The study evaluated the feasibility and efficacy of a non-immersive virtual reality (VR) system on upper extremity (UE) recovery in ischaemic stroke patients in comparison to a conventional physiotherapy.

An open-label, parallel-group, randomised controlled trial randomly assigned the participants to two groups, VR intervention or conventional physiotherapy.

Two tertiary stroke care centres in South India participated in the study.

Sixty first-ever ischaemic stroke patients (1–6 months of stroke onset) having spasticity grades of 1 or 1+ as per Modified Ashworth scale and Brunnstrom recovery stages of 3, 4 or 5 in the UE were included in the intention-to-treat analysis.

High-intensity non-immersive VR-based comprehensive rehabilitation gaming system with a duration of 12 weeks (3 days/week) was compared with equally intensive conventional physiotherapy.

The feasibility outcome was the compliance with the treatment. The primary efficacy outcome was the improvement in the motor function assessed by the Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT). The secondary outcomes included the performance in activities of daily living by the Barthel index (BI) and the quality of life by the 36-item short form health survey (SF-36).

The treatment compliance was similar in two groups (p=0.19). Both groups improved in motor performance, activities of daily living and quality of life. However, there were no significant differences in the FMA (p=0.58), WMFT (functional ability scale, p=0.33; performance time, p=0.44), BI (p=0.84) and SF-36 (physical, p=0.87; mental, p=0.99) scores between the groups.

The non-immersive VR system was feasible, effective and safe; however, it was not found to be superior to conventional physiotherapy. The trial was stopped early and did not reach its proposed sample size and hence, the findings are to be interpreted cautiously.

Clinical trial registry India: CTRI/2021/11/038339 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc1OTI=&Enc=&userName=CTRI/2021/11/038339).

This study assessed the associations between asthma, gastro-oesophageal reflux disease (GORD) and health-related quality-of-life (HRQoL) among adolescents.

A cross-sectional survey.

Six randomly selected schools across all five educational zones of the Anuradhapura district in Sri Lanka.

A total of 1127 adolescents aged 13–14 years were included from six randomly selected schools representing all five educational zones in the Anuradhapura district, Sri Lanka.

Prevalence of asthma and GORD, the associations between asthma, GORD and HRQoL among adolescents in Sri Lanka.

This study of 1127 adolescents (44.8% male, mean age 13.66±0.56 years) found that 16.1% (n=181) had current asthma and 17.9% (n=202) exhibited symptoms of GORD. A significant association was observed between current asthma and GORD (OR 2.30, 95% CI 1.59 to 3.31, p=0.0005). Comorbidity of asthma and GORD was observed in 4.8% of participants (n=54). The total HRQoL score was not associated with asthma, GORD or those having both asthma and GORD. However, the presence of GORD was associated with poor emotional functioning (unstandardized regression coefficient ± standard error = -4.7±1.7, p=0.008).

Asthma and GORD were significantly associated among early adolescents in Sri Lanka. While overall HRQoL did not differ by disease status, the presence of GORD was associated with poorer emotional functioning.

To estimate the treatment outcomes among individuals treated for hypertension in the public sector in 89 districts across 15 states in India and to identify the risk factors for uncontrolled blood pressure (BP).

An analysis of a cohort of people with hypertension from 2018 to 2022 from public sector health facilities.

All India Hypertension Control Initiative (IHCI) implementing districts using digital information systems across 15 states of India, namely Andhra Pradesh, Bihar, Goa, Gujarat, Jharkhand, Karnataka, Maharashtra, Nagaland, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, Uttar Pradesh and West Bengal.

Individuals aged 30 years or older, who were diagnosed with hypertension or on medication at the time of registration between 1 January 2018 and 31 December 2021 were included in the study.

Treatment outcomes were controlled BP, uncontrolled BP and missed visits in the reporting quarter (1 January 2022–31 March 2022). We analysed the risk factors for uncontrolled BP.

Out of 1, 235, 453 hypertensive individuals enrolled in the IHCI project across 15 states, 1, 046, 512 remained under care, with 44% BP control. The control varied from 26% to 57% in various types of facilities. The states of Maharashtra, Punjab and Rajasthan had above 50% control, while Nagaland, Jharkhand and Bihar had below 25%. BP control declined from 68% when defined using a single recent reading to 52% when defined using the two-visit readings. Younger individuals (

We documented the implementation of IHCI strategies at scale and measured treatment outcomes in a large cohort. Overall, BP control improved with variations across states. We need focused strategies to improve control in higher-level facilities, among males and people with diabetes. Using two BP readings may support consistent treatment adherence.

To examine state-level variation in mental health screening practices for high school athletes in the USA and evaluate associations between screening protocols and adolescent depression-related and suicide-related outcomes.

Cross-sectional study of preparticipation examination (PPE) forms and Youth Risk Behaviour Surveillance System (YRBSS) data.

High school athletics across all 50 US states and the District of Columbia.

732 676 high school students who completed the 2021 YRBSS survey (grades 9–12).

Prevalence of depressive symptoms and suicide-related behaviours, measured using YRBSS items on sadness/hopelessness, suicide ideation, planning, attempts and suicide attempts resulting in injury. State-level PPE forms were reviewed for presence and depth of mental health screening, including Patient Health Questionnaire-4 (PHQ-4) and eating disorder (ED) risk questions.

Screening practices varied widely, ranging from no mention of mental health in some states to required evaluations with formal referral protocols in others. Of 732 676 students, 503 861 (68.7%) reported feeling sad or hopeless, 608 416 (83.0%) seriously considered suicide and 64 072 (8.8%) attempted suicide in the past year. States with required screening protocols had higher reported rates of depressive symptoms (71.0% vs 68.7%, p

High school athletes represent a vulnerable group in need of structured and standardised mental health screening. State-level screening policies were associated with lower suicide attempt rates, though causal inference is limited by the cross-sectional design. Standardised use of validated mental health tools may support early identification and intervention for at-risk adolescents.

Peer support in youth mental health settings holds promise as a developmentally appropriate and impactful initiative; however, research exploring implementation remains limited. To advance the field and strengthen future implementation efforts, the aim of the present study was to generate new understandings about how non-peer service providers working alongside youth peer support workers experience the peer support role in youth mental health settings.

Guided by interpretive description and tenets of a research community partnership model, semi-structured interviews were conducted with non-peer service providers (n=11) across three integrated youth services centres in British Columbia, Canada, from August to December 2020. Data were analysed inductively using a constant comparative approach to identify and construct themes.

Participants emphasised integration and supervision of youth peer support workers as essential for successful peer programming within integrated youth services, highlighting three interconnected themes: defining supervisory roles, envisioning role clarity and capacity and governance of youth peer support services.

Integrated youth services initiatives and peer-led agencies can play key roles—both directly and indirectly—to strengthen the governance and infrastructure of youth peer support.

High quality handover is critical for patient safety and care continuity. Existing practice is based on a weak evidence base in which the patient voice is poorly captured. The aim of this study was to identify outcomes of importance to patients, families and carers regarding interventions to improve in-hospital handover between healthcare practitioners.

A rapid systematic review of qualitative literature was carried out after prospective registration with PROSPERO and was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines.

The Ovid MEDLINE database was searched.

Qualitative or mixed-methods studies reporting patient, family or caregiver perspectives on in-hospital handovers were eligible for inclusion.

Synthesis was informed by the best-fit framework approach using a published taxonomy of handover-related outcomes and the Core Outcome Measures in Effectiveness Trials taxonomy. Outcomes were reported according to two distinct types of handover: bedside (patient-involved) and provider-focused (patient-uninvolved).

A total of 34 studies, including 1262 participants across a range of specialties and predominantly high-income settings, were analysed. 53 bedside and 31 provider-focused handover outcomes were identified according to four domains; adverse events, quality of patient care, quality of handover and patient/caregiver satisfaction. Bedside handover studies frequently reported outcomes relating to patient engagement and communication with healthcare staff. One study was carried out in a low income country; however, outcomes identified were broadly similar.

These findings expand the known outcomes for evaluating handover interventions and highlight the importance of prioritising the patient and public perspective in research. This work will contribute to developing a core outcome set for trials in surgical handover but can also be applied to handover practices for any other discipline within the hospital environment.

CRD42023493367.

While previous studies have shown an association between anti-Mullerian hormone (AMH) levels and endometriosis, there are limited data on the relationship between AMH levels and age among women with endometriosis.

The present study aimed to investigate the associations between age and AMH levels in women with and without endometriosis.

A cross-sectional, population-based study using data from the ongoing Tehran Lipid and Glucose Study.

A total of 1005 eligible reproductive-age women were selected. These participants were categorised into two groups: women with confirmed endometriosis (n=305) and controls (n=700).

None.

Association between AMH levels and age among women with endometriosis and healthy controls, using linear, quadratic and segmented regression analyses.

A total of 1005 women aged 18–48 years participated in the study, including 305 (30.3%) with endometriosis and 700 (69.7%) healthy controls. Women with endometriosis had significantly lower AMH levels compared with healthy controls (1.99±1.42 vs 2.30±1.61 ng/mL; p=0.029). In healthy controls, an increase of 1 year was associated with –0.15 ng/mL of AMH (95% CI: –0.17 to –0.14). Segmented regression identified a threshold at 27 years (1.92), with a sharper decline below this age (slope: –0.35, 95% CI: –0.47 to –0.23; p

Our study showed that women with endometriosis had significantly lower AMH levels compared with healthy controls and did not demonstrate the age-related threshold observed in the control group, where AMH levels declined more sharply before 27 years of age. These findings suggest that endometriosis may alter the typical pattern of AMH, indicating that clinicians should interpret AMH levels with caution in this population. Further research is needed to validate these results in other populations and explore alternative biomarkers or strategies for more accurately assessing ovarian reserve in women with endometriosis.