Diabetes affects 537 million people worldwide, with type 2 diabetes (T2D) estimated to account for most cases. Type 1 diabetes (T1D), latent autoimmune diabetes in adults (LADA) and other specific types due to other causes remain under-recognised, especially LADA, given the absence of a standardised definition. In the province of Quebec (Canada), no population-based prevalence and incidence estimates are available for all diabetes phenotypes. Current medico-administrative algorithms fail to distinguish among diabetes subtypes, limiting accurate surveillance and effective prevention and clinical strategies.

This retrospective, longitudinal study (1997-2027) will be conducted in Quebec.

Phase 1 will assess classification performance of the Corsenac et al. (2022) medico-administrative algorithms. Diagnostic performance metrics will be calculated per phenotype (T1D, T2D, LADA and others), using three independent subsamples as references in a first cohort (A1-A2-A3; n5200). It composed respectively of: (A1) self-reported diagnoses of T1D and LADA; (A2) diagnoses of T2D and other specific types due to others causes, confirmed by a physician; and (A3) general population respondents reporting diabetes status and phenotypes (if applicable). Subsamples are structured to capture the diversity and relative proportions of diabetes phenotypes, ensuring sufficient statistical power for population-based and subgroup analyses. All records (A1, A2, A3) will be probabilistically linked with medico-administrative and pharmaceutical claims from the Régie de l’assurance maladie du Québec (RAMQ) by the Institut de la statistique du Québec (ISQ). Machine learning methods will be then applied to refine algorithmic definitions for the four phenotypes (T1D, T2D, LADA, others).

In phase 2, refined algorithms will be applied to a second medico-administrative population-based cohort, named C (n=50 000) to produce the first simultaneous prevalence and incidence estimates for the four phenotypes.

Analyses will be restricted to individuals continuously covered by RAMQ’s public drug insurance, which provides pharmaceutical data and covers 46% of the Quebec population. Calibration on population margins (phase 1) and standardised inverse probability weighting (phase 2) will reweight estimates (performance metrics in phase 1 and frequencies in phase 2) to represent the general Quebec population.

The different ethics boards of partner institutions approved the feasibility of the study. The study was registered on ClinicalTrials.gov, NCT06573905. Results will be disseminated through scientific and public health channels.

Home care services face increasing challenges driven by population ageing, ageing-in-place policies, growing complexity of care needs among home care recipients and shortages of qualified personnel. These developments underscore the need to better use the available workforce and its competencies. Workforce composition refers to the skill mix and organisational structures of home care services, including professional backgrounds, team configurations and work scheduling practices. Competence utilisation refers to how effectively health personnel apply their skills and qualifications in service delivery. This scoping review aims to map existing knowledge on how workforce composition and professional skill sets influence (1) the organisation of tasks, roles and responsibilities and (2) competence utilisation in home care services. By examining the relationship between workforce organisation and competence use, the review seeks to identify factors that support or constrain the optimal use of workforce competence in home care services.

This scoping review will be conducted according to the Arksey and O’Malley methodological framework as refined by Levac. The review process will be guided by the Joanna Briggs Institute methodology for scoping reviews. The review has been conducted between April and August 2026. The literature search will be conducted on MEDLINE, EBSCOhost CINAHL, Scopus, ProQuest and Embase to include peer-reviewed primary research studies published in scientific journals. The search will also be supplemented by Google Scholar to identify additional and grey literature in order to improve search coverage. The search strategy has been developed with support from an experienced university librarian. Using the Population–Concept–Context (PCC) framework, inclusion criteria are: (1) employees in home care services, (2) workforce organisation and competence utilisation and (3) municipal or district-based home care services. Exclusion criteria are: (1) volunteers or staff without care responsibilities, (2) studies focusing only on patient outcomes without addressing competence or workforce structure and (3) institutional or hospital-based settings. An online platform will be used to share search results and perform record screenings by two reviewers independently to enhance accuracy and reliability. Data from included sources will be charted and synthesised narratively, supported by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews flow diagram (PRISMA-ScR).

The scoping review will not require ethics approval, as all data will be obtained from publicly available literature. The review authors will adhere to principles of honesty and transparency throughout the data extraction and reporting processes and enhance the trustworthiness of the synthesised findings. Findings will be submitted for publication in a peer-reviewed journal and disseminated through presentations at relevant conferences.

To investigate the behavioural and social determinants of type 2 diabetes mellitus (T2DM) self-care adherence in South Ethiopia using the integrated health belief model (HBM) and health-related quality-of-life (HRQoL) frameworks.

A cross-sectional study.

Three public hospitals in South Ethiopia: Wolaita Sodo University Comprehensive Hospital, Humbo Primary Hospital and Boditi Primary Hospital.

404 systematically sampled adults aged 18–60 years with a confirmed diagnosis of T2DM who had been attending follow-up clinics for at least 12 months. Exclusion criteria included newly diagnosed T2DM, pregnancy, severe comorbidities or critical illness and unwillingness to participate.

The primary outcome was adherence to diabetes self-care, assessed using the Summary of Diabetes Self-Care Activities scale across five domains: diet, physical activity, medication intake, blood glucose monitoring and foot care. Good adherence was defined as engagement in recommended behaviours on ≥50% of days per week. Secondary outcomes included socio-demographic factors, clinical variables, HBM constructs (perceived susceptibility, severity, benefits, barriers, cues to action and self-efficacy) and HRQoL domains (physical, psychological, social and environmental).

Of 404 participants, 58.4% demonstrated good adherence. In multivariable analysis, insulin-only treatment (AOR=3.0; p

The findings challenge the direct application of standard behavioural models in low-resource settings. Structured factors, such as poverty, can overwhelm psychological mechanisms. Effective interventions must integrate economic support with psychological care to improve self-care adherence.

This review explores the conceptual frameworks, methods, barriers and facilitators associated with the human-centred design (HCD) process employed when developing digital health dashboards (DHDs) for the care of older adults.

This scoping review is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) guidelines, ensuring a systematic approach to identifying and synthesising relevant literature.

Five databases were searched including EMBASE, MEDLINE, PsychInfo, CINAHL and Cochrane Library from January 2012 to 30 March 2026.

Studies were eligible if they involved the HCD of DHDs for health management in older adults aged 60 years and over. The design process could involve a range of stakeholders, including older adults, healthcare professionals, carers, technology experts and other relevant parties involved in dashboard design.

Search terms included older persons, ageing, decision support systems, dashboards, human-centred design etc. Study screening was done in Rayyan, and data extraction was conducted in MS Excel using the Joanna Briggs Institute data extraction tool. HCD approaches were mapped to the Double Diamond framework using thematic analysis.

A total of 15 studies were included which employed iterative HCD approaches, involving stakeholders at various stages of dashboard development. Several conceptual frameworks were identified including user-centred design and behaviour change frameworks as well as HCD methods identified including user interviews, focus groups, co-design workshops, usability testing and surveys. Key facilitators included ongoing user engagement, multidisciplinary collaboration and iterative prototyping. Barriers included limited digital literacy among older adults, challenges in recruiting diverse user groups and resource constraints impacting the breadth of HCD activities.

Dashboards developed using HCD approaches suggest improved usability, acceptability and relevance for older adults, supporting better self-management of health conditions. However, inconsistent frameworks, lack of research outside Europe, America and Australia and underuse of dashboard analytics were identified as challenges. Future research should adopt validated HCD frameworks, address acceptability factors and evaluate real-world use to develop more inclusive and sustainable digital health tools for older adults.

To estimate the global, regional and national burden of maternal haemorrhage (2000–2021) and its 2050 projections in 204 countries and territories.

This study systematic analysis of the burden of maternal haemorrhage sourced data from the Global Burden of Disease (GBD) 2021 study. We estimated the incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) due to maternal haemorrhage. Changes in the burden from 2000 to 2021 were computed using AAPC. To detect statistically notable changes in the trends of maternal haemorrhage metrics between 2000 and 2021, Joinpoint regression analysis using the Joinpoint Regression Programme was conducted. We also projected mortality rates, YLDs and YLLs through to 2050 using maps and trends generated by the GBD Foresight visualisation tool.

Globally, the incidence of maternal haemorrhage among women aged 15–49 years declined from 881.98 per 100 000 reproductive aged women (95% uncertainty interval (UI) 687.01 to –1150.23) in 2000 to 714.00 (95% UI 556.97 o t908.54) in 2021, with an average annual percentage change (AAPC) of –0.91 (–1.37 to –0.49). Similar downward trends were observed for maternal deaths, DALYs, YLDs and YLLs attributable to maternal haemorrhage, with AAPCs of –3.78 (–4.39 to –3.18), –4.68 (–4.83 to –4.55), –1.21 (–1.54 to –0.89) and –4.80 (–5.10 to –4.52), respectively. Sub-Saharan Africa, particularly Western Sub-Saharan Africa, recorded the highest burden in 2021, which is almost 300 times higher than in Western Europe. Elevated rates of mortality, DALYs and YLDs were also evident in Sierra Leone, Chad, Niger, Mali, Nigeria, Burkina Faso, Central African Republic, Somalia and South Sudan in 2021 and projections for 2050. However, the high-income Asia Pacific region had the lowest incidence, DALYs and YLDs at 151.32 (109.63–203.68), 2.21 (1.72–2.86) and 0.87 (0.46–1.38) per 1 00 000 women, respectively. Australasia recorded the lowest maternal death count and YLLs attributed to maternal haemorrhage at 0.69 (0.50–0.90) and 0.56 (0.41–0.74) per 1 00 000 women, respectively.

While the global burden of maternal haemorrhage has declined over time, significant regional and national inequities persist. Even though the 2050 projections show improvement in the burden of maternal haemorrhage, there is also regional and national variation in the rate of decrease in maternal haemorrhage burden. Targeted, context-specific interventions are urgently needed to reduce maternal haemorrhage-related mortality and morbidity.

To determine the prevalence and clinical characteristics associated with polyneuropathy in kidney transplant recipients (KTRs).

Cross-sectional study.

SENS study at the University Medical Center Groningen, the Netherlands, December 2021–May 2023.

KTR, participating in the ongoing TransplantLines Biobank and Cohort Study, ≥12 months post-transplantation.

Participants underwent a structured neurological assessment including history taking, neurological examination, quantitative sensory testing and nerve conduction studies. An expert panel classified participants into no/possible, probable/definite large fibre polyneuropathy or small fibre neuropathy. Large-fibre subtypes included axonal or demyelinating, pure sensory, pure motor and sensorimotor. To assess potential associations with clinical characteristics, logistic regression analysis was conducted.

We included 160 KTRs with a mean age of 59.8±11.6 years at a median of 6.1 (95% CI 3.9 to 13.1) years post-transplantation, with 16 KTRs (10%) diagnosed with polyneuropathy before study inclusion. In total, 84 KTRs (53%) were identified with large fibre polyneuropathy and 7 KTRs (4%) with small fibre neuropathy. KTRs with large fibre polyneuropathy presented with either sensor-predominant polyneuropathy (40 KTR (48%)) or sensorimotor polyneuropathy (44 KTR (52%)). We found no neurophysiological characteristics of demyelination. Overall, 18% (95% CI 11% to 27%) of KTRs with large fibre polyneuropathy were asymptomatic. Higher age (OR=1.04 (1.01 to 1.08), p=0.01), male sex (OR=2.55 (1.19 to 5.60), p=0.02), diabetes (OR=5.58 (1.36 to 38.14), p=0.03) and elevated urea levels (OR=1.12 (1.04 to 1.23), p=0.01) were significantly associated with polyneuropathy in KTR.

In contrast with previous studies, axonal sensory or sensorimotor polyneuropathy is highly prevalent and often underdiagnosed in KTR. Next to higher age and male sex, it was independently associated with diabetes and higher urea levels. Further research is needed to reveal the aetiology and course of polyneuropathy in KTRs.

NCT04664426.

To assess the level of health system responsiveness (HSR) and its associated factors among outpatients attending primary healthcare units (PHCU) in Arba Minch, South Ethiopia.

Facility-based cross-sectional study.

Three PHCUs (one primary hospital and two health centres) in Arba Minch town, Southern Ethiopia.

A total of 379 outpatients aged 18 years and above were selected using a systematic random sampling.

Primary outcome: level of HSR, measured across seven domains (communication, confidentiality, basic amenities, dignity, choice, prompt attention and autonomy) using a 28-item tool adapted from the WHO HSR framework. Secondary outcome: factors associated with HSR, identified via bivariate and multivariable linear regression.

The overall HSR was 59.4%. The highest-performing domains were confidentiality (73.9%) and dignity (70.7%), while the choice of healthcare provider was rated lowest (34.6%). In multivariable linear regression analysis, factors significantly associated with HSR score were travel time to reach the health facility on foot (β = –0.26, 95% CI –0.37 to –0.14); out-of-pocket payment for transport (β = –6.51, 95% CI –8.33 to –4.70); patient satisfaction score (β=1.57, 95% CI 1.27 to 1.88) and perceived quality of healthcare score (β=0.32, 95% CI 0.14 to 0.49).

HSR among outpatients in PHCU was moderate, with several individual and service-related factors associated with patient experiences. These findings suggest the need for focused interventions to improve responsiveness domains, although more research is required to demonstrate causal relationships.

Doxycycline as post-exposure prophylaxis (doxy-PEP) has emerged as an efficacious strategy to reduce Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoeae) and syphilis (sexually transmitted infections (STIs)) among gay, bisexual and other men who have sex with men (GBM). There is a need to identify prescribing criteria that maximise the number of STIs averted while minimising excessive use.

In this prospective longitudinal cohort study with repeated measures and biobehavioural data collection, participants completed a questionnaire and tested for STIs at each visit.

Community-based, population-level study conducted in three large Canadian cities between February 2017 and July 2023.

2449 GBM were recruited through respondent-driven sampling (RDS); 1998 had ≥1 follow-up visit, contributing 7551 person-years of observation. Eligible participants were aged ≥16 years, cis- or transgender men, reported sex with another man in the past 6 months and resided in Montreal, Toronto or Vancouver.

Adjusted rate ratios (aRR) of STIs, accounting for RDS recruitment, loss to follow-up and confounding were estimated using generalised estimating equations (GEE) Poisson regression. For identified STI risk factors, the proportions of STIs averted through doxy-PEP prescription (based on the efficacy of doxy-PEP for each bacterial STI) and the number needed to treat (NNT) for 1 year to avert one STI, assuming 100% adherence, were calculated.

Among 1998 participants, the combined incidence rate of any C. trachomatis, N. gonorrhoeae and syphilis infection was 29.5 (95%CI 27.3 to 31.9) per 100 person-years. STI risk factors that had the most impact as doxy-PEP criteria were history of any of the three STIs in the past 12 months (P12M) (aRR=2.0, 95% CI 1.8 to 2.2, 36% STI averted, NNT=2.1); ≥10 male sexual partners in the past 6 months (P6M) (aRR=3.8, 95% CI 3.0 to 4.9, 41% STI averted, NNT=2.4); HIV-pre-exposure prophylaxis (PrEP) use P6M (aRR=1.7, 95% CI 1.5 to 2.0, 29% STI averted, NNT=2.5); use of any chemsex-related substance P6M (aRR=1.2, 95% CI 1.1 to 1.4, 28% STI averted, NNT=2.6); and group sex event attendance P6M (aRR=1.2, 95% CI 1.1 to 1.3, 27% STI averted, NNT=2.3). Reporting≥10 male sex partners P6M represented the most useful criterion for syphilis prevention (52% syphilis infections averted, NNT=20). Prescribing doxy-PEP to GBM having any of the following STI risk factors, namely, ≥1 bacterial STI P12M, ≥10 male sex partners P6M, or HIV-PrEP use P6M, would substantially increase the proportion of all STI diagnoses potentially averted (60%) with minimal increase of the NNT (2.7).

This work informs on the impact of various doxy-PEP clinical prescribing criteria and demonstrates the benefit of focusing on any of the following three criteria: ≥1 bacterial STI P12M, ≥10 male sex partners P6M or HIV-PrEP use P6M.

Cardiovascular disease (CVD) is the leading cause of death worldwide and is associated with a broad range of physical, emotional and social burdens. Existing tools such as Systematic Coronary Risk Evaluation and WHO CVD risk charts identify clinical risk factors but fail to capture patient-perceived burden and the risk of burden awareness. The Assessment of Burden of Chronic Conditions (ABCC)-tool, a validated, person-centred instrument, offers a more holistic approach. The aim of the current study is to develop and validate a new module within the ABCC-tool for patients with an elevated cardiovascular (CV) risk or CVD (cardiovascular risk management (CVRM) module).

A mixed-methods design was used across four phases and expert meetings to identify the items for the module. All phases took place in the Netherlands. Phase 1 (literature search) was performed in 2021, phase 2 (semistructured interviews) was completed between January and October 2021, phase 3 (survey) was completed in November 2023 and December 2024, and phase 4 (semistructured interviews) was completed in January 2025.

Phase 2 involved 14 experts by experience (patients with CVD or people at elevated risk) and 10 healthcare professionals in the field of CVD. Phase 3 included 86 healthcare professionals. Phase 4 included 12 experts by experience. In total, four expert meetings took place, attended by three experts by experience, nine healthcare professionals and seven researchers.

The module was refined iteratively, using qualitative and quantitative insights at each phase of development. The model was only finalised after thorough content validation.

No suitable patient-reported outcome measures (PROMs) focusing specifically on CVRM were identified in the literature. Interviews revealed significant burdens in terms of physical, emotional and social burdens. Feedback from expert meetings and validation rounds led to substantive refinement. The final module contains 10 items and was deemed valid by both experts by experience and healthcare professionals.

The CVRM module of the ABCC-tool has been systematically developed and validated in terms of content. The final module focuses on the multidimensional burden of CVD and dealing with its risk factors and aims to support self-management. The module complements existing risk assessment tools by focusing on the burden experienced by the patient and the burden resulting from risk awareness.

The Asia-Pacific Colorectal Screening (APCS) score is a validated tool for predicting advanced colorectal neoplasia (ACN) in the Asia-Pacific region. An adjusted APCS (A-APCS) score was recently developed by incorporating body mass index into the original score and was reported to outperform the original score but lacked external validation. This study aimed to compare the A-APCS score with the original APCS score in asymptomatic Vietnamese individuals.

A cross-sectional study.

Dai Phuoc Polyclinic, Ho Chi Minh City, Vietnam.

Asymptomatic individuals underwent colonoscopy screening.

Participants were categorised into three risk groups based on the sum of the APCS and A-APCS scores: average risk (AR), moderate risk (MR) and high risk (HR). The performance of the two scores was compared via receiver operating characteristic (ROC) analysis and McNemar tests.

A total of 714 participants (median age 51 years, range: 18–79; female-to-male ratio: 1:1.46) were included, with an ACN prevalence of 9.0%. Both scores indicated effective predictive ability for ACN in the HR group compared with the AR group, with OR=3.878 (95% CI 1.777 to 8.068) and 3.266 (95% CI 1.617 to 6.595), respectively. The A-APCS score was more effective than the APCS score in predicting ACN in the MR group than in the AR group. However, no significant differences in area under the ROC curve were observed between the two scores for ACN prediction.

Compared with the APCS score, the A-APCS score may not provide improved ACN risk stratification in asymptomatic Vietnamese individuals. Both scores are suboptimal and should be used to prioritise, rather than exclude, candidates for colonoscopy.

Many older people experience Mild Cognitive Impairment (MCI), which may compromise the effectiveness of health promotion programmes.

We explored engagement with behaviour change among participants scoring 18-25 on the Montreal Cognitive Assessment receiving HomeHealth, a health promotion intervention supporting older adults with mild frailty to maintain independence in England ().

Of the 46 semistructured process evaluation interviews, 29 participants scored in the MCI range, purposively selected for demographic characteristics and degrees of cognitive impairment and the seven support workers.

Thematic analysis resulted in three themes: Navigating the impact of MCI; Addressing memory as a goal in the intervention; and Adapting Behaviour Change Interventions for MCI. Participants had varied opinions about whether their memory was problematic and whether anything could be done to help. Many reported not discussing memory concerns with support workers. Barriers to engagement in behaviour change included limited social support and not acknowledging memory problems. Facilitators included setting goals which increased or were linked to existing health behaviours, using reminders/prompts and actively involving family members.

Implementing these facilitators into existing and new health promotion interventions delivered to older adults, with suspected but unacknowledged MCI, could overcome the current barriers people with MCI face when trying to engage and benefit from interventions.

ISRCTN54268283