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

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

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

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

COVID-19 pandemic affected physical, psychological and social well-being of many individuals, including healthcare workers, who were at the forefront of the pandemic. Thus, the pandemic may have reduced the sexual quality of life of frontline healthcare workers, which in turn could compromise their ability to provide quality healthcare to patients. This scoping review aims to gather and synthesise current available global evidence on the interactions among COVID-19, sexual quality of life and healthcare delivery among healthcare workers.

The JBI framework for performing scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Reviews (PRISMA-ScR) guided the conduct of this scoping review. A search strategy was developed and will be implemented in five major databases, including PubMed, SCOPUS, JSTOR, Dimensions AI and CENTRAL. Additional records will be obtained via Google, Google Scholar, WHO IRIS, ProQuest Dissertations and Theses Global, as well as reference lists of selected full-text studies, ending in January 2026. Eligible studies will include original peer-reviewed articles conducted among healthcare workers that examine how COVID-19 affected their sexual health and how this, in turn, influenced their healthcare delivery. The data will be extracted and charted using predetermined criteria to completely understand the relationship between COVID-19-induced psychological distress and sexual health among healthcare workers. Using a narrative synthesis and thematic analysis, the findings from the selected studies will then be summarised and synthesised.

Since primary data would not be collected for this study, ethical approval will not be needed. The study’s findings will be derived from publicly accessible documents and previously published articles. The findings of the review will be submitted for publication in a peer-reviewed journal and presented at conferences and workshops.

The scoping review protocol has been registered with the Open Science Framework (https://osf.io/2yjkx).

Phase-specific fever management (ie, tailoring care to the rising, plateau and defevering stages of fever) and the cautious use of evidence-based natural medicinal products (NMPs, eg, herbal preparations with demonstrated evidence of safety and effectiveness) are hypothesised to reduce antibiotic (AB) use for acute, uncomplicated upper respiratory tract infections (URTIs). The objective of the trial is to investigate the effects of a parental phase-specific FeverApp and an NMP WebApp on AB use, the number of primary care visits and the gut microbiota of children with acute, uncomplicated URTIs.

The study design is a randomised controlled trial with three arms: a FeverApp group, an NMP WebApp group and a control group. Participants are parents of children aged 3 months to 12 years with fever (≥38°C) and symptoms of an acute, uncomplicated URTI. Parents (n=320) will complete a baseline questionnaire and collect a baseline stool sample from their child. The intervention groups then use one of the apps, and all parents report URTI symptoms of their child on days 2, 5 and 7. On day 10, they complete a follow-up questionnaire, and they collect a second stool sample from their child. The FeverApp contains evidence-based information about fever and how to manage it, tailored fever advice and an option to monitor a child’s health status during a fever episode. The NMP WebApp is an evidence-based online decision-making tool that helps parents navigate the use of NMPs with reported safety and effectiveness for URTI symptoms. The primary endpoint is AB use, and secondary endpoints include recovery time, complications/adverse events, the number of primary care visits/telephone consultations and changes in gut microbiota composition. Participants were recruited nationwide (urban and rural) via online advertising and community flyers.

A waiver was obtained from a recognised Institutional Review Board, participants signed for informed consent, and all data are pseudonymised and stored securely. Results will be published in scientific, peer-reviewed journals.

NCT06140446 (www.clinicaltrials.gov).

The study by Goto et al screened adolescents across Ukraine for mental health consequences of war.1 These adolescents had a range of exposures to the Russian invasion beginning in early 2022 and completed self-report symptom questionnaires. Prior studies cited in the article suggested that children and adolescents may be especially vulnerable to war-related mental health problems. Given the difficulties of conducting research during ongoing hostilities, this study’s efforts to collect and systematically evaluate a large research...

In the Netherlands, approximately 2200 major amputations of the lower extremities are performed each year, the majority in vascular patients. Around 61% of these patients will develop postamputation pain (PAP). PAP is a severe, lifelong, disabling condition profoundly affecting quality of life. During amputations, the common practice is to cut the nerves without employing nerve-surgical techniques to prevent chronic pain due to neuroma formation. In recent years, targeted muscle reinnervation (TMR) has been the most frequently studied technique for treating PAP, inhibiting neuroma formation by rerouting the cut mixed nerve to a functional motor nerve. We hypothesise that a primary TMR procedure during major lower limb amputations will result in a lower prevalence of PAP.

We propose a national, multicentre, randomised, sham-controlled trial comparing TMR with traction neurectomy in major amputations of the lower extremities in patients with vascular disease. 203 patients will be recruited with an indication for a transfemoral to transtibial amputation as a primary or secondary sequela of vascular disease. The subjects are randomly assigned to the TMR group or the traction neurectomy group. PAP will be evaluated 1 year postoperatively as the primary endpoint. Secondary outcomes include quality of life, mobility, neuropathic pain, hospital anxiety and depression, cost-effectiveness and complications.

This study has been reviewed and approved by the local ethical review body, ‘The Medical Ethics Committee Leiden The Hague Delft’, under the reference: P24.073 on 28 November 2024. Results will be published in peer-reviewed journals.

NCT06719245. Dutch trial registry: NL87196.058.24

Mental health issues such as depression and anxiety are highly and disproportionally prevalent among university students. Beyond the academic rigour, stressors imposed by a new environment result in them being vulnerable to the onset and manifestation of mental health symptomatology. Leveraging smartphones and wearables for digital phenotyping capabilities is an innovative approach for monitoring and intervening in the mental health conditions of university students. This provides a unique opportunity to collect and identify digital and behavioural biomarkers, subsequently enabling the development of predictive models to identify university students at risk.

This study—Brightline—will employ an observational study design over a 6-month period, recruiting 500 students from a major public university in Singapore. Passive data collection will occur continuously throughout the monitoring period through a wearable device (Fitbit Charge 6) and smartphone sensors via the Brightline app, which uses a digital phenotyping data collection platform. Active data collection will consist of self-report questionnaires to be completed at the beginning of the study and follow-up assessments at 1, 3 and 6 months after. The passive and active data collected will be analysed to identify the digital biomarkers associated with depression, anxiety, stress, loneliness and affect among university students. Predictive models of these mental health issues will also be developed.

This study was approved by the Nanyang Technological University Institutional Review Board (IRB-2023-894). Findings from this study will be published in peer-reviewed journals and presented at academic conferences.

NCT06770075.