Atrial fibrillation (AF), with a prevalence of 1–2%, is the most common cardiac arrhythmia. AF is associated with a fivefold increased risk of cardioembolic events; approximately 20% of all strokes are caused by AF. Pulmonary vein isolation (PVI) has become the first-line treatment for AF. However, PVI cannot eliminate the residual stroke risk. Current guidelines recommend that anticoagulation be continued in this specific group of patients, regardless of the presence or absence of AF. In this large AF population post-PVI, who are considered to be in an earlier stage of AF, it is unknown whether left atrial appendage closure (LAAC) offers an alternative to direct oral anticoagulant (DOAC) therapy.

The trial will be a prospective, randomised, multicentre non-inferiority study comparing two treatment strategies in AF patients after atrial ablation. Patients will be randomly assigned to either percutaneous LAAC (group A) or DOAC treatment (group B) in a 1:1 ratio; both sequential and concomitant planned ablation with or without LAAC are accepted. Randomisation will be conducted using web-based randomisation software. A total of 1012 participants (506 patients per group) will be enrolled. The primary effectiveness measure will be the occurrence of any of the specified events within 24 months after randomisation: stroke/transient ischaemic attack/systemic thromboembolism, cerebral haemorrhage, other major haemorrhages (Bleeding Academic Research Consortium ≥2), cardiovascular mortality and all-cause mortality.

The study was approved by the Ethical Review Board of Shanghai Chest Hospital, China (KS(Y)20287). Written informed consent will be obtained from all participants. The trial will follow the Declaration of Helsinki and Good Clinical Practice. Confidentiality will be maintained with anonymised, securely stored data. Findings will be disseminated through peer-reviewed publications and conferences.

ChiCTR2000036538.

Does a simulation-based training intervention with an artificial intelligence (AI) navigation system improve their clinical bronchoscopy performance? And can the AIs outcome measures be used to evaluate clinical performance?

Pre–postintervention study.

Odense University Hospital of Southern Denmark, pulmonary endoscopy suite.

Nine bronchoscopists (4 experienced, >500 bronchoscopies and 5 intermediates, 10–500 bronchoscopies).

Diagnostic completeness (DC), structured progress (SP), procedure time (PT) and procedure efficiency (DC/PT).

The primary outcome measures showed no statistically significant difference between the pre- and postintervention bronchoscopies DC: 53% versus 59%, p=0.16, SP: 29% versus 32%, p=0.35 and PT: 219 s versus 181 s, p=0.22. The experienced outperformed the intermediates regarding DC: 73% versus 43%, p

DC, SP and PT showed no statistically significant difference after a simulation-based training intervention. DC, SP and procedure efficiency differentiated between experienced and intermediate bronchoscopists and can be used to evaluate clinical bronchoscopy performance.

Tobacco use causes approximately 8 million deaths worldwide each year. Against the backdrop of a rapidly expanding game market, there is growing potential to develop tailored gaming interventions for smoking cessation. This study protocol describes the development of a personalised Serious Game Applet based on an integrated TTM–PMT–HAPA framework (Transtheoretical Model, Protection Motivation Theory, Health Action Process Approach) and evaluates its effectiveness compared with conventionalShort Messaging Service (SMS) -based smoking cessation interventions.

Design: The study comprises two phases. The first involves developing the Serious Game Applet using the TTM–PMT–HAPA theoretical framework. The second phase consists of a multicentre, two-arm, single-blind cluster randomised controlled trial, which will enrol 1320 eligible smokers from various enterprises. Enterprises will be randomised to either the Serious Game Applet group or the SMS push control group. Eligible participants include daily smokers aged 18–45 years, working in non-tobacco-related enterprises, with exhaled carbon monoxide levels ≥6 ppm.

Outcomes: Primary outcomes are smoking abstinence rates at 3 and 6 months. Secondary outcomes include abstinence rates at 1, 2 and 9 months; point-prevalence cessation rates at 1, 2, 3, 6 and 9 months; changes in cigarette consumption; stage transitions in smoking cessation; nicotine dependence scores and withdrawal symptoms. The trial will be conducted as a field study targeting smartphone users across three cities in Fujian Province, China.

This study has been approved by the Biomedical Research Ethics Committee of Fujian Medical University (Approval No. 127, 2024). Results will be disseminated through peer-reviewed journals and academic conferences.

ChiCTR2400088105.

The working-age population (WAP) refers to individuals aged 15–64, who are the main drivers of production. Among the various factors affecting their productivity, hearing loss plays a significant role. However, epidemiological data on hearing loss in the WAP remain limited. The study analyses the global, regional and national situation of hearing loss in the WAP and predicts the disease burden up to 2040.

This study was based on data from the Global Burden of Disease (GBD) 2021 study, covering 204 countries and territories from 1990 to 2021.

The study population included all individuals aged 15–64 years, consistent with the United Nations definition of the WAP and adopted in the GBD 2021 study.

Data on the prevalence and years lived with disability (YLDs) due to hearing loss among the WAP were extracted from the GBD database. The disease burden was represented using both absolute numbers and age-standardised rates (ASRs). Trends were analysed with the estimated annual percentage change (EAPC). Subgroup analyses on sociodemographic index (SDI), gender, disease severity and causes were performed, and projections for 2040 were estimated using the Nordpred model.

Globally, from 1990 to 2021, the number of hearing loss cases in the WAP increased from 558.08 million to 1.04 billion, and the number of YLDs rose from 14.45 million to 26.55 million. In 2021, the prevalence in the WAP was 19 607.24 per 100 000, with YLDs at 501.81 per 100 000. The EAPC shows an upward trend: the change in age-standardised prevalence is 0.11 (95% uncertainty interval (UI 0.10, 0.12), and the change in age-standardised YLDs is 0.10 (95% UI 0.08, 0.11). High SDI regions have the lowest burden of hearing loss globally. At the regional level, as SDI increases, the age-standardised prevalence and YLDs of hearing loss show a downward trend. In contrast, the burden is higher in Oceania, Southeast Asia, South Asia, Eastern Sub-Saharan Africa and East Asia. The top three countries in terms of prevalence and YLDs are Madagascar, Malawi and Kenya. By 2040, the global prevalence and YLDs of hearing loss in the WAP are projected to be 1.31 billion and 33.30 million, respectively, with ASRs of 19 890.33 and 512.27 per 100 000 population.

The burden of hearing loss in the WAP is gradually increasing, with differences in prevalence and YLDs across regions, countries and SDI levels. Continued attention is needed for this vulnerable group’s hearing loss, along with the implementation of effective measures to reduce future burdens.

Community participatory modelling merges participatory research approaches with mathematical modelling. Participatory approaches are grounded in the engagement of people with lived experience (eg, who are affected by the health condition under study) throughout the research process. Mathematical modelling of infectious disease (ID) dynamic transmissions is increasingly used as a tool for public health decision-making, generating predictions, inferring mechanisms and estimating the impact of potential interventions—all of which guide policies, strategies and resource allocation as part of the preparation and response to ID epidemics. However, little is known about the engagement of people with lived experience and affected communities in the ID modelling process. We will map the literature to explore participatory approaches undertaken in ID modelling (practical aspects of formalising participatory modelling), levels of participation and the potential influence from the perspective of communities engaged.

The scoping review will follow the Joanna Briggs Institute Manual for Evidence Synthesis. The search strategy includes three electronic bibliographic databases (MEDLINE, Scopus and Embase), no language restrictions and sources published from 2000 to present. We will implement the search with and without the participatory keyword, as we recognise that some studies do not explicitly term community engagement as participatory modelling. After deduplication, two authors will independently screen the titles, abstracts and full texts, with discrepancies resolved with a third team member. We will extract the relevant information from the main text, parameter tables, supplemental files, bibliography, acknowledgment and author affiliation sections. The data extraction will follow a deductive content analysis where we draw from community-based participatory research approaches and established mathematical modelling steps. We will also extract data to assess whether there was equitable engagement of knowledge users by checking for indicators of three equitable engagement domains as outlined by the Ward framework (equity within partnership (eg, whether knowledge user influenced modelling decisions or remuneration), capacity to engage in future partnerships and shift in power/influence (eg, coauthorship). We will supplement our narrative analyses with summaries in tabular format and using appropriate data visualisations.

No ethics approval will be required for this scoping review because we will map evidence from publicly available literature sources. We will develop multilingual abstracts or one-page lay summaries of the findings (English, French and Swahili), a policy brief and will coauthor an open-access journal article. A summary of the findings will be shared via knowledge user-led presentations at the Maisha HIV and AIDS Conference and with other community-based organisations at the quarterly peer-to-peer support meetings.

The protocol has been registered in Open Science Framework, DOI: https://doi.org/10.17605/OSF.IO/XQ2WP (December 2024).

In addition to hypertension, the constellation of metabolic abnormalities (diabetes mellitus, dyslipidaemia and/or obesity) independently increases the incidence and severity of cardiovascular diseases, and this is compounded by the modern lifestyle and ageing society. The prevalence of metabolic syndrome is high and non-hypertensive heart failure is common in Asians. Adverse cardiac remodelling is an important substrate for cardiac dysfunction in the onset and progression of heart failure and its amelioration improves outcomes and prognosis. A better understanding of metabolic-driven cardiac remodelling is warranted due to the rising prevalence and complexity of metabolic syndrome and strong interests in targeted therapy.

Response of the myocardium to hypertrophic conditions in the adult population is a prospective observational cohort study with an aim to establish the significance of cardiac remodelling by cardiovascular magnetic resonance (CMR). The current recruitment target is 2000 participants. Expanding from the initial population with hypertension, the study examines adults with cardiometabolic conditions, including diabetes, dyslipidaemia, obesity and fatty liver disease. Eligible patients are identified at National Heart Centre Singapore, primary care clinics and through public outreach. Physical, clinical, imaging and biochemical data are collected. Cardiac remodelling features pertaining to hypertrophy, fibrosis and functional changes are assessed on CMR. Body adiposity is mapped by MRI across the heart, liver and abdomen. Outcome data are adjudicated and follow-up assessment will be available in a subset of participants. Blood biomarkers will be investigated in relation to imaging findings. Cross-sectional analysis will establish the implication of cardiometabolic disease towards cardiac remodelling, while follow-up and outcome analysis will infer on disease progression and prognosis.

The study was approved by the SingHealth Centralised Institutional Review Board (2015/2603). Written informed consent is obtained from all participants. Study findings will be reported in peer-reviewed journals and at scientific conferences.

ClinicalTrials.gov, NCT02670031.

Heroin users have a high burden of respiratory morbidity, including premature lung function impairment. Further, methadone treatment has been found to aggravate lung function impairment and can independently cause asthma. However, the lung function status among heroin users on medication-assisted therapy (MAT) in Tanzania is yet to be studied. This study aimed to assess the magnitude, pattern and factors associated with lung function impairment among heroin users on MAT.

This was a quantitative, analytical cross-sectional study.

This study was conducted at MAT Clinic at Muhimbili National Hospital in Dar-es-Salaam, Tanzania.

Individuals aged 18 years or above with heroin use disorder on stable dose of methadone without heroin withdrawal symptoms (Maintenance Phase of Treatment) were recruited.

Participants were enrolled through systematic sampling technique. Data were collected using a questionnaire, and lung functions were measured using a spirometer. Lung function impairment was defined as the percentage of participants with forced expiratory volume in 1 s (FEV1)

We enrolled 302 participants into the study (mean age of 42.78±7.56 years). Lung function impairment was observed in 28.5% of participants, with an average age of 44±8 years. Restrictive lung disease was the most common pattern of lung function impairment affecting 13.2% of the participants. The predictors of lung function impairment were being underweight (OR) 4.73, 95% CI) 2.61–8.59, p

Heroin users on MAT have a high magnitude of lung function impairment. Routine lung function testing is recommended.

This study aims to describe the knowledge, attitude and practice (KAP) regarding surgical scars among patients who had postorthopaedic surgery, and to explore correlations between these factors.

A multicentre, cross-sectional, observational study.

Conducted across multiple secondary/tertiary care hospitals between July and September 2024.

Of 816 enrolled participants undergoing orthopaedic surgery, 54.5% were male, 43.6% were aged 31–45 years, 73.9% were urban dwellers, 31.2% had a bachelor’s degree and 65.4% were married.

None (questionnaire-based assessment).

Primary outcomes were KAP scores (knowledge: 0–22; attitude: 9–45 and practice: 7–35), analysed via correlation and regression.

Mean scores: knowledge (12.5±6.9), attitude (27.6±3.3) and practice (28.2±6.5). Knowledge was negatively correlated with attitude (r=–0.24, p

Patients who had postorthopaedic surgery demonstrated poor scar-related knowledge and negative attitudes but proactive practices. Greater knowledge correlated with better practice, suggesting targeted education could optimise scar management. Further research should explore causal relationships and the efficacy of interventions.

This study aimed to assess the global, regional and national burden of non-rheumatic degenerative mitral valve disease (nrDMVD) from 1990 to 2021 using data from the global burden of disease (GBD) Study 2021, focusing on trends in incidence, prevalence, mortality and disability-adjusted life-years (DALYs). The analysis evaluated disparities by age, sex and sociodemographic index (SDI).

This was a systematic analysis leveraging GBD 2021 data and employing decomposition and frontier analyses to quantify the contributions of ageing, population growth and epidemiological transitions. Age-standardised rates (ASRs) and absolute case numbers were analysed across 204 countries and territories.

Global, regional and national data spanning 1990 to 2021, stratified by SDI quintiles (low to high), 21 GBD regions and age-sex groups.

Individuals diagnosed with nrDMVD, with data representing global populations categorised by age, sex and SDI.

Primary outcomes included incidence, prevalence, mortality and DALYs. Secondary outcomes encompassed age-standardised rates (ASR) (age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), age-standardised mortality rate (ASMR) and age-standardised DALYs rate (ASDR)) and temporal trends.

In 2021, there were 15.49 million prevalent cases (ASPR: 182.13 per 100 000 population) and 36 843 deaths (ASMR: 0.46 per 100 000 population) globally. From 1990 to 2021, ASRs for prevalence, mortality and DALYs declined significantly (estimated annual percentage change range: –0.17% to –0.31%), while absolute case numbers increased by 85% due to population ageing. High-SDI regions exhibited the highest ASIR (28.49 per 100 000) and ASPR (364.24 per 100 000), while low-SDI regions showed underdiagnosis. Sex disparities were pronounced, with higher ASIR (16.13 vs 11.38) and ASPR (385.09 vs 241.64) in females. Projections to 2050 indicated continued ASR declines, yet rising absolute cases. Frontier analysis identified Serbia, Georgia and high-SDI countries (eg, the Netherlands) as having the largest gaps between actual and achievable disease burden.

Despite declining ASRs, nrDMVD remains a critical global health challenge, driven by ageing populations and regional inequalities. Targeted interventions addressing gender disparities, ageing-related healthcare and resource allocation in low-SDI regions are urgently needed to mitigate future burdens.

This study aimed to estimate the prevalence of depression and anxiety and associated risk factors among non-communicable diseases (NCD) clinic attendees in rural Rwanda.

Cross-sectional.

44 health centres in three rural districts in Rwanda.

Adults aged 18 years and older with a clinical diagnosis of diabetes, hypertension and/or asthma, who were attending a follow-up appointment during the study period (n=595).

Primary outcome measures were depression (measured by Patient Health Questionnaire-9) and anxiety (measured by Generalised Anxiety Disorder-7). Explanatory measures included sociodemographic and behavioural risk factors associated with depression and anxiety.

Of 595 participants, 265 (44.5%) had depression (95% CI: 40.5% to 48.6%) and 202 (33.9%) had anxiety (95% CI: 30.1% to 37.9%). Comorbidity of depression and anxiety was found in 137 participants (23%). Participants with no formal education had significantly higher odds of reporting depression and anxiety compared with those with primary and secondary/higher education (adjusted OR (aOR)=2.08; 95% CI=1.27 to 3.33, p=0.004, aOR=5.00; 95% CI=1.12 to 25.00, p=0.035, respectively). In addition, participants who were unemployed were more likely to report depression and anxiety (aOR=3.03; 95% CI=1.62 to 5.67, p

The overall prevalence of depression and anxiety was found to be significantly high among the study participants. The risk factors that were associated with depression and anxiety included level of education, district of residence, employment status and past trauma exposure. The findings emphasise the need for integrating mental health screening into NCD care, district-specific interventions, employment support services and trauma-focused care.

The Asian American, Native Hawaiian and Pacific Islander (AANHPI) community is the fastest-growing racial/ethnic population in the USA. Previous research identified that medical students perceived a lack of exposure to AANHPI patients and topics in medical school curricula; however, there remains a lack of potential interventions to address this need. The goal of our study is to present a case study for identifying interventions in medical school curricula that improve cultural humility-based training for providing medical care for AANHPI populations.

In this qualitative study, authors conducted four virtual focus groups with 15 medical students at a single institution to identify curricular interventions. The authors then conducted virtual semistructured interviews with eight medical educators one-on-one to explore the feasibility of the proposed interventions. Data were analysed using qualitative thematic analysis, and analysis was performed with ATLAS.ti.

Medical students and medical educators based at medical institutions in the USA.

15 medical students and eight medical educators participated in the study.

All medical students (n=15) and educators (n=8) noted that there is limited engagement of AANHPI communities in current medical curricula and limited curricular components that address the diversity within the AANHPI umbrella. Medical student focus groups identified three interventions to improve cultural humility-based training for treating AANHPI patients: reflection spaces, community engagement and clinical training on documenting cultural needs. Educators supported the feasibility and importance of these interventions to prepare students to work with not only AANHPI patients but also with patients of other diverse backgrounds.

AANHPIs represent a heterogeneous population consisting of unique cultural heritages. Our research demonstrates the importance of highlighting this community in cultural humility curricula to provide an example of how to consider and appreciate diversity in patient populations. In this paper, we present student and medical educator-supported curricular interventions that not only increase awareness of issues impacting AANHPI communities, but also emphasise building skills of self-reflection, lifelong learning and empathy that are applicable to patients of all backgrounds.