Intraductal papillary mucinous neoplasms (IPMNs) are common pancreatic cystic neoplasms with malignant potential. Current evidence on IPMN management is derived largely from retrospective surgical cohorts that over-represent high-risk cases and provide limited insight into the long-term outcomes of conservatively managed lesions. Australia currently lacks a prospective national dataset to evaluate surveillance pathways, practice patterns, guideline adherence and long-term outcomes in individuals with IPMN. Variation between international guideline recommendations may also contribute to differences in surveillance intensity and thresholds for intervention. The Australian Pancreatic Cyst Registry (APCR) was established to address these evidence gaps.

The APCR is a prospective, multicentre clinical quality registry that collects clinical, imaging, management and outcome data for individuals with IPMN across public and private healthcare settings in Australia. Historical information is extracted from existing clinical documentation where available, with prospective data collection continuing during routine follow-up. The registry operates under an opt-out model and aims to enrol up to 10 000 participants over a 5-year recruitment period. Participants are followed through routine clinical care until discharge from surveillance, diagnosis of pancreatic cancer, withdrawal or death. Standardised electronic case report forms capture clinical and imaging variables aligned with risk features described in the 2024 Kyoto guidelines. This analysis will describe participant characteristics, cyst features, management and clinical outcomes, with comparative, time-to-event and multivariable analyses undertaken where appropriate. Guideline adherence and the predictive performance of established risk stratification frameworks will also be evaluated.

The study protocol was approved by the Monash Health Human Research Ethics Committee (Project ID: RES-24-0000-634A). Findings will be disseminated through peer-reviewed publications, conference presentations and updates to participating sites.

Tea-tribe communities in Assam face a substantial and under-recognised burden of stroke, shaped by socioeconomic marginalisation, limited access to formal healthcare and distinct cultural practices.

We estimated the prevalence of physician-diagnosed stroke, described associated functional and psychological disabilities, characterised gaps in diagnosis and care, and developed a logistic regression-based classification score for prevalent stroke among tea-tribe adults in Cachar district, Assam, Northeast India.

We conducted a community-based cross-sectional door-to-door survey (July 2024–August 2025) across five tea estates among permanent tea-tribe residents aged ≥18 years. Trained community health workers collected data on sociodemographics, vascular risk factors, healthcare utilisation and poststroke functional and psychological outcomes using a structured questionnaire, the Modified Rankin Scale and a symptom inventory. Stroke was identified through community symptom screening and confirmed by teleconsultation with a senior neurologist, supported by neuroimaging where available. A multivariable logistic regression model with stepwise selection identified factors associated with prevalent stroke and regression coefficients were converted into an additive point-based classification score. Internal validation used 1000 bootstrap samples and a 70:30 train–test split. The model performance was assessed using the area under the receiver operating characteristic curve and Brier score.

Among 3818 participants, 164 had a history of stroke (prevalence 4.3%), with a higher prevalence in older adults, men, unemployed or semiskilled or skilled workers and households below the poverty line. Hypertension was the strongest risk factor and its combination with daily tea containing added salt was associated with markedly higher odds of stroke. Alcohol consumption, smoking and previous heart disease were also associated with stroke. Stroke survivors had high functional and psychological burdens and fewer than half reached a health facility within 4.5 hours or underwent CT/MRI. The final model showed good discrimination (area under the curve 0.84) and calibration (Brier score 0.037). The derived classification score (0–19 points) identified a highly associated group (scores >13) with a stroke prevalence of 14.5%.

The tea-tribe community in Assam faces a high stroke burden, substantial disability and major gaps in timely diagnosis and care. A simple, internally validated classification score based on demographic, socioeconomic and vascular factors may help target community screening and prevention but requires external validation and cautious interpretation given the cross-sectional design and self-reported exposures.

People experiencing homelessness (PEH) face multiple barriers to seeking healthcare and have poorer health outcomes. Point of care tests (POCTs) provide a potential solution to improving access to diagnostics for this population. This survey aimed to understand if these technologies could address unmet needs in primary care for PEH.

An online survey was circulated via dedicated inclusion healthcare newsletters to professionals providing community-based care for PEH in England. The survey focused on experiences of diagnostics and opinions on the use of POCTs for this population.

Thirty-two healthcare workers participated, including GPs, nurses and other allied practitioners from 13 different Integrated Care Boards across England.

Descriptive analyses were performed using standard statistical parameters. A reflexive thematic analysis was performed on free-text responses.

There was evidence of current POCT use but with marked variation across services as to which tests are available. Healthcare workers were overwhelmingly positive about the potential for POCTs, with rapid results facilitating prompt diagnosis and management, increasing likelihood of engagement. C reactive protein testing was considered as the test, which could confer the most benefit to acute care, with renal function and troponin also being discussed, whereas tests to determine cardiometabolic risk were thought to have the most patient benefit in chronic care. Point of care ultrasound for diagnosis of respiratory pathologies and deep vein thrombosis and POCTs for malnutrition were suggested as potential future technologies to address unmet healthcare needs.

The majority of responders expressed that enhancing the provision of POCTs would be beneficial, both in acute and chronic care scenarios, due to the benefits of getting rapid results and reducing the need for repeat appointments or onward referral for diagnostics.

The aim of this study was to describe the literature that has been published on colorectal surgery patients’ experiences, including the challenges and solutions related to the transition from hospital to home.

With surgery being an inevitable treatment for most individuals with colorectal disease, optimising the discharge transition from the hospital to home requires careful consideration of surgical patient experience, including a thorough understanding of their challenges during the transition period, particularly surrounding education.

A search was conducted of MEDLINE, Embase, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials. Inclusion criteria included peer-reviewed literature published between January 2012 and April 2023 involving adult (age ≥18) colorectal surgery patients from countries with healthcare systems comparable to Canada (ie, Canada, Australia, France, Germany, the Netherlands, New Zealand, Sweden, the UK and the USA). Patients or the public were not involved in the design of this scoping review.

41 articles were included, the majority of which were qualitative (73.1%) and conducted in the USA (29.3%). A total of 180 patient-reported challenges were identified; most occurred postoperatively (76.7%) and pertained to environmental factors (58.3%) and body functions (35.5%). The most frequently reported environmental challenge was insufficient patient education (30.9%), and the most frequent challenge related to body function was negative emotions (25.7%). Seven categories of solutions were identified, with education being the most frequently cited (36.0%) solution within the included literature.

Educational interventions addressing both bodily function and environmental factors are needed to improve colorectal surgery patients’ experiences and care quality during their transition home from the hospital.

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’.

Tribal people in India face a growing risk of multimorbidity, primarily from cardiovascular diseases (CVD) due to changing lifestyles and unique socio-cultural and political factors. We aimed to identify treatment patterns and barriers to medication adherence for CVD. This will inform culturally sensitive implementation strategies that may improve outcomes among tribal communities.

We conducted an exploratory cross-sectional study among participants with multimorbidity in a South-Indian tribal setting. We used a structured questionnaire, guided by the Consolidated Framework for Implementation Research(CFIR), to assess comorbidities, treatment patterns, adherence and potential factors influencing adherence. Descriptive statistics and multivariable logistic regression identified correlates for medication non-adherence.

We recruited 200 participants with a mean age of 64.6±9.71 years. The majority were female (115, 57.5%), of tribal origin (160, 80%) and had no formal education (169, 84.5%). The commonly reported comorbidities included hypertension (168, 84%) and diabetes (113, 56.5%) followed by chronic kidney disease (CKD) (47, 24%). Self-reported non-adherence to medications (missing at least one CVD pill in the past week) was reported by 120 (60%) participants. Key correlates of non-adherence identified were lower levels of education (OR 8.27, 95% CI 1.96 to 35.01, p=0.004), diabetes (2.94, 95% CI 1.04 to 8.33, p=0.04) and high pill burden (5.04, 95% CI 1.88 to 28.84, p=0.03), while social support (0.85, 95% CI 0.7 to 0.97, p=0.013) and positive illness perception (0.95, 95% CI 0.91 to 0.99, p=0.05) were positively associated with good adherence.

These tribal communities face complex challenges in managing CVD and multimorbidity. Improving adherence will require developing simple, patient-centred and culturally appropriate strategies through community engagement. Simplified medication regimens, including rational fixed dose combination pills may improve adherence. Additionally, the high prevalence of CKD observed underscores the need for investigation and integration of regular CKD screening in the health system.

Organ preservation strategies for rectal cancer following neoadjuvant treatment require intensive endoscopic monitoring to detect early luminal recurrence. This is termed 'Watch and Wait' (WAW). Standard protocols commonly mandate flexible sigmoidoscopy every 3–4 months for 2 years. Digital proctoscopy with the LumenEye device has been shown to be a safe alternative that can be performed in an outpatient setting without the need for sedation and with less staffing requirements. The study objective is to evaluate the economic implications of using digital proctoscopy compared with flexible sigmoidoscopy for patients with rectal cancer managed under a WAW protocol.

The study was conducted in a secondary care National Health Service (NHS) setting. A cost comparison analysis was performed over a 2 year time horizon (seven procedures per patient). 177 procedures on rectal cancer patients undergoing WAW with digital proctoscopy between August 2023 and November 2024 were included. The control group, that is, flexible sigmoidoscopy was modelled. The base case was flexible sigmoidoscopy without sedation. Scenarios using sedation were also evaluated. Costs were categorised into fixed and variable costs. A one-way sensitivity analysis, probabilistic sensitivity analysis and What-If scenarios were also performed.

The primary outcome was the minimum cost difference between the two procedures. The secondary outcome measure was the robustness of the cost differences. Over 2 years, the total cost per patient was £768.92 (95% CI £656.6 to £900.7) for digital proctoscopy compared with £1,588.15 (95% CI £1458.1 to £1725.2) for flexible sigmoidoscopy without sedation. The absolute minimum cost saving per patient is £820.23 (95% CI £648.7 to £985.1). Cost savings increased to £848.94 (95% CI £677.20 to £1013.83) to £935.62 (95% CI £761.02 to £1103.08) when sedation was used in flexible sigmoidoscopy procedures. Personnel costs during the procedure and recovery phase were the dominant cost drivers for flexible sigmoidoscopy. Probabilistic sensitivity analysis and What-If scenarios confirmed the robustness of the findings, with flexible sigmoidoscopy remaining more costly.

Digital proctoscopy with the LumenEye device is a cost-saving alternative to flexible sigmoidoscopy for patients with rectal cancer on a WAW protocol. Our findings support the integration of digital proctoscopy into WAW pathways as a cost-efficient alternative within resource-constrained healthcare systems. Endoscopy service pressures are also likely to be alleviated.

This study aims at understanding the important correlates of child undernutrition in India using a quantile regression approach.

Cross-sectional study.

The study utilizes the secondary data from the latest round of the National Family Health Survey (2019–2021) to assess the individual, maternal and household-level determinants of under-nutrition among Indian children aged 0–5 years.

The unit of analysis is children under the age of 5 years and the sample size is 224, 218.

The outcome measures of this study are stunting, wasting and underweight.

Results from our study show that birth order and size of the child at birth have a statistically significant association with stunting, wasting and underweight. While currently breastfeeding is negatively associated with HAZ scores (below 50th quantile), maternal height is positively associated with HAZ, WAZ and WHZ scores in all quantiles. Mother’s age, body mass index and education level have significantly stronger association with HAZ and WHZ scores. Furthermore, children from richer and richest households are likely to have higher HAZ, WAZ, and WHZ scores compared to the children from poorest households. For instance, the WHZ scores increased from 0.15 in the 10th quantile among the poorest to 0.43 among the richest at the same quantile. Moreover, at the 90th percentile, this coefficient increased from 0.11 among the poorest to 0.46 among the richest.

It is crucial to acknowledge that to have healthy babies, we must have healthy mothers. Thus, interventions to address child nutrition in India should also focus on maternal health, education, increasing the women’s agency and women empowerment. The findings of the study suggest that concerted efforts addressing the manifold determinants of children’s nutritional status from the government, non-governmental organisations and civil societies will ensure bolstered nutritional outcomes for children in India.

The Government of India launched the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) to expand access to affordable generics through private retail outlets named as Jan Aushadhi Kendras (JAKs). This study examines the association of PMBJP with out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and impoverishment rate (IR) attributable to medicines.

A cross-sectional observational study was conducted across nine Indian states in 2022–2023.

Outpatient (OPD) and inpatient (IPD) departments of secondary and tertiary government hospitals, private pharmacies and JAKs in 18 districts of India

A total of 10 336 patients were recruited from OPD (n=2881) and IPD (n=1009) departments of government hospitals as well as pharmacy settings (n=6446). Data on sociodemographics, disease severity, number of generic prescriptions, source of acquiring medicines and medicine-related OOPE were collected through semistructured interviews and periodic follow-ups.

Primary outcomes included mean OOPE on medicines, incidence of CHE (≥40% of non-food consumption expenditure on medicines), IR among JAK and non-JAK users were the primary outcomes of the study. Secondary outcomes comprised awareness of JAKs, generic prescribing rates in hospitals and the factors associated with OOPE, CHE and IR.

Patients procuring medicines exclusively from JAKs reported the lower mean OOPE (OPD: 172; IPD: 275; pharmacy: 307), compared with significantly higher spending at private pharmacies (OPD: 1085; IPD: 3165; pharmacy: 1031). After adjusting for covariates, OOPE among exclusive JAK users was significantly lower relative to private pharmacy users by 60.6%–89.3%. Furthermore, matched analysis confirmed 42% lower expenses, compared with private pharmacies. The likelihood of CHE was also significantly greater among private pharmacy users. However, utilisation of JAKs remained limited, mainly due to low awareness, perceived stock shortages and low rates of generic prescribing.

PMBJP is associated with significant reduction in OOPE and financial hardship, positioning it as an effective cost-containment intervention within India’s universal health coverage framework. Strengthening supply chains, promoting generic prescribing and integrating JAKs with public facilities would further maximise its impact.

Glycated haemoglobin A1c (HbA1c) measurement is essential for managing diabetes, yet limited data exist on the performance of point-of-care (POC) HbA1c devices in low- and middle-income countries (LMICs). This study evaluated the analytical performance and usability of HbA1c devices in different LMIC settings.

This prospective, cross-sectional multicentre study evaluated the accuracy and usability of four POC devices (i-SENS A1Care, HemoCue HbA1c 501 System, Abbott Afinion 2 and Siemens DCA Vantage) against a laboratory-based HbA1c method at two hospitals in Nigeria and Cambodia.

Adults with or without diabetes and haemoglobin ≥8 g/dL were enrolled.

The primary objective was to evaluate HbA1c POC device accuracy versus laboratory reference testing; secondary objectives evaluated device usability and technical characteristics when used by trained professionals.

Capillary and venous blood samples were tested on all devices using two cartridge lots followed by reference testing. Usability was assessed via operator questionnaires. Accuracy was evaluated using regression slopes, intercept, absolute bias at 30, 48 and 75 mmol/mol, and Bland-Altman analysis, including capillary-venous concordance.

A total of 248 participants completed all study procedures (n=125 in Cambodia, n=123 in Nigeria). Siemens DCA Vantage and Abbott Afinion 2 showed strong agreement with the reference method, with no clinically significant differences and narrow limits of agreement. In contrast, i-SENS A1Care and HemoCue HbA1c 501 System displayed greater bias, especially at elevated HbA1c levels. Most results fell within limits of agreement, though high-HbA1c outliers were more common with the A1Care and HbA1c 501 System devices. Usability feedback was positive overall, when devices were rated across various dimensions, such as clarity of instructions, safety and labelling, although limited user sample size constrains the generalisability of these findings.

Siemens DCA Vantage and Abbott Afinion 2 demonstrated reliable accuracy and usability. In contrast, i-SENS A1Care and HemoCue HbA1c 501 System require cautious interpretation at high HbA1c levels. Ongoing evaluation is critical to ensure the appropriate use of POC devices in diverse clinical settings.

NCT06170515.