To examine the risk of severe cardiovascular (CV) events in patients with chronic obstructive pulmonary disease (COPD) across different time periods following COPD exacerbations and the incidence rate of cardiopulmonary events in a real-world setting in China.

Retrospective cohort study.

Regional electronic health records database from Yinzhou District of Ningbo City, China.

A total of 14 713 patients aged ≥40 years with a first COPD diagnosis between 1 January 2014 and 1 March 2022.

The risk of severe CV events (ie, hospitalisation and a primary or secondary discharge code for acute coronary syndrome, heart failure decompensation, cerebral ischaemia, arrhythmia and CV-related death) during different exposed time periods following a COPD exacerbation, the incidence rate of overall cardiopulmonary events (ie, severe exacerbation of COPD, all-cause mortality, inpatient CV events, inpatient ischaemic stroke and inpatient tachyarrhythmia/atrial fibrillation) and the incidence rate stratified by COPD exacerbation history.

We included a total of 14 713 patients. During a median (IQR) follow-up of 2.8 (4.0) years, 20.1% experienced severe CV events. Compared with the unexposed period, the risk of severe CV events was the highest in the first 10 days following a COPD exacerbation (adjusted HR 10.00, 95% CI 8.16 to 12.25). The risk of severe CV events decreased over time but remained significantly elevated up to 90 days post exacerbation. We found that 32.7% of COPD patients experienced cardiopulmonary events, with a crude incidence rate of 9.38 (95% CI 9.09 to 9.69) per 100 person-years.

This study is the largest retrospective cohort study investigating CV and cardiopulmonary events among patients with COPD in China. Our findings highlight an elevated risk of CV events closer to the time of COPD exacerbations and show that nearly one-third of COPD patients experience cardiopulmonary events.

Poor participant retention in randomised clinical trials, resulting in missing outcome data, can impact the validity, reliability and generalisability of results. While participants’ views on general non-retention issues have been reported elsewhere, a qualitative evidence synthesis specifically focusing on trial processes (ie, outcome data collection) impacting retention has not been undertaken to date. This is an important research question to inform targeted interventions to support retention. This review aims to address this by systematically searching and synthesising the evidence on participant reasons for trial non-completion, linked to outcome data collection.

We conducted a qualitative evidence synthesis of qualitative studies and mixed methods studies with a qualitative component, in Embase, Ovid MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Social Science Citation Index, Cumulative Index of Nursing & Allied Health Literature and Applied Social Sciences Index and Abstracts, up to February 2025. We used Thomas and Harden’s thematic synthesis approach. The Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative framework was used to assess confidence in the review findings.

We identified 11 studies reporting qualitative data from 14 separate trials, with findings from 105 trial non-retainers. The studies were undertaken between 2007 and 2025.

There were three types of participant non-retention behaviours reported across the studies, where participants either: (1) missed at least one clinic visit; (2) did not complete a postal questionnaire or (3) did not complete online data collection. We developed four analytical themes outlining participant-reported influences on trial non-retention, specifically related to trial processes (ie, data collection for outcome measures): fluctuating health, balancing trial burdens, navigating life as a trial participant and managing expectations of participation.

This review generates important insights into participants’ reasons for trial non-completion linked to outcome data collection. The review highlights the need for further research into supporting trial recruitment discussions that provide clear, realistic expectations for potential trial participants, as well as strategies that recognise, and where possible, address some of the influences on participants to improve outcome data completeness and ultimately improve trial retention.

To investigate the risk factors for primary non-central malposition of peripherally inserted central catheter (PICC) tip in neonates admitted to the neonatal surgical department, compare the malposition rates across different insertion sites in disease types, and explore whether different diseases affect PICC tip malposition.

A retrospective case–control study conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

A 3A women’s and children’s hospital in South China (Guangdong Province).

A total of 558 neonates aged ≤28 days who underwent PICC insertion between January 2019 and November 2024 were enrolled. Neonates with congenital circulatory system malformations, incomplete clinical data and death or treatment withdrawal before tip positioning were excluded.

The primary outcome was the incidence of primary non-central PICC tip malposition confirmed by X-ray or ultrasound within 24 h after insertion. Secondary outcomes included comparison of primary non-central PICC tip malposition rates across different insertion sites and comparison of primary PICC tip malposition rates by insertion sites across different disease groups.

558 neonates were included in this study, including 460 cases with PICC tip in place and 98 with PICC tip malposition. In binary logistic regression analysis, the PICC insertion site was considered an independent risk factor (OR 2.908, 95% CI 1.748, 4.840, p

Medical staff can choose appropriate upper or lower limb veins for PICC insertion without worrying about the impact of abdominal diseases or thoracic diseases on non-central PICC tip malposition. PICC insertion via the head and neck veins should be performed with caution in neonates, as these sites carry a high risk of primary non-central tip malposition compared with other insertion sites.

Cardiac resynchronisation therapy (CRT) is a cornerstone device-based treatment for patients with heart failure with ventricular dyssynchrony. However, approximately 30–40% of recipients fail to achieve clinical response. Despite extensive research, validated prediction tools grounded in high-level evidence and readily applicable in clinical practice remain lacking. This study protocol describes the development and real-world validation of a simplified clinical scoring model for CRT response derived from systematic review and meta-analysis.

This study will develop a CRT response prediction model via meta-analysis and preliminarily validates it in a single-centre retrospective cohort. Initially, systematic searches of multiple databases up to 31 January 2026 and meta-analysis will synthesise effect estimates for candidate predictors, creating an evidence-based foundation that conceptually functions as a ‘training dataset’. Predictor selection and prioritisation will be guided by study frequency, effect magnitude and clinical accessibility, with factor weights derived directly from pooled random-effects meta-analytic estimates. Log relative risks will be converted to integer scores to establish a series of nested prediction models. Model performance will then be comprehensively assessed in an independent ‘validation dataset’ comprising a single-centre cohort from Xinjiang Medical University, evaluating discrimination (area under the receiver operating characteristic curve), calibration (calibration plots and Hosmer-Lemeshow test) and clinical utility (decision curve analysis). The final scoring system will be identified through comparative model evaluation guided by parsimony principles.

This meta-analysis exclusively uses published, de-identified data and therefore does not require ethical approval. The validation cohort employs retrospectively anonymised patient data in strict adherence to the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the Institutional Review Board of the First Affiliated Hospital of Xinjiang Medical University (Approval No.: K202403-48-2503A-Y1). As this constitutes a retrospective analysis of existing data, individual informed consent will be waived. Comprehensive measures to protect participant privacy and ensure data integrity will be implemented throughout all research procedures. The findings will be presented at academic gatherings or published in scholarly, peer-reviewed journals.

CRD42024572313

Mucosal melanoma (MM) carries a high risk of postoperative relapse and poorer survival than cutaneous disease. Prospective data from China support adjuvant temozolomide–cisplatin (TMZ/DDP) in resected MM, while radiotherapy (RT) may augment antitumour immunity and synergise with programmed death 1 (PD-1) inhibitor. We therefore designed an adjuvant regimen combining short-course RT (SCRT) with chemotherapy and PD-1 inhibitor after curative-intent resection.

This investigator-initiated, single-arm, prospective, phase II study at Fudan University Shanghai Cancer Centre enrols adults (≥18 years) with histologically confirmed MM after R0/R1 resection, Eastern Cooperative Oncology Group (ECOG) performance status 0–1 and M0 disease. Patients receive six 3-week cycles of systemic therapy: pucotenlimab 200 mg IV on day 1; TMZ 200 mg/m² orally on days 1–5 and DDP 25 mg/m² IV on days 1–3. (SCRT; 25 Gy in five fractions) is delivered after the first two cycles of systemic therapy, followed by four additional cycles of systemic therapy without RT. The primary endpoint is 1-year recurrence-free survival (RFS). Secondary endpoints include locoregional RFS, distant metastasis-free survival, overall survival and safety (CTCAE V.5.0). The planned sample size is 47 (44 evaluable), providing 80% power (one-sided α of 0.10) to detect an improvement in 1-year RFS from 55% to 70%. Time-to-event endpoints will be estimated using Kaplan–Meier methods with 95% CIs.

The protocol was approved by the Ethics Committee of Fudan University Shanghai Cancer Centre (approval number: 2407300-5), and all participants will provide written informed consent. Findings will be disseminated in peer-reviewed journals and at scientific conferences.

ChiCTR2400093001.

Youth vaping remains a global public health challenge. We will evaluate a pragmatic, theory-driven digital game-based learning intervention (VAPGAMO), delivered in public secondary schools to reduce adolescents’ intention to vape at 3-month follow-up.

Parallel cluster-randomised controlled trial with schools as clusters. Eight public secondary schools in an urban Southeast Asian district (Klang, Malaysia) will be randomised 1:1 to intervention or attention-matched online flash game. The intervention is a single 90 min, facilitator-led module grounded in the Theory of Planned Behaviour. Surveys at baseline, immediately postintervention and 3 months. The primary outcome is intention to vape at 3 months. Secondary outcomes are knowledge, attitudes, injunctive norms and refusal self-efficacy (perceived behavioural control). Prespecified implementation outcomes include acceptability, fidelity, reach, time-on-task and cost per student. Primary analysis will use generalised estimating equations with cluster-robust SEs, adjusted for baseline covariates; the intra-cluster correlation coefficient and design effect will be reported; intention-to-treat will be applied.

Universiti Putra Malaysia JKEUPM-2024-887; approvals from the Ministry of Education, Malaysia. Findings will be disseminated in peer-reviewed outlets and shared with education and health authorities to inform school-health programming. De-identified data and code will be made available on publication, subject to approvals.

Thai Clinical Trial Registry (TCTR20241222001).

Patient awareness of their diagnosis and management plan is crucial for improving compliance, empowering patients and enhancing outcomes. We aimed to assess surgical patients’ awareness of their diagnosis, management plans and associated factors.

A cross-sectional study was conducted from December 2024 to March 2025 on 400 adult surgical inpatients who had undergone surgery in the general surgery, gynaecology and obstetrics, and orthopaedic wards at Debre Tabor Comprehensive Specialized Hospital, Ethiopia. Data were collected using a structured written questionnaire and analysed using the SPSS V.25. Bivariate and multivariate logistic regression were used to identify factors associated with patients’ awareness of their diagnosis and care plan, with significance determined using adjusted ORs and 95% CIs.

Overall, 52% of respondents had global awareness of their clinical conditions and management plans. Awareness was highest for clinical diagnosis (78.9%), necessity of admission (78.9%) and operations performed (72.0%). However, more than 50% of respondents did not seek information on the diagnosis, possible cause and investigation related to their condition. In multivariable analysis, patients with tertiary education were 7.12 times more likely to have global awareness than those without formal education (adjusted OR, AOR=7.12; 95% CI 1.95 to 25.95), and patients living in urban areas were 3.15 times more likely to have global awareness than those in rural areas (AOR=3.15; 95% CI 1.63 to 6.10; p

Awareness of various aspects of healthcare ranged from 35.5% to 78.9%, with about half of respondents demonstrating global awareness of their diagnosis and management plans. Implementing shared decision-making models may improve patients’ understanding of their care plans.

Early-stage mycosis fungoides (MF) is diagnostically challenging due to overlap with inflammatory dermatoses. Age-related immunological and cutaneous changes may modify histopathological presentation. We aimed to compare clinical, histopathological and immunophenotypic features of early-stage MF between geriatric and non-geriatric patients.

Multicentre retrospective cross-sectional study.

Dermatology departments of tertiary centres in Türkiye.

A total of 541 patients diagnosed with early-stage MF were included and stratified into geriatric (≥65 years) and non-geriatric (18–64 years) groups.

The primary outcomes were age-related differences in histopathological and immunohistochemical features. Secondary outcomes included clinical characteristics and quality of life measures. Primary endpoints were prespecified a priori (epidermotropism, basilar lymphocytes, epidermal atrophy, dermal lymphocytic infiltration, papillary dermal fibrosis and CD4-dominant versus CD8(+)/CD4(–) phenotypes); all other comparisons were considered exploratory.

The geriatric group had a higher proportion of males (59.5% vs 47.1%; p=0.004), while lesion type, duration, surface involvement and Dermatology Life Quality Index scores did not differ between groups. Histopathologically, epidermotropism (81.3% vs 63.3%), basilar lymphocytes (57.1% vs 45.7%), epidermal atrophy (26.6% vs 13.8%), dermal lymphocytic infiltration (75.8% vs 58.5%) and papillary dermal fibrosis (55.2% vs 38.4%) were more frequent in geriatric patients (all p

Although clinical characteristics were comparable across age groups, geriatric patients showed differences in reported histopathological and immunophenotypic features; these observations may facilitate clinicopathological recognition of early-stage MF in older individuals. However, some features (particularly epidermal atrophy and superficial/papillary fibrosis) are not MF-specific and may partly reflect background age- and site-related changes.

Periodontitis and chronic kidney disease (CKD) are inter-related conditions that can significantly impact patient health. This study aims to evaluate the efficacy of active non-surgical periodontal therapy (NSPT) combined with supportive periodontal care (SPC) in reducing tooth loss and improving masticatory function in patients with CKD and stage III periodontitis.

This randomised controlled trial will recruit 86 patients diagnosed with both stage III periodontitis and CKD. Participants will be randomly assigned at a 1:1 ratio to either an experimental group receiving active NSPT supplemented with SPC or a control group receiving oral hygiene instruction with scheduled periodontal monitoring. The intervention will last for 24 months, with assessments conducted at baseline and 3, 6, 12, 18 and 24 months. The primary outcome is the incidence of tooth loss due to periodontitis over the 2-year follow-up period. Secondary outcomes include the number of lost teeth, masticatory function, clinical periodontal parameters and oral health-related quality of life.

The study protocol and informed consent form were approved by the Institutional Ethics Committee of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (SH9H-2022-T404-1). Findings will be disseminated to participants and published in peer-reviewed journals.

ChiCTR2300068923.

Healthcare services are mainly organised around single health conditions and need reconfiguration to meet the needs of people with multiple long-term conditions (multimorbidity). Typically, people are offered annual reviews for each of their long-term conditions separately. In a randomised controlled trial, a comprehensive computerised template based on a personalised care model increased the person-centredness of multimorbidity reviews in primary care, but there were implementation challenges. We sought to understand and address the challenges of implementing a template to support personalised primary care for people with multimorbidity (PP4M).

To explore the extent of implementation and factors influencing uptake of the PP4M intervention. To understand factors influencing implementation and normalisation of the template.

Convergent parallel mixed methods within a non-randomised hybrid implementation-effectiveness study. Normalisation Process Theory (NPT) informed design, data collection and analysis.

Primary care (general practices) in three English regions.

Quantitative: Patients aged 18 years or over and had at least three types of long-term conditions (routine data collection); staff involved in using the template in implementation practices (Normalisation MeAsure Development (NoMAD) questionnaire).

Qualitative: Staff at implementation practices.

A multimorbidity computerised template to support personalised annual reviews. NPT-informed implementation package delivered to implementation practices included: process mapping, software support and training.

Routine medical record data; NoMAD questionnaires and qualitative interviews in implementation practices.

Measures of reach, fidelity, acceptability and sustainability.

Quantitative data: descriptive statistics, logistic regression and difference-in-difference models. Qualitative data analysis conducted using NPT coding manual.

In practices that received an NPT-informed implementation package, use of the template increased more, across patients with a range of demographics and health conditions, than in those that did not receive the implementation package (OR 2.86 (95% CI 2.34 to 3.49)). The implementation package successfully triggered NPT processes of coherence and cognitive participation, and, to a lesser extent, collective action and reflexive monitoring. Contextual factors, including a lack of staff generalist skills and disease-specific incentives, impeded engagement and sustained implementation.

Focusing on the processes of normalisation as mechanisms of implementation facilitated development of an implementation strategy with potential to trigger those mechanisms, but did not sufficiently address contextual factors. Implementation strategies to support personalised care must consider wider system and practice level contextual factors, such as incentives and staff training.

https://doi.org/10.1186/ISRCTN40295449 (2022–08-03, retrospectively registered.)

Although important learnings come from traditionally designed large prospective asthma cohorts, highly restrictive inclusion and exclusion criteria limit generalisability to clinical practice. Moreover, small sample sizes for important disease subtypes, narrow scope of clinical data collection and limited biomarker assessments reduce the power of some studies to detect important and diverse longitudinal disease courses. The Real-world and Genomic data-based Asthma Insights through Network Analysis (REGAIN) study takes a novel approach to asthma cohort development by employing a pragmatic definition of asthma and simplified study procedures for biospecimen and data collection. REGAIN will produce a large scale, real-world, longitudinal clinical and molecular description of asthma powered to characterise and compare clinically relevant asthma subtypes. This design will provide insights on distinct longitudinal trajectories of disease, predictors of response to therapies and likelihood of clinical remission, all of which should help guide asthma management.

REGAIN is a clinical observational retrospective and prospective cohort study designed to determine large scale, real-world longitudinal clinical and molecular descriptions of asthma according to types of treatment, level of asthma control and inflammatory biology based on clinical biomarkers. Key questions include predictors of change in asthma control as well as timing and durability of clinical remission on biological therapy. To complement these clinical insights, REGAIN will produce one of the largest multiscale data sets in asthma that will include demographic and clinical features, inflammatory biomarkers, responses to therapy with inhaled steroids and other inhaled controllers with or without asthma biologics, and serial airway epithelium and peripheral blood transcriptomics and proteomics. REGAIN targets enrolment of 780 participants with asthma fitting one of five prespecified asthma subtypes with the aim of better characterising under-studied groups and allowing comparative analyses to elucidate important differential therapeutic responses and clinical trajectories. We target enrolment of 400 healthy controls to provide a healthy state molecular description of the tissues sampled in REGAIN participants with asthma. Participants with asthma are followed prospectively for 18 months with assessment of longitudinal clinical status including prospective clinical data collection, integration of electronic medical record data and serial biospecimen collection at 6 and 18 months. Participants with asthma starting treatment with asthma biologics undergo additional clinical assessment and biospecimen sampling at 3 months to track early clinical and molecular response to therapy. Healthy participants without asthma are evaluated cross-sectionally on enrolment without longitudinal follow-up in order to compare molecular profiles for airway epithelium and blood. An optional study component for participants with asthma employs a mobile phone application, digital inhaler monitors and home digital peak flow measurements and contributes data on real-time medication use, serial lung function and geolocated environmental data relevant to asthma.

The REGAIN protocol and all amendments were approved by The Icahn School of Medicine at Mount Sinai Program for Protection of Human Subjects (PPHS19-0358), and all participants provided written informed consent. Enrolment began in November 2019 and was completed in February 2024. Results will be presented at local, national and international meetings, and results will be submitted to peer-reviewed journals for consideration for publication.

NCT06623435.

Invasive arterial blood pressure monitoring is critical for perioperative and critically ill patients, yet traditional radial artery cannulation near the wrist joint is prone to catheter dysfunction (eg, kinking, occlusion) due to positional changes, compromising accuracy and patient safety. This trial hypothesises that modifying the cannulation site to 1.5–2.5 cm proximal to the radial styloid process may enhance catheter stability.

This is a prospective, parallel-group, randomised, controlled, analyst-blinded trial. A total of 486 participants (243 per group) will be enrolled at the Sixth Affiliated Hospital, Sun Yat-sen University. Eligible patients (18–75 years, American Society of Anesthesiologists physical status I–III, requiring elective surgery with radial artery cannulation) will be randomised 1:1 to the modified group (1.5–2.5 cm proximal to the radial styloid process) or the conventional group (traditional site). The primary outcome is the incidence of arterial catheter dysfunction (defined by criteria such as blood sampling difficulty, position-dependent waveform or improved waveform post-square wave test). Secondary outcomes include frequency of catheter dysfunction, damping abnormality rate, first-puncture success rate, number of arterial punctures, arterial cannulation time, complication incidence and blood pressure measurement differences.

This study protocol (V.4.0) was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University in Guangzhou, China on 2 September 2025. The first participant was recruited on 15 September 2025, with an estimated completion date of 31 December 2025. Informed consent will be obtained from all participants. Findings will be published in peer-reviewed journals.

NCT06566456.

To analyse the associations between exposure to different air pollutants and the morbidity of pulmonary embolism (PE).

Time series study with a distribution lag non-linear model.

275 cities in China, 1 January 2015 to 31 March 2022.

27 369 cases of PE.

The associations between exposure to different air pollutants and the morbidity of PE.

During the study period, 27 369 cases of PE were recorded. PM_2.5(Particulate Matter 2.5), PM₁₀(Particulate Matter 10) and NO₂(Nitrogen Dioxide) exposure levels were associated with an increased risk of developing PE in the single-pollutant model. PM_2.5 exposure caused the greatest risk of developing PE at lag 1 in the single-day lag model, with a relative risk (RR) value of 1.033 (95% CI 1.007 to 1.058). PM₁₀ and NO₂ exposure had the greatest effects at lag 0, with RR values of 1.038 (95% CI 1.016 to 1.059) and 1.039 (95% CI 1.009 to 1.068), respectively. No associations were found between CO(Carbon Monoxide), O₃(Ozone) or SO₂(Sulfur Dioxide) exposure levels and the risk of developing PE. PM_2.5, PM₁₀ and NO₂ exposure levels were most strongly associated with the development of PE at lag 01 in the cumulative lag model, with RR values of 1.052 (95% CI 1.009 to 1.095), 1.053 (95% CI 1.020 to 1.086) and 1.058 (95% CI 1.005 to 1.111), respectively.

Short-term exposure to PM_2.5, PM₁₀ and NO₂ can increase the risk of developing PE, especially in females. The effects of PM_2.5 and PM₁₀ exposure were more significant in cold seasons and in North China.

Artificial intelligence (AI)-driven chatbots have been rapidly adopted across research, education, business, marketing and medicine. Most interactions, however, come from non-experts using chatbots like search engines, including for everyday health and medical queries.

We conducted an original study to audit chatbot responses in health and medical fields prone to misinformation.

Five popular chatbots were assessed: Gemini (Google), DeepSeek (High-Flyer), Meta AI (Meta), ChatGPT (OpenAI) and Grok (xAI). In February 2025, each chatbot was prompted with 10 questions from five categories: cancer, vaccines, stem cells, nutrition and athletic performance. We deployed an adversarial-like framework, using open- and closed-ended prompts designed to strain models toward misinformation or contraindicated advice. Two experts from each category rated responses as ‘non-problematic’, ‘somewhat problematic’ or ‘highly problematic’ using a coding matrix based on objective, predefined criteria. Citations were scored for accuracy and completeness, and each response was given a Flesch Reading Ease score.

Nearly half (49.6%) of responses were problematic: 30% somewhat problematic and 19.6% highly problematic. Response quality did not differ significantly among chatbots (p=0.566) but Grok generated significantly more highly problematic responses than would be expected under a random distribution (z-score +2.07, p=0.038). Performance was strongest in vaccines (mean z-score –2.57) and cancer (–2.12), and weakest in stem cells (+1.25), athletic performance (+3.74) and nutrition (+4.35). Chatbot outputs were consistently expressed with confidence and certainty; from 250 total questions, there were only two refusals to answer (0.8%), both from Meta AI. Reference quality was poor, with a median completeness score of 40% (Q1–Q3: 20–67%). Chatbot hallucinations and fabricated citations precluded any chatbot from producing a fully accurate reference list. All readability scores were graded as ‘Difficult’ (30–50), equivalent to college sophomore–senior level.

The audited chatbots performed poorly when answering questions in misinformation-prone health and medical fields. Continued deployment without public education and oversight risks amplifying misinformation.

Ethnic disparities in reproductive, maternal, neonatal and child health (RMNCH) persist in Latin America, rooted in structural racism and colonial legacies. Evidence on the temporal evolution of these disparities and the impact of policies targeting Indigenous populations remains limited. Following the 2000 economic crisis, Ecuador showed the region’s largest ethnic gaps in intervention coverage and social determinants. Since 2008, inclusion policies have advanced. This study analysed trends in RMNCH coverage, social determinants and their potential association with policies and strategies over 14 years.

Using a mixed-methods design, we analysed three nationally representative surveys (2004, 2012 and 2018) to assess changes in social determinants and the coverage of six RMNCH services; defined as the proportion of women and children receiving essential health services across the continuum of care, including family planning, antenatal care, skilled birth attendance and child immunisation, stratified by ethnicity (Indigenous women and children, Afro-Ecuadorian populations and Mestizo and White populations). We estimated absolute inequality measures and adjusted coverage ratios using Poisson regression models. Through a literature review and temporal graphs, we analysed plans, policies and strategies in health, education and ethnic inclusion during the same period to estimate potential impact.

By 2018, Indigenous populations doubled their representation in the highest wealth quintiles (10% to 20%) and increased secondary education attainment (25% to 45%), with slower progress in rural areas. RMNCH coverage, including prenatal care, institutional deliveries and professional-assisted births, rose significantly (27% to 75%) among Indigenous populations. Afro-Ecuadorians also experienced improvements in RMNCH coverage and social determinants, though progress was less pronounced compared with Indigenous groups. Although ethnic gaps persisted, inequalities declined over the study period. These reductions coincided with increased social investment in rural health and education, constitutional recognition of plurinationality, and policies promoting intercultural health practices. However, gaps in monitoring and impact evaluation were evident.

Ecuador demonstrates that inclusive and integrated policies, leadership, social participation and sustained social investment can reduce ethnic inequalities, promote the integral development of society and strategies that should be maintained. Temporal studies based on routine surveys are crucial for monitoring the impact of such policies. These findings provide a pre-pandemic benchmark and serve as a reference for countries aiming to improve health outcomes among Indigenous and Afro-descendant populations and advance the Sustainable Development Goals.

The FirstCPR cluster randomised trial delivered multimodal basic life support (BLS) learning opportunities to community organisations. An a priori process evaluation examined intervention implementation, including participation, reach, uptake and member engagement.

The study used a multimethod process evaluation. Data were collected via semistructured interviews, focus group discussions, participant surveys, study records, web analytics and in-field observations. These sources captured participation patterns and implementation measures (delivery, reach, uptake and engagement: opt-in to digital messages and attendance at training sessions), as well as reasons for refusals and withdrawals. Qualitative data were analysed thematically and organised using the UK Medical Research Council process-evaluation framework. Qualitative and quantitative data were analysed separately and subsequently interpreted collectively to contextualise implementation patterns and identify barriers and enablers that influenced trial successes and failures.

Intervention uptake and engagement varied significantly across organisations, with greater success observed in social and faith-based groups. Of the 82 intervention clusters, 78 (95%) received intervention materials; 74 (90%) engaged in at least one activity and 15 (18%) engaged in all activities. Participation was primarily driven by the organisation’s leadership interest and support in providing BLS training to members, and by the time available to facilitate intervention activities. The presence of a dedicated liaison/champion emerged as the most critical enabler of member engagement and implementation. Feedback recommended concise, simple and culturally tailored modules, with practical components delivered in shorter, convenient sessions. Intervention delivery was affected by contextual challenges, including COVID-19 disruptions that limited in-field recruitment and group activities.

Process evaluation can strengthen community-based interventions by identifying mechanisms and contextual factors that shape implementation and engagement. Partnering with social and faith-based organisations may be an effective approach to disseminating educational programmes such as life-saving skills to lay communities. Minimising research burden and ensuring organisational leadership support may improve participation while brief, practical and culturally tailored training may enhance engagement.

ACTRN12621000367842.

Chronic postsurgical pain (CPSP) after hip arthroplasty is a major complication that affects patients’ long-term quality of life. However, reliable tools for the individualised prediction of CPSP risk after hip arthroplasty are lacking. This study aims to develop and validate a nomogram model to predict CPSP risk in patients undergoing hip arthroplasty.

This prospective observational cohort study will consecutively recruit 300 patients undergoing primary hip arthroplasty at the Department of Orthopaedics and Joints, Nanping First Hospital Affiliated with Fujian Medical University. The primary outcome is CPSP assessed at 3 months postoperatively (Visual Analogue Scale score ≥4). Candidate predictor variables have been identified based on literature review and clinical expertise, and include demographics, comorbidities, preoperative pain, psychological status and surgical and perioperative management. The dataset will be randomly split into development and internal validation sets in a 7:3 ratio. We will employ Least Absolute Shrinkage and Selection Operator regression to select variables and will use multivariable logistic regression to build the final prediction model. Internal validation will be performed using bootstrap resampling (1000 repetitions). The model’s discrimination, calibration and clinical utility will be assessed using the C-statistic (area under the curve), calibration plots and decision curve analysis, respectively. The final model will be presented as a nomogram.

The study protocol has been approved by the Ethics Committee of Nanping First Hospital (Approval No: NPSY202412034). All participants will provide written informed consent. The results will be submitted for publication in a peer-reviewed academic journal.

ChiCTR2500107193; https://www.chictr.org.cn/showproj.html?proj=282634.

Poststroke motor dysfunction places a heavy burden on individuals and society. Virtual reality (VR) offers enhanced motor skill transfer and active rehabilitation by overcoming the scenario-specific constraints of conventional therapies. Validating the efficacy of VR rehabilitation could lead to scalable and cost-effective solutions, potentially enabling home-based rehabilitation. However, the widespread clinical application remains constrained by the lack of rehabilitation-specific VR and multidimensional quantitative assessments. The aim of this study was to investigate the multidimensional effects and neural mechanisms of VR rehabilitation in poststroke motor recovery.

This study is a prospective, randomised, controlled clinical trial protocol designed to evaluate the effects of multisensory VR training on motor dysfunction in patients who had a stroke using multidimensional assessments. The trial consists of a baseline assessment, a 4-week intervention period and an endpoint assessment. A total of 40 patients who had a stroke will be randomly allocated in a 1:1 ratio to either a VR combined with treadmill group or a treadmill-only group. The primary outcome measure is the Fugl-Meyer Assessment of Lower Extremity score, while secondary outcomes include three-dimensional gait analysis, the Berg Balance Scale score, the activities of daily living score and functional near-infrared spectroscopy results. Safety will be evaluated by monitoring the incidence of adverse events. This study aims to determine whether VR rehabilitation offers superior efficacy in improving motor function in patients who had a stroke by using a multidimensional assessment approach, including neural coupling function, muscle movement mechanics and clinical performance. The findings will provide robust, high-quality evidence to support the broader application of VR in clinical practice.

The trial was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (2022–155). This study protocol was registered with the clinicaltrials.gov (NCT06275516). The results will be published in a peer-reviewed journal or presented at a conference.

NCT06275516.

To investigate the association between quantitative retinal vascular parameters and coronary artery disease (CAD) and to evaluate the efficacy of a retinal phenotype-based diagnostic model as a non-invasive tool for early CAD screening.

A retrospective cross-sectional study.

A single-centre study conducted at the Cardiovascular Center of Beijing Tongren Hospital, Capital Medical University, China, between January and October 2024.

417 patients with suspected angina undergoing their first coronary angiography (CAG) were enrolled. Inclusion criteria were age >18 years and high-quality fundus photography within 24 hours pre-CAG. Major exclusions were prior coronary interventions, severe systemic/valvular heart diseases and ocular conditions impairing retinal vascular visualisation.

The primary outcome was the association between quantitative retinal vascular parameters and the presence of CAD (defined as ≥50% stenosis). Secondary outcomes included the diagnostic performance area under the receiver operating characteristic curve (AUROC) of three predictive models: one based on quantitative retinal vascular parameters alone, one based on traditional risk factors and a combined model integrating both retinal and clinical variables.

This study enrolled 417 patients undergoing initial CAG. Compared with non-CAD controls (n=190), patients with CAD (n=227) had higher prevalence of hypertension, dyslipidaemia and diabetes, along with elevated levels of fasting blood glucose, lipoprotein(a) (Lp(a)), triglyceride (TG) and glycated haemoglobin (HbA1c) (all p

Our findings, derived from an artificial intelligence-based fully automated quantitative retinal vascular parameters measurement method, revealed that multiple quantitative fundus parameters—including FD, VD and other morphological parameters were significantly associated with CAD risk. The CAD diagnostic model we developed demonstrates strong performance and high interpretability, making it suitable for early CAD screening and diagnosis.

Non-communicable diseases (NCDs) have become the leading cause of mortality globally, with a sharp rise in Iran due to lifestyle changes and urbanisation. Although many NCD risk factors are modifiable, limited understanding of their determinants hinders effective prevention. To address this, the Prospective Epidemiological Research Studies in Iran (PERSIAN) Cohort was established in 2014 to study NCDs nationwide. The Sabzevar PERSIAN Cohort Study (SPECS) is the first in northeastern Iran, aiming to investigate environmental and social factors influencing NCDs in a unique regional context.

SPECS enrolled 5174 adults (aged 35–70 years) in northeastern Iran between January 2018 and January 2019 through a census and an online registration process. The baseline data collection included demographic verification, informed consent, health questionnaires, anthropometric measurements and biological samples (blood, urine, hair, nails). The annual follow-up began in April 2019, with full reassessments every 5 years over a 15-year period. The data is gathered via an active and passive follow-up, supported by trained staff and registry linkages.

Of the 5174 participants, 4241 (81%) remained in the study. Among the cohort, 54.5% were female, with a mean age of 50.5 years. The majority were married (93.5%), and nearly half had at least high-school education (46.5%) and moderate socioeconomic status (49.4%). Drug abuse history (smoking/drugs) was reported by about 15% of the sample. The mean body mass index was 26.9 kg/m², and the average blood pressure was higher in males (118.1/74.0 mm Hg) than in females (111.5/70.2 mm Hg). The common conditions included hypertension (22.8%), kidney stones (22.4%), fatty liver (15.4%) and diabetes (13.8%). Cancer had the highest treatment rate (100%), while fatty liver had the lowest (70.1%). Stroke had the highest mean age of onset (51.2 years), and epilepsy the lowest (23.7 years). All health data were self-reported.

SPECS, part of the national PERSIAN cohort initiative, is the only adult NCD-focused study in Khorasan Razavi. Its 15-year follow-up aims to generate region-specific insights into the incidence of NCDs and their risk factors. The ethnically homogeneous sample enhances statistical power, and the findings may inform culturally tailored health policies. While self-reported data have limitations due to bias, high initial participation and access to free healthcare support long-term engagement, especially among lower-income groups.