This study investigated perinatal depressive symptoms among pregnant and postpartum Filipino women.

Cross-sectional survey.

The Philippines.

Participants were recruited online and face-to-face from maternal care facilities.

Perinatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) score, with prevalence calculated based on ≥13 cut-off, indicating clinically significant symptoms of depression. Patterns of depressive symptoms were examined by demographics, perinatal time period and other obstetric information using adjusted regression coefficients (ab) and risk ratios (aRR).

A total of 856 women participated in the study, comprising 356 pregnant and 500 postpartum women. EPDS scores were, on average, similar between pregnant (14.4) and postpartum women (14.1). Using the locally validated cut-off of ≥13 revealed that 69.1% of pregnant and 62.0% of postpartum women reported clinically significant depressive symptoms. Consistent EPDS scores and prevalence were observed across pregnancy trimesters and within 12 months postpartum and beyond. Women who received adequate prenatal care were less likely to experience antenatal (ab=–1.59, 95% CI –3.13 to –0.05) and postpartum (ab=–1.30, 95% CI –2.48 to –0.12) depressive symptoms. Postpartum EPDS scores and depressive symptom prevalence (EPDS score ≥13) were higher among 18–24-year olds (ab=1.96, 95% CI 0.30 to 3.61; aRR=1.23, 95% CI 1.03 to 1.47) and single mothers (ab=3.46, 95% CI 0.22 to 6.71; aRR=1.42, 95% CI 1.07 to 1.90), compared with older and married mothers, respectively.

At least 60% Filipino mothers experienced clinically significant perinatal depressive symptoms, which exceeds the established global average of 25%. Younger and single postpartum women were at greater risk, while pregnant and postpartum women who attended adequate prenatal visits were less likely to report depressive symptoms. Our study underscores the need for further research to uncover the true burden of poor perinatal mental health and calls for targeted early interventions and integrative public health strategies to support at-risk mothers, particularly those from socially disadvantaged backgrounds.

Non-communicable diseases are the leading causes of premature mortality worldwide. Both genetic predispositions and environmental exposures affect disease risk. While biobanks have increased understanding of genetic predictors of these diseases, environmental influences are expected to have a greater impact on disease development. Individuals also create their own environments and lifestyles based on genetically regulated preferences, leading to gene–environment interactions that require large datasets to study. Finnish biobanks typically lack sufficient lifestyle and environmental data, which limits their use. We present a protocol for a biobank-recall study (BioRecall) to collect data on lifestyle and environmental exposures and combine these findings with genotypes, biological samples and clinical outcomes.

All previously genotyped donors from the Central Finland Biobank who have been diagnosed with type 2 diabetes and have consented to recall will be invited to participate in the pilot study. The preliminary feasibility assessment reveals that there are 1580 suitable candidates. Participants will complete an electronic questionnaire on a secure online platform. The questionnaire includes validated questions on lifestyles, anthropometrics, weight loss history, health, symptoms, work characteristics, emotional states and residential environments. Postcode information will facilitate the addition of spatial environmental data. Genotype and related clinical data will be provided in the study in accordance with the Finnish Biobank Act and combined with questionnaire data.

The Human Sciences Ethics Committee of the University of Jyväskylä delivered a favourable statement regarding the study protocol (1671/13.00.04.00/2023). Central Finland Biobank approved the research plan (no: BB24-0333-A01). The data collected will be returned to the Central Finland Biobank for research purposes with the participants’ consent. Permission for data usage can then be applied through standard protocols of the Fingenious service (https://site.fingenious.fi/en/). If successful, the study will be expanded to other donors and Finnish biobanks.

The management of active patients with symptomatic knee osteoarthritis (KnOA) who are too young for total knee arthroplasty poses a specific challenge to clinicians. Research studies show that improving quadriceps muscle strength improves pain and function; however, aspects of the disease render it difficult for patients to achieve and maintain improvements. Recombinant human growth hormone (rHGH) is shown to increase the magnitude and duration of muscle growth when combined with exercise treatment in adult populations. Hence, rHGH combined with physical therapy may provide meaningful benefits in the treatment of KnOA.

This is a single-centre, double-blind, randomised trial to pilot a future Phase III trial from 2025 to 2028. Participants are aged 18–60 with clinical and radiographic evidence of isolated degenerative arthritis of the knee (patellofemoral or tibiofemoral). The investigational product is rHGH (Saizen (somatropin of rDNA origin, EMD Serono)) and a saline placebo. Participants will deliver the solution via subcutaneous injection area once per day at a dose of 0.5 mg HGH per body surface area (0.5 mg/m²) for 6 weeks, alongside participation in a lower limb strengthening programme developed by rehabilitation specialists. 17 participants will be recruited into each study arm.

The primary outcomes are feasibility (compliance with the study drug regimen for the 6-week administration period and enrolment rate) and safety (the proportion of minor and major adverse events between groups). The primary endpoint for these outcomes will be at 6 weeks. The secondary outcomes are knee extension strength, knee flexion strength, radiographic arthritis progression, thigh muscle circumference, MRI-measured quadriceps muscle volume and patient-reported outcome measures (Knee Osteoarthritis Outcome Score (KOOS), SF-20 and Tegner). The primary endpoint for these outcomes will be at 12 weeks, and the final endpoint will be 24 months, where final radiographic (X-ray) assessment will take place.

The primary outcome of compliance will be a calculation of mean compliance between groups, which can be analysed as a t-test after the treatment period. A two-sample, two-sided t-test will compare the clinical (secondary) outcome of greatest interest: knee extension strength at baseline versus week 6 compared between treatment groups. Other secondary outcomes will be compared using a simple linear mixed-effects model. The ² test will be used to determine whether the number of participants who made meaningful changes was different between groups. The null hypotheses are that the rHGH and placebo groups will have no difference in compliance rates, safety events, knee extension strength at 12 weeks and arthritis grade progression at 24 months.

This study has been approved by the Sunnybrook Research Institute Research and Ethics Board (#6427) and received a no-objection letter from Health Canada Clinical Trials. The primary sponsor is the Sunnybrook Centre for Clinical Trial Studies (CCTS). The findings of this study will be published in a peer-reviewed journal and presented at orthopaedic conferences.

NCT07036003.

To estimate the prevalence and identify the determinants of assistive device usage in daily life among older adults in India.

Cross-sectional analysis of nationally representative survey data.

India

A total of 66 316 adults aged ≥45 years with complete information on assistive device use from Wave 1 of the Longitudinal Ageing Study in India, 2017–2018.

The primary outcome was self-reported use of any assistive device, including visual, hearing, mobility or other assistive devices. There were no predefined secondary outcome measures. Sociodemographic and health-related variables were analysed as covariates to assess factors associated with assistive device use.

The prevalence of assistive device use was 38.61% (95% CI: 37.73% to 39.50%). Use increased with age, from 34.48% among adults aged 45–59 years to 52.07% among those aged ≥75 years (adjusted prevalence ratios (aPR) 1.30; 95% CI: 1.25 to 1.35). Prevalence was higher among men (40.94%) than women (37.51%) (aPR 1.06; 95% CI: 1.03 to 1.09), among individuals with education above primary level (54.28%) compared with those with up to primary education (28.35%) (aPR 1.42; 95% CI: 1.36 to 1.48), and among urban residents (53.88%) vs rural residents (31.16%) (aPR 1.18; 95% CI: 1.14 to 1.22). A clear socioeconomic gradient was observed, with prevalence increasing from 27.65% in the poorest to 50.66% in the richest wealth quintile (aPR 1.32; 95% CI: 1.25 to 1.39). Assistive device use was higher among participants with chronic conditions (47.30%) than those without (28.16%) (aPR 1.15; 95% CI: 1.11 to 1.19) and was markedly higher among those with a prior eye or vision diagnosis (64.93%) compared with those without (14.61%) (aPR 3.94; 95% CI: 3.78 to 4.11). Among users, spectacles or contact lenses were most common (89.26%), followed by walking sticks or walkers (11.62%) and dentures (6.15%). State-level prevalence varied widely, ranging from 71.27% in Goa to 13.44% in Arunachal Pradesh.

Assistive device use was reported by less than half of Indian adults aged ≥45 years. The findings reveal clear socioeconomic and geographic inequities in access to assistive devices, with substantially lower use among older adults with less education, those in poorer wealth quintiles and rural residents. These disparities highlight the need for equity-focused interventions that improve accessibility to assistive devices, particularly for socially and economically disadvantaged groups and individuals with chronic conditions.

To estimate the population-level incidence of emergency department (ED) visits for violent behaviour, identify associated factors and quantify the contribution of people presenting to ED for violent behaviour on the total number of ED visits for mental health problems.

Retrospective cohort study.

Regional healthcare authority serving a population of 1.2 million in Romagna, Italy, January 2022 to December 2023.

871 119 residents (70% of the regional population; 55.6% female) alive on 1 January 2022 with data on comorbidities. Participants were followed until 31 December 2023 with censoring at death.

Primary outcome: incidence of ED visits for violent/homicidal. Factors associated with violent ED visits were examined. Secondary outcome: quantification of the contribution of people presenting to ED for violent behaviour on the total number of ED visits for any mental health problem.

286 individuals (76.9% male) had 573 ED visits for violent behaviour, representing 4.2% of all psychiatric ED visits with an annual incidence rate of 3.48 per 10 000 person-years (95% CI 3.21 to 3.78). Male sex was associated with violent behaviour (OR 3.85, 95% CI 2.60 to 5.70; OR 4.64, 95% CI 3.12 to 6.92 among mental health service users). High comorbidity and prior mental health service use increased the risk. Having an ED visit for violent behaviour was associated with higher odds (OR 10.9, 95% CI 8.02 to 14.96) and higher incidence rate (incidence rate ratio 1.51, 95% CI 1.35 to 1.69) of psychiatric ED visits for other mental health problems.

ED visits for violent behaviour occur at relatively low population rates but predominantly affect high-risk groups: males with prior mental health service contact and either minimal or very high comorbidity. These findings supported the need for tailored interventions that address both the immediate risk of violence and underlying mental health issues, especially for high-risk groups.

To investigate associations between shift work patterns and sleep disturbance, and to assess if the association is modified by demographic factors, socioeconomic factors, anthropometric and lifestyle factors, health conditions or sleep traits.

Analysis of cross-sectional data obtained from the UK Biobank baseline assessment.

UK Biobank, a large-scale prospective cohort study which recruited half a million participants aged 40–69 years between 2006 and 2010 from across the UK.

A total of 285 175 employed or self-employed participants at baseline (2006–2010), including 148 296 (52.0%) females and 136 879 (48.0%) males. The sample comprised 94.0% White, 0.7% Mixed race, 0.36% East Asian, 2.0% South Asian, 1.8% Black and 0.89% from other ethnic backgrounds.

Sleep disturbance was defined as the presence of both insomnia and excessive sleepiness symptoms.

A total of 42 181 (14.8%) participants had sleep disturbance defined based on insomnia and excessive sleepiness. 236 200 (82.8%) were non-shift workers, while 48 975 (17.2%) were shift workers, which included 24 062 (49.1%) working day shifts only, 17 940 (36.6%) working night shifts sometimes or usually, and 6973 (14.2%) working night shifts always. Compared with non-shift workers, all shift workers had higher multivariable-adjusted odds of sleep disturbance: (non-night shifts: OR in model 3 (OR) 1.21 (95% CI 1.16 to 1.27); sometimes/usually night shifts: OR 1.37 (95% CI 1.30 to 1.44) and always night shifts: OR 1.50 (95% CI 1.38 to 1.63)). The association between shift work pattern and sleep disturbance was modified by age (p_interactioninteraction=0.0005) and smoking status (p_interaction=0.04).

Shift work is associated with a higher odds of sleep disturbance compared with non-shift work in all participants, with greatest odds observed among those always working night shifts. The association was stronger among individuals who were younger than 55 years old, from an ethnic minority background and never smokers. Future large-scale longitudinal studies are needed to further investigate these associations.

To describe the outcomes and associations of pericardial disease, with a particular focus on the outcomes of patients admitted with primary or secondary pericardial disease.

Retrospective observational study.

All public and private hospitals in New South Wales, Australia.

Hospitalised patients with pericardial disease admitted from 2004 to 2021 that was (a) a primary diagnosis or (b) a secondary diagnosis.

Mortality both in-hospital and during several years of available follow-up.

Out of 45 446 patients diagnosed with pericardial disease, under half (46.8%) had pericardial disease as the primary reason for hospitalisation. Patients in whom pericardial disease was the primary compared with the secondary diagnosis were more commonly male (68.2% vs 59.1%), younger (median 51.2 years vs 66.0 years) and less comorbid (age-adjusted median Charlson Comorbidity Index 1 vs 4). In patients with pericardial disease, adjusted in-hospital mortality was fivefold lower if this was the primary diagnosis (OR 0.21, p

Patients with pericardial disease have a low in-hospital mortality of about 1% if this was the primary diagnosis. However, patients in whom it was a secondary diagnosis, especially in the presence of comorbidities such as malignancy, had a much worse prognosis.

Many amputees experience phantom limb pain (PLP). Pharmacological management is the mainstay of treatment, but effectiveness is limited, and it is associated with significant side effects. Sensory discrimination training (SDT) is a non-pharmacological treatment for PLP. Previously, SDT required a clinician, or carer, to administer it, creating a barrier to real world use. In this trial, an automated SDT device (SP1X, 2pd Ltd, Middlesbrough, United Kingdom) for the self-management of PLP will be investigated for efficacy.

The Phantom Relief is a decentralised, randomised, placebo-controlled, mixed-methods, superiority trial. Participants will take part from their own homes, using an electronic data capture tool to complete all trial documentation. Eligible, consenting individuals with PLP (intensity rated as ≥4 on a 0–10 scale; n=100) will be randomised to receive the SP1X device (intervention group) or a placebo device SP1X7 (placebo group). The first and second treatment sessions will be observed via video call to provide set-up guidance and any additional advice needed. The primary outcome measure will be the McGill Pain Questionnaire revised (SF-MPQ-2). Outcome measures will be collected at baseline, 3 weeks (immediately post intervention) and 3 months follow-up. Statistical analysis will be carried out by a blinded statistician (analysis of covariance model conditioning on the baseline and stratification factors). Semi-structured interviews will be carried out with a sub-sample (n=10–15) of intervention group participants. Participants will be provided with their allocated device for home use. Online video calls will be used to instruct participants on how to set up and use the device by the research assistant (RA). The RA will observe the first and second treatment sessions and provide any additional advice needed. Participants in both groups will be asked to use the device for 60 min/day for at least 15 days of the 21-day treatment period and to record device use in a study diary.

Approval has been obtained from Teesside University School of Health and Life Sciences Research and Ethics Committee, the North of Scotland Research Ethics Service, Health Research Authority, and a letter of no objection was obtained from the Medicines and Healthcare products Regulatory Authority. The results will be disseminated through peer-reviewed articles, conference presentations and a doctoral thesis.

NCT04103983.

To evaluate the diagnostic accuracy of CT in identifying small and large bowel obstruction and associated complications, including ischaemia and perforation, in adult patients.

Systematic review and meta-analysis reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy reporting guidelines.

Ovid MEDLINE and Embase were searched from 1946 to 20 February 2025.

The study included randomised controlled trials, cohort studies and case–control studies evaluating the diagnostic accuracy of CT for bowel obstruction in adults (aged ≥18 years). Only studies published in English were included. Conversely, case reports, editorials, conference abstracts without full data and studies focusing exclusively on paediatric populations or animal models were excluded.

Three reviewers independently extracted data on study characteristics, CT modality, diagnostic accuracy metrics (sensitivity, specificity and predictive values) and complications. Risk of bias was assessed using the QUADAS-2 tool. A random-effects meta-analysis was conducted. Heterogeneity was assessed using I² and Tau² statistics.

Sixty-five studies with 9418 patients were included. The pooled sensitivity and specificity of CT for bowel obstruction were 90% (95% CI 78 to 96; I²=56%, Tau²=0.36) and 88.8% (95% CI 78.0 to 94.8; I²=65%, Tau²=0.35), respectively. For bowel ischaemia, CT showed a pooled sensitivity of 47.0% (95% CI 32.4 to 59.9; I²=0%, Tau²=0.00) and specificity of 85.3% (95% CI 77.9 to 89.5; I²=1%, Tau²=0.45). Multidetector CT (MDCT) outperformed older modalities across all endpoints. Ischaemia was present in 22.05% of all cases, with higher rates in small bowel obstruction. Perforation and mortality rates were 3.98% and 4.40%, respectively. No significant publication bias was detected, and the certainty of evidence was graded as moderate for most diagnostic accuracy outcomes.

CT, particularly MDCT, offers high diagnostic accuracy for bowel obstruction and is a critical tool for detecting serious complications such as ischaemia and perforation. However, sensitivity for ischaemia remains modest. Standardised protocols and prospective studies are needed to enhance early identification and optimise care pathways.

Hospital administrators (HAs) aim to strike a balance between providing efficient and compassionate treatment. Health informatics and service management abilities are two areas that are evolving alongside digital health. This study outlines the health information technology (IT) competencies necessary for sustainability in the healthcare industry and looks at the competencies needed for HAs to manage everyday responsibilities.

Grounded theory is used in this qualitative study and reported based on the Standards for Reporting Qualitative Research guidelines. The participants were HAs who worked in different healthcare fields and held MBAs from the same private university. Respondents were selected through purposeful sampling, and consent was obtained before conducting telephone conversations. Data were gathered until the point of theoretical saturation. Every theme was outlined in a thematic framework.

Healthcare administrators gain knowledge about using applications and technology through the service. A hospital setting is a good place for healthcare administrators to begin their careers to fully understand the intricacies of the field. The key findings of the study indicate that HAs recognised policies and procedures as important areas of competency that required focused attention. HAs are increasingly relying on mid- to advanced-level healthcare technologies in their daily work. Each administrator has gained competencies according to their experience and opportunities. A few years of domain expertise make healthcare administrators competent and educated about every aspect of their profession.

According to healthcare administrators, practice and experience serve as the cornerstones on which their competencies are built. In the rapidly changing environment of digital healthcare, interdepartmental collaboration is essential for long-term success and adaptability, especially between HAs, IT personnel and medical specialists. Developing capabilities and resilience in this dynamic environment requires a diverse approach.

To quantify the costs associated with a stepped model of depression care—Integrated Chronic Care Clinics-Depression Module (IC3D)—in rural Malawi.

Cross-sectional cost analysis.

Integrated chronic care clinics (n=14) throughout Neno District, Malawi.

The stepped model of depression care provided behavioural therapy (Problem Management Plus (PM+)) to adults (aged 18+) with moderate depression and joint PM+ and antidepressant therapy (ADT) to those with moderate-to-severe and severe depression. The model incorporated two cost-saving features: treatment was integrated into existing chronic care services within the health system, and PM+ was group-based rather than one-on-one.

We conducted time-driven activity-based costing to quantify the marginal economic cost of implementing PM+ and ADT, inclusive of training and supervision. We measured all costs in 2025 US dollars and quantified costs from a societal perspective—including human resources, infrastructure, equipment, consumables, indirect costs and opportunity costs.

The marginal cost of PM+ was $90 per patient treated for five sessions over 2 months, while ADT was $138 for eight sessions over 8 months. In both instances, human resources (45% from PM+, 52% for ADT) and consumables (30% for PM+, 31% for ADT) represented primary health system cost drivers. In the first year of implementation, 15 002 depression screenings were conducted, 724 adults were evaluated with a diagnostic tool and 398 adults subsequently received care: 263 received PM+ alone, 31 received ADT alone and 104 received both PM+ and ADT. The total cost of introducing operations throughout Neno District was $62 806.

These findings indicate that integrating depression care services into the Malawian health system is financially feasible and successfully reached many individuals with major depressive disorder.

NCT04777006.

Polypharmacy, defined as the concurrent use of multiple medications, is a growing concern among the elderly, especially in low-income and middle-income countries such as Iran. This study aims to explore the prevalence and patterns of polypharmacy among the elderly in Iran, using health insurance claims data to identify common drug classes and coprescribed medications, with a focus on informing policy decisions and improving medication management.

Retrospective population-based observational study.

Nationwide data from the Iran Health Insurance Organization (IHIO) across 24 provinces.

1 876 527 individuals aged 65 years and older, insured by the IHIO from 2014 to 2017. Individuals with incomplete demographic information or lacking medication records in the database were excluded from the analysis.

Prevalence and patterns of polypharmacy, demographic factors associated with polypharmacy, and common drug classes used. Medications were classified using the Anatomical Therapeutic Chemical system. Polypharmacy was defined as the use of five or more medications, with cumulative polypharmacy considering total drug use over time, and consecutive polypharmacy focusing on the frequency of monthly drug use. Logistic regression and association rule mining were applied to explore demographic factors and medication patterns associated with polypharmacy.

Of the study population, 74.9% experienced cumulative polypharmacy over 6 months and 64.6% over 1 month, with 7.6% experiencing consecutive polypharmacy. Females and those aged 75–79 were more prone to polypharmacy. Systemic glucocorticoids were the most commonly used medications (50.02%), followed by HMG-CoA reductase inhibitors (42.73%) and platelet aggregation inhibitors (41.92%). Polypharmacy was most strongly associated with medications related to the alimentary tract and metabolism, cardiovascular system, nervous system and blood and blood-forming organs.

Polypharmacy is highly prevalent among the elderly in Iran, with significant variations by gender, age, insurance fund and region. The findings highlight the need for targeted interventions to manage polypharmacy and improve medication safety in this population.