To understand how reductions in resource allocation affect food safety services in England.

This longitudinal ecological study analysed secondary observational data.

England, data at the local authority level.

Ecological study, without human participants.

The primary outcome measures were the number of staff, represented by the number of full-time equivalents per capita, number of interventions per establishment, and proportion of hygiene-compliant establishments.

A £1 decrease in food safety expenditure per capita was associated with a 2% (–3.3 to –0.7) decrease in staffing levels and a 1.6% (–3.2 to –0.1) decrease in the number of interventions achieved per establishment. A one-unit reduction in staff was associated with a 42.2% (–80.5 to –11.9) decrease in the number of interventions achieved. No evidence of an association was found between expenditure or staff levels and the proportion of compliant establishments.

Spending reductions negatively affected the capacity of food safety teams to provide key services. Reductions in food safety expenditure significantly affected food hygiene staff levels and service provision. This finding raises concerns about the capacity of food safety teams to operate and the potential for increased public risk of gastrointestinal infections.

To examine the associations between food-related behaviours and nutrient intake on nutritional status among clients undergoing Community-Based Treatment and Rehabilitation (CBTaR) in Kelantan, Malaysia.

Cross-sectional analytical study.

Seven CBTaR centres (n=7) across the state of Kelantan, Malaysia.

A total of 393 adult clients (aged 18 years and above) enrolled in CBTaR programmes between June and December 2022 were selected through stratified random sampling.

The primary outcome was nutritional status, assessed using body mass index. Secondary outcomes included nutrient intake (macronutrients and micronutrients) and food-related behaviours (emotional eating, external eating, restrained eating and food addiction), measured through Bahasa Malaysia validated questionnaires and 24-hour dietary recalls. All variables were introduced into the structural equation modelling to examine the associations among these variables and their association with nutritional status.

The results revealed that food-related behaviour was significantly associated with the nutrient intake (β=–0.524, p≤0.001). Additionally, the drug use profile significantly determined the food-related behaviour (β=–0.129, p=0.006) and nutritional status (β=–0.134, p=0.007). Nutrient intake was found to be a significant predictor of nutritional status (β=–0.213, p≤0.001). Sociodemographic and drug use profiles were significantly correlated with nutritional outcomes through behavioural and dietary associations. Importance-performance map analysis identified nutrient intake as the most impactful variable, highlighting the need for urgent intervention (R²=0.272).

This study highlights that nutrient intake is a significant predictor associated with food-related behaviours on nutritional status among individuals with substance use disorder. Integrating nutrition counselling and behavioural interventions into CBTaR services may improve recovery and long-term health outcomes.

Antimicrobial resistance (AMR) is a critical public health issue in Bangladesh, exacerbated by the widespread practice of non-prescribed antibiotic dispensing. This study seeks to assess their knowledge and attitudes, particularly how these factors influence non-prescribed antibiotic dispensing practices in Bangladesh.

A total of 287 pharmacy staff across four regions of Bangladesh were included in the study. Data were collected using a structured questionnaire assessing knowledge, attitudes and practices regarding non-prescribed antibiotic dispensing.

The study found that 92.4% of respondents dispensed antibiotics without prescriptions. The practice was significantly more prevalent among those with poor knowledge (99.28% in below-average vs 86.09% in above-average knowledge groups, p

These findings highlight knowledge and attitude towards antibiotic dispensing play a vital role where weak regulation, education and economic incentives further worsen the situation. Urgent interventions, including improved pharmacist training, prescription monitoring and public awareness campaigns, are essential to reduce non-prescribed antibiotic dispensing and align practices with Bangladesh’s National Action Plan on AMR.

Bangladesh is facing a growing obesity epidemic; however, evidence on sex-specific patterns and socioeconomic determinants is limited.

We aimed to investigate sex differences in obesity prevalence and to assess how socioeconomic and demographic factors influence obesity risk among adult men and women.

We analysed data from the Bangladesh Demographic and Health Survey 2022. Prevalence of obesity (body mass index ≥25.0 kg/m²) among men and women was estimated by sociodemographic characteristics. Two multinomial logistic regression models were fitted: first, to quantify sex-specific odds of obesity with socio-demographic variables as interaction terms for effect modification; and second, adjusted sex-stratified models to assess determinants of obesity separately in men and women.

Overall, 30% of our participants had obesity, with women more affected than men (36% vs 20%; adjusted OR (aOR) 2.75, 95% CI 2.53 to 3.00). Interaction analyses showed attenuation of the female-male difference among those with higher education (interaction aOR 0.57, 95% CI 0.43 to 0.74), richest quintile (interaction aOR 0.63, 95% CI 0.47 to 0.83) and urban residence (interaction aOR 0.81, 95% CI 0.68 to 0.96). Obesity was positively associated with age, education, wealth and urban residence, with stronger effects in men, except for higher education (interaction aOR 0.65, 95% CI 0.47 to 0.89), richest quintile (interaction aOR 0.72, 95% CI 0.54 to 0.98) and urban residence (interaction aOR 0.84, 95% CI 0.70 to 0.98).

Obesity disproportionately affected women, although association with socio-demographic factors was stronger in men. Targeted sex-specific interventions that address socioeconomic and contextual determinants are needed to mitigate obesity burden in Bangladesh.

To determine the prevalence of internet addiction and examine its association with psychological factors specifically depression, anxiety and loneliness among Malaysian public university students.

Cross-sectional study.

All public universities in Malaysia, 20 universities.

The study included 7278 students from 20 public universities in Malaysia.

Statistical analyses were performed usingSTATA V.17 software. Descriptive statistics summarised participants’ demographic characteristics, prevalence of internet addiction and psychological distress (depression, anxiety and loneliness). Pearson’s correlation was used to assess bivariate relationships between internet addiction and psychological variables, while multiple logistic regression identified independent factors associated with internet addiction after adjusting for significant confounders.

The study found that 38.6% of the students showed signs of internet addiction, along with a high level of psychological distress; 24.8% had depressive symptoms, 32.4% experienced anxiety and 35.5% reported loneliness. Moderate positive correlations were observed between internet addiction and depression, anxiety and loneliness (p

The findings indicate significant associations between internet addiction and psychological factors such as depression, anxiety and loneliness. A comprehensive, multifaceted approach is essential to address psychological distress among university students and reduce the risk of internet addiction.

Metabolic bariatric surgery (MBS) can lead to substantial fat-free mass loss (FFML) due to malnutrition, decreased protein intake and insufficient physical activity. Disproportional FFML has been associated with an increased risk for adverse health outcomes. Resistance training (RT) combined with protein intake contributes to maintenance and increase of fat-free mass (FFM) in healthy individuals. However, it is unclear whether RT and protein supplementation can prevent FFML after MBS.

In the EffectiveNess of pRotein supplementatIon Combined witH resistance Exercise training to counteract Disproportional fat-free mass loss following metabolic bariatric surgery (ENRICHED) randomised controlled trial, 400 patients scheduled to undergo MBS will be randomised in a 1:1 ratio to the ENRICHED perioperative care programme (intervention group) or the standard perioperative care programme of the Dutch Obesity Clinic (control group). The study is currently recruiting participants at two centres in the Netherlands: Nieuwegein and Amsterdam. The postoperative standard programme consists of 13 group sessions spread over a period of 18 months. As part of the ENRICHED programme, RT and protein supplementation will be added 3 weeks after MBS. Additional whole-body RT consists of home-based training sessions two to three times a week, and supervised RT sessions of 45–60 min once weekly, performed at 60–75% of one-repetition maximum (1-RM). Protein supplementation will start by adding 20 g of whey protein to the daily intake. The supplementation will be gradually increased with 20 g every 4 weeks until a total of 60 g whey protein a day is reached. After 12 weeks of protein supplementation, the focus shifts towards incorporating protein-rich food products into the daily dietary intake. The primary endpoint is the prevalence of disproportional FFM loss, defined as FFML/total weight loss ≥30%, at 3 months post-MBS. Secondary endpoints are differences in body composition, muscle strength and function, cardiorespiratory fitness, (cardio)metabolic health, health-related quality of life, gastrointestinal discomfort, cost-effectiveness of the intervention and treatment satisfaction. Outcomes will be assessed preoperatively and at 3, 6 and 12 months postoperatively.

The study protocol V.2.0 was approved by the Medical Research Ethics Committee Oost-Nederland (NL-OMON57119) on 9 April 2025. All participants will provide written informed consent prior to enrolment. Study findings will be disseminated through peer-reviewed publications and conference presentations. Insights gained in this study will provide evidence for a patient-tailored intervention that could be implemented in clinical practice.

NCT07156552.

The study aims to present recommendations for a revised Doctor of Pharmacy (Pharm-D) curriculum that aligns with regional needs and international standards of pharmacy education.

An exploratory qualitative study involving individual semistructured interviews. Data were collected and reported in accordance with Consolidated Criteria for Reporting of Qualitative Studies.

Face-to-face interviews were conducted in the respective offices of the experts and online interviews were conducted on Zoom and Google Meet.

Purposive and snowball sampling was used to recruit experts due to the eligibility criteria of including associate professors with a PhD, and snowball sampling facilitated the recruitment of experts from all provinces and internationally. Interviews were transcribed verbatim and data were analysed using an inductive thematic approach using NVivo V.15. All interviews were conducted in English.

The study engaged 49 experts from national and international settings with an age range of 25–60 years (median=43 years). The researchers came out with six themes and their subthemes from the data including: (a) understanding current Pharm-D curriculum in Pakistan, (b) inevitable changes required in the Pharm-D curriculum, (c) specific-subject based changes, (d) foundational steps to achieve the required changes, (e) barriers to the implementation of these changes and (f) impact of Pharm-D curriculum change.

The findings highlighted a clear need to revise the curriculum by incorporating enhanced clinical pharmacy content, integrated learning approaches, elective courses, interprofessional education, mandatory hospital and clinical placements, experiential learning through simulation-based methods and research components through a collaborative approach from policy makers and academic stakeholders.

Drug poisoning, caused predominantly by fentanyl in the unregulated drug supply, is the leading cause of death among persons 10–59 years in British Columbia (BC), Canada. In March 2020, in response to the emergence of the COVID-19 pandemic, the province of BC released the Risk Mitigation Guidance (RMG) as a clinical tool for physicians and nurse practitioners, allowing prescribers to provide selective withdrawal management medications, such as hydromorphone, dextroamphetamine, diazepam and others, as a legal and regulated supply of pharmaceutical alternatives to individuals who were at-risk of COVID-19 and overdose. In July 2021, the government of BC released the prescribed safer supply (PSS) policy, extending the scope beyond the COVID-19 pandemic and initial medications offered under the RMG. Recent studies have shown clear benefits among people with a diagnosed opioid use disorder who were prescribed PSS, in reducing mortality, as well as improving retention on opioid agonist treatment for those who were coprescribed PSS medications. The objective of the analysis detailed in this protocol is to use a cross-model comparison approach, comparing two independently developed models which are currently used in public health institutions in BC, to estimate the impact of this policy on opioid overdose-related mortality, while also considering the potential negative impacts of PSS medication diversion to those who are opioid naïve. This project will add to the limited evidence-base on the population-level impact of pharmaceutical alternatives interventions to date.

We have identified two appropriate mathematical models to evaluate the impact of PSS on the number of opioid overdose-related deaths within BC from the inception of the programme (March 2020) until December 2022. We will use recently established guidelines on conducting a cross-model comparison to identify structural and parameter differences between the models and perform adaptation steps to generate the counterfactual scenarios. These will include creating additional health states for the population representing individuals receiving PSS, and parameterising the overdose risk, mortality and retention in the new compartments from a comprehensive population-level data set. Harmonisation will be conducted to ensure that both models evaluate the same scenarios with the same data. Further sensitivity analyses will be conducted to consider alternative counterfactual scenarios and changes to the population following the implementation of the intervention.

This study is exempt from research ethics board review, as outlined in the Tri-Council Policy Statement, because it relies on data that is available in the public domain and there is no possibility of identifying individual persons. Results of the model validation analysis will be distributed through peer-reviewed journals and knowledge translation materials posted on the websites of the BC Centre for Disease Control and Centre for Advancing Health Outcomes.

https://osf.io/kju2p/overview.

To explore existing strategies for managing sleep disorders in individuals with vision impairment (VI), identifying interventions, geographical trends and research gaps.

Scoping review.

Medline ALL (Ovid), Embase and Web of Science Core Collection, with supplementary searches in Google Scholar. The final search was completed on 28 November 2025.

Original research studies examining strategies to manage sleep disorders in adults (≥18 years) with VI, published in English. Studies focusing on animal models or unrelated to sleep management were excluded.

Two reviewers independently screened titles, abstracts and full texts using Covidence, extracted data using a predefined form and resolved discrepancies by consensus. A narrative synthesis approach was used to summarise findings by intervention type, study design and outcomes.

Of 4368 records screened, 16 studies met inclusion criteria. Participants ranged from 18 years to 85 years (median 40.5). Most studies included individuals with no light perception, though VI definitions were often inconsistent. Pharmacological interventions dominated (13/16, 81.3%), mainly melatonin or melatonin receptor agonists, with some use of zopiclone, low-dose benzodiazepines and tricyclic antidepressants. Non-pharmacological approaches were under-represented, including bright light exposure (n=1), virtual Hatha yoga (n=1) and caffeine modulation (n=1). Substantial variation existed in sleep assessment methods.

This scoping review highlights the predominant focus on pharmacological treatments, especially melatonin, while non-pharmacological strategies remain underexplored. Future research should explore accessible, non-pharmacological interventions and address sleep health inequities faced by individuals with VI.

10.17605/OSF.IO/7E83R.

Chronic kidney disease (CKD) arises due to uncontrolled hypertension (HTN). HTN significantly increases the risk of complications in vital organs, mainly the kidneys. If hypertensive individuals receive early intervention, the majority of these complications and deaths from CKD can be avoided. Having a clinically applicable tool to predict the future risk of those complications can prevent early disability and premature mortality. However, to this day, there is a lack of a validated risk prediction model specifically designed for CKD of hypertensive patients in Ethiopia. We aimed to develop a risk prediction model for CKD among hypertensive patients at the University of Gondar Comprehensive Specialised Hospital (UoGCSH), Ethiopia.

A retrospective follow-up study was conducted from 1 January 2012 to 30 December 2021. The Least Absolute Shrinkage and Selection Operator regression methods were used to select predictors. The performance of the models was assessed using the Area Under the Curve and calibration plots. The internal validity of the model was evaluated using bootstrapping methods, and the model was presented as a nomogram. Decision curve analysis was conducted to assess the net benefit of the prediction model in clinical and public health contexts.

Data from patients’ medical records were collected via the Kobo Toolbox in the UoGCSH.

We followed a total of 1120 Patients diagnosed with HTN.

The incidence of CKD among adult hypertensive patients was 19.82% (95% CI 17.59% to 22.26%). In the multivariable logistic regression analysis, age, residency, baseline blood pressure status, type of HTN, family history of HTN, baseline serum creatinine levels, proteinuria at baseline and dyslipidaemia were identified as statistically significant predictors of CKD. The nomogram demonstrated a discriminatory power of 91.98% (95% CI 90.09% to 93.88%) and a calibration p value of 0.327. The sensitivity and specificity of the prediction model were 80.63% (95% CI 74.81% to 85.61%) and 87.97% (95% CI 85.66% to 90.03%), respectively. The developed nomogram has a greater net benefit than using the treat-all or treat-none strategies when the threshold probability of the patient is increased.

The nomogram demonstrated excellent discrimination and calibration in identifying hypertensive patients at high risk of CKD. This predictive model offers clinicians a valuable tool for early identification of high-risk individuals, enabling timely interventions, personalised counselling and optimised management through close monitoring to prevent disease progression.

This study aimed to determine the prevalence of cervical high-risk human papillomavirus (hrHPV) in a community-based setting and its risk factors association in women living in hard-to-reach areas in Bangladesh.

A cross-sectional study

The study was carried out in six subdistricts, located in hard-to-reach and climate-impacted regions of Bangladesh.

A total of 8000 married women aged 30–60 years were invited for screening. Women who were unable to give consent, were pregnant or had a hysterectomy with removal of the cervix, previous screening less than 5 years, or treatment of the cervix or had symptoms of potential cervical cancer were excluded.

A community-based hrHPV self-collected screening for cervical cancer was conducted from June 2022 to July 2023.

Prevalence of cervical hrHPV and risk factor association.

11 127 women were eligible for screening; 7850 women submitted hrHPV self-swabs, 7828 valid HPV test results were reported and 164 women (2.1%) tested hrHPV positive. Women living in the North were 2.1 times more likely to be hrHPV positive compared with women living in the South (adjusted OR (AOR)=2.1, 95% CI: 1.5 to 3.8, p=0.023) and widowed women were 3.0 times more likely to be hrHPV positive than married women (AOR=3.0, 95% CI: 1.7 to 5.3, p=0.001). Another risk factor associated with testing hrHPV positive was the use of hormonal contraceptives for 5 years and above (AOR=7.0, 95% CI: 2.0 to 24.4, p=0.002).

The study identified a low overall prevalence of hrHPV infection (2.1%) among women in hard-to-reach areas in Bangladesh, with some regional variations. Higher prevalence was observed in widowed compared with married women and among women reporting more than 5 years of hormonal contraceptive use. This study shows no evidence of particularly high-risk groups in hard-to-reach areas in Bangladesh. The findings support the feasibility of implementing a nationwide hr-HPV-based self-sampling strategy as a viable approach to reach WHO targets for reducing the burden of cervical cancer. Recommendation for policymakers to support future research to identify hrHPV prevalence among women in comparable groups in other geographically remote areas in Bangladesh.

NCT05234112.

There is substantial literature on opioid pharmacotherapies from a service user perspective, mostly focused on methadone and buprenorphine. However, as a relatively new formulation, much less is known about user experiences and views of Long-Acting Injectable Buprenorphine (LAIB). To date, no published reviews have qualitatively described LAIB service user experience. The objective of this scoping review is to identify and describe the peer-reviewed qualitative studies examining the service user experience of LAIB.

This scoping review will follow the methodology described by Arksey and O’Malley, further adapted by Levac et al and others. The search strategy will be developed in collaboration with an expert librarian and will include searches of Medline, Embase, PsycINFO, CINAHL, Scopus and Web of Science as well as citation chaining. The search dates will range from 2016, when LAIB was first approved, to the date of the final search. Included studies will investigate the perspectives and experiences of LAIB treatment participants with opioid dependence, within an Opioid Treatment Programme (OTP). For service users, the pharmacological formulation of LAIB significantly reshapes both the clinical practice and the social dynamics within OTPs. To effectively capture the depth and nuance of service users’ experiences, this review will be limited to qualitative, mixed-method, case series or case study designs, with a further restriction to peer-reviewed articles published in English. Identified references, with duplicates removed, will be imported into Covidence for title/abstract screening, full-text review and data extraction by two independent reviewers. All decisions on data inclusion or exclusion will be by consensus agreement, using a third reviewer if necessary. A living experience researcher will lead analysis of manuscript content in NVivo using inductive coding to produce a descriptive thematic analysis. The narrative summary will present key study characteristics, quality appraisal and synthesised findings that describe service user experiences and perspectives of LAIB, guided by the Systematic Reviews and Meta-Analysis for Scoping Reviews checklist.

This scoping review undertakes secondary analysis of data in the public domains only and thus does not require ethics approval given no participants are directly involved. The results of the review will be published in a peer-reviewed journal, presented at relevant academic and community conferences, and discussed and disseminated to/with community organisations, service users and policy-makers.

Prepublication history and additional supplemental material for this paper are available online. To view these files, visit: Open Science Framework https://doi.org/10.17605/OSF.IO/XMHKN.

To explore the barriers and facilitators in adherence to the guidelines in the management of benign paroxysmal positional vertigo from the perspective of primary care physicians.

Qualitative study using focus groups.

L’Hospitalet del Llobregat (Barcelona), Spain.

Qualitative study using focus groups. Structured 90 min focus groups were conducted until data saturation was reached. Each session included a moderator and an observer from the research team. Sessions were transcribed and thematically analysed by three independent researchers.

Purposeful sampling was used to form four groups of 4–10 participants, selected by sex, age, years of experience and primary care team (PCT). Participants were recruited between January and February 2023.

A total of 34 family physicians belonging to four PCTs participated in the study. The main barriers identified were a lack of time, negative initial experiences, a fear of harming patients (especially older adults), difficulty in nystagmus visualisation and challenges in managing patient expectations, as many preferred medication over physical manoeuvres. Facilitators included potential time savings from effective early management, the value of initial practical training with periodic refreshers, access to expert consultants for case discussions and the availability of digital tools, such as tutorials, videos and aids for nystagmus interpretation.

Health systems should invest in protected time for history-taking and physical examination, and in regular, updated training for primary care professionals. This could improve vertigo management and reduce unnecessary investigations and medications, ultimately benefiting both patients and the healthcare system.

To analyse demographic trends and decision-making patterns regarding prenatal diagnosis (PND) in couples at risk for hereditary haemoglobinopathies at the Thalassemia and Rare Haematological Disease Centre in Turin over a 40-year period.

Retrospective observational study analysing demographic and clinical data from 1983 to 2023.

Tertiary care genetic service Centre in Orbassano (TO), Northern Italy.

Couples seeking genetic counselling and PND for hereditary haemoglobinopathies. Selection criteria included couples at risk of having children affected by β-thalassaemia major or Sickle Cell Disease (SCD).

Primary outcomes included acceptance rates of PND and pregnancy termination (TOP). Variables analysed included couples’ age at first consultation, age at first PND, birthplace, employment status, specific haemoglobinopathy risk and number of pregnancies.

The analysis identified three main factors influencing PND and TOP decisions: nationality, type of haemoglobinopathy risk and number of previous pregnancies. Age showed no significant correlation with decision-making patterns. The impact of education level and employment status could not be definitively determined due to unavailable or unfit data.

The 40-year analysis of prenatal diagnosis for haemoglobinopathies in Turin shows evolving trends influenced by immigration patterns, improved medical treatments and cultural factors, leading to increased acceptance of affected pregnancies in recent years, particularly after 2015, due to better disease management and comprehensive healthcare support. This comprehensive analysis of our centre’s experience provides valuable insights that can serve as a model for similar institutions worldwide in supporting couples through carrier screening and PND processes.

To develop prediction models for short-term outcomes following a first acute myocardial infarction (AMI) event (index) or for past AMI events (prevalent) in a national primary care cohort.

Retrospective cohort study using logistic regression models to estimate 1-year and 5-year risks of all-cause mortality and composite cardiovascular outcomes.

Primary care practices in England contributing data to the Clinical Practice Research Datalink (CPRD) Aurum and CPRD GOLD databases between 2006 and 2019.

Patients with an incident (index) or prevalent AMI event. Models were trained on a random 80% sample of CPRD Aurum (n=1018 practices), internally validated on the remaining 20% (n=255) and externally validated using CPRD GOLD (n=248).

Discrimination assessed using sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Calibration assessed using calibration plots.

In the index (prevalent) cohorts, 94 241 (64 789) patients were included in the training and internal validation sets, and 16 832 (7479) in the external validation set. For the index cohort, AUCs for 1-year [5-year] all-cause mortality were 0.802 (95% CI 0.793 to 0.812) [0.847 (0.841 to 0.853)] internally and 0.800 (0.790 to 0.810) [0.841 (0.835 to 0.847)] externally. For the primary composite outcome (stroke, heart failure and all-cause death), AUCs were 0.763 (0.756 to 0.771) [0.824 (0.818 to 0.830)] internally and 0.748 (0.739 to 0.756) [0.808 (0.801 to 0.815)] externally. Discrimination was higher in the prevalent cohort, particularly for 1-year mortality (AUC: 0.896, 95% CI 0.887 to 0.904). Models excluding treatment variables showed slightly lower but comparable performance. Calibration was acceptable across models.

These models can support clinicians in identifying patients at increased risk of short-term adverse outcomes following AMI, whether newly diagnosed or with a prior history. This can inform monitoring strategies and secondary prevention and guide patient counselling on modifiable risk factors.

Epidemics pose significant challenges for fragile health systems, particularly in humanitarian emergencies. Recent responses to epidemics such as cholera in Yemen and Ebola virus disease in the Democratic Republic of the Congo have highlighted the lack of effective and integrated coordination. We review existing global models for addressing large-scale epidemics in humanitarian emergencies, identify gaps and inefficiencies, and propose operational recommendations to enhance response mechanisms.

A two-pronged approach was used to identify and critically assess current response coordination frameworks. Using the Arksey and O’Malley framework, a scoping review was undertaken, which was complemented by key informant interviews with humanitarian emergency response experts. The interviews focused on identifying the existing challenges and potential strategies to improve epidemic response in humanitarian contexts.

The scoping review included 51 documents (13 peer-reviewed articles and 38 grey literature documents). We conducted in-depth interviews with 28 respondents representing 17 different agencies and donors.

We focused on two major response architectures: the Incident Management System (IMS) and the cluster system. IMS is an important coordination and response instrument increasingly being used to respond to infectious disease threats.

Outcome measures of interest included the gaps in the current mechanisms to address infectious disease threats in complex humanitarian emergencies.

Unlike the cluster system model, which relies on consensus decision-making, IMS has a command-and-control approach, ensuring rapid decision-making. However, it can also lead to vertical responses that neglect the cross-sectoral and complex needs of affected communities. In addition, we found that the absence of context-specific response coordination mechanisms, with clear roles and responsibilities for involved stakeholders, was a common shortcoming. Fragmented response efforts that sidelined national and local stakeholders and a lack of reliable funding were also identified as important weaknesses.

We recommend the integration of coordination mechanisms into a sufficiently flexible framework that can be adapted to local contexts, while empowering national and local actors and ensuring the continuity of essential humanitarian services. We propose a paradigm shift towards mechanisms that respect humanitarian principles, effectively addressing the epidemic threats while remaining focused on deploying community-centric response efforts.

This study aimed to understand the knowledge possessed by informal medicine vendors regarding antibiotics and antibiotic resistance, identify the perceptions held by informal medicine vendors about antibiotics and their uses and examine the practices employed by informal medicine vendors in the sale and distribution of antibiotics.

Exploratory qualitative study using semi-structured interviews and direct observations.

Markets and shops across 11 villages in the Nanoro health district, Burkina Faso.

23 informal medicine vendors, aged between 25 and 55 years and with 8–30 years of experience, were recruited through snowball sampling in the Nanoro health district of Burkina Faso.

Informal medicine vendors exhibited a limited understanding of antibiotics, often confusing them with other treatments and referring to them using local terminologies based on perceived use and effectiveness. Antibiotics were perceived as universal remedies, supported by therapeutic belief, empirical reasoning and community solidarity, with empirical diagnosis, approximate dosing and informal preparation techniques passed on through imitation. These findings emerged across themes including perceptions, symbolic attributes and sales practices.

Informal medicine vendors in rural Burkina Faso demonstrated limited understanding of antibiotics and antimicrobial resistance, with practices shaped by local beliefs and empirical experience. These findings underscore the need for context-sensitive interventions that include tailored education and regulatory engagement to improve antibiotic stewardship and mitigate the spread of resistance.

The global prevalence of osteoarthritis (OA) is expected to rise as the population ages, leading to increased physical impairments that often reduce physical activity. Knee OA, in particular, is a leading cause of chronic pain and disability in people over 40. OA progression varies among individuals, with factors such as higher age and body mass index contributing to a more rapid progression. However, research suggests that engaging in physical activity such as hiking and running may help alleviate pain and slow OA progression. However, current literature on the relationship between physical activity and knee OA is largely retrospective, lacks comparative analyses across different physical activity types and rarely considers the intensity of physical activity. To address these gaps, the LoaD study was designed as a prospective cohort study aimed at examining how different physical activity types (ie, hiking, running, cycling and tennis) and their intensities relate to knee OA progression over 24 months in physically active individuals with early signs of the condition.

This prospective cohort study will include 300 participants (75 per physical activity group), who will be followed for 24 months. Eligible participants are aged 45–65, meet the National Institute for Health and Care Excellence (NICE) criteria for clinical knee OA and engage in a minimum weekly activity level for either running (60 min), cycling (120 min), playing tennis (60 min) or hiking (1 hike of 10 km). Baseline and follow-up assessments will include MRI, physical examination (eg, biometrics, lower extremity strength) and blood sampling for molecular biomarker assessment (eg, genetics, inflammatory biomarkers). Participants will receive monthly online questionnaires (eg, demographics, lifestyle, general health, history of knee injuries) and their physical activities will be tracked continuously by global positioning system data from wearable devices. The study’s primary outcomes focus on knee OA progression and symptom changes. These will be assessed through (1) structural progression of knee OA, measured using the MRI Osteoarthritis Knee Score (MOAKS) and (2) clinical symptom progression evaluated by (a) the Knee Injury and Osteoarthritis Outcome Score sport and recreation function subscale and (b) Visual Analogue Scale for pain during an activity nominated by the participant to be the most aggravating for knee pain in the past month (VASNA, 0–10). Differences between groups on the primary outcomes will be analysed using mixed-effects models to determine the impact of activity type and intensity on knee OA progression.

The study is approved by the Erasmus MC Medical Research and Ethics Committee (MREC) (MEC-2022-0420). The results of this study will be made publicly available through peer-reviewed international open-access scientific journals and national and international conferences. Participants will be informed about the results as soon as they are published.

A successful extubation process is critical for the future health outcomes of paediatric patients, as it tests the functioning of the respiratory system without the support of mechanical ventilation. However, extubation can cause stress, pain, anxiety or discomfort in patients, which may sometimes lead to an increased likelihood of reintubation. Music-based interventions and therapies have been shown to be effective in reducing anxiety and stress levels in ventilated patients in the paediatric intensive care unit (PICU), but studies evaluating the effect of music therapy during the extubation process in the PICU are scarce.

This is a pragmatic multicentre randomised clinical trial with two parallel arms. The intervention group will receive standard care + music therapy during the extubation process, and the control group will receive standard care alone. The main outcome measure is heart rate, which will be measured every minute for 5 min pre-extubation, during the extubation process and up to 10 min postextubation. Secondary outcome measures are: oxygen saturation, respiratory rate, blood pressure and heart rate variability. A total of 82 patients will be randomised.

This study was approved by the Research Ethics Committee of the Fundación Universitaria Sanitas (CEIFUS 1356-24, date of approval: 3 May 2024). All parents or legal guardians of patients will sign a written informed consent, and if applicable, assent from participants will be sought. The results will be disseminated through publications in peer-reviewed journals, conferences and presentations at the hospitals’ clinical committees.

Version 1.0, 18 December 2024.

NCT06591533, trial registration date: 10 September 2024.