Climate change has led to extreme heat events, disproportionately affecting vulnerable populations. Heat stress during pregnancy is linked to adverse health outcomes, yet the biological mechanisms remain poorly understood. This research study aims to investigate the effect of environmental heat on maternal, fetal and infant health and examine the biological pathways linking heat stress to adverse pregnancy outcomes.
This prospective cohort study will recruit 6000 pregnant women from three districts in Sindh, Pakistan. Eligible participants ≥18 years old, will have a minimum of five scheduled visits from
The study has received ethical approval from the Aga Khan University (AKU) (Ref: 26249) and the Pakistan National Bioethics Committee (Ref: 1065/23/1736). Written informed consent will be obtained from all participants before enrolment. Referral pathways to healthcare facilities will be established to ensure timely management of pregnancy complications. Findings will be disseminated through peer-reviewed publications, scientific conferences, and engagement with policymakers and public health stakeholders to inform climate-resilient maternal health strategies. Results will also be shared with participants and communities through meetings and informal sessions to raise awareness and support evidence-based heat adaptation.
Data on postdischarge care for stroke and myocardial infarction (MI) patients remain limited. Logistical barriers, including fragmented communication and poor coordination between patients and physicians, contribute to suboptimal outcomes and hinder secondary prevention. Mobile health (mHealth) offers a promising strategy to support continuity of care. We aimed to synthesise existing literature and evaluate mHealth interventions for postdischarge MI and stroke care.
This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline.
PubMed, CINAHIL, Scopus and Cochrane were searched from 26 July 2016 to 5 July 2024.
This scoping review included randomised controlled trials and observational studies published in peer-reviewed journals that evaluated mHealth interventions for postdischarge care in MI and stroke. Studies reporting outcomes such as mortality, functional capacity, readmissions or adverse events were included.
Two authors independently extracted and summarised the data. Subsequently, methodological quality was independently assessed by two other authors using the Joanna Briggs Institute checklist.
We identified 31 eligible studies, with 14 631 participants and 59.9 mean years old. Most participants were male. Among these, three (%) originated from low-middle income, seven (%) from upper-middle income and 21 (%) from high-income countries. Overall, we identified 17 studies using mobile apps: eight as a single intervention, and nine combined with remote sensors, seven with SMS, three studies used web-based platforms, two used phone calls, one study combined SMS and phone calls and another used remote sensors only. Multimodal telerehabilitation reported better outcomes compared with single-mode mHealth interventions. Most studies assessed functional capacity (26 studies) and quality of life (21 studies).
This review highlighted increased mHealth uptake among postdischarge MI and stroke patients, including significant underrepresentation of female participants, scarce studies from low-middle-income countries or rural areas and limited reporting of hard clinical endpoints. While mHealth showed positive outcomes across most studies, it further highlights contextual factors that account for digital disparity and the need to prioritise inclusive, user-centred designs and integrate objective measurement tools on future trials and policy frameworks.