This study aimed to identify intraoperative and perioperative factors influencing 30-day mortality after cardiac surgery and to develop a risk score (POP-score) for its prediction.

Retrospective cohort study with multivariable regression analysis.

A tertiary care cardiac surgery centre in Austria; data from consecutive patients undergoing cardiac surgery between 2010 and 2020 were analysed.

A total of 8072 patients were included. The cohort was randomly divided into a derivation cohort (75%) and a validation cohort (25%).

The primary outcome measure was 30-day mortality. We analysed associations between intraoperative and perioperative variables and 30-day mortality, assessed via multivariable regression analysis.

Several factors were significantly associated with 30-day mortality, including intraoperative RBC transfusion (OR 3.407 (95% CI 2.124–5.464)), postoperative high-sensitive cardiac troponin T cut-off levels (OR 2.856 (95% CI 1.958 to 4.165)), need for dialysis/haemofiltration (OR 2.958 (95% CI 2.013 to 4.348)) and temporary extracorporeal membrane oxygenation support (OR 5.218 (95% CI 3.329 to 8.179)) (p

The validated POP-score provides an improved tool for predicting 30-day mortality after cardiac surgery by incorporating intraoperative and perioperative factors alongside the EuroSCORE II. Although model performance was evaluated using 7-day peak troponin data, the score can be calculated within the first 72 hours postoperatively in most patients, supporting its clinical applicability for early decision-making, resource allocation and patient counselling. Further research is warranted to assess its clinical utility in diverse populations.

The EPHOR-NIGHT cohort was established to investigate how night shift work influences biological pathways and chronic disease risk using a comprehensive working-life exposome approach, focusing on cardiometabolic, mental health, cognitive and biological ageing outcomes.

The cohort includes 937 workers aged 20–65 years (88% female), primarily from the healthcare sector (96%) in Spain, Sweden, Denmark and the Netherlands. Participants were categorised as permanent day (39%), permanent night (35%) or rotating/other shift workers (26%). Data collection included questionnaires, daily ecological momentary assessments, wearable sensors tracking light, physical activity, heart rate and environmental exposures and biological samples (blood collected once and saliva collected during five points across the day), with harmonised protocols across countries.

From the 937 participants contributing data to the cohort, 708 had complete information from questionnaires, sensors and blood and saliva, with subsets undergoing advanced biological analyses, including genomics, targeted and genome-wide DNA methylation, telomere length and mtDNA copy number, metabolomics, transcriptomics, proteomics, hormone profiling and inflammatory biomarkers and blood metals. Many reported prevalent chronic conditions, including anxiety (27%), depression (18%) and metabolic disturbances. Night shift and rotating shift workers had greater exposure to long shifts and more scheduled rest days compared with day workers. Sleep duration and quality were poorest among permanent night shift workers.

A 2-year follow-up was completed in June 2025, including the collection of additional biomarker data, psychosocial work environment data and data related to female sexual and reproductive health. Findings from the EPHOR-NIGHT study aim to inform prevention strategies and occupational health policies. Data will be made available to support broader research efforts on shift work and health.

To examine state-level variation in mental health screening practices for high school athletes in the USA and evaluate associations between screening protocols and adolescent depression-related and suicide-related outcomes.

Cross-sectional study of preparticipation examination (PPE) forms and Youth Risk Behaviour Surveillance System (YRBSS) data.

High school athletics across all 50 US states and the District of Columbia.

732 676 high school students who completed the 2021 YRBSS survey (grades 9–12).

Prevalence of depressive symptoms and suicide-related behaviours, measured using YRBSS items on sadness/hopelessness, suicide ideation, planning, attempts and suicide attempts resulting in injury. State-level PPE forms were reviewed for presence and depth of mental health screening, including Patient Health Questionnaire-4 (PHQ-4) and eating disorder (ED) risk questions.

Screening practices varied widely, ranging from no mention of mental health in some states to required evaluations with formal referral protocols in others. Of 732 676 students, 503 861 (68.7%) reported feeling sad or hopeless, 608 416 (83.0%) seriously considered suicide and 64 072 (8.8%) attempted suicide in the past year. States with required screening protocols had higher reported rates of depressive symptoms (71.0% vs 68.7%, p

High school athletes represent a vulnerable group in need of structured and standardised mental health screening. State-level screening policies were associated with lower suicide attempt rates, though causal inference is limited by the cross-sectional design. Standardised use of validated mental health tools may support early identification and intervention for at-risk adolescents.

When deciding acute healthcare delivery location, multiple factors should be considered, including risks associated with potential care locations and the willingness of decision stakeholders to take those risks. Individual risk tolerance potentially informs these choices. We therefore aimed to investigate the risk tolerance of staff, patients and carers in front-door and ambulatory care units.

Several variants of the ‘multiple price list’ method of risk tolerance assessment were employed. The different variants covered financial and health outcomes, and known and unknown odds in the ‘risky’ options. For financial outcomes, participants made seven choices between a guaranteed (eg, £70) and risky (eg, chance of £20 or £160) outcome, with the higher quantity in the risky outcome increasing with each choice, in six ‘lottery sets’. For health outcomes, participants made choices between a guaranteed and risky outcome measured in number of healthy days.

Staff, patients and carers were recruited from front-door and ambulatory care units in the UK.

Risk tolerance was the primary outcome measure and was established in two ways—number of times the guaranteed option was chosen, and the point where participants switched from the guaranteed to the risky option.

Among 338 participants, a wide range of risk tolerance levels were demonstrated, and three key findings were identified—participants were less risk tolerant in health-based than financial decisions; older people had a more dichotomised approach to health risk-taking than younger people; and patients could engage in informed, structured discussions about risk, including when acutely unwell.

These findings suggest that, while stakeholders in location-of-care decisions may have different risk tolerance levels, they can engage in structured discussions about risk, which should inform shared decision-making. Additionally, older patients, who constitute a significant proportion of hospital attendees, may be more willing to take health-based risks than younger people. Future work may benefit from formal exploration of people’s rationale for their decisions and may be considered in other clinical settings.

Prehospital emergency care (PEC) requires rapid evidence-based decisions to maximise the effectiveness of care and to improve clinical outcomes. There are multiple challenges related to clinical research performed in the PEC setting. The aim of our study is to systematically review and assess the characteristics, quality of reporting, risk of bias and pragmatism in recent PEC trials, thereby identifying potential gaps and strengths that can guide the design of future prehospital studies.

We will systematically search databases MEDLINE, Embase and Cochrane CENTRAL to identify all randomised controlled trials conducted in the field of PEC and published in English language between 2010 and 2024. No restrictions will be made to the participants, interventions and outcomes. Risk of bias will be evaluated using the Cochrane Risk of Bias 2 tool. The level of pragmatism will be assessed using the Pragmatic-Explanatory Continuum Indicator Summary-2 score. Exploratory data analysis will be used to investigate and summarise main patterns. Differences in characteristics between PEC fields, study designs, publication year and associations between pragmatism levels, risk of bias and quality of reporting will be the primary focus.

There are no ethical concerns directly relevant to this review. This study has been previously registered with the Open Science Framework (osf.io/rzn9j). The manuscript will be submitted for publication to a relevant, peer-reviewed journal.

Suicide has a substantial economic burden, yet in low- or middle-income countries, the analysis is constrained by the absence of disaggregated economic data. Existing studies primarily rely on gross costing methods, overlooking sector-specific costs such as healthcare, law enforcement and productivity losses at the family and community levels. Furthermore, the societal perspective, essential for understanding the multifaceted economic impacts of suicide, remains insufficiently explored in the Indian context.

This study will quantify the economic burden of suicide and suicide attempts in India. The initial phase will involve developing a resource-use measure instrument to capture the societal costs associated with suicide. Subsequently, a retrospective, incidence-based study will be conducted in India using the developed instrument. This will also be complemented with the Health-Related Quality of Life Assessment using EuroQOL (EQ-5D-5L). Exploratory subgroup cost comparisons (eg, suicide methods, healthcare facility type) will use non-parametric tests, including the Mann–Whitney U and Kruskal–Wallis tests. Generalised linear mixed models (gamma distribution and log link) will analyse longitudinal cost and HRQoL data, besides bootstrapping techniques and sensitivity analyses.

Ethics approval was obtained for the study from the institutional review board of the Indian Law Society (ILS/141/2024). All data collected during the study will adhere to ethical guidelines, taking informed consent. The findings of the study will be disseminated through peer-reviewed journals to aid data-driven decision-making.

Clinical Trial Registry of India (CTRI/2025/02/080380), date of registration: 12/02/2025.

Patients living with chronic obstructive pulmonary disease (COPD) experience periods of disease stability and exacerbations (ECOPD). COPD imposes a negative and impactful extrapulmonary impairment and commonly overlaps with multimorbidity, particularly cardiovascular disease. Pulmonary rehabilitation (PR) aims to improve physical activity (PA) and quality of life, while behavioural change interventions (BCIs) aim to promote lifestyle changes and autonomy. However, after ECOPD, a variety of barriers often delay patient referral to PR. This study aims to assess the effects of a BCI for patients after ECOPD, focusing on cardiovascular health, PA and functionality. Additionally, the study will assess 6-month sustainability of PA and conduct a cost-utility analysis comparing a non-intervention group in the Unified Health System.

This randomised clinical trial will assess patients with ECOPD over 12 weeks using a BCI based on self-determination theory to increase daily steps. First, the cardiovascular and functional profile will be evaluated. Afterwards, the patients will receive an accelerometer to monitor the PA level. After 7 days, questionnaires will be applied on quality of life, symptoms and motivational levels for PA. Patients will be randomised into control group or intervention groups, both will receive educational booklets and IG will also receive an educational interview. PA will be tracked using activPAL accelerometer at weeks 1, 4 and 12, and follow-up at 6 months. Data analysis will include unpaired Student’s t-test or Mann-Whitney test for group comparison, and a linear mixed model to assess intervention effects over time. Economic evaluation, using STATA (V.14), will involve correlation analysis, and p

This study has been approved by the Federal University of São Carlos’ Ethics Committee, Irmandade Santa Casa de Misericórdia de São Carlos and Base Hospital of São José do Rio Preto. All procedures will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and applicable regulatory requirements. All results will be presented in peer-reviewed medical journals and international conferences.

Brazilian Registry of Clinical Trials under the registration number RBR-6m9pwb7.

Asynchronous telemedicine-based second opinions, using a purely document-based and written procedure, offer an opportunity to support patients in their medical decision-making, particularly those who cannot secure a timely face-to-face appointment nearby. The aim of the study is to investigate the benefits and challenges of asynchronous telemedicine in obtaining a second opinion and clarify for whom and under what conditions it is suitable.

We conducted a qualitative interview study as part of a larger mixed-methods study. The interviews were transcribed verbatim and analysed using qualitative content analysis.

Germany.

The study involved 40 patients (20 women and 20 men) who sought an asynchronous telemedicine-based second opinion via an online platform, predominantly for orthopaedic issues.

Asynchronous telemedicine-based second opinions offer advantages such as access to distant specialists, the ability to consult from home without waiting times, timeliness and a detailed, fact-based report. However, the absence of face-to-face contact presents challenges: it can feel impersonal, technical problems may arise, it can be difficult to articulate symptoms and medical history in writing, and spontaneous interaction or correction is limited.

Under certain conditions, telemedicine-based second opinions can be individualised without face-to-face interaction. Key factors for success include a clear medical question, a well-organised process with good customer support, comprehensive and individualised information, and patient readiness (technical skills, internet access and the ability to articulate symptoms in writing). Major challenges for the German healthcare system include overcoming a potential digital divide as certain patient groups may not be reached by digital services.

To examine the association between behavioural risk factors and their physiological sequelae among adults aged 40 and above in Bo District, Sierra Leone.

Cross-sectional study.

Household survey in Bo District, Sierra Leone.

The study included 1978 randomly sampled adults aged 40 and above (44.4% male and 55.6% female). The majority of participants were aged 40–49 years (34.5%). Data were collected using a household survey based on the validated WHO STEPs questionnaire.

Multivariable logistic regression analysis was performed to determine associations between behavioural risk factors (diet, physical activity and salt intake) and the presence of hypertension, diabetes and/or obesity, adjusting for sociodemographic variables.

The primary outcomes were the presence of hypertension, diabetes or overweight/obesity. Hypertension was defined as systolic blood pressure of ≥140 mm Hg and/or diastolic blood pressure of ≥90 (measured); diabetes as fasting glucose of ≥7.0 mmol/L, random plasma glucose level of ≥11.1 mmol/L or the use of antidiabetic medications (self-reported) and overweight/obesity as having a body mass index of ≥25 kg/m² (measured).

At least one physiological risk factor for cardiovascular diseases, that is, hypertension, obesity or diabetes, was present in 43.5% of participants. Hypertension was associated with urban living (OR=1.46, 95% CI (1.41 to 1.51)), older age (OR for 80+=3.98, 95% CI (3.70 to 4.28)), insufficient fruit and vegetable intake (OR=1.52, 95% CI (1.46 to 1.60)) and low physical activity (OR=1.35, 95% CI (1.27 to 1.43)). Diabetes was associated with urban residence (OR=1.84, 95% CI (1.66 to 2.05)), older age (OR for 70–79=3.82, 95% CI (3.28 to 4.45)), low fruit and vegetable consumption (OR=1.61, 95% CI (1.36 to 1.90)), high salt intake (OR=1.34, 95% CI (1.21 to 1.49)) and low physical activity (OR=1.47, 95% CI (1.26 to 1.71)). Obesity was associated with urban living (OR=1.66, 95% CI (1.59 to 1.72)), high salt intake from two or more sources (OR=1.21, 95% CI (1.17 to 1.25)) and low physical activity (OR=1.30, 95% CI (1.22 to 1.39)). Male sex (OR=0.37, 95% CI (0.36 to 0.38)) and older age (OR for 80+=0.39, 95% CI (0.35 to 0.43)) were protective factors.

In Bo District, nearly half of adults over 40 face hypertension, diabetes or obesity, especially urban dwellers, older age groups and those eating too few fruits and vegetables, consuming excess salt and getting little exercise. Public health efforts should focus on urban-targeted nutrition education, salt-reduction strategies, community exercise programmes and routine blood pressure and glucose screening, working with local leaders to ensure sustainable lifestyle changes and early disease detection.