Stress is nearly ubiquitous in everyday life; however, it imposes a tremendous burden worldwide by acting as a risk factor for most physical and mental diseases. The effects of geographic environments on stress are supported by multiple theories acknowledging that natural environments act as a stress buffer and provide deeper and quicker restorative effects than most urban settings. However, little is known about how the temporalities of exposure to complex urban environments (duration, frequency and sequences of exposures) experienced in various locations – as shaped by people’s daily activities – affect daily and chronic stress levels. The potential modifying effect of activity patterns (ie, time, place, activity type and social company) on the environment–stress relationship also remains poorly understood. Moreover, most observational studies relied quasi-exclusively on self-reported stress measurements, which may not accurately reflect the individual physiological embodiment of stress. The FragMent study aims to assess the extent to which the spatial and temporal characteristics of exposures to environments in daily life, along with individuals’ activity patterns, influence physiological and psychological stress.

A sample of 2000 adults aged 18–65 and residing in the country of Luxembourg completed a traditional and a map-based questionnaire to collect data on their perceived built, natural and social environments, regular mobility, activity patterns and chronic stress at baseline. A subsample of 200 participants engaged in a 15-day geographically explicit ecological momentary assessment (GEMA) survey, combining a smartphone-enabled global positioning system (GPS) tracking and the repeated daily assessment of the participants’ momentary stress, activities and environmental perceptions. Participants further complete multiple daily vocal tasks to collect data on vocal biomarkers of stress. Analytical methods will include machine learning models for stress prediction from vocal features, the use of geographic information systems (GIS) to quantify dynamic environmental exposures in space and time, and statistical models to disentangle the environment–stress relationships.

Ethical approval (LISER REC/2021/024.FRAGMENT/4-5-9-10) was granted by the Research Ethics Committee of the Luxembourg Institute of Socio-Economic Research (LISER), Luxembourg. Results will be disseminated via conferences, peer-review journal papers and comic strips. All project outcomes will be made available at https://www.fragmentproject.eu/.

Scoliosis-specific exercises require specialist supervision, frequent clinical visits, and high costs, limiting accessibility. Additionally, females with idiopathic scoliosis (IS) engage in less physical activity (PA) than sex- and age-matched peers, leading to poorer bone and muscle health. These challenges underscore the need for accessible, home-based interventions targeting both musculoskeletal health and spinal alignment.

This single-blinded, randomised controlled trial aims to investigate the efficacy of a 16-week home-based exercise intervention on bone mineral density (BMD), Cobb angle, spinal flexibility, core muscle endurance, lean body mass, and quality of life (QoL) in females with IS. 28 participants will be randomly assigned (1:1) to either an intervention group (IG) or a control group (CG). Both groups will perform Schroth and core stabilisation exercises three times per week, while the IG will additionally perform impact-loading exercises. The primary outcome is BMD. Secondary outcomes include Cobb angle, lean body mass, cosmetic trunk deformity, spinal flexibility, core muscle endurance, and QoL. All outcomes will be assessed at baseline and post-intervention, with interim evaluations (excluding BMD, Cobb angle, and lean body mass) conducted at weeks 4, 8, and 12. All assessors, radiologists, and statisticians will remain blinded to group allocation. Treatment effects between groups over time will be analysed using two-way mixed-design analysis of variance (ANOVA).

This study addresses a critical gap in IS management by integrating a preventive and therapeutic home-based programme. The approach aims to improve musculoskeletal health, spinal alignment, and overall QoL. Its accessible format may inform future guidelines for conservative treatment and early intervention. Such interventions could significantly enhance bone health, reduce the risk of progression, and improve long-term musculoskeletal outcomes in young females with mild to moderate IS.

This study has received ethical approval from the Research Ethics Committee, Faculty of Associated Medical Sciences, Chiang Mai University (No. AMSEC-67EX-045). The findings will be disseminated through a peer-reviewed publication.

TCTR20241001001.

Dysmenorrhoea (period pain) is a global public health issue affecting up to 91% of the 1.8 billion individuals who menstruate. While research has emphasised the improvement of menstrual health in low-middle-income countries, undertreated dysmenorrhoea remains an issue in high-income countries (HICs), where individuals often assume their pain experiences are normal. Studies report that individuals with dysmenorrhoea delay seeking medical care, avoid it entirely or are subjected to diagnostic and treatment delays. Difficulties accessing care are troubling, as individuals may suffer without access to evidence-based techniques, as well as the potential for underlying pathologies (eg, endometriosis, pelvic inflammatory disease) to go undiagnosed.

Many HICs have launched strategies for women’s health to address gaps in care access and knowledge around menstruation. Guided by Levesque and colleagues' (2013) Conceptual Framework of Access to Healthcare, this review will contribute to these strategies by providing an overview of factors affecting healthcare access for dysmenorrhoea in HICs from the point of perceiving a healthcare need to engaging with care, as well as factors affecting perceived quality of care.

This scoping review will follow the Joanna Briggs Institute’s (JBI) guidance for scoping reviews and will be conducted with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist extension for Scoping Reviews. Guided by Levesque and colleagues’ (2013) Conceptual Framework of Access to Healthcare, searching will seek to locate both peer-reviewed studies across PubMed, CINAHL, PsycINFO and Web of Science databases, as well as using web scraping to locate relevant grey literature. Results will be synthesised and mapped to construct a pathway to care, highlighting factors affecting the healthcare access for dysmenorrhoea, as well as factors related to the quality of healthcare interactions.

This review does not require ethical approval, as only existing data will be analysed. Results will be shared using peer-reviewed publications and conference presentations. Datasets emerging from the study will be made available on Open Science Framework.

This review was initially registered on Open Science Framework (https://osf.io/2dsrc/) in February 2024, with an updated protocol registered in February 2025.

Impostor syndrome (IS) is a psychological state whereby individuals doubt their abilities despite evidence of competence. Though IS has been studied in specific medical groups, no review to date compares findings across groups. This study aimed to: (1) determine the range of IS rates among medical undergraduates versus postgraduates and (2) examine associated factors across both groups.

This scoping review used the Joanna Briggs Institute methodology for scoping reviews, using a five-step framework.

PubMed, Scopus and PsycINFO databases were searched from inception until September 2024.

Studies were included if they were (1) empirical studies with a defined IS rating scale, (2) involving medical undergraduates, residents or clinicians and (3) published in English.

Three independent reviewers used standardised methods to screen and review selected studies, and extract key variables.

54 studies (77.8% from the West) were included. There was equal study distribution between undergraduates (46.3%, 25 studies) and postgraduates (46.3%, 25 studies), with the rest covering both groups. IS prevalence was substantial across all groups when assessed using the Clance Impostor Phenomenon Scale, ranging from 30.6% to 75.9% among undergraduates, 33.0% to 75.0% among residents and 23.5% to 50.0% among faculty and clinicians. In undergraduates, IS was associated with learning breaks, transition periods and poor academic performance. Among postgraduates, IS was correlated with younger age, junior ranking, fewer work years, inadequate faculty support or self-perceived poor clinical and teaching skills. Additionally, IS affected physical and psychological well-being (stress, anxiety, depression, burnout) and was associated with sociodemographic factors (single status, females), personality (neuroticism, perfectionistic traits, with conscientiousness, agreeableness and extraversion as protective) and interpersonal issues (conflicts, poor sense of belonging).

Given the high IS prevalence and associations with specific factors, practical measures are recommended to address IS and optimise learning and care for medical undergraduates and professionals.

Poststroke individuals have a high incidence of falls during the first months after discharge. The factors contributing to falls in poststroke patients are multifaceted, with balance deficits being the most prominent. Fall-related self-efficacy has also been identified as a key factor influencing the effectiveness of fall prevention interventions. Additionally, family members play a crucial role in fall prevention by providing support, supervision and assistance with mobility and daily activities. While previous studies support the potential benefits of a fall prevention programme for poststroke individuals, further evidence is needed to confirm their effectiveness. Building on the positive outcomes of self-management (SM) interventions in reducing falls across diverse populations, this study aims to evaluate the effects of an individual and family SM (IFSM) fall prevention programme on balance ability and fall-related self-efficacy among poststroke individuals.

This study will be a two-arm, single-blind, pre–post test randomised controlled trial. The target sample will consist of 60 poststroke adults with moderate severity and their primary family members. The intervention group will receive the IFSM fall prevention programme, which consists of 10 weekly sessions. The main components of the programme are exercise, home environment assessment, assistive technology, medication review and safety during daily activities. The control group will receive usual care but will not participate in any specific intervention. Primary outcomes—balance ability and fall-related self-efficacy—will be assessed at baseline and week 8 after discharge. Secondary outcomes will include the number of falls and fall-related injuries.

Ethical approval was obtained from the Research Ethics Committees of the Faculty of Nursing, Chiang Mai University and the Affiliated Hospital of Guizhou Medical University. The results will be disseminated to poststroke individuals and their families through workshops; to healthcare professionals via professional training and meetings; and to researchers via conferences and publications.

NCT06577662.

The use of sevoflurane, a commonly used paediatric anaesthetic, raises concerns about potential long-term neurotoxic effects on behavioural and neurocognitive development, particularly during critical neurodevelopmental stages in preschool children. Endogenous hydrogen sulfide (H₂S), a neuroprotective gasotransmitter, may be affected by anaesthetic exposure, but its role in sevoflurane-induced neurotoxicity remains unclear.

This prospective cohort study aims to evaluate behavioural and neurocognitive outcomes in 200 preschool children aged 4–6 years (1:1 allocation), with exposure to sevoflurane general anaesthesia (GA) as the primary predictor. A family-centred, professionally guided questionnaire-based assessment approach will be employed. Data accuracy and reliability will be ensured through the integration of real-time medical records and standardised instruments. Moreover, by investigating changes in serum H₂S levels among children in the exposed group, this study offers a novel perspective on the potential neurotoxic mechanisms of GA and may inform the development of targeted neuroprotective interventions.

Ethical approval was obtained from Shengjing Hospital of China Medical University Ethics Examination Committee (2024PS1204K). We will present the results of the study at national and/or international conferences and in peer-reviewed journals. The study began in October 2024 and is expected to be completed in December 2025.

ChiCTR2400090174.

Chronic musculoskeletal pain (CMP) is a prevalent and distressing condition. Cupping therapy, one of the most popular complementary and alternative medicines, has been widely used to reduce CMP. But the evidence remains controversial on the effect of cupping therapy on CMP. The objective of this review and meta-analysis is to assess the effectiveness of cupping therapy in patients with CMP.

Systematic review and meta-analysis.

PubMed, Web of Science, EBSCO, Cochrane Library and CNKI (China National Knowledge Infrastructure) were searched through 20 December 2024.

We included randomised control trials that compared cupping therapy for patients with CMP on outcomes (ie, pain intensity, functional disability and mental health).

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Meta-analysis was conducted using random and fixed effects models. Findings were summarised in GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence profiles.

The results showed that cupping therapy (standardised mean difference (SMD)=–1.17; 95% CI=–1.93 to –0.42; p=0.002; I²=94%) had a significant reduction effect on patients with CMP’s pain intensity with moderate quality based on a random-effect model. But cupping therapy had no improvement effects on functional disability (SMD=–0.24; 95% CI=–0.93 to 0.46; p=0.51; I²=93%) and mental health (SMD=0.08; 95% CI=–0.12 to 0.27; p=0.46; I²=0%).

This study indicates that cupping therapy may be efficient in alleviating pain intensity in patients with CMP with immediate effects. But it cannot improve functional disability and mental health significantly.

CRD42023406219.

Older adults are prone to developing multiple chronic diseases and have increased medication usage. This has led to the prescription of potentially inappropriate medications (PIMs). This study aimed to assess PIM prevalence among patients visiting the primary care unit (PCU) of a tertiary care hospital and evaluate the associated factors.

A retrospective cross-sectional study by reviewing medical records in the hospital information system.

The PCU of a tertiary care hospital.

Patients aged ≥65 years who visited the PCU between 1 June and 30 November 2023 and received at least one oral medication.

PIMs were diagnosed using the updated American Geriatrics Society Beers criteria 2023, and logistic regression was used to identify factors associated with PIM prescriptions.

The study included 1600 participants, of whom 62.9% were female, with a median age of 72.0 years (IQR=68.0–77.0). The prevalence of PIMs was 39.4%. The three most common PIMs prescribed were diuretics, benzodiazepines and sulfonylureas. An increasing number of underlying diseases, presenting with acute illness (compared with follow-up only) and being treated by staff physicians (compared with trainee physicians) were significantly associated with increased odds of PIM prescriptions (adjusted OR (95% CI) = 1.59 (1.42 to 1.79), 1.58 (1.28 to 1.94) and 1.84 (1.33 to 2.54), respectively).

PIM prescriptions among older patients in the PCU were high, particularly in those with multiple comorbidities and acute illness presentations. Therefore, physicians should prescribe medications with caution, and various explicit criteria can be used as screening tools to prevent PIM prescriptions.

To explore the association between perioperative SARS-CoV-2 infection and the postoperative complications during the breakout of the Omicron epidemic wave.

Observational retrospective cohort study. Multivariable logistic regression was performed to explore the association between the duration from surgery to COVID-19 diagnosis and the likelihood of postoperative complications.

A general hospital in China.

7927 patients aged 18 years and older who underwent surgical treatment between 1 December 2022 and 28 February 2023.

The outcome was a composite of postoperative adverse events that occurred within the initial 30 postoperative days.

Of all patients, 420 (11.76%) experienced postoperative complications. Compared with No COVID-19, preoperative COVID-19 within 1 week (pre-1w) exhibited a high risk of postoperative complications (adjusted OR (aOR), 2.67; 95% CI 1.50 to 4.78), followed by patients with pre-2w (aOR, 2.14; 95% CI 1.20 to 3.80). For patients with postoperative COVID-19 within 1 week (post-1w), the aOR was 2.48 (95% CI 1.48 to 4.13), followed by patients with post-2w (aOR 1.95; 95% CI 1.10 to 3.45), and those with post-3w (aOR 2.25; 95% CI 1.27 to 3.98). The risks of postoperative complications decreased roughly with the increase of the time interval between the surgery date and SARS-CoV-2 infection. Stratification analyses suggested that perioperative COVID-19 increased the risk of postoperative complications in older patients, smokers, those with comorbidities or experiencing moderate or severe COVID-19 symptoms.

Our findings reveal a significant time-dependent relationship between perioperative COVID-19 and postoperative complications, highlighting the importance of tailored preoperative risk evaluations, enhanced postoperative surveillance, and the implementation of effective postoperative COVID-19 prevention measures.

ChiCTR2300072473.

The current diagnostic pathway for patients with a suspected inherited bleeding disorder is long, costly, resource intensive, emotionally draining for patients and often futile, as half of patients will remain without a diagnosis and be labelled ‘bleeding disorder of unknown cause’. Advances in understanding the genetic basis of the inherited bleeding disorders, coupled with both increasing infrastructure for genetic/genomic testing and decreasing costs, have increased the feasibility of introducing genomic testing into the clinical diagnostic pathway as a potential solution to improve the care of these patients. Yet, there remain evidence gaps on the optimal integration of genomic analysis into the diagnostic pathway.

Using a multicentre randomised-controlled trial design, we will evaluate an early genomic testing strategy for the diagnosis of newly referred patients with a suspected inherited bleeding disorder. Eligible participants will be randomised to early genomic testing diagnostic pathway (intervention) or standard diagnostic pathway (control) and will be followed for a 12-month period. Patients in the control group who remain undiagnosed at study end will be offered identical early genomic testing to ensure equitable access to the intervention. The study will follow a parallel fixed design with waitlist control group and a 1:1 allocation ratio. The study will be conducted at three tertiary care centres in Ontario, Canada, with a target sample size of 212 participants. Clinical utility will be evaluated via the primary outcome of diagnostic yield, as well as the secondary outcome of time to diagnosis. Additional secondary outcomes will allow for assessment of patient impact via health-related quality of life and patient burden measures, as well as evaluation of economic impact through a cost-effectiveness analysis and budget impact analysis.

This investigator-initiated study was approved by the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board through Clinical Trials Ontario (CTO-4909). Participant informed consent/assent is required. Findings will be disseminated through academic publications.

ClinicalTrials.gov, NCT06736158.