Health-related quality of life (HRQoL) assessments are a cornerstone of outcome evaluations for patients with cancer. The aim of this project was to assess patients with cancer in Lubumbashi/Democratic Republic of the Congo and: (1) evaluate what constitutes a clinically important health problem, (2) evaluate HRQoL and (3) compare HRQoL to controls.

Cross-sectional, prospective study.

Patient recruitment took place in 12 hospitals in Lubumbashi.

Inclusion criteria were a secured diagnosis of cancer, aged 18 years and above, no serious cognitive impairments.

(1) Semi-structured interviews with patients and healthcare professionals were conducted to investigate aspects of clinical importance. (2) The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was employed to quantitatively assess HRQoL; (3) an exploratory comparison of HRQoL data to Spanish controls, multinational reference data and the European general population data is performed.

(1) 20 patients (x-age=55.0 years; 70.0% female) and 10 healthcare professionals were interviewed. Social isolation, need for help/care and worries were frequently mentioned aspects making a health problem clinically important. (2) 103 patients (x-age=54.0 years; 67.0% female) with various cancer types were assessed. The prevalence of clinically important problems ranged from 26.2 % for fatigue to 94.1% for financial problems. (3) Compared to matched Spanish controls (n=207), symptom burden was more pervasive (OR 1.18 for insomnia to 28.0 for financial problems) than functional health limitations (max. OR 2.12 for role function). While adjusting HRQoL scores for age, sex, comorbidities and treatment intention decreased effect sizes of score difference across countries for 14 out of 16 scales, statistically significant differences across countries (p<0.05) remained for ten scales even after adjusting for covariates.

Clinical characteristics, aspects of clinical importance and HRQoL profiles of patients with cancer in Lubumbashi were reported. Aspects of clinical importance were identified, whereas a high symptom burden was reported by patients with cancer in Lubumbashi. Enhancing symptom management in Lubumbashi may alleviate symptom burden of patients with cancer.

Sleep is an important natural process carried out by the human body. It allows the body to rest and the brain to process information attained over the course of the day. Sleep is intrinsically linked to mental health, with those with mental illness more likely to require support in attaining adequate sleep. Recently, the College of Psychiatrists in Ireland’s REFOCUS committee has sought to co-design an information leaflet for those with mental illness detailing the latest recommendations from the literature regarding sleep for this population, regardless of whether or not they take psychotropic medications. Given the rapidly expanding research focus on this topic, there are many published systematic reviews on the subject. As such, this proposed umbrella review seeks to collate the existing qualitative-based systematic reviews into sleep and mental illness and synthesise them in order to draw out the key recommendations that can be used by the committee to co-design an information leaflet to be used in practice to support service users with sleep disturbance.

This proposed review aims to explore how service users of mental health services experience sleep with and without the medication used to treat mental illness. An umbrella review that is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is proposed. Search terms are stated, and a variety of databases

(Medline, Embase, CINAHL, Web of Science, Scopus) will be searched. The search range is from 1 January 2016 to present (2026).

Given that this paper presents a protocol for an umbrella review into sleep and mental illness, no ethical approval was required. The proposed umbrella review has been registered with the repository: PROSPERO on 18 March 2026 where it is freely available. The results of the umbrella review will be disseminated through both a peer reviewed publication and through an information leaflet co-designed by the College of Psychiatrists in Ireland’s REFOCUS committee. This protocol and subsequent umbrella review is and will be co-designed by psychiatrists, service users and family members of those with mental illness. Such individuals are named authors on this protocol and will be named authors on the proposed umbrella review as well.

CRD420261343674.

To investigate real-world healthcare experiences of individuals in the UK who consulted health and care professionals for nocturia. The study explored the assessments, management strategies, referrals and follow-up patterns received by patients experiencing lower urinary tract symptoms (LUTSs), as well as their level of satisfaction with those. The association of sociodemographic factors with these patterns was also analysed.

A cross-sectional online survey.

Community-based, UK.

From 2012 completers, 453 (22.5%) reported consulting healthcare professionals for LUTS (55.0% female, 75.5% White; aged 18–65+ years; convenience sampling via online panels/networks).

None (observational survey study).

Healthcare provider consulted; assessments (eg, history, bladder diary, examinations, tests); management (eg, behavioural, pharmacological); referrals/follow-up; satisfaction; associations via ² tests.

Among 453 respondents who sought professional advice for LUTS, 211 reported nocturia and 143 had nocturia confirmed through the survey’s follow-up questions. General practitioners were the most consulted providers (73.1%), but guideline-recommended tools such as bladder diaries were underutilised (13.9%). Only 12.1% were referred to specialists. Satisfaction with care was mixed: 59% were satisfied with assessment and 54% with treatment, but dissatisfaction was common around referrals, follow-up and cause explanation. Long-term conditions and disability were associated with greater unmet needs. Participants consistently called for more accessible information, clinician training and better self-management support.

These findings suggest that patients’ reported experiences of assessment and management varied, which may reflect differences in actual practice, recall or communication during consultations, particularly in relation to nocturia. However, because the data are cross-sectional and self-reported, these results should be interpreted cautiously. They highlight areas where patient assessment, communication and follow-up could potentially be improved.

To determine the prevalence of lower urinary tract symptoms (LUTS) and nocturia, public knowledge of associated risk factors, self-management practices and advice-seeking behaviours among community-dwelling adults in the UK, as well as to examine the sociodemographic correlates of these outcomes.

A cross-sectional online survey.

Community based, UK.

2062 UK adults accessed the survey; 2012 provided complete sociodemographic data for analysis (50.2% female, 49.8% male; 81.7% white, 9.4% Asian/Asian British; aged 18–65+ years); convenience sampling via online panels and networks, with informed consent.

None (observational survey study).

Prevalence of LUTS/nocturia; awareness of symptoms/risk factors; self-management strategies; advice sources; demographic associations.

Among all respondents, 52.7% reported experiencing nocturia, with 42.2% having symptoms nightly and 47.1% waking at least twice per night. While 90.5% recognised fluid intake before bed as a cause, knowledge of other risk factors (eg, cardiovascular disease, salt intake, sleep disorders) was limited. Nearly half (43.2%) of those with symptoms had never sought advice; only 27% sought professional input. Online resources (eg, National Health Service website, Google) were consulted more frequently than healthcare professionals. Age, sex, ethnicity, long-term condition status and disability were associated with variations in awareness and advice-seeking behaviours.

Nocturia is highly prevalent, but advice-seeking is quite low. While awareness of behavioural contributors is relatively good, several contributing medical conditions and other health-related factors were less known. These findings highlight a need for national health literacy campaigns focused on specific risk factors, evidence-based self-care tools and greater professional engagement. Addressing these gaps can normalise discussions about bladder health, reduce stigma and improve early detection and management of LUTS in the community.

Cognitive impairment after critical illness is a common occurrence that has a profound impact on millions of people worldwide each year. Currently, no interventions after critical illness have been found to promote cognitive recovery. Cognitive training has shown promise in other populations (eg, community-dwelling adults), predominantly in improving the trained cognitive domain (eg, memory, reasoning or executive function). In pilot work, in-person cognitive training with intensive care unit (ICU) survivors was found to not only improve the trained domain but also may reduce disabilities in daily function. Computerised cognitive rehabilitation (CCR) is a more scalable option, which we have demonstrated the feasibility of use among ICU survivors. Whether CCR is efficacious in ICU survivors remains unknown.

The Returning to Everyday Tasks Utilising Rehabilitation Networks-III (RETURN-III) study is a multicentre, randomised, double-blinded, parallel group controlled trial testing the hypothesis that CCR versus active control will result in less cognitive impairment after critical illness. Adult patients who recently experienced acute respiratory failure or shock in medical and surgical ICUs at two hospitals in Nashville (TN, USA) will be enrolled. Participants will be randomised within 12 weeks of hospital discharge to a 12-week home-based programme of CCR (or control), with the goal of five 30 min sessions per week. In-person assessments will be performed at baseline, 3 months and 12 months after randomisation. The primary outcome is global cognitive function 3 months after randomisation using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) score. Secondary outcomes will include 12-month RBANS global cognitive function, 3-month and 12-month subjective cognition by the Cognitive Self-Report Questionnaire, daily function related to cognition by the Functional Activities Questionnaire and processing speed/executive function by Trail Making Test part B. With an anticipated enrolment of 160 patients, the study will have at least 80% power to detect a 7-point or higher difference in RBANS cognition scores between the two groups (

The RETURN-III study was approved by the institutional review boards at each participating site. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences following completion of data collection.

NCT04353804.

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.

To elicit and quantify registered nurses’ (RNs’) preferences for key shift attributes and to estimate the trade-offs between shift pattern characteristics and pay.

Cross-sectional online discrete choice experiment with d-efficient design; 12 choice tasks per respondent. Preferences were estimated using multinomial logit models with clustered standard errors; willingness to accept (WTA) values were derived as ratios of attribute coefficients to the pay coefficient.

United Kingdom.

1449 registered nurses (RNs) recruited via the Nursing and Midwifery Council distribution list.

Utility coefficients (β) for shift length, schedule predictability, shift request flexibility, weekend working frequency, pay level and night-shift frequency; WTA derived from the pay attribute; subgroup and interaction analyses by age, pay band, current shift status, caring responsibilities, sector and satisfaction.

All six attributes were statistically significant predictors of shift pattern choices. The strongest aversions were to night-only working (β=–1.113) and having no whole weekends off (β=–0.790), which required an estimated 29% additional compensation in the primary model and 21% additional compensation, respectively. Unpredictable rotas (β=–0.220), restricted shift-choice flexibility (β=–0.189 for only swaps) and absence of pay increase (β=–0.525) also reduced utility. Nine-to-ten-hour shifts were preferred over 8-hour shifts (β=0.144), whereas 12.5-hour shifts were disliked (β=–0.179). Subgroup analyses showed significant heterogeneity by age and current shift status, with more limited evidence of pay-band differences. Interaction analyses suggested broadly consistent aversion to night work and weekend loss across the nursing workforce.

Nurses strongly prefer rota designs that avoid exclusive night work and protect whole weekends off. Predictability and meaningful scope to request shifts also matter. These preference estimates provide policy-relevant benchmarks for rota design and unsocial-hours compensation.

Retention in HIV care is associated with higher rates of antiretroviral treatment adherence and viral suppression, as well as lower risk of AIDS-related morbidity and mortality. However, the multidimensional nature of retention complicates measurement standardisation, limiting comparability and global evaluation.

This study explored how HIV stakeholders define and assess retention, aiming to develop a patient-centred and conceptually robust understanding to inform research and practice.

We conducted a qualitative study using interpretive description methodology, an applied qualitative approach designed to generate practice-relevant knowledge in health research. We purposively sampled 20 stakeholders representing diverse areas of expertise and geographic regions across World Bank country income classifications. We conducted and video-recorded in-depth semistructured interviews and subsequently transcribed them. Using constant comparative analysis, we identified recurring, convergent and contradictory patterns.

The analysis identified five overarching themes. The first two, exploratory themes, included Patient-Centred Understanding of Retention in HIV Care, which captured how stakeholders conceptualised retention in their respective contexts and Operationalisation of Retention Measures, which explored the key components used to measure retention. The next two explanatory themes, included Purpose-Driven Definitions of Retention, which described how retention measures were selected based on their intended use, and Building Capacity through Shared Understanding and Integrated Action, which emphasised retention as a cyclical, interconnected process dependent on collaboration between patients and health systems. The final, prescriptive theme, Advancements Shaping Retention, reflected stakeholders’ shared vision of improving retention through innovations in HIV treatment and technology.

The findings suggest that stakeholders operationalise retention measures in line with specific objectives and individual health goals, while remaining attentive to contextual realities. Retention measures should remain flexible and patient-centred, rather than relying on a single rigid standard.

Bacterial translocation and gut dysbiosis are key drivers of systemic immune activation in decompensated cirrhosis, precipitating inflammatory complications such as acute-on-chronic liver failure (ACLF). Currently, no licensed therapies effectively restore intestinal barrier function or reverse dysbiosis in this vulnerable population. While previous studies have suggested benefits of faecal microbiota transfer (FMT) in hepatic encephalopathy or alcohol-associated hepatitis, data on its safety and immunomodulatory effects in decompensated cirrhosis with ascites are lacking. This Phase IIa trial (TransImmune) aims to evaluate the safety and tolerability of encapsulated FMT. Furthermore, it will assess feasibility, microbial engraftment and downstream effects on intestinal barrier integrity, as well as systemic and peritoneal inflammation.

This is a prospective, single-centre, randomised, double-blind, placebo-controlled Phase IIa pilot study. A total of 24 patients with decompensated cirrhosis and ascites will be randomised in a 1:1 ratio to receive either encapsulated FMT or placebo over three consecutive days. The investigational product, INTESTIFIX 001, is an encapsulated FMT preparation derived from rigorously screened healthy donors and manufactured under Good Manufacturing Practice (GMP) conditions with predefined release specifications, including minimum alpha-diversity QC criteria, manufactured by the Cologne Microbiota Bank (CMB). The primary endpoints are the occurrence of serious adverse events (SAE) up to the end of study (EOS) and the occurrence and severity of treatment-emergent adverse events (TEAE). Secondary endpoints evaluate signals of clinical efficacy, specifically: (1) systemic inflammation (white blood cell count, C-reactive protein, procalcitonin and IL-6); (2) gut inflammation (faecal calprotectin); (3) organ dysfunction (Child-Pugh, MELD and CLIF-SOFA scores); (4) quality of life (EQ-5D-5L and CLDQ) and (5) the number of antibiotic-free days. Patients will be monitored across five study visits up to 90 days.

The study was approved by ethics committee review and the German Federal Institute for Drugs and Medical Devices (BfArM). The trial is registered under EU CT no. 2023–5 07 790-18-00. The results of the study will be disseminated via peer-reviewed publications and at international conferences.

EU Clinical Trials Register: 2023-507790-18-00. Registered on 8 August 2024.

Frailty, a critical health indicator of ageing, poses significant public health challenges for individuals and society. This study analysed the longitudinal association between changes in employment status and frailty among middle-aged and older adults in Korea across different employment types. It also examined how employment transitions impact frailty components, particularly weakness, isolation and exhaustion.

A longitudinal study.

A nationwide community-based longitudinal study using data from the Korean Longitudinal Study of Aging from 2006 to 2022.

Individuals aged 45 years or older residing in private households across Korea (excluding Jeju Island) enrolled in Wave 1 (2006). For consistency, only participants with at least four observations during the entire study period were retained. Those with fewer than four observations (n=48 228) were excluded, amounting to a final of 6122 participants, of whom 2718 were men and 3404 were women. Furthermore, for the subgroup analysis of employment types, participants not classified as regular, temporary, daily, self-employed or unpaid family workers were excluded.

The primary outcome was frailty assessed using the Korean Frailty Instrument. Secondary outcomes were the individual frailty components, including weakness, isolation and exhaustion.

The study included 6122 participants (2718 men and 3404 women). Frailty was observed in 3.9% of men and 8.5% of women. Returning to or maintaining employment was significantly associated with reduced frailty risk between both genders (male: Unemployed -> Working OR 0.61, Working -> Working OR 0.59; female: Unemployed -> Working OR 0.68, Working -> Working OR 0.77). Employment type-based analysis revealed that transitioning to permanent employment has the strongest protective effect on men (Unemployed -> Permanent Employment OR 0.25).

Returning to or maintaining employment was associated with a lower risk of frailty. Promoting stable employment environments and encouraging labour force participation among middle-aged and older adults may contribute to better health outcomes in ageing societies.

To identify clinical indicators reflecting potentially treatment-modifiable prognostic factors associated with pain recovery in patients with non-specific neck pain and to develop a prototype clinical compass for visualising patient-specific profiles.

Secondary analysis of data from a multicentre, prospective, observational prognostic cohort study, with a 6-month follow-up between January 2020 and March 2023.

30 physiotherapy primary care practices.

Patients with a new episode of non-specific neck pain.

Patients completed questionnaires at baseline, 6 weeks, 3 months and 6 months assessing pain intensity and biological, psychological and social factors. Questionnaire total scores and individual items reflecting selected potentially modifiable factors were tested separately as candidate indicators. Baseline and repeated indicators were examined as effect modifiers of pain trajectories using growth-curve models. Subsequently, modifiable clinical indicators were incorporated as effect modifiers to evaluate their influence on the trajectory of pain intensity over time. Non-redundant significant indicators were integrated into a prototype clinical compass.

Data from 603 participants were collected. A quadratic growth-curve model best explained the longitudinal change of pain intensity. 24 clinical indicators were significantly associated with the trajectory of pain intensity over time. Two characteristics were excluded as they demonstrated high intercorrelation. Based on these findings, a clinical compass comprising 22 clinical indicators was developed to visualise patient-specific profiles.

This study provides a prototype clinical compass that may inform prognostic reasoning in primary care physiotherapy, but further evaluation is needed before clinical implementation.

Long COVID is a debilitating condition consisting of prolonged neurological symptoms such as cognitive impairment (‘brain fog’) and sleep disturbance. Symptoms may be associated with ongoing neuroinflammation from the persistence of a viral reservoir, activation of other viruses, protracted macrophagic inflammatory memory or enduring viral Spike protein that stimulates proinflammatory cytokines via toll-like receptor (TLR) signalling. Bezisterim (NE3107) is an oral, blood–brain barrier-permeable, anti-inflammatory, insulin-sensitising dehydroepiandrosterone derivative that inhibits TLR-driven neuroinflammation and is being developed for neurodegenerative diseases in which TLR-driven inflammation contributes to cognitive decline.

ADDRESS-LC (NCT06847191) is a phase 2, triple-blind, placebo-controlled, randomised proof-of-concept study to evaluate the efficacy and safety of bezisterim in adults with long COVID. This multicentre study will recruit 208 adults (aged 18–69 years) with symptoms of fatigue and neurocognitive impairment for at least 3 months following an index SARS-CoV-2 infection. Individuals who meet all eligibility criteria will be randomised 1:1 to receive bezisterim 20 mg or placebo two times per day for 12 weeks. Cognition, fatigue, sleep, post-exertional malaise, quality of life and burdensome symptoms will be evaluated via several assessments, including a bespoke Cogstate Cognition Battery, Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function Short Form (SF)-8a, PROMIS Fatigue SF-13a and Patient’s Global Impression of Severity, among others.

The protocol has been approved by an institutional review board prior to study initiation. The study is being conducted at multiple clinical research sites across the USA. A current list of participating study sites is publicly available through the ClinicalTrials.gov registration record (NCT06847191). The study protocol has received central institutional review board approval (Advarra #Pro00081088), and participating sites obtained the necessary approvals and agreements required for study conduct and data access in accordance with applicable regulations and Good Clinical Practice guidelines. Authorised representatives of the sponsor, regulatory authorities and ethics committees may access study-related records for monitoring, auditing and regulatory purposes consistent with participant informed consent. The study will disseminate results through academic publication and conference presentations.

NCT06847191.

Osteoporotic vertebral fractures (OVFs) significantly impact morbidity, mortality, function and quality of life. Stable fractures with controllable pain can be managed conservatively. Those that remain painful can be treated with minimally invasive measures of vertebral augmentation (VA). In contrast, severe and unstable OVFs risk collapse, progressive kyphosis and neurological damage. Conventional VA is considered insufficient for these unstable fractures, making surgical stabilisation necessary to restore spinal load-bearing capacity, and allow fast and painless mobilisation. However, spinal surgery in elderly osteoporotic patients is challenging due to tissue fragility and common comorbidities. In addition, poor bone quality increases the risk of surgical implant failure, new fractures, complications and re-intervention.

This trial aims to assess the non-inferiority of a novel minimally invasive interventional technique, called stent-screw assisted internal fixation (SAIF), compared with multilevel surgical stabilisation in terms of quality of life and radiological outcomes such as vertebral height restoration and kyphotic correction in patients with unstable OVFs.

This is a multicentre, parallel-group, randomised controlled non-inferiority trial that will be conducted in four European centres.

A total of 140 patients with type Osteoporotic Fracture (OF) 3–5 OVFs (according to the AO Spine-DGOU Osteoporotic Fracture Classification System) will be randomised 1:1 to receive either SAIF intervention or surgical stabilisation.

The primary outcome is to determine whether the effect of SAIF intervention is not inferior to surgical stabilisation on pain and quality of life at 1-year follow-up.

The principal secondary outcomes are to evaluate whether the effect of the SAIF intervention is not inferior to surgical stabilisation in terms of radiological outcome and cost-effectiveness.

Ethics approval was obtained from the Ethics Committee of the Canton Ticino, Switzerland (CE 4004). Results will be disseminated through international publications in peer-reviewed journals, in addition to international conference presentations.

NCT07071870.

We aimed to examine existing and emerging master narratives on mental health and to capture the changing emphasis in these narratives over time. Making these shifts explicit can facilitate alignment of actors and practices that must collaborate to support those seeking help.

We gathered data via a scoping review, semistructured interviews and podcast episodes. Data analysis consisted of a thematic analysis to identify narratives and a content analysis to map shifts in emphasis over time.

Semistructured interviews and included podcast episodes were all Dutch. The scoping review included Dutch and English publications.

Semistructured interviews were performed with 11 participants working in medical education and mental health provision. The selected podcast featured interviews with 15 people who aim to change the Dutch mental healthcare system.

We extracted four master narratives and observed a shift in emphasis as well as a coexistence of narratives. The narratives we found were: (1) treating a classification, (2) understanding the patient’s problem, (3) recovering life-balance and (4) building collective resilience. We found increasing emphasis on ‘building collective resilience’ when discussing the future of mental health.

Our concretisation of narrative patterns underlying the perspectives and approaches in mental health is a first step in creating a collective understanding of the shifting master narratives, which enables working with it in practice. The shift has implications for mental health professionals, educators, policymakers and those seeking help. Future research should further examine these implications and explore the perspectives of individuals seeking mental health support and their network, both of which remain insufficiently addressed.

Antimicrobial resistance (AMR) poses a serious threat across human, animal and environmental health. The One Health approach emphasises multisectoral collaboration and is critical in addressing AMR. While One Health governance has gained recognition from international organisations, there remains limited understanding of how it can be effectively implemented across institutional, social, economic and political contexts. This scoping review aims to explore the design and implementation of One Health governance across contexts.

Scoping review

We searched PubMed, Scopus, Web of Science and grey literature sources in December 2024, updating our search in March 2026.

Eligible sources included empirical and conceptual work on One Health governance.

We searched for and screened documents and extracted data following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We then applied qualitative analysis to examine governance mechanisms; implementation contexts; conceptualisations of effectiveness; evidence of effectiveness and key barriers and facilitators.

We included 171 documents from over 50 countries. We explored six dimensions of One Health governance: participation, leadership, coordination, decision-making, resourcing and accountability. Existing governance structures and wider aspects of country context shaped One Health governance. While there was broad agreement on the goals of One Health governance—namely, to support disease prevention, detection and response—empirical evidence on effective approaches was relatively limited. Facilitators included strong political will and crisis-driven momentum, while barriers included siloed systems, sectoral dominance, limited accountability, inadequate funding and lack of institutionalisation.

This review highlights the range of approaches to One Health governance that exist and outlines how context may shape the design and implementation of One Health governance. Evaluative research should further explore which approaches to One Health governance are most effective in specific contexts. These insights are particularly relevant for AMR, where sustained cross-sectoral governance beyond outbreak-driven responses is essential to counter the ‘silent pandemic’.

Neighbourhood socioeconomic status (nSES) and built environment features strongly influence diet, physical activity and cancer screening adherence, potentially affecting colorectal cancer (CRC) incidence and prognosis. The aim of this study is to assess the association between neighbourhood obesogenic environments (eg, nSES, restaurant and retail food indices, recreational facilities, and business district residence) and CRC risk and mortality.

A secondary data analysis was performed using prospectively collected data from the Southern Community Cohort Study.

12 states in the Southeastern USA.

We analysed data from 70 519 participants enrolled in the Southern Community Cohort Study.

The primary outcomes in this study are CRC risk and mortality.

We used multivariable Cox proportional hazards models, adjusting for individual-level factors to investigate neighbourhood-level risk factors associated with CRC risk and mortality. We further performed race-stratified analyses (Black/White) to examine potential disparities in CRC risk.

Among 70 519 participants (69.49% Black, 30.51% White), 927 (1.31%) were diagnosed with CRC (1.37% Black and 1.19% White participants). Of these, 255 (27.5%) died from CRC. Compared with participants residing in the highest (fifth) nSES quintile, those residing in the wealthier (fourth) quintile of nSES exhibited a higher CRC risk (adjusted HR (aHR) 1.27 (95% CI 1.03 to 1.57)). The Retail Food Environment Index was associated with an increased risk of CRC among participants residing in the fifth (wealthiest) nSES quintile (aHR 3.07 (95% CI 1.23 to 7.61) for Tertile 1 vs None; aHR 3.06 (95% CI 1.23 to 7.60) for Tertile 2 vs None). Similar associations were observed among both Black participants (aHR 3.65 (95% CI 1.19 to 11.20) for Tertile 1 vs None) and White participants (aHR 5.20 (95% CI 1.29 to 20.97) for Tertile 2 vs None) living in the same neighbourhoods, although these subgroup estimates should be interpreted cautiously due to wide CIs. Living in a low-walkability neighbourhood was associated with a higher risk of CRC (aHR 2.42 (95% CI 1.09 to 3.56)) among residents in the second-lowest nSES quintile, particularly among Black participants (aHR 3.41 (95% CI 1.29 to 9.02)). Compared with residents of the most walkable neighbourhoods, those in the least walkable (aHR 2.23 (95% CI 1.10 to 4.54)), below-average walkable (aHR 2.10 (95% CI 1.08 to 4.07)) and above-average walkable areas (aHR 2.33 (95% CI 1.24 to 4.39)) had significantly higher CRC mortality risk.

Our findings suggest that nSES and unhealthy food environments are associated with CRC risk, while less walkable environments were associated with higher CRC mortality. These findings highlight the need for a more detailed assessment of neighbourhood-level deprivation and support enhanced public policies targeting neighbourhood deprivation in low-income populations in the Southeastern USA.

Children with life-limiting conditions are living for longer and with more complex conditions than ever before. It is estimated that there are more than 21.6 million babies, children and young people (children) in need of palliative care internationally.1 There is worldwide agreement that access to palliative care is a right of these children,...

Sub-Saharan Africa (SSA), including Tanzania, is double-burdened with high rates of teenage pregnancy and new HIV infections among adolescent girls and young women (AGYW) aged 15–24 years. Moreover, pregnant AGYW living with HIV in SSA have poorer adherence and retention on HIV treatment and elevated risks of vertical HIV transmission to their infants, as compared with older women. This paper describes the methods for the ENGAGE project, aiming to investigate and optimise healthcare for prevention of vertical HIV transmission (commonly prevention of mother-to-child transmission (PMTCT)) for AGYW living with HIV in Tanzania.

ENGAGE uses a mixed-methods design to co-create and prototype an intervention package for pregnant/postpartum AGYW living with HIV through three phases in three Tanzanian regions. Phase 1 characterises the problem by investigating care engagement and outcomes in a cohort of N=10 147 AGYW receiving PMTCT services in routine healthcare. Phase 2 uses qualitative interviews to understand the social-structural drivers of care engagement from the perspective of AGYW, healthcare providers and community stakeholders and an evidence review of potential solutions. In phase 3, we will use findings from phase 1 and 2 to co-create (together with AGYW and healthcare providers) an intervention package to optimise PMTCT care for most at-risk AGYW. The co-creation will be done through an intervention development action cycle, where ideas are presented, feedback sought and refinements made iteratively via several workshops over about 6 months. The resulting co-created intervention package will be prototyped at selected facilities/communities and refined into a final version, ready for piloting for feasibility, acceptability and preliminary effect in a later phase. This protocol focuses on the co-creation phase 3 and its preceding phases 1 and 2.

ENGAGE has received ethical approval from the Tanzania National Health Research Ethics Committee (NIMR/HQ/R.8a/Vol.IX/4637), and the Swedish Ethical Review Authority (2024-05745-01) for analysis of data in Sweden. Findings will be disseminated to AGYW, healthcare providers, community stakeholders, health officials, researchers, policy makers and the wider local and global scientific community.

Despite implementation of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), screening coverage for oral, breast and cervical cancers remains below 2%. Screening quality is inadequately addressed and delays in diagnosis and treatment initiation continue to persist. This multisite implementation research aims to improve district-level coverage and quality of screening, early diagnosis and timeliness of treatment initiation through a model co-developed within the NP-NCD context.

The study will be conducted in three phases across seven districts in diverse regions of India. In phase I (formative), the current status, barriers and facilitators of cancer screening, diagnosis and treatment initiation under NP-NCD will be assessed. In phase II (optimisation), a model (package of implementation strategies) will be co-developed and iteratively optimised with multistakeholder engagement at the subdistrict level to improve screening coverage and quality and strengthen the referral system for early diagnosis and treatment initiation. In phase III (scale-up and evaluation), the model will be implemented at the district level and evaluated for improvements in screening, early diagnosis and treatment initiation. A convergent mixed-methods design will be used, incorporating household surveys, facility assessments and stakeholder interviews. Implementation Research Logic Model will guide planning, execution and evaluation in the present study. Determinants of screening coverage and quality, early diagnosis and treatment initiation will be assessed using the Consolidated Framework for Implementation Research. Implementation strategies for the model will be finalised using the Expert Recommendations for Implementing Change framework. Implementation and service outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.

Ethical approval has been obtained from all study sites. The study findings will be disseminated at the state, national and global levels through meetings and conferences and submitted to a peer-reviewed journal for publication.

CTRI/2025/08/092672.

To identify subgroups with similar social determinants of health (SDOH) characteristics using latent class analysis (LCA) and examine their associations with physical and mental health, cognitive function and missed workdays at 3 and 6 months post-SARS-CoV-2 infection. We hypothesised that intersecting SDOH factors would differentially influence COVID-19-related health outcomes across subgroups.

Prospective cohort study from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), with longitudinal data collection and cross-sectional analyses at baseline, 3-month and 6-month follow-ups.

Multicentre registry across eight US academic medical centres (Chicago, Dallas, Houston, Los Angeles, New Haven, Philadelphia, San Francisco and Seattle).

Adults aged ≥18 years, fluent in English or Spanish, with self-reported acute COVID-19 symptoms and a confirmed positive SARS-CoV-2 test within 42 days before enrolment (9 December 2020 to 12 August 2022), and access to an internet-connected device. Exclusions included incarceration, inability to provide informed consent, lack of confirmed SARS-CoV-2 infection or no internet access. Of 3791 eligible participants with complete baseline data, 2897 (76.4%) completed the 3-month follow-up and 2666 (70.3%) completed the 6-month follow-up; most were aged 18–49 years (74–75%), female (66–67%), white (86.6–87.5%) and non-Hispanic (86.6–87.5%).

Prespecified primary outcomes were physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS)-29 V.2.1 T-scores for depression, anxiety, fatigue, sleep disturbance, pain interference, physical function and social participation), cognitive function (PROMIS Cognitive Function Short Form 8 T-scores) and missed workdays due to illness (binary: >1 week vs ≤1 week, from a single-item survey). All measures were self-reported and collected at baseline, 3 months and 6 months; no changes from protocol.

LCA identified a 4-class model as optimal (lowest Bayesian Information Criterion (BIC) after evaluating 1–7 class models; significant demographic differences (² p

In this US prospective cohort, SDOH-based subgroups showed persistent disparities in health outcomes post-SARS-CoV-2 infection. Findings highlight the urgent need for intersectional approaches to address systemic inequities in post-COVID-19 recovery.

NCT04610515.