diagnostic category, ensuring that materials such as treatment guidelines and appropriate antidotes, such as ethanol and fomepizole, are available and supporting providers to enact care practices that reflect these guidelines.

Pregnancy-related anaemia significantly affects human development across life stages. In sub-Saharan Africa (SSA), country-specific epidemiological variations primarily driven by nutritional practices, socioeconomic factors and health-system disparities contribute to heterogeneity in prevalence, severity and adverse birth outcomes (ABOs). While anaemia and micronutrient deficiencies in pregnancy are well studied globally, comprehensive trimester-specific evidence and their associations with ABOs in SSA remain scarce. This review, therefore, examines the breadth and nature of existing evidence on these associations within SSA, thereby updating current knowledge and informing regionally tailored interventions and future research.

A scoping review methodology will be employed due to the limited volume of literature addressing the specific research questions and population. The review will follow the Joanna Briggs Institute (JBI) framework, applying the population-concept-context approach. Comprehensive searches will be conducted across CINAHL, MEDLINE, Cochrane Library, Scopus, Google Scholar, EBSCO Open Dissertations and relevant organisational websites. The planned search period will span from 1 January 2016 to 31 December 2025. Two reviewers will independently screen and extract data using JBI-adapted protocols within the Rayyan review platform. Any discrepancies will be resolved via discussion with the research team. Findings will be synthesised narratively through descriptive content analysis and visual mapping.

This review will include peer-reviewed studies and grey literature that investigate the associations between anaemia or deficiencies in iron, folate and vitamin B₁₂ during pregnancy trimesters and ABOs in SSA. All relevant sources of evidence will be considered, regardless of study design or methodology, provided they report on women of reproductive age who experienced anaemia in any trimester and were subsequently identified with ABOs. Birth outcomes of interest include low birth weight, macrosomia, small or large for gestational age, preterm birth, post-term birth and stillbirth. Only sources published in English from 2016 onward will be included. The studies’ quality will be evaluated using Cochrane’s risk of bias assessment and mixed methods appraisal tools and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review.

This scoping review will not require ethical approval as it will synthesise published data and reports. It has been registered with the Open Science Framework. This review does not involve human participants. The final report will be submitted for publication in a peer-reviewed journal. The findings will be used to shape subsequent research, serving as a fundamental element of the evidence and knowledge mapping framework. As this study protocol was not reviewed by an ethics committee, the appropriate contact for research integrity matters is the Faculty of Health and Environmental Sciences, Auckland University of Technology.

This real-world study investigated the changes of lipid lowering therapy (LLT) usage in patients with high or very high cardiovascular (CV) risk in the UK and the group of all other European countries in the SANTORINI study up to 1 year from baseline and the impact this treatment had on the attainment of low-density lipoprotein cholesterol (LDL-C) risk-adjusted goals set by the National Institute for Health and Care Excellence (NICE) and those in the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines.

Secondary analysis of the SANTORINI dataset (an international, prospective, observational, non-interventional study (NCT04271280)).

Primary and secondary care centres in the UK and the group of other European countries (Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden and Switzerland).

663 UK patients with high and very high CV risk were included in this analysis and 8502 from the group of other European countries. Of these, 380 UK patients and 6830 from the group of other European countries had LDL-C information available at baseline and 1-year follow-up.

The primary objectives were to describe patients’ lipid management, LDL-C levels at 1-year follow-up and their attainment of 2023 NICE (≤2.0 mmol/L) and 2019 ESC/EAS LDL-C 2019 guideline-recommended LDL-C goals (

Over the course of 1-year follow-up, the overall proportion of UK patients on no LLT reduced from 20.4% at baseline to 7.1%, similar to that observed in the group of other European countries (baseline–20.9%, 1 year–3.0%). The proportion of UK patients receiving LLT monotherapy increased from 74.8% at baseline to 84.9%, higher at both time points than that observed for the group of other European countries (baseline: 52.0%, 1 year: 55.0%). The use of any combination therapy increased slightly from baseline to 1 year in the UK overall cohort (4.9% vs 7.1%) and overall in the group of all other European countries, the cohort increased from baseline (27.1%) to 1 year (40.2%). Overall, mean (SD) LDL-C levels in the UK were 2.5 (1.2) mmol/L at baseline and 2.1 (1.0) mmol/L at 1 year and for the group of other European countries were 2.4 (1.2) mmol/L at baseline and 2.0 (0.9) mmol/L at 1 year. The overall proportions of UK patients achieving the UK NICE treatment goal and ESC/EAS 2019 guidelines at baseline versus 1-year follow-up were 40.3% vs 52.6% and 22.9% vs 32.9%, respectively; 21.1% and 30.9% of patients in the group of other European countries achieved the ESC/EAS 2019 guidelines at baseline and 1-year follow-up, respectively.

In this UK-focused analysis of the SANTORINI study, use of LLT increased modestly over 1 year, accompanied by a reduction in average LDL-C levels. However, mean LDL-C remained above the NICE goal, and attainment of both NICE and ESC/EAS LDL-C thresholds remained suboptimal. The findings highlight continued opportunities to optimise lipid management in UK clinical practice, including the potential for broader use of combination therapies.

Numbers of ethnically diverse older adults are increasing in the UK. These individuals often have complex health problems that are exacerbated by language barriers (ie, limited English proficiency), acculturation experiences and socio-economic level. Further, this diverse group is also the most sedentary and least active subgroup in the wider population which raises major health issues. A number of interventions have been implemented to improve older adults’ physical activity and decrease their sedentary behaviour. Nevertheless, there is a lack of research examining how stakeholders’ perspectives can inform the transferability of interventions into the real-world particularly for ethnically diverse older adults. Therefore, the purpose of the current study was to explore the perspectives of stakeholders regarding the transferability of a 12-week intervention that aims to increase activity and decrease sedentary behaviour among ethnically diverse sedentary older adults.

A qualitative exploratory study employing reflexive thematic analysis was conducted using purposive sampling and in-depth interviews to recruit a diverse group of stakeholders representing varied professional roles, service delivery and organisational sectors related to older adults’ physical activity and well-being. The Population–Intervention–Environment–Transfer Model of Transferability (PIET-T) model served as a theoretical and conceptual framework for assessing the transferability of health interventions. Prior to the interview, the researcher explained the intervention study that was assessed in a prior feasibility study. This helped us identify stakeholder perspectives about potential challenges and practical considerations for transferring the intervention within existing policy and service frameworks. The primary researcher (NAAM) transcribed data from recorded interviews. Using reflexive thematic analysis, themes were generated from the data set and were interpreted using the PIET-T model.

The findings showed that different concepts of the PIET-T model influenced intervention transferability. The findings generated the following key themes: (1) User-centred and organisation supported programmes (Population), (2) intervention appropriateness and adaptations (Intervention), (3) organisational and system context (Environment) and (4) transferability and implementation factors (Transferability). Overall, the PIET-T model addresses key factors within each domain to facilitate the transferability of intervention.

Exploring diverse stakeholder perspectives was crucial for facilitating transferability and ensuring readiness for real-world implementation. Stakeholders suggested key modifications, including translated materials, adjusted duration, flexible digital delivery options and stronger collaboration with local organisations and healthcare systems to improve transferability among ethnically diverse older adults.

To describe the epidemiology, ecological determinants and public-health response to a yellow-fever (YF) outbreak in Wa East District (WED), Ghana, and to identify operational gaps to strengthen surveillance and immunisation in high-risk rural settings.

A cross-sectional descriptive outbreak investigation integrating epidemiological, entomological, vaccination-coverage and community knowledge assessments, conducted under Ghana’s Integrated Disease Surveillance and Response framework.

WED, located in the Upper West Region of Ghana, is an agrarian, forest-fringe area bordering the Mole National Park, characterised by limited access to health services and seasonal nomadic movements.

All suspected YF cases (N=57) reported between epidemiological weeks 41–46 of 2021; 50 community respondents interviewed for knowledge and awareness and 52 households inspected for entomological indices.

Demographic and clinical characteristics of cases, spatial–temporal distribution, vaccination coverage, Aedes vector indices, community knowledge and awareness levels and response interventions.

A total of 57 suspected cases (33 males 24 females) were identified, of which 12 (21.1%) were laboratory-confirmed. The case-fatality ratio among confirmed cases was 33.3% (95% CI 9.7% to 65.1%). Most cases occurred in individuals aged 6–30 years and were clustered in the Ducie community. The epidemic curve, based on confirmed cases, showed a single focal wave between epidemiological weeks 41 and 46 of 2021, peaking in week 45 and declining thereafter following intensified outbreak response activities, particularly surveillance and risk communication. Routine YF vaccination coverage was 25% before the outbreak, increasing to 95% after the mass campaign. The district’s composite risk score was 83%, indicating very high transmission risk. Entomological indices (House Index=48.5%, CI=36.1%, Breteau Index=159.6) exceeded WHO thresholds, confirming intense Aedes proliferation. Community awareness was low, with only 22% recognising the viral cause, 16% identifying mosquitoes as vectors and 10% knowing that vaccination prevents YF.

The outbreak reflected the convergence of ecological vulnerability, low baseline immunity and poor community awareness. Sustained high routine immunisation, structured Aedes surveillance and continuous risk communication are essential to prevent recurrence and advance Ghana’s commitment to the WHO Eliminate Yellow Fever Epidemics strategy.

To examine the metabolic syndrome (MetS) and its components as risk factors for a cardiovascular (CV) event, in individuals without diabetes and/or hypertension, and to explore which of the risk factors are the most predictive for cardiovascular disease (CVD) and whether the assessment of risk could be simplified.

A longitudinal, cross-sectional study.

A randomly selected population.

In 2002–2005, 2816 randomly selected residents of Skaraborg, Sweden, underwent physical examinations and blood tests as part of the Skaraborg Project. Exclusion of individuals with diabetes mellitus and/or hypertension at baseline left 2328 persons for analyses.

CV events were assessed in 2011 using national Swedish registers.

A total of 293 (13%) were defined as having the MetS according to the National Cholesterol Education Programme (NCEP) and 292 according to the International Diabetes Federation (IDF) definition, whereof 27 had a CV event after a mean follow-up time of 9.7 years. The MetS according to NCEP was significantly predictive of a CVD with an HR 2.4 (95% CI 1.4 to 3.9) but not according to the IDF definition. Blood pressure was significantly predictive according to both definitions (HR 1.77, 95% CI 1.06 to 2.97). Also, triglycerides (Tg) were significantly predictive for a CV event (HR 2.05, 95% CI 1.17 to 3.59). Neither waist circumference, high-density lipoprotein nor fasting plasma glucose was predictive for a CV event. Combining a blood pressure ≥125/≥80 mm Hg with Tg ≥1.5 mmol/L was predictive for CVD (HR 2.1, 95% CI 1.3 to 3.6) with a sensitivity of 32.5% and numbers needed to examine (NNE) 7.1. Lowering the cut-off for Tg to ≥1.2 mmol/L (HR 2.1, 95% CI 1.3 to 3.4) increased sensitivity to 44.9% and NNE became 8.

Using blood pressure combined with Tg was shown to be an equally good predictor for CVD as the complete MetS in individuals without diagnosed diabetes or hypertension. Therefore, healthcare personnel should pay attention to individuals with a borderline blood pressure, and if equivalent to or equal to 125/85, continue with measuring Tg for a discussion concerning lifestyle.

Enhancing Quality of Life for Individuals with Stroke (EQL-stroke) is an international, collaborative multiphase project aiming to strengthen supported self-management for older adults recovering from stroke at home in Sweden, Latvia and the Netherlands. Existing poststroke pathways may provide insufficient support for self-management during the transition from hospital to home, and there is limited evidence on interventions that integrate social networks and everyday environmental context.

EQL-stroke uses a participatory, multimethod design across three phases. Phase I generates knowledge through policy review, qualitative interviews and people–place mapping (~25 participants per country) and includes cross-cultural adaptation of the Collective Efficacy of Networks Scale. Phase II co-designs and specifies a tailored social network-informed supported self-management intervention (the Network-Based Intervention), including core components and principles for local adaptation (~15 participants per country). Phase III will recruit approximately 20–40 stroke survivors for a single-arm pilot feasibility study with an 8-week follow-up and embedded process evaluation to assess feasibility, acceptability and fidelity in routine practice.

Ethical approval has been obtained from the Swedish Ethical Review Authority (reg. no. 2025-00083-01), the Rīgas Stradina Universitāte Research Ethical Committee (reg. no. Rīgas Stradina Universitāte Research Ethical Committee) and the Research Ethics Committee of the Faculty of Spatial Sciences, University of Groningen (reg. no. 2025-07). Findings will be disseminated through peer-reviewed publications, stakeholder engagement activities and patient/public channels.

Leprosy is a chronic disease caused by the bacillus Mycobacterium leprae and remains a public health concern in endemic countries. Early diagnosis is fundamental to prevent transmission and irreversible disabilities. Histopathological identification of acid-fast bacilli in tissue specimens is traditionally considered the laboratory reference standard; however, its sensitivity is limited, particularly in paucibacillary forms. Immunohistochemistry (IHC) has been proposed as an adjunctive diagnostic tool for detecting M. leprae antigens in tissue samples, but its diagnostic accuracy has not been systematically synthesised. This protocol outlines a systematic review aimed at evaluating the sensitivity and specificity of IHC in the laboratory diagnosis of leprosy.

This systematic review of diagnostic test accuracy studies will include analytical observational studies and clinical trials evaluating IHC in human subjects with suspected leprosy. The reference standard will be defined as the identification of acid-fast bacilli in skin biopsy specimens from patients with compatible clinical presentation using conventional staining methods (eg, Fite-Faraco), with the exclusion of alternative mycobacterial infections when applicable. Searches will be conducted in PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Scopus, Web of Science and BVS/LILACS (Biblioteca Virtual em Saúde/Latin American and Caribbean Health Sciences Literature), as well as grey literature sources, at 31 May 2026. Two independent reviewers will perform study selection, data extraction using a standardised Microsoft Excel form and risk of bias assessment using the Quality Assessment of Diagnostic Accuracy Studies-2. Sensitivity and specificity estimates will be calculated. If appropriate, a bivariate random-effects meta-analysis will be conducted using RevMan (Review Manager) and Stata.

Ethical approval is not required because this study will use publicly available data. The results will be submitted to a peer-reviewed journal and presented at scientific conferences.

To identify key factors influencing the implementation of technology-enabled virtual wards (VWs), also known as hospital at home, drawing on the qualitative accounts of stakeholders involved in implementation, using the updated Consolidated Framework for Implementation Research (CFIR) as a guiding analytical framework.

Qualitative semi-structured interviews with implementation leads. All interviews were conducted online, using MS Teams or Zoom, between January–June 2024, and audio-recorded with consent. Audio-recordings were transcribed, anonymised and exported to NVivo V.12 Pro software for data management. The updated CFIR was used to guide thematic analysis of interview data.

Adult VW services in one regional health and social care system in North West England, UK.

Service implementation leads from 11 hospital sites providing adult VW services. Job titles and roles varied across sites and included both operational and clinical service leads.

20 interviews were conducted with 22 participants. Four implementation themes were identified: (1) complexity and adaptability: the ability to adapt the service to local conditions was valued by leads, but also contributed to wide variation in operational, clinical, workforce and digital components of VW models; (2) resource and infrastructure: workforce capacity was identified as a key implementation challenge along with information technology system capability and interoperability; (3) performance demands: leads were concerned that an excessive focus on bed numbers and occupancy levels, without accounting for patient acuity, could negatively affect implementation, straining the service and staff capacity; and (4) readiness for change: organisational and professional readiness for change was considered crucial for increasing referrals and enabling successful implementation, yet leads reported that the level of behavioural and cultural change required had been underestimated.

Implementation of a national VWs programme has resulted in wide service variation in one UK region, which raises questions about service equity and poses challenges for wider programme evaluation. Despite this variation, common factors found to help or hinder implementation have been identified. This study provides greater understanding of the factors that influence the implementation of VW services and outlines actionable insights to help refine VW strategies. These insights can support future planning and sustainability of technology-enabled inpatient-level care at home more widely.

Adolescent girls and young women (AGYW) living with HIV in Ghana face multiple intersecting forms of marginalisation. Beyond the clinical management of HIV, little is known about how they construct meaning, navigate identity and imagine their futures within structural contexts shaped by stigma, gender inequity, economic precarity and colonial legacies.

To explore how AGYW living with HIV in Ghana understand and negotiate their social identities in work and school. We then aimed to understand how their lived experiences at school and work are shaped by broader systems of power.

This qualitative study drew on semi-structured interviews with AGYW (ages 11–24, n=24) receiving HIV care in Kumasi, Ghana. Data were coded both inductively and deductively. Themes were interpreted through the Ghanaian context using intersectionality, Critical Disability Studies, spoiled identity theory and African feminist decolonial theory. The analysis was conducted iteratively and reflexively, with attention to positionality, gender and structural power dynamics.

Seven major themes were identified: (1) social support; (2) concrete plans for the future; (3) unattainability of the future; (4) coping via detachment; (5) need for privacy and confidentiality; (6) role as an arbiter of HIV information; and (7) financial stress. Across these themes, AGYW described dynamic processes of identity negotiation, moral and emotional labour and structural constraint. HIV was rarely the sole barrier. Rather, it intersected with gender norms, family dynamics, age hierarchies, economic marginalisation and misinformation to shape participants’ social worlds. Some participants coped through detachment or concealment, while others reclaimed agency through caregiving roles, education or aspirational goals.

AGYW living with HIV in Ghana are not only navigating a chronic illness but also resisting a layered matrix of social and structural injustice. Their stories reveal both vulnerability and strategic agency. Interventions and policy must go beyond biomedical care to address stigma, provide confidential and affirming school and work environments, and offer structural supports for emotional, educational and economic well-being.

To make informed health choices, and avoid waste and unnecessary suffering, people need critical thinking skills. However, like health interventions, educational interventions can have adverse effects. In this systematic review, the objective was to assess the extent to which researchers have included potential adverse effects in studies of interventions intended to improve the critical thinking of laypeople about health choices.

This study was a systematic review, in which we updated the search for an earlier systematic review of intended effects of relevant interventions. The earlier review did not address potential adverse effects. We did not update the analysis of intended effects.

We searched Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Epistemonikos, Medical Literature Analysis and Retrieval System Online (MEDLINE), Education Resources Information Center (ERIC) and Web of Science up to March 2025. In addition to studies from the original review and updated search, we included any additional studies included in a similar, even earlier review. Our unit of analysis was study report (eg, journal article).

We included all studies from the original review. We applied the same inclusion criteria to the results of the updated search: the study included a comparison, the population was laypeople and the intervention was intended to improve understanding of ≥1 key concept for informed health choices.

We extracted data about study design (randomised trial or other), participants (children, adolescents or adults), study setting (countries), main intervention (resources delivered to participants) and comparator (usual/no intervention or other). For the analysis, we extracted verbatim text describing any assessment of a potential adverse effect of the intervention. We conducted a narrative synthesis of the extracted data.

We included 35 reports of quantitative studies (including multi-method and mixed-methods studies). Most often, the study was a randomised trial, the setting was a high-income country, the population included adults (including university students) and the intervention was school-based (including university). In one of the 35 reports, authors described assessing a potential adverse effect.

To our knowledge, this is the first systematic review assessing the extent to which researchers have assessed adverse effects of any category of educational interventions. Our review shows that researchers generally have not assessed potential adverse effects of interventions to improve critical thinking about health choices. Researchers should pay more attention to such effects, while policymakers and educators making decisions about implementing relevant interventions should consider the lack of evidence. The findings of this study suggest a need for research that facilitates assessing potential adverse effects of interventions to improve critical thinking about health choices.

Inadequate emergence is a common postoperative complication in elderly patients following major abdominal surgery. This study was designed to determine its incidence, identify associated risk factors and characterise its clinical subtypes within this high-risk cohort.

This prospective single-centre cohort study was conducted at a comprehensive specialised tertiary care hospital in Northwest Ethiopia. Consecutive patients aged 65 years and older scheduled for elective major abdominal surgery under general anaesthesia were enrolled.

The primary outcome was the proportion of patients experiencing inadequate emergence.

A total of 388 patients were analysed. Inadequate emergence occurred in 21.9% of participants (95% CI 14.3% to 31.6%), with hypoactive emergence observed in 10.7% and emergence delirium in 11.2%. Multivariable logistic regression identified several independent predictors, including advanced age (adjusted OR (AOR)=1.9; 95% CI 1.5 to 8.2), preoperative anxiety (AOR=2.7; 95% CI 1.2 to 7.2), prolonged preoperative fasting (AOR=2.1; 95% CI 1.8 to 9.1), non-ketofol-based induction (AOR=3.4; 95% CI 1.6 to 6.3), absence of abdominal field block (AOR=4.2; 95% CI 4.0 to 9.6), substantial intraoperative blood loss (>1000 mL; AOR=1.9; 95% CI 1.2 to 7.6), postoperative nausea and vomiting requiring antiemetics (AOR=2.2; 95% CI 2.1 to 7.1) and presence of an indwelling urinary catheter (AOR=2.4; 95% CI 1.8 to 7.9).

Inadequate emergence occurred in approximately one in five elderly patients undergoing elective major abdominal surgery. Independent predictors included advanced age, major intraoperative blood loss, postoperative nausea/vomiting requiring antiemetics, non-ketofol-based induction, preoperative anxiety, absence of abdominal field block, presence of an indwelling urinary catheter and prolonged preoperative fasting.

Partners of cancer patients often show similar levels of distress like the oncological patients themselves, and they are a primary resource for the patient’s physical and emotional support. Integrating self-care in daily routines is applied as a treatment approach in cognitive behavioural therapy. Carrying out self-care in caring relatives prevents anxiety and depression, enhances health-related quality of life and reduces caregiver burden. So far, there is no instrument which assesses self-care specifically in partners of cancer patients. The aim of this prospective mixed-methods validation study is to develop and psychometrically evaluate a psychological self-reported questionnaire assessing self-care in partners of cancer patients (SC-PC questionnaire).

Recruitment of participants will take place online and offline across Germany, Austria and Switzerland. The data collection will be carried out via personal cognitive qualitative interviews and a web-based data assessment tool within four phases: (1) personal qualitative semi-structured interviews with n15 partners of cancer patients on self-care in different areas of life; (2) pretest of derived self-care items concerning feasibility, comprehensibility and completeness with n=3–5 (psycho-)oncological experts and n=20–30 partners of cancer patients; (3) pilot study with an exploratory factor analysis with n=300 partners of cancer patients, based on an expected initial item pool of approximately 30 items and a 10:1 item-participant ratio; and (4) main validation study with confirmatory factor analysis with n=400 partners of cancer patients, based on an expected final item pool of approximately 20 items and a 20:1 item-participant ratio. Subgroup analyses will be calculated with demographic and medical variables.

A project-specific concept for data protection was established. All legal and professional regulations will be complied with. In order to meet ethical standards and protect participants from potential emotional burdens during this mainly decentralised study, ethical guidelines for online studies were implemented in the study design. The study was approved by the ethics committee of the University of Ulm (number/ID of the approval: 230/25). Results will be presented at conferences and published in scientific peer-reviewed journals for broad reach. The resulting self-care questionnaire may be implemented as a new measurement instrument in research projects investigating psycho-oncological interventions for partners of cancer patients and the practical field of cancer counselling for progress assessment.

DRKS00038519.