IgG4-related disease is a chronic fibroinflammatory disease with multiorgan involvement. Glucocorticoids and/or immunosuppressants as well as rituximab are both first-line treatments in remission induction therapy. However, relapse is common during the maintenance period, particularly in patients with re-elevation of serum IgG4 level. This study aims to evaluate whether adding mycophenolate mofetil (MMF) during the maintenance phase for such patients can reduce the risk of disease flare.

This study is a multicentre, randomised, double-blind, placebo-controlled study. A total of 108 eligible patients with re-elevation of serum IgG4 level during maintenance therapy will be included in this study and randomised in a 1:1 ratio to receive add-on MMF 0.5 g one time per day or placebo for 52 weeks. The primary outcome is the proportion of patients experiencing relapse at week 52. Secondary outcomes include time-to-relapse, changes in disease activity and serum IgG4 level, stratified relapse rate according to the elevation level of IgG4. Analyses will follow the intention-to-treat principle.

The study has been approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (approval no. K3231). Written informed consent will be obtained from all participants before enrolment. Findings will be disseminated through peer-reviewed journals and conference presentations.

NCT05974683.

To evaluate the impact of intradialytic exercise (IDE) on cardiovascular structural and functional parameters in patients receiving maintenance haemodialysis (MHD).

A systematic review and meta-analysis.

PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials were searched from inception through January 2026.

Randomised controlled trials (RCTs) involving adults receiving MHD who underwent structured IDE versus usual care or non-exercise controls and reported cardiac, vascular or cardiorespiratory outcomes.

Two independent reviewers performed literature screening, data extraction and outcome-level risk of bias assessment using the Cochrane Risk of Bias 2 (RoB 2) tool. Random-effects models were used to pool mean differences (MDs) and 95% CIs. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Fourteen studies involving 934 participants were included. IDE increased left ventricular end-diastolic volume (3 studies, 213 participants; MD 14.15 mL, 95% CI 2.06 to 26.24; p=0.022), improved left ventricular ejection fraction (LVEF) (6 studies, 396 participants; MD 2.21%, 95% CI 0.28 to 4.15; p=0.025), reduced pulse wave velocity (PWV) (4 studies, 211 participants; MD –1.36 m/s, 95% CI –2.58 to –0.13; p=0.031) and increased peak oxygen uptake (Peak VO₂) modestly (6 studies, 583 participants; MD 2.76 mL/kg/min, 95% CI 0.08 to 5.43; p=0.044). Diastolic blood pressure (DBP) was reduced (4 studies, 221 participants; MD –4.54 mm Hg, 95% CI –7.57 to –1.51; p=0.003). No significant differences were observed for left ventricular mass index (LVMI) (5 studies, 258 participants; MD –1.19 g/m², 95% CI –5.63 to 3.24; p=0.597) or systolic blood pressure (SBP) (4 studies, 221 participants; MD –8.76 mm Hg, 95% CI –20.38 to 2.86; p=0.139). Outcome-level risk-of-bias assessments predominantly showed some concerns, with high risk identified for individual contributing results. Heterogeneity was substantial for Peak VO₂ (I²=90.07%) and SBP (I²=73.20%). Certainty of evidence was moderate for LVMI, LVEF, PWV and DBP and low for the remaining outcomes.

IDE may improve cardiovascular function, arterial stiffness and cardiorespiratory fitness in patients receiving MHD. Effects on LVMI and SBP remain uncertain. Certainty of evidence ranged from moderate to low, and risk-of-bias concerns and substantial heterogeneity for some outcomes warrant cautious interpretation.

CRD420261336421.

To assess the implementation of infection prevention and control (IPC) measures and associated factors in healthcare in low-resource settings during the COVID-19 pandemic.

Multinational cross-sectional study.

The study was conducted from February to November 2022 in Côte d’Ivoire, Democratic Republic of Congo, Madagascar and Nigeria.

A total of 6749 healthcare workers (HCWs) at 324 healthcare facilities (HCFs) were enrolled from different levels of care and types.

Standardised HCW and HCF questionnaires assessed COVID-19-related exposures and IPC measures and descriptive analyses were conducted overall and by country and HCF. Partial proportional odds models were used to assess factors associated with HCW compliance to hand hygiene and mask wearing.

Among 324 HCFs, the reported presence of IPC programmes ranged from 51.4% (n=111) at primary non-hospitals to 83.3% (n=18) at tertiary HCFs. More than half reported no patient or HCW screening (57.4%, n=186). Only 19.8% (n=64) reported handrub at point of care in every room. Among 6749 enrolled HCWs, 54.0% were working in high-risk patient care. More HCWs reported sufficient availability of masks (62.7%, n=4231) compared with respirators (28.5%, n=1926). HCW compliance with hand hygiene and mask wearing, respectively, was improved by presence of an IPC programme (OR: 1.3, 95% CI 1.2 to 1.5; OR: 1.4, 95% CI 1.2 to 1.6), IPC training received by the HCW (OR: 1.5, 95% CI 1.3 to 1.7; OR: 1.3, 95% CI 1.2 to 1.5) and availability of handrub and masks, respectively (OR: 5.9, 95% CI 4.1 to 8.4; OR: 2.3, 95% CI 2.0 to 2.7).

We conducted a large survey including HCFs across levels of care and type in urban and rural regions in sub-Saharan Africa. Critical gaps in IPC programmes and access to IPC equipment during the COVID-19 pandemic hindered HCW compliance with recommended IPC practices. To improve general infection control and pandemic preparedness in low-resource settings, continued focus on strengthening IPC programmes and ensuring access to materials/equipment is essential.

Lung cancer is the leading cause of cancer-related death worldwide, with substantial variations in incidence, stage at diagnosis and outcomes across regions. High-quality, standardised diagnosis and treatment are essential to improving survival and quality of life. Multidisciplinary care (MDC) is a cornerstone of cancer care; however, its implementation faces barriers such as limited resources, uneven policy support and inequitable access to specialised care, particularly in low- and middle-income countries. To date, no global scoping review has systematically mapped lung cancer MDC—covering implementation models, facilitators, barriers, policy frameworks, technology integration and evidence gaps. This review seeks to fill that gap and inform the optimisation of MDC models.

The Joanna Briggs Institute methodological framework, underpinned by the framework of Arksey and O’Malley and enhanced by Levac and colleagues, will be used for this scoping review. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR). We will perform a comprehensive search of six electronic databases (PubMed, CINAHL, Scopus, CNKI, VIP and WanFang) and grey literature sources (ClinicalTrials.gov). In addition, we will screen the reference lists of included studies for further relevant publications. Two review authors will independently conduct the screening and data extraction processes; discrepancies will be resolved through consensus or discussion with a third review author. Findings will be presented graphically and tabularly, together with a narrative description.

We will collect all data from published and grey literature, meaning ethical approval is not necessary. To disseminate our findings, we plan to use diverse means, such as publishing in peer-reviewed journals and presenting at academic conferences.

https://doi.org/10.17605/OSF.IO/MVSPH.

Chronic kidney disease (CKD) is frequently accompanied by nutritional imbalance, inflammation and metabolic disturbance. Single-marker assessment may not capture the multidimensional nutritional heterogeneity of CKD. This protocol aims to derive nutritional phenotypes in adults with CKD and examine their cross-sectional associations with prevalent anaemia and metabolic abnormalities.

This single-centre study comprises an electronic health record (EHR)-based retrospective baseline cross-sectional cohort and a prospective continuous-enrolment baseline extension for standardised measurements. Retrospective records will be deterministically linked at the person level across the hospital information system, laboratory information system and dialysis system using a shared hospital patient identifier. Adults aged 18 years or older with CKD confirmed using Kidney Disease: Improving Global Outcomes (KDIGO)-based criteria will be included. The common-core phenotype will be derived from body mass index, serum albumin, ferritin and 25(OH)D. Haemoglobin, lipid measures, glycated haemoglobin and fasting plasma glucose will be used only for outcome ascertainment and descriptive characterisation, not for latent phenotype derivation. C reactive protein and/or the NLR will be examined as complementary inflammation-related variables in covariate, effect-modification and sensitivity analyses. Waist circumference and standardised body-composition measures will inform a prospective subcohort specific extended phenotype framework. Bayesian latent class/profile models will identify phenotypes, and Bayesian regression models will estimate their associations with prevalent anaemia, dyslipidaemia and prevalent diabetes or diabetes-level hyperglycaemia while propagating phenotype-classification uncertainty. Missing data will be handled according to variable role. Pooled cross-phase analyses will be restricted to the common-core variable framework, with extended phenotyping limited to the prospective subcohort.

The study was approved by the Ethics Committee of Cangzhou Central Hospital (approval No. 2025–286-02). The retrospective component will use de-identified EHR data under an approved waiver of individual informed consent, whereas written informed consent will be obtained for the prospective component. Findings will be disseminated through peer-reviewed publications and academic conferences.

Open Science Framework: 10.17605/OSF.IO/FZ65E.

The increased resources available to improve the population’s sexual and reproductive health do not always reach migrant women equally. This is relevant in a context where 26.6% of births in 2024 were to foreign-born mothers. The objective of this study is to analyse the adherence among the migrant population in the autonomous region of the Basque Country (Spain) to the established protocols for pregnancy, childbirth and postnatal care, as well as their use of health services. In addition, it aims to identify the barriers and facilitators that influence their access to and continuity of care.

This mixed-methods study comprises two phases: (a) a population-based, descriptive, retrospective study using data from the routine monitoring of health programmes for women who gave birth during 2024 in the Basque Country. Variables related to the women’s characteristics, healthcare utilisation, and the course of pregnancy, childbirth and the postnatal period will be analysed. The analysis will include descriptive statistics, bivariate techniques and multivariate modelling; (b) a qualitative study using focus groups. At least five focus groups will be organised to ensure representation by continent and country of origin. These groups will explore experiences and perceived barriers related to the adaptation of sexual and reproductive health self-care practices to the healthcare system among migrant women. The sessions will be audio-recorded, transcribed verbatim, coded and categorised to develop a conceptual framework that will later be analysed with the text.

The study has been approved by the Basque Country Ethics Committee. Informed consent will be obtained from all participants for the collection of primary data, and participants may withdraw from the study at any time without consequence. Authorisation has also been granted by the Basque Health Service Directorate to access recorded data, which will be provided in anonymised form, ensuring that individuals cannot be reidentified. Findings will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.

Oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) present a remarkable public health challenge worldwide. They are the leading causes of cancer-related morbidity and mortality in low-resource regions. In rural and underserved populations, access to diagnostic facilities is limited, and delays in confirmation often result in late-stage presentations. Field screening camps frequently serve as the first and sometimes only point of contact for many at-risk individuals; however, conventional cytology relies on laboratory infrastructure and specialist review, making same-visit diagnoses unfeasible. Recent advances in artificial intelligence-driven systems have created opportunities for point-of-care (PoC) diagnosis, enabling real-time disease detection and triage directly in community settings. This study aims to develop and clinically validate a convolutional neural network (CNN)-enabled PoC cytology device for real-time screening of OPMDs such as leukoplakia, oral submucous fibrosis, erythroplakia and OSCC in community field settings, following Standards for Reporting Diagnostic Accuracy Studies 2015 (STARD) and Standard Protocol Items: Recommendations for Interventional Trials 2013 (SPIRIT) guidelines.

This diagnostic accuracy study will evaluate an artificial intelligence (AI)-based PoC cytology screening tool for OPMDs and OSCC. A total of 900 participants (360 retrospective, 540 prospective) will be included to ensure adequate representation of normal, OPMDs and OSCC cases for both model development and clinical validation. Retrospective smears will be used to train and internally validate a deep learning CNN to classify smears as low-risk or high-risk. All slides will be independently reviewed by two blinded cytopathologists, with a third adjudicator resolving disagreements; inter-rater reliability will be assessed using Cohen’s kappa. Prospective validation will be evaluated in patients with clinically suspicious lesions against AI predictions with cytopathologist review and histopathology when available. Diagnostic performance will be assessed using sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve, which will be calculated. Secondary outcomes are concordance with expert cytology, turn-around time and operational feasibility.

The protocol adheres to the Central Ethics Committee on Human Research ethical guidelines and has received institutional ethical approval from Datta Meghe Institute of Higher Education and Research (Deemed University) with the reference no. DMIHER (DU)/IEC/2024/18. Written informed consent will be obtained before recruitment.

The results will be published in peer-reviewed scientific journals and presented at national and international conferences.

CTRI/2025/01/079408.

To examine the association between caffeine citrate administration and necrotising enterocolitis (NEC) in very preterm infants (VPIs).

A multicentre retrospective cohort study.

Level III neonatal intensive care units participating in the Chinese Neonatal Network.

The participants comprised neonates with a gestational age of under 32 weeks.

Exposure to caffeine citrate administration after birth.

Primary outcome measures were the incidence of NEC (≥stage IIA) and surgical NEC. Secondary outcome measures included severe neonatal morbidities, including severe intraventricular haemorrhages, severe retinopathy of prematurity, late-onset sepsis, bronchopulmonary dysplasia, death, duration of parenteral nutrition and length of neonatal intensive care unit stay.

A total of 45 624 VPIs were included. Among 36 514 who received at least one dose of caffeine citrate, 2315 (6.3%) developed NEC (≥stage IIA) and 849 (2.3%) experienced surgical NEC. Among 9110 VPIs without caffeine exposure, 544 (6.0%) developed NEC (≥stage IIA) and 263 (2.9%) experienced surgical NEC. Caffeine citrate exposure did not affect the incidence of NEC (≥stage IIA) between groups (adjusted OR (aOR), 1.01; 95% CI 0.83 to 1.24; adjusted absolute risk (aAR), –0.15; 95% CI –1.21 to 0.92); however, its early administration (within 72 hours after birth) was associated with a lower incidence of surgical NEC (aOR, 0.76; 95% CI 0.64 to 0.89; aAR, –0.92; 95% CI –1.55 to –0.29). In subgroup analysis, caffeine citrate administration was associated with a reduction in the incidence of NEC (≥stage IIA) among VPIs receiving invasive ventilation at admission (aOR, 0.8; 95% CI 0.67 to 0.94; aAR, –2.04; 95% CI –3.82 to –0.25) and vasopressors before NEC occurred (aOR, 0.64; 95% CI 0.52 to 0.78; aAR, –5.17; 95% CI –7.94 to –2.39).

While the incidence of NEC (≥stage IIA) in VPIs has not been affected by caffeine citrate, early administration (within 72 hours after birth) was associated with a reduced incidence of surgical NEC. Furthermore, among VPIs who received invasive ventilation at admission and vasopressors, the administration of caffeine citrate was potentially correlated with a decreased occurrence of NEC (≥stage IIA).

To examine the association between baseline sleep quality and subsequent glycaemic outcomes in adults with type 2 diabetes mellitus (T2DM), using repeated fasting blood glucose measurements and longitudinal glycaemic pattern analyses.

Prospective cohort study.

The Taizhou Diabetes Family-based Cohort in Zhejiang Province, China.

A total of 1421 adults with T2DM with baseline sleep quality assessment and follow-up fasting blood glucose measurements were included.

Baseline sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Follow-up fasting blood glucose measurements were obtained through 30 June 2025. The primary outcomes were continuous fasting blood glucose levels and binary fasting blood glucose status defined as ≥7.0 mmol/L during follow-up. Secondary outcomes included glycaemic variability and latent glycaemic trajectory classes.

Poorer baseline sleep quality was associated with less favourable glycaemic outcomes during follow-up. In the fully adjusted model, each 1-point increase in PSQI score was associated with a 0.096 mmol/L higher fasting blood glucose level (95% CI 0.081 to 0.111), and poor sleep quality was associated with a 0.669 mmol/L higher fasting blood glucose level (95% CI 0.547 to 0.791). For the binary outcome, each 1-point increase in PSQI score was associated with higher odds of fasting blood glucose ≥7.0 mmol/L (OR 1.10, 95% CI 1.08 to 1.12), and poor sleep quality was associated with 1.61-fold higher odds of fasting blood glucose ≥7.0 mmol/L (95% CI 1.37 to 1.91). Higher PSQI scores were also associated with greater glycaemic variability and higher odds of membership in less favourable glycaemic trajectory groups.

Among adults with T2DM, poorer baseline sleep quality was associated with higher fasting blood glucose levels, poorer glycaemic control, greater glycaemic variability and less favourable long-term glycaemic trajectories. These findings suggest that sleep quality may be a relevant and easily assessable marker for identifying individuals at risk of suboptimal long-term glycaemic management.

To evaluate the availability of mental health services and resources across a stratified multistage sample of care and treatment clinics (CTCs) delivering HIV care from eight geographical zones of Tanzania.

Cross-sectional facility-based baseline survey.

81 CTCs representing national geographical zones and service delivery tiers.

Health facility in-charges or service providers with knowledge of HIV/non-communicable disease (NCD) services (Tier 1: n=11; Tier 2: n=13; Tier 3: n=9; Tier 4: n=48).

Availability of (1) trained mental health professionals, (2) screening/assessment tools for mental health and (3) educational materials.

Mental health services were unevenly distributed across facility tiers. Over half of Tier 1 facilities reported having trained mental health professionals (6/11; 54.5%) and screening tools (6/11; 54.5%), compared with only 35.4% (17/48) and 2.1% (1/48), respectively, in Tier 4 facilities. No Tier 2 or Tier 3 facilities reported availability of trained staff or screening tools. Educational materials were present in only 18.2% (2/11) of Tier 1 facilities and 8.3% (4/48) of Tier 4 facilities. Overall, more than two-thirds of facilities lacked any mental health resource assessed.

Mental health services remain limited across all facility levels, with nearly complete absence at lower-tier facilities. Urgent investment is required to integrate mental health into HIV and NCD care, especially at primary care settings.

This study aims to explore use trajectories of rehabilitation services among ageing Canadians (45–85 years) with osteoarthritis.

We will conduct a population-based cohort study using data from the Canadian Longitudinal Study on Aging (CLSA). We will describe rehabilitation use among respondents with osteoarthritis of the knee, hip or hand at baseline, 3-year and 6-year follow-up. Rehabilitation service use is measured via a single self-reported item capturing contact with a physiotherapist, occupational therapist or chiropractor in the past 12 months. We will use latent class growth analysis to identify 6-year trajectories of rehabilitation use, assigning participants to a single trajectory based on their highest probability of trajectory membership. All analyses will be stratified by income and within each income bracket by sex, gender and age. CLSA sampling weights will be applied to produce population estimates.

Ethics approval for this study was obtained from the Research Ethics Board of Western University (REB #128991), Ontario Tech University (REB #17980) and the Canadian Memorial Chiropractic College (REB# 242014). Informed consent was obtained from all CLSA participants at the time of recruitment. Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences, with relevance for researchers, clinicians and policymakers working to improve equitable access to rehabilitation for ageing Canadians.

Cardiac arrest (CA) remains a major health burden with poor survival and poor neurological outcomes despite decades of advances in resuscitation science. Although high-quality cardiopulmonary resuscitation is essential, it provides only limited cerebral and coronary perfusion, and current strategies relying on high-dose epinephrine may adversely affect cerebral microcirculation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a potential adjunct to improve coronary and cerebral perfusion without compromising microvascular blood flow. Although animal studies and small human case series suggest physiological and clinical benefits of REBOA in CA, randomised clinical trials are lacking.

This prospective, randomised controlled, single-centre clinical trial investigates the effect of REBOA during the treatment of CA. The planned study duration is 36 months, with a total of 98 patients to be randomised to either standard advanced life support (ALS) or ALS plus REBOA. Adult patients with an in-hospital CA, successful placement of a femoral artery introducer sheath and any electrical cardiac activity in the initial rhythm analysis are eligible for inclusion. Exclusion criteria comprise traumatic CA, asystole as the initial rhythm, pregnancy and CA occurring on intensive care units, in the operating room or in cardiac catheter laboratory. The primary outcome is sustained return of spontaneous circulation lasting for at least 20 min. Secondary and exploratory outcomes include survival, neurological outcome, changes in aortic blood pressure, end-tidal CO₂ and near-infrared spectroscopy values as well as causes of death and vascular complications related to the intervention. Statistical analyses will be performed on a modified intention-to-treat basis.

The study protocol (Version 2.1, 11.02.2026) was approved by the Cantonal Ethics Committee of Cantone Bern (2025-D0108). Study results will be disseminated through peer-reviewed journals.

NCT07434726.

Internalised weight stigma (IWS) has been associated with lower physical activity (PA) levels in Western populations with diabetes, but evidence from Asian primary care settings remains limited. This study examined factors associated with PA levels, including IWS, among obese type 2 diabetic patients in Hong Kong primary care.

Cross-sectional questionnaire study.

A single general outpatient clinic in Hong Kong.

310 Chinese adults aged 18–69 years with type 2 diabetes and Body Mass Index ≥25 kg/m² who attended routine follow-up appointments were randomly sampled.

The primary outcome was to identify factors, particularly internalised weight stigma, associated with adequate physical activity levels. PA levels were assessed using the Chinese version of the International Physical Activity Questionnaire–Long Form, with ‘adequate PA’ defined as achieving moderate or high PA levels. IWS was assessed with Chinese Weight Self-Stigma Questionnaire. Secondary outcomes were the proportion of participants achieving adequate PA levels, the proportion with high IWS, and the sociodemographic and clinical factors associated with high IWS. Multivariate logistic regression was used to evaluate the association between these predictors and PA levels.

18.1% of participants had inadequate PA levels and 9.4% had high IWS. In multivariate logistic regression, high IWS (adjusted OR (aOR) 0.273; 95% CI 0.114 to 0.655; p=0.004), female sex (aOR 0.480; 95% CI 0.249 to 0.926; p=0.029), polypharmacy (aOR 0.339; 95% CI 0.170 to 0.675; p=0.002) and presence of chronic pain (aOR 0.249; 95% CI 0.112 to 0.554; p=0.001) were negatively associated with adequate PA levels independently (all p

Internalised weight stigma is independently associated with lower odds of achieving adequate PA levels among obese diabetic patients in primary care. Screening for IWS and addressing psychosocial barriers may represent a useful target for future intervention studies.

A growing body of evidence supports prehabilitation in cancer patients, but the findings have been inconsistent. This overview aimed to identify, evaluate and summarise the effect of prehabilitation on the clinical outcomes of cancer patients.

Overview of systematic reviews.

PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and the JBI Evidence Synthesis database (Joanna Briggs Institute, University of Adelaide, Australia; hosted on Ovid) were searched from inception to January 2025. The search was updated in May 2026, and no new articles were included.

We included systematic reviews of randomised controlled trials (RCTs) involving adult cancer patients with a clinically established diagnosis who received prehabilitation interventions prior to surgical treatment. We excluded abstract-only citations, narrative reviews and scoping reviews. Reviews were excluded if ≥50% of the included studies were postoperative interventions, or if preoperative subgroup data could not be extracted.

Two reviewers independently extracted data on participants’ characteristics, types of interventions, outcomes, synthesising methods and pooled anticipated absolute/relative effects for outcomes meta-analysed. Two reviewers assessed methodological quality using the A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) tool and assessed the certainty of evidence for prehabilitation using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Overlap among included systematic reviews was quantified using the corrected covered area (CCA).

Twenty systematic reviews (137 RCTs and 18 941 participants) were included. Low- to moderate-certainty evidence indicated that prehabilitation may improve preoperative physical fitness (eg, 6-minute walk test, preoperative cardiopulmonary function, preoperative lung function), reduce surgical complications and shorten the length of hospital stay. None of the included systematic reviews demonstrated a statistically significant effect on preoperative handgrip strength, 30-day readmission, mortality, anxiety or depression. Findings regarding physical activity and quality of life remained inconsistent. Overlap among included reviews was slight (CCA=4.15%).

Low- to moderate-certainty evidence suggests that prehabilitation may improve preoperative physical fitness, reduce surgical complications and shorten the length of hospital stay in adult cancer patients undergoing surgery, whereas current evidence does not support a beneficial effect on 30-day readmission, mortality, quality of life or psychological status. Given the predominantly low-to-moderate certainty of the evidence and the methodological heterogeneity across the included systematic reviews, these findings should be interpreted with caution. Methodologically robust and transparently reported RCTs and systematic reviews are needed to strengthen the certainty of evidence and to inform clinical implementation of prehabilitation.

CRD 42024533214.

To investigate the associations between the use of epidural analgesia (EA) and intrapartum care, labour, birth and neonatal outcomes in uncomplicated pregnancy low-risk women, to inform evidence-based intrapartum practices and support informed maternal choice.

Retrospective cohort study.

Single maternity hospital in Northern Italy.

A total of 3406 uncomplicated pregnancy low-risk women who gave birth between 2019 and 2023 were included. Participants were grouped according to whether they received EA (n=417) or not (n=2989).

Labour progression, intrapartum care practices, maternal and neonatal outcomes were evaluated according to exposure to EA. Associations between EA and the study outcomes were assessed using descriptive and inferential statistics and multivariable logistic and linear regression analyses, adjusted for maternal age, parity and other outcome-specific confounders.

Women receiving EA experienced higher rates of prolonged first and second stage of labour (adjusted OR (aOR) 24.3 and 5.0, 95% CI 17.8 to 33.6 and 3.8 to 6.6, respectively), amniotomy and oxytocin use (aOR 7.7 and 17.8, 95% CI 5.7 to 10.6 and 12.9 to 24.6, respectively), caesarean section (aOR 7.2, 95% CI 3.1 to 17.1), lithotomy position at birth (aOR 2.3, 95% CI 1.7 to 3.0) and urinary retention (aOR 6.0, 95% CI 3.1 to 11.5). No differences were observed in neonatal outcomes.

In uncomplicated pregnancy low-risk women, EA during active labour was associated with increased rates of clinical interventions and altered labour patterns, with no differences in neonatal outcomes. These findings underscore the importance of the midwife’s role in promoting physiological labour while ensuring effective pain management.