Mental health is now recognised as a major global concern affecting people from diverse backgrounds. There is growing evidence that the gut microbiota plays a crucial role by producing metabolites that significantly influence a person’s mood and behaviour. Despite its importance, there is a significant gap in the profiling and understanding of the gut microbiota’s influence on mental health among Malaysians. Therefore, this study aims to determine gut microbiome profiles among patients with major depressive disorders (MDD) of different treatment groups attending psychiatric clinics in the state hospitals and compare them to healthy individuals in the community of Klang Valley, Malaysia.

This cross-sectional study will be carried out in Klang Valley, Malaysia. Eligibility of the patients will be assessed by the psychiatrists prior to recruitment of patients. Patients with MDD will be categorised into monotherapy and polypharmacy while healthy individuals will be used as a comparison group. Demographic data will be recorded. Stool samples will be subjected to DNA extraction and 16S rRNA gene-sequencing analysis to determine the microbial compositions of the gut microbiome.

This study will be conducted following the procedure set by the National Medical Research Register Malaysia. The Medical Research Ethics Committee (MREC), Ministry of Health Malaysia, has ratified this study and granted ethical approval to conduct this study (NMRR ID-22-00893-JVW). All the participants will be given an information sheet and will sign a consent form to participate. Participants have the right to withdraw from the study at any time without an explanation. All information gathered will be used for research purposes only and treated as confidential. The results will be submitted to peer-reviewed journals for publication as well as presented at national and international conferences. Informing policy makers at all levels is a crucial aspect of the dissemination and will be done from local to international levels.

This study was registered under National Medical Research Register Malaysia (NMRR ID-22-00893-JVW), a mandatory procedure of the Ministry of Health Malaysia before the start of a research.

To compare influenza-related hospitalisation, mortality and effects of background factors in adults with type 2 diabetes (T2D) and age-matched and sex-matched controls. To explore associations between clinical variables and the risk of severe influenza outcomes.

Register-based nationwide cohort study.

Data from the National Diabetes Register are cross-linked to the Swedish Population Register, Statistics Sweden and the Swedish Patient Register.

371 811 patients with T2D from the Swedish National Diabetes Register and 1 728 856 matched control individuals from the Swedish population followed over the 2013/14–2018/19 influenza seasons.

Data on hospital admissions, mortality, socioeconomic factors and pre-existing conditions were collected. Risk associations were analysed using Cox proportional hazards models. Within the diabetes group, non-linear associations between common clinical variables and influenza hospitalisation were examined.

1.6% of those with diabetes and 1.0% of controls were hospitalised for influenza, with influenza-related mortality at 0.12% and 0.08% respectively. Adjusted HR for hospitalisation in T2D was 1.57 (95% CI 1.52 to 1.61) and 1.44 (95% CI 1.29 to 1.61) for mortality. Absolute risk was highest in those with cardiovascular, kidney or respiratory disease. Relative risk was greatest in younger (

This study confirms that T2D increases the risk of hospitalisation and mortality from seasonal influenza. Support to achieve HbA1c and eGFR targets and following vaccination guidelines is important.

Cumulative interpersonal traumatisation increases the risk of psychosis and is linked to psychotic symptom severity and reduced recovery rates. Psychosis and treatment themselves can also be traumatising, with a first episode of psychosis posing challenges to one’s identity. Despite a growing evidence base for the safety and effectiveness of trauma therapies for psychosis, implementation remains poor in early intervention for psychosis (EIP) services, partly due to resource constraints. Narrative exposure therapy (NET) is an effective intervention for post-traumatic stress disorder in ethnically diverse populations. Crucially it has potential to address barriers to implementation of trauma therapies in EIP as it has a brief duration with minimal training requirements. This feasibility study will evaluate the feasibility and acceptability of conducting a definite trial of NET in people with early psychosis.

An individually randomised parallel groups feasibility randomised controlled trial with embedded qualitative evaluation will be conducted. 50 individuals with first episode psychosis and a history of multiple trauma under the care of an EIP service in two NHS trusts in England will be recruited. Participants will be randomised to receive either 15 sessions of NET in addition to treatment as usual or treatment as usual alone. Assessor blinded assessments will be conducted at baseline, 4 months (post-intervention) and 8 months (follow-up). Analyses will focus on feasibility outcomes (recruitment, retention and completion rates) and preliminary estimates of intervention effects to inform planning for a fully powered trial. Qualitative interviews will be carried out with participants allocated to NET and clinicians to investigate acceptability, barriers and facilitators, possible mechanisms of change, potential benefits or harms and recommendations. A sub-study in the NET group will investigate acceptability of completing Experience Sampling Data daily during therapy to monitor changes on candidate primary and secondary outcomes.

This study received REC/HRA ethical approval from the London - City & East Research Ethics Committee (REC) (25/LO/0350). The results of the study will be reported and disseminated at international conferences and in open-access peer-reviewed scientific journals.

ISRCTN39471182.

This study aims to estimate the rate of recruitment of participants.

This is a pilot, multicentre, double-blind, placebo-controlled, randomised controlled trial of oral oxycodone and sublingual placebo vs sublingual buprenorphine and oral placebo for postoperative pain management for 7 days after pelvic exenteration.

Patients will be recruited from three metropolitan quaternary referral centres that offer advanced gastrointestinal surgery in Australia.

The inclusion criteria will be patients over the age of 18 years undergoing pelvic exenteration surgery and exclusion criteria are previous adverse events related to the study drugs, currently requiring monoamine oxidase inhibitor medications and if epidural analgesia is planned in the perioperative period.

Enrolled patients will undergo pelvic exenteration surgery and be initiated postoperatively on patient-controlled analgesia. In the postoperative period, when clinically appropriate to take oral medications, patients will be commenced on trial analgesia for 7 days. Participants will be randomised to receive either oral active oxycodone 5–10 mg up to 3 hourly as required (with sublingual placebo) or sublingual active buprenorphine 200–400 mcg 3 hourly as required (with oral placebo).

The primary outcome measure is the rate of recruitment over a 6-month period. Secondary outcomes include an assessment of missing data, protocol adherence and acceptability of the trial to participants.

The trial received ethics approval from Sydney Local Health District, Royal Prince Alfred Hospital Human Research Ethics Committee (No: X25-0128 & 2025/ETH01058). The results of the study will be disseminated by publication and presentation at local annual scientific meetings in Australia.

The study protocol is prospectively registered at the Australian New Zealand Clinical Trials Registry (ANZCTR) (www.anzctr.org.au; ACTRN12625000901404).

The KoMAC (Korean Medicine for Aging Cohort) study investigates health characteristics related to ageing from both conventional and Korean medicine (KM) perspectives through a prospective, multicentre cohort study that also serves as a platform for future embedded intervention studies.

This study aimed to recruit 1000 adults aged 50–65 years from both urban (Iksan and surrounding areas, Jeonbuk Province) and rural (Jangheung and surrounding areas, Jeonnam Province) regions in Korea. Recruitment began in August 2023. The inclusion criteria were residence in the target region, literacy and written consent.

Initial data showed regional differences in health behaviours and conditions; rural participants showed higher rates of alcohol consumption, smoking and childbirth experience among women, while urban participants showed lower pulmonary function and less favourable hearing thresholds. Ageing was associated with a general decline in physical and psychosocial function, particularly in women. KM-based phenotypic analysis revealed an age-related increase in kidney deficiency patterns and blood stasis, particularly in women. Emotional assessments indicated a decline in joy with age. Laboratory findings showed age-related increases in blood urea nitrogen levels in women, consistent with changes observed in KM-based phenotypes.

The KoMAC study will continue with annual follow-ups, and blood samples will be collected again at the final follow-up visit to identify ageing-related risk factors. Embedded randomised controlled trials will evaluate the effects of KM-based interventions on health outcomes.

Clinical Research Information Service (KCT0008863).

Understanding whether socioeconomic and ethnic backgrounds influence help-seeking and communication with emergency medical services (EMS) is essential to mitigate disparities.

We explored how public housing residents seek help and communicate with EMS, focusing on barriers and enablers to out-of-hospital cardiac arrest (OHCA) recognition and swift EMS responses.

Explorative qualitative analysis of audio recordings of emergency service calls regarding non-EMS witnessed OHCAs. Audio recordings were screened and selected to ensure call variety—then transcribed and analysed using thematic analysis inspired by the concepts of social wrongs and social orders. We also analysed the dispatch protocol, a tool for managing emergency service calls.

Four public housing areas with >50% ethnic minority residents in Copenhagen, Denmark.

Non-EMS witnessed OHCAs from 2017 to 2022.

We included 17 calls regarding 13 OHCAs and defined two themes. The effective call aligned with the dispatch protocol, leading to swift OHCA recognition and dispatcher-assisted cardiopulmonary resuscitation (CPR). In contrast, the challenging call, which did not match the framework of the dispatch protocol, entailed one or more of the following characteristics, leading to delayed or missed OHCA recognition: (1) multiple people involved (multiple callers, third-party caller or bystanders communicating with caller), (2) language barriers, (3) emotionally unstable callers and (4) lack of emergency medical competencies. Across themes, witnesses contacted someone in their network instead of calling emergency services immediately. This was a barrier to OHCA recognition in the challenging calls, which some dispatchers managed using calm intonation and simple inquiries.

We identified two themes concerning communication in emergency service calls from public housing areas: the effective call and the challenging call, resulting in swift or delayed/missed OHCA recognition, respectively. The dispatch protocol enabled swift recognition in the effective calls but was a barrier in the challenging calls. Across themes, witnesses used network-based help-seeking before calling emergency services, delaying EMS responses and dispatcher-assisted CPR.

To map and synthesise existing evidence on pregnant women’s perceptions and experiences of social media communication for antenatal care (ANC).

Scoping review.

Four electronic databases (PubMed/MEDLINE, Embase, Web of Science and Google Scholar) alongside ‘grey’ and supplementary searches were conducted between December 202–January 2026.

All studies reporting pregnant women’s perceptions or experiences of social media communication for ANC.

Data were extracted independently by two reviewers using a structured charting framework. Extracted data were synthesised using a descriptive and narrative approach, with pregnant women’s perceptions and experiences analysed through reflexive thematic analysis.

Six studies met the inclusion criteria. Across platforms including WhatsApp, Facebook, Instagram and WeChat, pregnant women generally perceived social media communication as acceptable and beneficial, particularly for accessing trustworthy information, reassurance between visits, peer support and flexible engagement. Experiences varied by platform, moderation model and context. Key challenges included limited personalisation, variability in moderators’ capacity and responsiveness, digital literacy barriers, data affordability, privacy concerns and sociocultural influences. Equity-related considerations were recurrent, highlighting the potential for uneven experiences if digital communication is not carefully designed and standardised.

Social media communication is generally experienced positively by pregnant women as a complement to routine ANC, particularly when professionally moderated and responsive to women’s informational needs. However, variability in experiences and equity-related challenges underscore the need for further research and careful implementation. This scoping review provides a preliminary mapping of the evidence and identifies priorities for future qualitative synthesis, primary research and the development of inclusive, person-centred digital ANC communication strategies.

Patients on low-dose prednisolone may develop adrenal insufficiency causing reduced health-related quality of life (HRQoL) and increased risk of adrenal crisis. This study examines whether supplemental hydrocortisone during mild to moderate stress improves HRQoL in patients with polymyalgia rheumatica/giant cell arteritis (PMR/GCA) with adrenal insufficiency on low-dose prednisolone.

A multicentre, randomised, double-blinded, placebo-controlled, clinical trial including patients with PMR/GCA receiving ongoing prednisolone ≤5 mg/day. Eligible patients undergo an adrenocorticotropic hormone (ACTH) test, and 250 patients with a stimulated cortisol

The study is approved by the Ethics Committee of the Capital Region of Denmark and the Danish Medicines Agency. Recruitment began June 2022. The last patient’s last visit is expected in 2026. Results will be disseminated via peer-reviewed publication and conference presentations.

EudraCT:2021-002528-18, CTIS:2024-518272-30-00, NCT05435781.

Asthma, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are prevalent chronic respiratory diseases associated with increased comorbidity, mortality and healthcare costs. Physical activity and exercise are widely recommended as part of treatment for these conditions, yet the specific effects of Nordic walking (NW) remain underexplored. The aims of this randomised controlled trial (RCT) are to improve physical fitness, functional capacity and respiratory health and increase regular physical activity and quality of life of older adults with asthma and/or COPD and/or OSA through a supervised 3-month group-based NW intervention combined with resistance, balance and mobility training.

This single-blinded, parallel-group RCT will recruit 100 adults aged 55–80 years diagnosed with asthma and/or COPD and/or OSA in the Northern Savo region of Finland. Participants will be randomly allocated to either an intervention group or a control group.

The intervention group will participate in a 12-week supervised exercise programme consisting of progressive NW sessions twice per week and resistance, balance and mobility training once per week. The primary outcome is a change in cardiorespiratory endurance. Secondary outcomes include functional capacity, physical activity level, spirometry parameters and quality of life. The control group will continue their usual physical activity and receive physical activity guidance after 12 weeks. Measurements were conducted at baseline, three and 9 months. Data will be analysed according to the intention-to-treat principle. Group differences over time will be examined using appropriate parametric or non-parametric methods depending on data distribution.

Ethical approval was obtained from the Regional Medical Research Ethics Committee of Eastern Finland Collaborative Area (892/13.00/2023). Findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.

The trial is registered at ISRCTN12097135, registration date: 7 June 2024.

To analyse the completeness of the COVID-19 vaccination schedule and identify factors associated with vaccine uptake.

Cross-sectional study.

Data were collected through face-to-face interviews conducted in all 26 Brazilian state capitals and the Federal District between 2022 and 2023, using a sequential sampling approach.

A total of 1392 individuals aged 18 years or older experiencing homelessness for at least 6 months were included.

The primary outcome was the completeness of the COVID-19 vaccination schedule (complete vs incomplete), based on self-reported vaccination status. Secondary analyses examined sociodemographic, institutional and behavioural factors associated with vaccine uptake using binary logistic regression.

Completion of the vaccination schedule was positively associated with receiving government aid (OR: 1.58; 95% CI 1.09 to 2.30), visits from street clinic health agents (OR: 3.19; 95% CI 1.95 to 5.36), prior COVID-19 diagnosis (OR: 5.77; 95% CI 3.17 to 11.15), support for mandatory vaccination (OR: 3.76; 95% CI 2.48 to 5.76), trust in vaccine efficacy (OR: 3.92; 95% CI 2.63 to 5.89), seeking information from community sources (OR: 1.91; 95% CI 1.01 to 3.88) and trust in federal authorities (OR: 1.57; 95% CI 1.06 to 2.31).

This study identified structural, social and individual factors associated with complete COVID-19 vaccination among people experiencing homelessness in Brazil. Although overall coverage was substantial, gaps in vaccination completeness persisted. Social support, healthcare outreach and trust in vaccines were associated with higher uptake, highlighting important barriers and facilitators to vaccination in socially vulnerable populations.

Pregnancy in women with pre-existing type 1 or type 2 diabetes (T1D, T2D) is associated with increased risk of complications, largely driven by maternal glucose control. Hormonal changes during pregnancy make glucose management more challenging. Physical activity (PA) may improve glucose control and reduce complications; however, little is known about PA patterns in this population and no pregnancy-specific PA guidance exists for women with pre-existing diabetes. Understanding the behaviours and experiences of both pregnant women and the healthcare professionals (HCPs) who support them is needed to inform evidence-based guidance.

This mixed-methods study comprises three sub-studies. The first will recruit 175 pregnant women (75 with T1D and 100 with T2D) who will complete three 7-day monitoring periods, one per trimester. PA will be assessed using wrist-worn accelerometers and exercise diaries, dietary intake via remote food photography, and corresponding continuous glucose monitor and diabetes-related well-being data will be collected.

The second involves a subsample of ~16 women participating in focus groups to explore experiences of being physically active during pregnancy.

The third invites ~100 HCPs involved in diabetes in pregnancy care to complete an online survey, ~10 HCPS will take part in an optional interview about their experiences of providing PA guidance.

The primary outcome is the change in PA across pregnancy. Secondary outcomes include associations between PA, glucose metrics, diet and diabetes-related well-being, and qualitative themes relating to experiences of women and HCP. Quantitative data will be analysed using multilevel modelling and regression analysis, and qualitative data using reflexive thematic analysis.

Ethical approval was granted by the East Midlands Nottingham 1 Research Ethics Committee (25/EM/0190) and University of Exeter Public Health and Sport Sciences ethics committee. Findings will be disseminated through peer-reviewed publications and conference presentations.

Hypertension is the leading global risk factor for mortality, causing over 10 million deaths annually. In sub-Saharan Africa, hypertension prevalence is high, particularly in rural areas, where it is less likely to be diagnosed, treated or controlled effectively. This results in a high burden of complications, including heart failure, stroke and kidney disease. Community-centred approaches using community health workers (CHWs), risk-based approaches and simplified treatment regimens have shown promise in improving hypertension management. However, there is limited evidence on the effectiveness of such approaches in rural sub-Saharan Africa.

The primary aim of this study is to assess the feasibility of a community-centred intervention for hypertension management in rural Kenya and The Gambia. The objectives are to evaluate the intervention’s adoption, fidelity, reach and dose; understand the mechanisms of action and contextual factors affecting its implementation; assess acceptability from the perspectives of patients, healthcare providers and policymakers; estimate the costs associated with the intervention; and evaluate study procedures to inform the design of a future full-scale trial.

We will conduct a mixed-methods, non-randomised, single-arm feasibility study, designed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) framework and checklist for feasibility and pilot studies, including best practice guidance for non-randomised feasibility studies. The study will be conducted in two rural sites: Kilifi, Kenya and Kiang West, The Gambia. The intervention was codesigned with stakeholders and includes community-based hypertension screening by CHWs, risk stratification and hypertension-mediated organ damage assessment at primary healthcare facilities, followed by treatment initiation using single-pill combination (SPC) antihypertensive therapy for eligible individuals. Training will be provided to all healthcare providers involved in the study. We will screen 500 participants aged 30–80 years at their residence (250 from each country), and we expect that about 45% will be referred for additional assessments and of these 25% (or 10% of the total sample) will be prescribed treatment with SPC. Data collection to evaluate the intervention and its implementation will involve quantitative measures of feasibility and clinical outcomes; observations to assess fidelity and costing measures; and qualitative interviews and focus group discussions with patients, healthcare providers and policymakers to understand the acceptability and contextual influences on intervention implementation.

Ethics approval was obtained from the Kenyan National Committee for Science, Technology and Innovation (ref: 415561), the Gambia Government/Medical Research Council Joint Ethics Committee (ref: 31372) and the London School of Hygiene and Tropical Medicine Ethics Committee (ref: 31372). Study findings will be disseminated through peer-reviewed publications, conferences, policy briefs, community engagement forums and accessible summaries shared via the Improving Hypertension Control in Rural sub-Saharan Africa and partner newsletters.

This study is registered with the ISRCTN- The UK’s Clinical Study Registry (ISRCTN81228019), and Pan African Clinical Trials Registry (PACTR202504839027548).