Existing frameworks on Commercial Determinants of Health (CDoH) largely focus on macro-level corporate practices and policy environments. Individual-level exposure—mediated through targeted marketing, pricing strategies, product availability and placement—remains underexplored, particularly in low- and middle-income countries. The absence of standardised tools to capture these exposures limits the ability to quantify commercial influences on health and weakens evidence-informed public health responses. There is a critical need for a robust, contextually grounded instrument to measure individual-level exposure to CDoH. Developing and validating an individual-level CDoH measurement tool is therefore essential to strengthen research, surveillance and policy action aimed at mitigating health-harming commercial influences. The availability of this tool will allow policymakers and public health practitioners to identify high-risk populations and monitor the effectiveness of regulatory actions addressing harmful commercial practices.

This study will follow standard guidelines for tool (questionnaire) development. The process will include four sequential phases: item generation, refinement, validity testing and construct validation. A literature review with a systematic search strategy and in-depth interviews with purposively sampled adults will inform domain identification and item generation. An e-Delphi process involving experts in CDoH and public health will refine and confirm items followed by content validity. This will be followed by assessment of face validity for clarity and relevance. Construct validity will be assessed through exploratory and confirmatory factor analyses, using fit indices such as Minimum ²/df, Goodness of Fit Index, Tucker-Lewis Index, Comparative Fit Index, Root Mean Square Error of Approximation and Standardised Root Mean Square Residual. Reliability will be estimated using Cronbach’s alpha, and convergent and discriminant validity will be examined through correlation analyses.

Ethical approval has been obtained from the Institutional Ethics Committee, Amrita Institute of Medical Sciences, Kochi (ECASM-AIMS-2025-267). Results will be disseminated through peer-reviewed publications, conferences and policy briefs, and the validated tool will be made accessible for research and public health applications.

Very preterm infants (

Australasian multicentre, two-arm, parallel-group, prospective, randomised, open, blinded-endpoint superiority trial in 868 infants born less than 32 weeks’ gestation. Infants are randomised to cycled environmental light and noise or routine care in a non-cycled hospital environment from soon after birth until discharge home. The intervention comprises wearing eye-masks and ear plugs from 20:00 to 6:00, followed by removal of these devices and exposure to normal environmental noise and 300-600 lux light from 6:00 to 20:00. The primary outcome is composite cognitive score on Bayley-4 developmental assessment at 2 years corrected postnatal age.

The trial is approved by the Child and Adolescent Health Service Human Research Ethics Committee under the National Mutual Acceptance Scheme in Australia. Infants are randomised to intervention or control group after informed parental consent is obtained. Results of the CIRCA DIEM Study will be disseminated widely via presentations at local, national and international conferences, publication in international peer-reviewed journals and inclusion on the study website. Information about trial findings will also be communicated directly to the parents/guardians of trial participants through the regular study newsletter. The trial investigators will seek opportunities to communicate study results to the lay public through media and social media avenues.

ANZCTRN12618000371291.

To evaluate the association between use of newer glucagon-like peptide-1 receptor agonists (GLP-1 RAs; semaglutide, tirzepatide) and alcohol-related hospitalisations among adults with alcohol use disorder (AUD) and type 2 diabetes (T2D) or obesity.

Retrospective cohort study using target trial emulation.

Electronic health record data from a collective of US healthcare systems.

Adults with AUD and T2D or obesity who started a newer GLP-1 RA (semaglutide or tirzepatide) or a relevant active comparator between 1 January 2018 and 31 December 2024.

Initiation of a newer GLP-1 RA compared with an active comparator across four target trials: (1) anti-diabetic medication (ADM) trial, (2) anti-obesity medication (AOM) trial, (3) medications for alcohol use disorder with T2D (MAUD-T2D) trial, and (4) medications for alcohol use disorder with obesity (MAUD-obesity) trial.

Time to first alcohol-related emergency department visits or hospitalisation within 1 year of treatment initiation. Non-alcohol-related hospitalisation was assessed as a negative control outcome. Propensity score based methods (weighting and matching) were used to control confounding and Cox proportional hazards models were used to estimate treatment effects.

A total of 40 703 adults met study criteria, including 18 676 in the ADM trial, 9391 in the AOM trial, 8942 in the MAUD-T2D trial and 11 198 in the MAUD-obesity trial. Initiation of a newer GLP-1 RA was associated with a lower hazard of alcohol-related hospitalisation in the ADM trial (HR 0.74, 95% CI 0.62 to 0.89 vs sulfonylureas; HR 0.78, 95% CI 0.65 to 0.92 vs other ADMs), the AOM trial (HR 0.68, 95% CI 0.54 to 0.85 vs other AOMs), the MAUD-T2D trial (HR 0.37, 95% CI 0.29 to 0.46) and the MAUD-obesity trial (HR 0.35, 95% CI 0.26 to 0.47).

Among adults with AUD and T2D or obesity, initiation of newer GLP-1 RAs was associated with a lower observed risk of alcohol-related hospitalisation.

To characterise current practices in adolescent sexual and reproductive health (SRH) assessment during routine clinical encounters in a tertiary care setting and to triangulate these findings with young adults’ experiences of adolescent healthcare, identifying gaps between recommended assessment approaches and real-world clinical practice.

Qualitative study using semistructured in-depth interviews (IDIs) and group discussions with clinicians, followed by a sequential triangulation phase involving IDIs with young adults. Data were analysed using Braun and Clarke’s reflexive thematic analysis.

A tertiary care hospital in South Karnataka, India.

33 clinicians across six departments participated in four IDIs and five group discussions (focus-group or small-group discussions). 10 undergraduate young adults were recruited for IDIs in the triangulation phase. Sampling was guided by the information power principle.

Not applicable.

Current patterns and practices of SRH assessment, perceived barriers and challenges and concordance between clinician-reported practices and young adults’ experiences of care.

Three domains emerged: current assessment practices, contextual challenges and improvement strategies. SRH assessment was largely symptom-driven and reactive rather than routinely integrated into consultations. Clinicians described practices shaped by sociocultural stigma, parental presence, privacy limitations and medicolegal uncertainty. In response, many relied on informal strategies such as rapport-building, indirect questioning or referral pathways. Triangulation with young adults’ experiences confirmed the reactive nature of SRH enquiry, but revealed critical mismatches: young adults perceived consent processes as opaque, investigations as unexplained and confidentiality as inconsistently protected, contrasting with clinician intentions to be protective and pragmatic.

Adolescent SRH assessment in tertiary care settings remains constrained by sociocultural, infrastructural and communication barriers. Clinicians often compensate through informal practices that lack standardised protocols. Integrating adolescent-focused communication training, standardised assessment approaches and supportive system-level and community interventions may strengthen disclosure and improve adolescent-centred SRH care. By triangulating provider and patient perspectives, this study reveals a systematic gap between clinician adaptive strategies, constructed as protective and adolescents’ experiences as opaque, non-participatory care offering contextually grounded implications for strengthening adolescent-centred SRH services in comparable LMIC settings.

Not applicable (Qualitative Study)

This scoping review identifies existing registries collecting data on Klinefelter’s syndrome (KS) patients and what data are collected, with the purpose of identifying any KS-specific registries. Findings to be used to inform future registry development.

A comprehensive scoping review was conducted. Multiple sources were reviewed and articles screened based on inclusion criteria and exclusion criteria.

Searches performed across multiple sources including PubMed, Embase, the Cochrane Library, WHO International Clinical Trials Registry Platform, Orphanet, EU Clinical Trials Register, King’s College London Library and charity organisation webpages.

The included studies were required to focus on KS patients with reported data from an active registry that routinely collects data on KS patients.

Basic information about registries identified in included articles was extracted. Registries identified were contacted with a standardised set of questions to collect additional contextual information. Findings are presented in tables.

The scoping review included 18 articles. From those, 10 registries storing KS patient data were identified. Only one of those registries was KS-specific. Only three out of 10 registries collected data that encompassed genetic, clinical and social variables. Most data included in registries were collected exclusively from medical records, although some registries included data from patient surveys. Registries that received government funding had more KS participants than those that did not.

With only one KS-specific registry existing worldwide and none within the UK, this review has identified a need for the development of further KS-specific registries. Data collected could be used to develop an accurate KS phenotype and therefore lead to increased diagnosis of the disorder, improving the lives of people with KS.

Point-of-care technologies (POCTs) are essential to providing clinical care for patients, with their potential for rapid and accurate results on site supporting efficient clinical decision-making.

To understand the current key needs, barriers and challenges of POCT developers for effective development and implementation of POCTs across diverse settings particularly in the domain of cancer, nutrition and infections.

A qualitative semi-structured focus group discussion (FGDs) was employed. The FGDs were guided by the needs assessment process and the Phase Gate Framework. The qualitative data were coded and analysed in NVivo and refined into various themes.

The study was conducted in person at Cornell Tech Campus in May 2024, New York, USA.

24 participants were purposively sampled from the PORTENT (Point-of-Care Technologies for Nutrition, Infection and Cancer) network. Participants included technical developers (eg, engineers, scientists, startup leads) and expert stakeholders (eg, funders, policy advisors, clinicians and academic partners) involved in POCT development, evaluation and implementation.

A total of 24 participants participated in the in-person FGDs in New York (n=24). Key themes identified included gaps in stakeholder engagement, limited regulatory preparedness, insufficient market analysis, challenges in scaling and manufacturing and the need for context-specific adaptation in low- and middle-income country (LMIC) settings. Participants emphasised the importance of user-centred and context-responsive design, strategic partnerships and early planning for regulatory and implementation pathways.

Technical developers and expert stakeholders in the POCT landscape face various barriers to efficient and effective development and implementation of POCTs. It is important to consider their needs when adapting POCTs in LMICs and diverse settings.

Thalassaemia, a genetic blood disorder, is a major public health burden. Most affected individuals reside in low-and-middle-income countries (LMICs). Screening programmes can reduce incidence, but in resource-constrained settings cost-effectiveness is important. This work aimed to investigate how economic evaluations of thalassaemia screening programmes have been conducted globally, to identify best practices for future evaluation suited to a LMIC context.

Systematic literature review.

The original review was undertaken between May and July 2023; an update was completed between November and December 2025. Electronic databases (MEDLINE, Embase, National Health Service Economic Evaluation Database, Health Technology Assessment Database, Cochrane Database of Systematic Reviews), economic databases (Cost-Effectiveness Analysis Registry) and grey literature (including conference proceedings) were searched. Additional validation searches were conducted in Google Scholar to identify relevant studies not indexed in the electronic databases.

Studies were screened against pre-specified criteria by two independent reviewers. Eligible articles reported an economic evaluation of a thalassaemia screening programme for pregnant women or children aged 2 years or younger in any geographic setting.

Data extraction for each included article was performed by one author and verified by a second. Findings were interpreted within the context of LMICs, given the high prevalence and resource limitations in these settings. The quality of each article was assessed using the Critical Appraisal Skills Programme Economic Evaluation Checklist; quality assessment for each article was performed by one author and verified by a second.

Of 2112 publications identified from database searches, ten were ultimately included: three cost-effectiveness analyses (CEAs), six cost-benefit analyses (CBAs) and one cost-utility analysis. Study quality varied widely, with most not reporting methodological details such as discounting rates and time horizon. Additionally, no studies employed standard cost-effectiveness metrics, such as quality-adjusted life-years. Seven studies adopted simplified approaches to evaluating thalassaemia screening programmes, relying on basic cost comparisons without formal modelling. Three studies used a decision tree model structure based on the chronological sequence of steps during the screening process. Of these, two Thailand-based studies were notable, given their robust decision tree model, explicit adoption of a lifetime time horizon, application of a discounting rate in line with Thai Health Technology Assessment Guidelines, and performance of sensitivity analyses using recognised methods.

The frequent use of simple cost comparisons likely reflects the complexities surrounding modelling of thalassaemia screening programmes. While traditional CEAs are predominantly used in cost-effectiveness research, practical and ethical challenges associated with calculating health utility differences in this context may limit their use. However, the absence of standard metrics does not preclude a robust economic evaluation, as evidenced by the two high-quality Thailand-based studies. The methods outlined in these papers can be used as a starting point for future economic evaluations, provided the evaluation is further tailored to the local setting. If development of a model is not possible, a simpler CBA with a robust, comprehensive approach could be used. In any case, it is vital to capture the societal benefits of screening programmes; any future evaluation within this context should therefore include a broad societal perspective.

CRD42023445001.