Glaucoma is an optic neuropathy caused by the gradual degeneration of retinal ganglion cells. This study aimed to investigate the knowledge, attitude and practice (KAP) towards glaucoma among ophthalmic inpatients.

A web-based questionnaire.

Local hospital.

Ophthalmic inpatients (n=1238).

The primary outcome was the patients’ KAP.

Multivariable logistic regression analysis showed that rural residence (OR=0.488, 95% CI 0.313 to 0.762, p=0.002), college education or above (OR=4.996, 95% CI 2.942 to 8.483, p

Ophthalmic inpatients might have moderate knowledge and attitude, but a proactive practice towards glaucoma. A history of glaucoma, previous glaucoma surgery, education level, residency and alcohol consumption were potentially associated with knowledge and attitudes towards glaucoma among ophthalmic inpatients.

The overuse of antibiotics for respiratory tract infections in primary healthcare in rural China is a particular challenge and is highly related to antibiotic resistance. Our research team designed a multi-component intervention focusing predominantly on health practitioners to reduce antibiotic prescriptions in rural communities of China. The effects of the intervention were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of the implementation of the intervention and related influencing factors.

Qualitative process study nested in a randomised controlled trial, including observation and semi-structured interviews.

Primary healthcare in rural China.

27 health practitioners from township health centres assigned to the intervention arm.

A complex intervention to reduce antibiotic prescriptions in rural communities of China, which includes the following components: training for health practitioners, a public letter of commitment, patient leaflets, a decision support system and a peer support group.

Not applicable.

Data were analysed using thematic analysis.

The overall multi-component intervention was described as useful in reducing antibiotic prescribing, with a particularly high acceptance and use of patient leaflets and the public letter of commitment among health practitioners. There were mixed views on the decision support system and peer support group. Practitioners reported usability-related barriers to using the decision support system during consultations. Practitioners did not understand the role or benefits of the peer support group and found it difficult to initiate group discussions, due to the lack of any existing clinical team at the primary care level.

The multi-component intervention appears to be acceptable and useful in primary healthcare in rural China. Successful implementation requires a comprehensive understanding of the contextual characteristics of the setting. Interventions to reduce antibiotic prescribing in China in the future could consider wider stakeholders including patients, retail pharmacies and health authorities.

ISRCTN30652037 (01/12/2020).

Although neurofilament light chain (NfL) is used as a biomarker of neurodegenerative decline, its application in surgery- and anaesthesia-induced acute cognitive dysfunction remains uncertain. We aimed to synthesise existing evidence to evaluate the potential of NfL as a biomarker for perioperative neurocognitive disorder (PND).

Systematic review and meta-analysis.

PubMed, EMBASE, MEDLINE, the Cochrane Library and the Cochrane Central Register of Clinical Trials were systematically searched up to March 2024.

Observational studies—including cohort, case-control and cross-sectional designs—were included if they reported cerebrospinal fluid (CSF) or blood NfL levels in individuals with and without PND.

Three independent reviewers assessed each article. Quality scoring was conducted, and the extracted data were analysed using STATA. Risk of bias was evaluated using the Newcastle–Ottawa Scale. Meta-analytical model selection was guided by the I² statistic, with I²≤40% indicating low heterogeneity and the use of a fixed-effect model; random-effects models were used when this threshold was exceeded.

Within-group analyses showed significant postoperative increases in blood NfL levels in both the postoperative delirium (POD) group (standardised mean difference (SMD) = 0.49; 95% CI 0.34 to 0.64) and the no-POD group (SMD=0.67, 95% CI 0.53 to 0.81). Between-group comparisons revealed significantly higher preoperative CSF NfL levels in the POD group (SMD=0.27, 95% CI 0.07 to 0.47). Both preoperative and postoperative blood NfL levels were also significantly elevated in the POD group (SMD=0.53, 95% CI 0.40 to 0.66, and SMD=0.58, 95% CI 0.43 to 0.73, respectively).

This meta-analysis suggests that NfL may be a potential biomarker for POD. Further research is needed to clarify the association between CSF and blood NfL levels and other forms of PND.

CRD42024516907.

With the increasing prevalence of asthma in children, exercise has become an essential component of asthma management, playing a significant role in improving overall health and quality of life. However, children with asthma face numerous challenges when participating in exercise, including physical limitations due to symptoms, fear of exacerbations and lack of parental support. In addition to these barriers, some factors can promote or facilitate exercise in this population. Therefore, this qualitative meta-synthesis aims to explore these barriers and facilitators through a qualitative meta-synthesis, to provide a basis for developing targeted exercise interventions, optimising asthma management and improving the health status and quality of life of children with asthma.

This qualitative metasynthesis will adhere to the Joanna Briggs Institute (JBI) framework. The final systematic literature search will be performed in the following electronic databases to include publications from their inception until 31 December 2025: PubMed, Embase, CINAHL, Web of Science and the Cochrane Library. The search strategy will include controlled terms and keywords related to ‘asthma’, ‘child’, ‘exercise’ and ‘qualitative research’. The inclusion criteria will comprise qualitative or mixed-methods studies published in English that explore the barriers to and facilitators of exercise participation in children under 14 years of age with asthma, their families or healthcare providers. Grey literature and non-English studies will be excluded. Study selection, data extraction and methodological quality assessment (using the JBI Critical Appraisal Checklist) will be conducted independently by two reviewers. Data will be synthesised using thematic synthesis.

Ethical approval will not be required for this qualitative synthesis, as it solely encompasses data derived from previously published research. Findings will be disseminated through professional networks, conference presentations and submission to a peer-reviewed journal.

PROSPERO, CRD42025641502.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by impairments in social interaction, communication and the presence of repetitive behaviours. Recent advancements in brain-computer interface (BCI) technologies have demonstrated potential benefits in enhancing cognitive, social and communication skills in individuals with ASD. However, the effectiveness of BCI-based interventions in ASD rehabilitation remains inconsistent across studies. Therefore, this protocol outlines a systematic review and meta-analysis to synthesise the evidence on the effectiveness of BCI-based interventions for ASD rehabilitation.

We will conduct a comprehensive literature search across multiple databases, including MEDLINE Ovid, Embase Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), Conference Proceedings Citation Index-Science (CPCI-S), Science Citation Index Expanded (SCI-EXPANDED) and so on, to identify relevant studies published from inception to the present. The search will be supplemented by screening the reference lists of included studies and relevant systematic reviews. Two independent reviewers will screen the titles, abstracts and full texts of identified studies for eligibility based on predefined criteria. Data extraction will be performed using a standardised form, and the risk of bias (RoB) will be assessed using the Cochrane RoB tool. Heterogeneity will be evaluated using the I² statistic, and a random-effects or fixed-effects model will be selected for meta-analysis based on the degree of heterogeneity. Subgroup analyses will be conducted to explore potential sources of heterogeneity, including participant age, ASD severity, type of BCI intervention and duration of the intervention. The review will be conducted from January 2026 to April 2026.

Ethical approval is not required for this study, as it does not involve the collection of primary data from individual patients. Findings will be disseminated through peer-reviewed publication and conference presentations.

CRD420251010496.

This study assessed the global burden of glaucoma using data from the Global Burden of Disease (GBD) 2021 study. The analysis of epidemiological trends aimed to inform future public health prevention strategies.

Retrospective cross-sectional study.

None.

Analysis of 1990–2021 GBD data on glaucoma prevalence, disability-adjusted life years (DALYs), age-standardised prevalence rates (ASPR), and age-standardised DALY rates (ASDR). Estimated annual percentage changes (EAPC) were calculated, Joinpoint regression identified trend changes, and Autoregressive Integrated Moving Average (ARIMA) modelling projected the burden for the year 2050.

Globally, the number of prevalent glaucoma cases increased from 4 072 106.59 (95% uncertainty interval (UI) 3 489 888.7 to 4 752 867.3) in 1990 to 7 587 672.9 (95% UI 6 522 906 to 8 917 725.4) in 2021. Concurrently, DALYs increased from 467 600.4 (95% UI 323 490.5 to 648 641.6) in 1990 to 759 900.2 (95% UI 530 942.9 to 1 049 127.2) in 2021. In contrast, the ASPR and ASDR declined to 90.1 per 100 000 population (95% UI 77.8 to 105.5) and 9.1 per 100 000 population (95% UI 6.3 to 12.5) in 2021, respectively. During the COVID-19 pandemic period (2019–2021), the slowest growth rates in crude case numbers and overall disease burden were observed, accompanied by the most pronounced decline in annual percentage change of ASPR. The highest estimates for both case counts and DALYs were identified in the 70–74 age group, with males demonstrating higher prevalence rates than females. Furthermore, regions with lower Sociodemographic Index (SDI) values bore a disproportionately higher burden of glaucoma.

These findings underscore the need to strengthen early screening and treatment of glaucoma, particularly in ageing populations, male groups and low SDI regions. We urge cautious interpretation of COVID-19 related data and vigilance against potential post-pandemic surges in burden. Critical strategies include enhanced screening and intervention for high-risk groups, targeted prevention measures and integration of ophthalmic care into public health emergency frameworks to alleviate the disease burden.

To explore the chain-mediating role of academic buoyancy and academic burnout between self-directed learning ability (SDLA) and learning engagement in undergraduate nursing students.

A cross-sectional survey.

This study was conducted in December 2024, involving 239 nursing undergraduates from a university in Daqing city, Heilongjiang province.

Independent samples t-tests and analysis of variance were employed to examine the relationships between undergraduate nursing students’ characteristics and learning engagement. Pearson correlation analysis was used to analyse the correlations among the variables. Based on self-determination theory, the chain-mediating effects of academic buoyancy and academic burnout between self-directed learning ability and learning engagement were tested using Model 6 of the SPSS PROCESS macro (V.3.5), with bootstrap samples set to 5000.

A total of 239 undergraduate nursing students were included in the analysis, of whom 84.94% were female. The sample comprised students from all academic years, including first-year (27.62%), second-year (33.47%), third-year (17.57%) and final-year students (21.34%). Most participants selected nursing as a voluntary major choice (62.34%), and 43.51% were from urban areas. The 239 undergraduate nursing students scored 72.26±10.26 on SDLA, 14.90±2.64 on academic buoyancy, 53.75±9.33 on academic burnout and 50.81±7.64 on learning engagement. SDLA and academic buoyancy were positively correlated with learning engagement (all p

SDLA is associated with higher learning engagement among nursing students through academic buoyancy and reduced academic burnout. These findings highlight the importance of developing SDLA and clarify the mediating roles of academic buoyancy and burnout in this relationship, providing valuable insights for enhancing learning engagement in nursing education.

To understand how reductions in resource allocation affect food safety services in England.

This longitudinal ecological study analysed secondary observational data.

England, data at the local authority level.

Ecological study, without human participants.

The primary outcome measures were the number of staff, represented by the number of full-time equivalents per capita, number of interventions per establishment, and proportion of hygiene-compliant establishments.

A £1 decrease in food safety expenditure per capita was associated with a 2% (–3.3 to –0.7) decrease in staffing levels and a 1.6% (–3.2 to –0.1) decrease in the number of interventions achieved per establishment. A one-unit reduction in staff was associated with a 42.2% (–80.5 to –11.9) decrease in the number of interventions achieved. No evidence of an association was found between expenditure or staff levels and the proportion of compliant establishments.

Spending reductions negatively affected the capacity of food safety teams to provide key services. Reductions in food safety expenditure significantly affected food hygiene staff levels and service provision. This finding raises concerns about the capacity of food safety teams to operate and the potential for increased public risk of gastrointestinal infections.

To assess Chinese medical staff’s knowledge and attitudes towards insomnia and explore their association with mental health status.

A multicentre cross-sectional survey conducted across hospitals in China using convenience sampling.

Multiple hospitals across different regions of China; level of care primarily secondary.

A total of 654 medical staff enrolled from 23 hospitals between April and June 2023, with 420 (64.22%) nurses. Inclusion criteria encompassed hospital staff involved in patient care; exclusion criteria included those on leave or unwilling to participate. Data on sex and ethnicity were collected but not specified in the abstract.

Primary outcomes included insomnia knowledge and attitudes, assessed by a structured questionnaire. Secondary outcomes encompassed mental health status, measured via the Depression-Anxiety-Stress Scale (DASS)-21 (stress, anxiety and depression). The interactions between these variables were analysed using structural equation modelling (SEM).

Of the participants, 392 (59.94%) reported insomnia symptoms. The median scores for insomnia knowledge and attitudes were 16.0 (range 0–24) and 27.0 (range 7–35), respectively. The median DASS-21 score was 30.0; 189 (28.90%) experienced stress, 400 (61.16%) anxiety and 302 (46.18%) depression. SEM analysis indicated that night shift work (β=–0.101, p=0.024) and job satisfaction (β=–0.258, p

Medical staff showed limited understanding of insomnia and a high prevalence of stress, anxiety and depression. Targeted education, optimised shift scheduling and accessible mental health support are recommended to promote staff well-being and improve care quality. Nevertheless, the findings should be interpreted with caution because of the cross-sectional design and convenience sampling method.

The Chinese neuroimmunological disease database (NIDBase) cohort was established to explore genetic and environmental risk factors, clinical features, multi-omics data and prognostic biomarkers. The aim is to enhance our understanding of central nervous system (CNS) demyelinating diseases. Additionally, the establishment of this cohort will address the critical issue of the lack of comprehensive genetic data and biological samples for precision diagnosis and treatment research related to neuroimmunological diseases in China.

56 hospitals in various regions of China were selected to participate in this study. The patients diagnosed with CNS demyelinating diseases were recruited, including clinically isolated syndrome (CIS), multiple sclerosis (MS), neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A).

At the time of patient enrolment, the clinical information is designated as baseline data. The collected baseline data include demographic information, disease history, clinical features of each demyelinating event, treatment records, standardised scales, questionnaire assessments and laboratory test results. Furthermore, biological samples, MRI and high-density electroencephalography (hd-EEG) data will be collected at baseline. All patients will be followed up at 3 months and 6 months and annually thereafter. As of December 2024, 3866 patients with CNS demyelinating diseases have been enrolled, including 84 CIS, 282 MOGAD, 1405 MS and 2095 NMOSD. Our findings indicate that CNS demyelinating diseases, particularly NMOSD, are more prevalent in women in China, with significant age differences observed among NMOSD patients compared with those with CIS, MS and MOGAD.

In future, all patients in our cohort will be followed up at 3 months and 6 months and then annually. By the end of December 2024, the database has been locked and is now being processed and analysed, while our data continue to be updated and expanded for further analysis. Both prospective and retrospective observations will be included in this study. Subsequent publications will emerge from this multicentre cohort, encompassing genomics, clinical cohort studies, hd-EEG biomarkers, imaging-based radiomics and electrical stimulation therapies.

NCT06443333.

This study explores the challenges experienced by Australian healthcare professionals (HCPs) in delivering type 2 diabetes care to people of culturally and linguistically diverse (CALD) backgrounds. We examined how sociocultural, linguistic and health systems factors influence their clinical practice.

A qualitative study employing semi-structured interviews was conducted from April to October 2024. Data were analysed using Braun and Clarke’s reflexive thematic analysis to identify patterns and themes in HCPs’ experiences, guided by a constructivist perspective.

The study was conducted in metropolitan Melbourne, Australia, across primary and tertiary healthcare settings.

A purposive sample of 11 Australian HCPs from diverse disciplines, including general practice, pharmacy, nursing, endocrinology, dietetics and podiatry, participated. All had provided type 2 diabetes care to people of CALD backgrounds within the previous 12 months. Participants included both male and female professionals, many from ethnically diverse backgrounds.

Three overarching themes were identified, reflecting HCPs’ perceived challenges to providing culturally responsive type 2 diabetes care to people of CALD backgrounds. These themes illustrated the multilevel challenges encountered by HCPs at the patient, organisational and provider levels, namely: (1) healthcare provision across diverse health literacy and cultural contexts, (2) navigating system gaps in multicultural clinical practice and (3) workforce preparedness gaps in culturally responsive care.

HCPs remain committed to providing culturally responsive type 2 diabetes care but continue to face constraints, including limited cross-cultural training and exposure, inadequate interpreter access, time pressures and insufficient culturally adapted resources. Effective care in multicultural settings requires recognising patients’ culturally shaped beliefs about health and illness and embedding cultural humility, reflexivity and competence within professional practice, essential steps towards advancing equitable type 2 diabetes care across Australia’s diverse communities.

Musculoskeletal (MSK) conditions account for up to one-third of general practice consultations and over one-fifth of emergency department attendances in the UK. Postpandemic, the elective orthopaedic surgery backlog remains one of the most substantial across surgical specialties. Despite this burden, undergraduate exposure to trauma and orthopaedics (T&O) remains limited and inconsistent. Most UK medical students receive only 2–3 weeks of T&O teaching, with up to 40% of foundation doctors feeling underprepared to manage MSK conditions. The Evaluation of Trauma and Orthopaedic Teaching in Medical Schools Nationally (TENDON Study) aims to evaluate the current state of undergraduate T&O education in UK medical schools from both student and educator perspectives.

This national, prospective, cross-sectional survey will be conducted between 25 July and 27 October 2025. A dual-instrument electronic survey was developed through Qualtrics, informed by the British Orthopaedic Association (BOA) Undergraduate Curriculum and UK Medical Licensing Assessment content map. Participants will include medical students (Years 1–6), foundation doctors and orthopaedic educators recruited through British Orthopaedic Medical Students Association and BOA networks, and designated school representatives. Survey domains include curriculum coverage, teaching methods, clinical exposure and self-reported competence. Quantitative data will be analysed using descriptive and inferential statistics; qualitative data will undergo thematic analysis. Reporting will follow the Checklist for Reporting Of Survey Studies framework, with relevant elements drawn from the Checklist for Reporting Results of Internet E-Surveys checklist.

Ethical approval was obtained from the Human Biology Research Ethics Committee, University of Cambridge. Findings will be disseminated via peer-reviewed publication, conference presentations and summary reports to curriculum leads and relevant educational bodies.

Maternal thyroid function affects fetal birth weight and age is an important factor in regulating thyroid function. Thus, we aimed to explore the association between age-specific preconception thyroid-stimulating hormone (TSH) and birth weight.

Cohort study.

A total of 97 755 preconception Chinese women aged 20–39 years old from the National Free Preconception Checkups Project were included.

Participants were divided into four age groups: 20–25 years, 25–29 years, 30–34 years and 35–39 years. The preconception TSH levels within 6 months before pregnancy and fetal birth weight, including large for gestational age (LGA), small for gestational age (SGA) and appropriate for gestational age (AGA), were collected and analysed using restricted cubic spline regression. Logistic regression investigated the relationship between various TSH groups and birth weight.

(1) Preconception TSH levels differed among four age groups; (2) in the 20-24 years group, preconception TSH was associated with the incidence of LGA and AGA (p2.12 mIU/L) TSH were associated with a higher risk of LGA and lower incidence of AGA in 20–24 years.

Preconception TSH exhibited a significant association with LGA and AGA in the 20–24 years age group, but not in the 25–39 years age group. Young preconception women should not neglect paying attention to their thyroid function, associated with the risk of LGA.

This study aims to categorise health behaviours in patients with lower limb deep vein thrombosis and explore the factors that influence these behaviours.

A cross-sectional study.

This study was conducted in four tertiary general hospitals in Urumqi, China.

This study included a total of 544 participants.

Self-rated abilities for health practices, health behaviour motivation, social support and health behaviour were the primary outcome measures.

Model 3 demonstrated superior fit across indices, supported by an Entropy value of 0.806 and a significant bootstrap likelihood ratio test (p

Three latent health behaviour subgroups, namely low, moderate and good, were identified among patients with lower limb deep vein thrombosis following hip or knee arthroplasty. Self-rated abilities for health practices, health behaviour motivation and social support were associated with these subgroups. These findings may provide preliminary insights for developing targeted interventions to support health behaviour improvement in this patient population.

To examine end-of-life knowledge, attitudes and behaviours associated with hospice care preference in community-dwelling older adults from Shanghai, China.

This was a cross-sectional study recruiting community-dwelling older adults from Shanghai. Bivariate analysis and multivariate logistic regression models were conducted to identify associated factors.

Seven community health service centres in Shanghai, China.

A total of 404 community-dwelling older adults.

Participants were asked to provide their hospice care preference (‘If you were to become critically ill with limited life expectancy, would you choose hospice care?’) and related reasons. To evaluate knowledge, attitudes and planning behaviours related to end-of-life issues, a structured questionnaire was developed through a multistep process. Demographic and clinical characteristics were also collected.

Nearly two-thirds of participants (65.8%) reported awareness of hospice care. Most of the participants (81.2%) reported they would choose hospice care at the end-of-life stage. Bivariate analyses showed that marital status, living status, education background and disposable personal income were significantly associated with hospice care preference. After controlling for confounding variables, the logistic regression analysis suggested the significant effects of knowledge level of hospice care (β=0.318, 95% CI (1.156 to 1.636), p

The Chinese older adults’ knowledge, attitudes and behaviours towards end-of-life issues in metropolitan areas has been changing. Their preference towards hospice care provides a good foundation for the utilisation of hospice care in the future. Community-based educational interventions should target demographic characteristics such as being unmarried, living alone and having lower levels of education and income among older adults to enhance their knowledge and family communication about hospice care.

Inflammatory bowel disease (IBD) patients in China exhibit critically low levels of physical activity, yet evidence for telemedicine-based aerobic exercise interventions remains scarce, particularly with objective physiological validation.

In this single-centre, open-labelled, semi-crossover randomised controlled trial, 28 inactive/mildly active adult IBD patients with low level of baseline physical activity will be randomly assigned to immediate or delayed 12-week telemedicine-based aerobic exercise training. The exercise prescription, stratified by baseline activity level, is designed to progressively elevate physical activity levels to moderate intensity. The telemedicine-based programme used fitness bands synchronised to a mobile app, WeChat-based real-time feedback and online group support and communication. The primary outcome is change in peak oxygen uptake measured by cardiopulmonary exercise testing (CPET). Secondary outcomes include other cardiorespiratory fitness parameters measured by CPET, physical activity level measured by International Physical Activity Questionnaire Short Form, Exercise Benefits/Barriers Scale, clinical disease activity, inflammatory markers, Inflammatory Bowel Disease Questionnaire, nutritional indices, Fatigue Severity Scale and Hospital Anxiety and Depression Score.

The trial has been approved by the Ethics Committee of the Affiliated Lihuili Hospital of Ningbo University (KY2024SL379-01). Results will be published in peer-reviewed journals and presented at scientific conferences.

NCT06804733.

Postoperative ileus (POI) is a prevalent complication following abdominal surgeries, significantly compromising patients’ quality of life and imposing a socioeconomic burden. Electroacupuncture (EA), a widely used therapeutic approach in China, has shown promise as an effective intervention for POI. However, the neural mechanism underlying its therapeutic effects remains unclear. Thus, this study aims to evaluate the efficacy of EA treatment for POI and investigate its central mechanism by functional MRI (fMRI).

This randomised controlled clinical trial will be conducted across three hospitals in China. A total of 50 eligible patients with colorectal cancer scheduled for elective laparoscopic surgery will be randomly assigned to either the EA or sham electroacupuncture (SA) group in a 1:1 ratio. All patients will undergo 5 sessions of 30 min EA or SA over 5 consecutive days post-surgery (once daily). Resting-state fMRI (rs-fMRI) scans will be performed at baseline and the end of treatment to examine brain functional changes related to EA treatment. The primary outcome is the time to first defecation. Secondary outcomes include the time to first flatus, ambulation, tolerability of semiliquid and solid food; length of postoperative hospital stay; severity of postoperative pain, abdominal distension and nausea; frequency of postoperative nausea and vomiting episodes; rate of readmission. Postoperative complications will be monitored and documented throughout the trial duration. Credibility and expectancy evaluation, along with blinding assessment, will be conducted after the first treatment session. Pearson/Spearman correlation analysis will be performed to determine the relationship between clinical variables and rs-fMRI metrics.

This protocol has been approved by the ethics committees of Beijing University of Chinese Medicine (number 2024BZYLL0113), Cancer Hospital Chinese Academy of Medical Sciences (number 24/323-4603), Beijing Friendship Hospital Affiliated to Capital Medical University (number 2024-P2-081-01) and Beijing Chaoyang Huanxing Cancer Hospital (number 2024-011-02). Participants will sign the paper-based informed consent form before enrolment. The results will be disseminated through peer-reviewed publications.

ITMCTR2024000504.

To compare elective surgeries rates and waiting times between Indigenous and non-Indigenous patients in Queensland.

Aggregated annual data analysis from July 2013 to December 2022 on elective surgeries and waiting times.

Public hospitals across Queensland.

All patients who had elective surgery in Queensland public hospitals between 2013 and 2022.

Rates and clinically recommended timeframes for elective surgeries.

Between 2013 and 2022, the overall estimated average rate of elective surgeries for Indigenous patients was 286 per 100 000 population, compared with 221 per 100 000 for non-Indigenous patients. Indigenous patients had higher rates of most elective surgeries except plastic and urological surgeries, where non-Indigenous patients had higher rates. Across all urgency categories, the percentages of elective surgery performed within clinically recommended timeframes were similar between Indigenous and non-Indigenous patients.

Our findings may point to the efficacy of specific policy and service delivery innovations undertaken in Queensland. Due to the limitations of our aggregated data, this inference warrants careful interpretation. More studies with disaggregated data are needed.

This study examined the effects of food accessibility on eating habits, home eating environment and anthropometrics among rural parent-child dyads.

This secondary data analysis utilised baseline and post-intervention data from a mindful eating intervention trial. Parents completed an online survey assessing their sociodemographics, height, weight, eating habits, food resource management behaviours, child feeding attitudes and practices, home eating environment and household food insecurity. Trained data collectors measured children’s height, weight, percent body fat and skin carotenoids at childcare centres. Using Geographic Information System tools, food accessibility was estimated by linking participants’ zip codes to Zip Code Tabulation Areas.

A total of 154 rural parent-child dyads from low-income households were successfully recruited from 26 Head Start childcare centres in the USA. The children’s mean age was 47.16 months (SD=6.56) while parents averaged 32.68 years old (SD=8.00). About one-third of the parents were single and nearly a third had an annual family income below US$20 000. Additionally, 44.2% of parents were unemployed and over half only had an education level of high school or below. Mixed-effect models revealed that at baseline, limited access to full-service restaurants and greater access to limited-service restaurants were related to higher BMI z-scores (p=0.021, 0.040) and percent body fat (p=0.020, 0.032) in children. Longitudinal analyses using pre-post intervention data indicated that parents’ increases in fibre intake from baseline to post-intervention were correlated with less access to limited-service restaurants (p=0.034), while their improved food resource management behaviours over time were associated with greater access to grocery stores/supermarkets (p=0.043) after accounting for other types of food access. Additionally, more access to convenience stores was associated with increases in perceived parental weight (p=0.027) over time.

These findings suggest that food accessibility influences both dietary behaviours and health outcomes, with grocery stores and full-service restaurants having positive impacts, while limited-service restaurants and convenience stores have detrimental effects.

The clinical trial associated with the study’s data is registered at ClinicalTrials.gov under the identifier NCT05780008 on 27 February 2023.

We aimed to refine and culturally adapt an evidence-based communication intervention (EBCI), which consists of the 3R message framing model (Reframe, Reprioritise, Reform) and human papillomavirus self-sampling (HPVSS) for use in a teaching hospital in Ghana, and evaluated its acceptability, feasibility, appropriateness and adoption potential among stakeholders.

Convergent mixed-methods design.

The study was conducted at a teaching hospital and its surrounding communities in the Central Region of Ghana.

A 36-member stakeholder advisory board comprising women living with HIV (WLHIV) (n=14), healthcare providers (HCPs) (n=11) and community members (n=11) participated in Nominal Group Technique sessions to adapt the intervention. The adapted EBCI was subsequently evaluated by 45 participants (WLHIV=30 and HCPs=15).

Outcome measures included key characteristics of the EBCI, acceptability, feasibility, appropriateness and its potential for adoption, which were assessed using validated Likert-type scales and structured interview guides.

Core components of the intervention (HPVSS+3R) were retained. Hospitals and community pharmacies were the preferred self-sampling venues (97%). WhatsApp audio in English and Fante/Akan was the most favoured delivery mode for 3R messages (81%). Evaluation results revealed high acceptability (mean=22.84), feasibility (mean=22.40) and adoption (mean=21.73) on a 5–25 point scale, as well as appropriateness (mean=13.3) on a 3–15 point scale. Qualitative findings highlighted convenience, privacy, empowerment and cultural relevance, which reduced fear and increased participant engagement.

The adapted EBCI demonstrated high acceptability, feasibility, appropriateness and adoption potential among key stakeholders, supporting its integration into the Ghanaian health systems to advance cervical cancer elimination goals.

NCT06739772.