Findings of previous studies on associations between dairy consumption and metabolic health status were inconsistent. This study aimed to assess the link between consumption of dairy foods and metabolic health status, brain-derived neurotrophic factor (BDNF) and adropin levels in adults.

Cross-sectional.

An observational study in Isfahan, Iran.

Adults (n=527) selected by multistage cluster random sampling. Dietary intakes were assessed via a validated 168-item food frequency questionnaire.

Anthropometric indices, blood pressure and biochemical parameters were assessed. The criteria proposed by Wildman et al were used to categorise participants into metabolically healthy and metabolically unhealthy (MU).

Participants had a mean age of 42.66 years (45.7% women). Moderate consumption of total dairy was, respectively, linked to 58% lower odds of MU (OR _{T2 vs T1}=0.42; 95% CI 0.18 to 0.96), after taking all confounders into account. Participants in the middle versus low tertile of low-fat dairy intake showed 51% marginally lower odds of MU (OR _{T2 vs T1}=0.49; 95% CI 0.22 to 1.08; p=0.08). No significant association was discovered between high-fat dairy intake and MU chance. However, higher total dairy intake was associated with lower odds of hypertension (OR _{T3 vs T1}=0.36; 95% CI: 0.14 to 0.93). No significant associations were observed between dairy intake and BDNF or adropin levels.

Moderate consumption of total and low-fat dairy was associated with lower odds of being metabolically unhealthy in Iranian adults, but high-fat dairy intake was not. Hypertension was less common among individuals with higher dairy intake. No association was found between dairy intake and serum levels of BDNF or adropin.

To understand the experiences of burnout and coping strategies among healthcare professionals working in the emergency department of tertiary care public and private hospitals in Karachi.

A qualitative exploratory design was employed.

One public-sector and one private-sector tertiary care hospital located in Karachi, Pakistan were selected for this study. Audio-recorded in-depth interviews were conducted with a total of 15 healthcare professionals working in the emergency department, which were later transcribed verbatim and analysed inductively.

The findings of the study identified two major themes contributing to burnout: individual and organisational themes, along with coping strategies used by healthcare professionals. Individual-level subthemes included emotional distress, arising from ethical dilemmas and constraints within the work environment, and work-life imbalance, where participants experienced difficulty maintaining personal well-being due to professional demands. Organisational-level subthemes included lack of leadership support and recognition, role conflict, inadequate resources, excessive workloads and exposure to workplace violence, all of which contributed significantly to burnout. Healthcare professionals reported both adaptive and maladaptive coping strategies. Adaptive strategies included positive reframing, peer support and relaxation techniques, whereas maladaptive strategies involved venting frustration and, in some cases, substance use to manage prolonged stress.

The findings revealed that the experience of burnout is caused by a range of interdependent factors at the individual and organisational levels. Multifaceted interventions are needed to address these issues such as national and emergency department staffing policies, mental health support, resilience training, workload management, flexible scheduling and the promotion of work-life balance.

To determine the safety and efficacy of ruxolitinib (RUX) and fostamatinib (FOS) compared with standard of care (SOC) in patients requiring hospital admission for the treatment of COVID-19 pneumonia.

Adaptive multiarm, multistage, randomised, open-label trial (three arm, two stage).

Five hospitals in England between October 2020 and September 2022.

Hospitalised patients (≥18 years) with COVID-19 pneumonia defined by a modified WHO COVID-19 severity grade of 3 or 4.

Participants were randomly assigned 1:1:1 to receive RUX (10 mg two times per day for 7 days then 5 mg two times per day for 7 days), FOS (150 mg two times per day for 7 days then 100 mg two times per day for 7 days) or SOC.

Primary outcome was development of severe COVID-19 pneumonia (modified WHO severity grade≥5) within 14 days of randomisation. Secondary outcomes included mortality, invasive and non-invasive ventilation, venous thromboembolism, duration of hospital stay, readmissions, inflammatory markers and serious adverse events (SAEs).

At stage 1, 181 patients were randomised, with 4 assessed as ineligible post randomisation. FOS was stopped early for futility with 16 participants (27.6%, n=58) developing severe COVID-19 pneumonia compared with 15 (25.0%, n=60) in the SOC arm (adjusted odds ratio (aOR) compared with SOC: 1.12; 95% CI 0.49 to 2.58; p=0.608). RUX progressed to stage 2 but the trial was stopped early due to slow recruitment. At the final analysis, 10 participants (16.1%, n=62) developed severe COVID-19 pneumonia in the RUX arm compared with 15 (24.6%, n=61) in the SOC arm (aOR: 0.63; 95% CI 0.25 to 1.57; p=0.161). Four (7.4%) participants in the FOS arm, none in the RUX arm and three (5.5%) in the SOC arm died within 14 days of randomisation. Infections were the most frequently reported SAE and were numerically higher in the FOS (10, 17.2%) and RUX (10, 16.1%) arms compared with SOC (7, 11.5%). Two unexpected serious adverse reactions occurred in the RUX arm only.

We found no evidence that FOS was superior to SOC for the treatment of COVID-19 pneumonia in patients requiring hospital admission. Due to early stopping, the trial was underpowered to establish RUX’s effect in this population. Further study is needed.

NCT04581954; EUDRA-CT: https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001750-22/GB.

Glucocorticoid therapy is prescribed for a variety of inflammatory conditions and is associated with severe adverse effects. A glucocorticoid withdrawal syndrome (GWS) may occur after prolonged glucocorticoid treatment—with or without biochemical glucocorticoid-induced adrenal insufficiency (GIAI). Previously, GWS was not considered an entity, probably due to the overlap between symptoms of GWS and GIAI. The Addison’s disease-specific quality of life questionnaire (AddiQoL-30) is a validated tool for quantifying symptoms of adrenal insufficiency resembling GWS. In the present study, we test the hypothesis that patients with a low AddiQoL-30 score and/or low cortisol response to a short Synacthen test (SST), after cessation of prednisolone treatment, may benefit from low-dose hydrocortisone therapy without increasing the risk of metabolic and cardiovascular disease during prolonged cortisol exposure.

REPLACE is a multi-centre, double-blinded, placebo-controlled randomised controlled trial in patients with polymyalgia rheumatica or giant cell arteritis after cessation of prednisolone treatment. Criteria for randomisation are an AddiQoL-30 score ≤85 and/or plasma cortisol response to SST, 30-min p-cortisol >100 and 85; and (2) patients with a SST-stimulated cortisol ≤100 nmol/L.

The study is conducted in accordance with the Declaration of Helsinki, registered at the Clinical Trials Information System (CTIS: 2024-513822-53-00) and Clinicaltrials.gov (NCT05193396), and publications will be in accordance with the recommendations of the International Committee of Medical Journal Editors. The trial is monitored by local independent Good Clinical Practice units and overseen by the Danish Data Protection Agency (journal no. 21/27119), the Regional Committees on Health Research Ethics for Southern Denmark (project ID: S-20210076), the Danish Patient Safety Authority and the Danish Medicines Agency.

NCT05193396.

Waiting for cardiac surgery is a stressful life event for most patients. Exploring what people experience while waiting and understanding their preferences and views on how waiting time could be improved will help to inform new strategies for more efficacious waiting list management. In this study, we explored experiences and views of people waiting for elective cardiac surgery across four major London hospitals.

Mixed-methods cross-sectional survey, with explanatory concurrent design.

Four cardiac surgery services across two National Health Service Trusts in London.

Patients on waiting lists for elective cardiac surgery at Royal Brompton, Harefield, St Thomas and King’s College hospitals between October 2023 and March 2024.

Experience of waiting for surgery, and preferences about how waiting time could be improved.

554 out of 1041 invited participants agreed to participate (recruitment rate 53.2%). Among them, 274 fully completed the survey (completion rate 49.5%). Most participants (from 52.2% to 70.9%) reported their daily and social activities were impacted by their cardiac condition, and worrying was an ubiquitous feeling (reported by 86%). Psychological distress was reported differently across women and men (higher in women). Eight themes were identified: worrying, daily activities, family/friends and social activities, sexual life, waiting list experience and feelings, communication, most important factors for surgery and suggested improvements. Communication with the surgeon and clinical team, and regular updates on waiting list progress are suggested as crucial factors to alleviate stress, thus potentially improving the experience of waiting for the surgery.

This study highlights the importance of emotional support, clear communication, regular updates on waiting list progress and building trust with the clinical team to improve patient-centred care while waiting for elective cardiac surgery. This finding can offer valuable insights for managing waiting lists in other surgery waiting list contexts.

NCT05996640.

To investigate the efficacy of two volumes of acute isometric wall squat exercise on pain sensitivity (primary outcome: pressure pain threshold (PPT)) and intensity (secondary outcome) in adults with knee osteoarthritis.

A parallel-group randomised controlled trial.

Outpatient physiotherapy clinics at hospitals in Saudi Arabia.

Participants (n = 90; mean (SD) age 49.0 (13.0) years) with chronic knee osteoarthritis, diagnosed by a specialist orthopaedic physician using radiographic evidence and clinical judgement, were recruited via two tertiary hospitals in Saudi Arabia.

Participants were stratified by sex and randomly allocated to one of three groups: isometric single-repetition wall-squat (ISO-SR; one repetition of a 3-min wall squat or to volitional fatigue at a 100° knee joint angle), isometric multiple-repetition wall-squat (ISO-MR; three repetitions of the same intervention) and control (quiet sitting for 7 min).

PPT was measured at the calf (primary site of interest), lumbar spine and forearm using a pressure algometer. Pain intensity was assessed using a visual analogue scale. Primary analyses compared changes between intervention and control groups. All participants were included in the ITT analysis.

The ISO-MR group had higher mean PPT ratings immediately postintervention in the calf (mean difference=9.4 (95% CI 5.6 to 13.2), p

Both the ISO-SR and ISO-MR exercises to volitional fatigue reduced pain sensitivity in patients with knee osteoarthritis. Neither exercise volume changed clinical pain intensity.

ClinicalTrials.gov registry (ID: NCT05605444).

To identify enablers and barriers for scaling up non-communicable disease (NCD) interventions across diverse global contexts and to map these factors to the WHO’s health system building blocks.

A multi-method qualitative study applying the Consolidated Framework for Implementation Research to analyse data from multiple projects nearing or completing scale-up.

Global Alliance for Chronic Diseases-funded implementation research projects conducted across 18 low- and middle-income countries and high-income settings.

Data was derived from documents (n=77) including peer-reviewed publications, policy briefs, and reports and interviews with stakeholders (n=18) (eg, principal investigators, medical professionals, public health workers).

Various context-specific interventions targeting sustainable scale-up of NCD (eg, diabetes, hypertension, cardiovascular disease) interventions at the community, primary care or policy levels.

The primary outcome was identifying contextual enablers and barriers to intervention scale-up. Secondary outcomes included exploring how these factors aligned with health system building blocks (eg, leadership/governance, healthcare workforce).

Twenty enablers (eg, intervention adaptability, strong stakeholder engagement, local empowerment) and 25 barriers (eg, resource limitations, intervention complexity, stakeholder burnout) were identified. Contextual alignment, supportive governance and capacity building were critical for sustainability, while cultural misalignment and socio-political instability frequently hampered scaling efforts.

Tailoring interventions to local health systems, ensuring stakeholder co-ownership and incorporating strategies to mitigate stakeholder burn-out are essential to achieving sustainable, scalable NCD solutions. Future research should focus on integrating systematic cultural adaptation, sustainable financing and workforce capacity building into scale-up planning.

Concussion is an acute injury that may contribute to short-term limitations and potential long-term risks.

To test whether a past concussion is associated with the risk of a subsequent serious motor vehicle crash.

Population-based longitudinal cohort analysis.

Ontario, Canada, from 1 April 2002 to 31 March 2022 (178 emergency departments).

Adults diagnosed with a concussion (cases) or an acute ankle sprain (controls), excluding individuals with a disqualifying illness (blindness, dementia, delirium), severe cases resulting in hospitalisation or those who died within 90 days.

Subsequent motor vehicle crash requiring emergency medical care.

We identified 3 037 028 patients, including 425 158 with a concussion and 2 611 870 with an ankle sprain. A total of 200 603 patients were injured in a subsequent motor vehicle crash over a median follow-up of 10 years, equal to an absolute risk of 1 in 15 patients (6.64 per 1000 patient-years). Patients with a concussion had a 49% higher motor vehicle crash risk compared with those with ankle sprain (adjusted relative risk=1.49, 95% CI 1.47 to 1.50, p

This study suggests a significant increased risk of a motor vehicle crash after a concussion that may justify a safety warning from clinicians.

Deep vein thrombosis (DVT) in critically ill patients is often undetected. However, it is unclear whether ultrasound surveillance for early detection of DVT in high-risk medical-surgical intensive care unit (ICU) patients improves patients’ outcomes. The DETECT trial (Diagnosing deep-vein thrombosis early in critically ill patients) evaluates the effect of twice-weekly bilateral lower limb ultrasound compared to usual care on 90-day mortality of critically ill adult patients admitted to medical, surgical and trauma ICUs.

The DETECT trial is an international, parallel-group, open-label, randomised trial, which will recruit 1800 critically ill adults from over 14 hospitals in Saudi Arabia and Kuwait. Eligible patients will be allocated to twice-weekly bilateral lower limb ultrasound or usual care. The primary outcome is 90-day mortality. Secondary outcomes include lower limb proximal DVT, pulmonary embolism and clinically important bleeding. The first patient was enrolled on 21 March 2023. As of 8 April 2025, 711 patients have been enrolled from 14 centres in Saudi Arabia and Kuwait. The first interim analysis was conducted on 14 May 2025. We expect to complete recruitment by December 2026.

Institutional review boards (IRBs) of each participating institution approved the study. We plan to publish the results in peer-reviewed journals and present the findings at international critical care conferences.

Clinicaltrials.gov: NCT05112705, registered on 9-11-2021.

South Asia carries the burden of a rapidly changing climate with floods and extreme heat. These disasters further translate into mental health distress, financial stress and detrimental effects on well-being, with women being the most vulnerable. This study aims to demonstrate that mental health screening, referral and resilience-building group sessions can be successfully administered by community health workers and primary health facility staff in a flood-affected rural population of women in Pakistan and provide evidence on the effectiveness of this approach for improving their mental health status.

A quasi-experimental design with a comparison group will be used for the study, preceded by a formative phase. The formative phase evaluated the feasibility of mental health screening by Lady Health Workers (LHWs) in flood-affected areas using a qualitative approach such as focus group discussions and in-depth interviews. Manuals developed by the study team of mPareshan will be used to train LHWs, Lady Health Supervisors (LHS) and health facility staff. Following this, LHWs will briefly screen women aged 18 to 49 years, administer awareness-raising and resilience-building sessions and refer women who screen positive for depression or anxiety to a primary health facility. Physicians at the health facility will confirm the diagnosis and provide counselling to mild-moderate cases, while severe cases would be referred to specialists. Statistical evaluation of quantitative data and thematic content analysis of qualitative data will be conducted to assess the feasibility and impact of the intervention. This trial is registered at clinicaltrials.gov with number NCT06756165.

The study acquired ethical approval from the Ethical Review Committee at Aga Khan University (2024-10475-30776) and the National Bioethics Committee (4-87/NBC-1158/23/481) in Islamabad. Approval was obtained from relevant provincial authorities. The trial will adhere to the ethical principles of autonomy, anonymity, confidentiality, equity and respect. All eligible participants will be provided with informed consent, details regarding the purpose and procedure of the study, and the right to withdraw at any time. Data and information will be anonymised and stored securely. Dissemination of the results of the trial will occur after its completion to stakeholders, participants and the public.

NCT06756165.

To examine the relationship between catastrophic thinking and postural stability in individuals with chronic non-specific neck pain (CNSNP); to assess the moderating role of pain duration and intensity; and to investigate the mediating role of fear-avoidance beliefs.

Cross-sectional observational study.

Outpatient musculoskeletal and pain rehabilitation clinics.

Eighty-six adults aged 18–65 years with CNSNP (mean age: 45.3±10.5 years) were recruited via purposive sampling.

Primary outcomes included postural stability parameters—centre of pressure path length, sway velocity, range of movement in the anterior-posterior and mediolateral directions, and sway area—measured using computerised posturography. Catastrophic thinking was assessed using the Pain Catastrophizing Scale (PCS). Secondary measures included the Neck Disability Index (NDI) to evaluate disability, the Visual Analogue Scale (VAS) to measure pain intensity, the Fear-Avoidance Beliefs Questionnaire (FABQ) to assess fear-related beliefs, and the Short Form-36 (SF-36) Health Survey to evaluate quality of life. Pain duration and intensity were analysed as moderating variables, and fear-avoidance beliefs were examined as a potential mediator.

Moderate positive correlations were found between PCS scores and COP path length (r=0.41, p=0.014), sway velocity (r=0.38, p=0.022) and sway area (r=0.43, p=0.011). Participants with high PCS scores demonstrated significantly worse postural stability than those with low PCS scores. Pain duration (β=0.35, p=0.004) and intensity (β=0.42, p=0.006) significantly moderated this relationship. Fear-avoidance beliefs were statistically identified as a partial mediator of the association between catastrophic thinking and postural stability (indirect effect=0.22; 95% CI 0.10 to 0.35).

Catastrophic thinking is linked to reduced postural stability in individuals with chronic non-specific neck pain, with pain characteristics and fear-avoidance beliefs potentially influencing this association. These results underscore the importance of psychological factors in balance and support the need for further longitudinal research to inform comprehensive management strategies.

Community health workers (CHWs) are trained lay people and trusted members of communities worldwide who play crucial roles in bridging healthcare gaps in low–middle-income countries yet remain underused and not well integrated within high-income countries like Canada. The objective of this scoping review is to map out available evidence on the integration of CHWs in high-income countries with universal healthcare systems.

This scoping review will include all available literature involving CHWs, or similar designations, and their integration into universal health systems within high-income countries. Literature will be excluded if it does not involve CHWs, universal healthcare systems, address integration or is conducted in low–middle-income countries. This review will include all available literature (including those that show null or negative results) that examines the integration of CHWs in high-income countries with a universal healthcare system. Documents describing integration may include, but are not limited to: tools, policies, models, frameworks, programmes or organisational features that seek to promote positive integration. Peer-reviewed and grey literature examining CHW integration in high-income countries with universal healthcare systems will be eligible for inclusion. Databases/sources to be searched (from inception until November 2025) will include: Medline (Ovid), Embase (Elsevier), Scopus (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Academic Search Premier (EBSCO), Business Source Complete (EBSCO), ProQuest Dissertations and Theses Global. Retrieval of full-text, all language studies (and other literature), data extraction, synthesis and mapping will be performed independently by two reviewers, following Joanna Briggs Institute methodology. Findings will be organised and presented according to the Levesque conceptual framework for healthcare access.

Ethics approval is not required for this scoping review and literature search will start in October 2025 or on acceptance of this protocol. The findings of the scoping review will be available (February 2026) and will be published in a peer-reviewed journal.