Parents of children with neurodevelopmental disorders often experience high levels of stress that impact their mental health, yet few interventions focus on their well-being. To address this gap, we developed a mental health intervention based on emotional intelligence (EI), designed for delivery in healthcare settings. We hypothesise that enhancing EI can reduce parenting stress and improve psychological well-being. This study aims to assess the effectiveness, cost-effectiveness and feasibility of this EI-based intervention in Bangladesh.

This hybrid type 1 effectiveness-implementation study will include a cluster randomised controlled trial, an implementation analysis and an economic evaluation. Eight child development centres will be randomly assigned in a 1:1 ratio to intervention and waitlist control groups. A total of 480 parents (mothers and fathers) will be recruited. The intervention consists of interactive sessions on EI skills, supported by personal diaries and a mobile app. Data will be collected at baseline and 12 weeks postintervention using validated tools to assess EI, parenting stress, psychological well-being and other mental health outcomes. Implementation will be evaluated using mixed methods to assess feasibility, acceptability and fidelity. Cost-effectiveness will be determined through a cost–utility analysis of direct and indirect costs.

Ethical approval was granted by the Institutional Review Board of Bangladesh Medical University (BSMMU/2022/10733). Written informed consent will be obtained at each stage of data collection and intervention. Findings will be disseminated through open-access publications, plain-language summaries, academic conferences, community workshops and policy briefs. Data will be shared in open-access platforms to inform mental health strategies in low-resource settings globally.

NCT06166550.

Sepsis and antibiotic resistance constitute a deadly synergy, causing the loss of millions of lives across the world, with their economic and developmental consequences posing a threat to global prosperity. Their impact is disproportionately felt in resource-limited settings and among vulnerable populations, especially children. A key challenge is prompt diagnosis and timely commencement of appropriate antibiotic therapies. These challenges are compounded in low-income and middle-income countries by a lack of comprehensive epidemiological data, with Nigeria being one such country for which it is lacking. Kaduna is the third largest state in Nigeria, with over 10 million inhabitants, of whom more than half are children under 14 years old. While bacterial sepsis and antimicrobial resistance (AMR) are recognised as a growing problem in the state, there are huge gaps in the current understanding of their aetiology. This project employs a cross-sectional design to investigate the clinical and haematological markers of paediatric sepsis, alongside determining the bacterial cause and prevalence of AMR at four high-turnover hospitals in Kaduna State, Nigeria. Further, whole-genome sequencing of isolated bacterial pathogens will be performed to determine the genetic features of resistance. This project represents the largest surveillance study of paediatric sepsis in Kaduna to date. Additionally, we aim to use the clinical, haematological, microbiological and genomic data to derive predictive models for sepsis causes, treatment strategies and patient outcomes.

This is a hospital-based, cross-sectional study that will recruit up to 461 children with bacterial sepsis who were admitted at the two teaching and two general hospitals in Kaduna State, Nigeria. Children presenting with features of fever, subnormal temperature and body weakness would be recruited into the study and have their blood samples collected. The blood samples will be used for culture, complete blood count, HIV and malaria testing. Accordingly, we will capture clinical presentation, haematological characteristics, causative pathogen from blood culture and patient outcomes. Nutritional status, known congenital immunosuppressive diseases, HIV infection and malaria infection will also be determined and documented. The bacterial isolates will be phenotypically characterised for AMR and genotypically following whole genome sequencing. Known and potential confounders to the outcomes of bacterial sepsis would be assessed in all participants, and adjustment for confounding would be performed using logistic regression and/or stratification±Mantel-Haenszel estimator where applicable.

Ethical approvals were granted by the University of Birmingham (ERN_2115-Jun2024), the Ahmadu Bello University Teaching Hospital (ABUTHZ/HREC/H45/2023), Barau Dikko Teaching Hospital, Kaduna (NHREC/30/11/21A) and the Kaduna State Ministry of Health (MOH/AD M/744/VOL.1/1110018). The study will be conducted using the international guidelines for good clinical practice and based on the principles of the Declaration of Helsinki. The results will be disseminated via oral and poster presentations in scientific conferences and published in peer-reviewed journal articles.

Cluster analysis, a machine learning-based and data-driven technique for identifying groups in data, has demonstrated its potential in a wide range of contexts. However, critical appraisal and reproducibility are often limited by insufficient reporting, ultimately hampering the interpretation and trust of key stakeholders. The present paper describes the protocol that will guide the development of a reporting guideline and checklist for studies incorporating cluster analyses—Transparent Reporting of Cluster Analyses.

Following the recommended steps for developing reporting guidelines outlined by the Enhancing the QUAlity and Transparency Of health Research Network, the work will be divided into six stages. Stage 1: literature review to guide development of initial checklist. Stage 2: drafting of the initial checklist. Stage 3: internal revision of checklist. Stage 4: Delphi study in a global sample of researchers from varying fields (n=) to derive consensus regarding items in the checklist and piloting of the checklist. Stage 5: consensus meeting to consolidate checklist. Stage 6: production of statement paper and explanation and elaboration paper. Stage 7: dissemination via journals, conferences, social media and a dedicated web platform.

Due to local regulations, the planned study is exempt from the requirement of ethical review. The findings will be disseminated through peer-reviewed publications. The checklist with explanations will also be made available freely on a dedicated web platform (troca-statement.org) and in a repository.

To seek consensus among global experts on concepts, measures and approaches to guide national and global action to address HIV-related stigma and formulate a call to action. This outlines priorities to unite actors in more effectively responding to and resourcing efforts to address HIV-related stigma.

An adapted Delphi consensus-building process using two rounds of online questionnaires.

Online questionnaires sent to a global expert panel.

50 global experts on HIV-related stigma and discrimination representing sectors including civil society, people living with HIV and key populations, research and academia, clinical practice, law, non-profit organisations, the United Nations, and policy and donor organisations.

The panel reached consensus on 55 points relating to the 12 broad themes extracted from the evidence base. These comprised the importance of addressing HIV-related stigma at scale; HIV-related stigma terms and definitions; Frameworks; Programming and approaches; Community leadership in HIV-related stigma-reduction implementation; Intersectional stigma and discrimination; Stigma and discrimination measures and assessment scales; Monitoring and evaluation; Stakeholder and community participation in monitoring and evaluation; Knowledge gaps and research needs; Funding and Commitment calls. From these, a consensus statement and call to action were formulated on priorities for strong political and financial commitments by all countries to reduce and mitigate HIV-related stigma and achieve global HIV targets adopted in 2021.

This study illustrated that global experts across sectors consider that action is needed to support the three critical enablers of the HIV response—society, systems and services—to ensure that HIV services are non-discriminatory and person-centred. The importance of attention and action to reduce stigma is critical in the current geopolitical and funding crisis affecting HIV and global health.

To investigate the association between self-stigma evaluated using the Japanese version of the Self-Stigma Scale (SSS-J) and diabetic complications, such as diabetic retinopathy (DR) and diabetic kidney disease (DKD).

Cross-sectional study.

One university hospital and one clinic in Fukuoka, Japan.

People (age ≥20 years) with type 2 diabetes receiving outpatient care, who were treated by diabetologists, and completed the SSS-J questionnaire (n=259).

The primary outcome was the level of self-stigma assessed using the SSS-J. The presence of DR and DKD was evaluated as secondary outcomes.

A positive correlation was found between self-stigma and glycated haemoglobin (HbA1c) levels (r=0.132, p=0.034). The mean SSS-J score was significantly higher in people with type 2 diabetes who had DR than in those without DR (p=0.006). There was no significant difference in the mean SSS-J scores of the patients with albuminuria (p=0.318) or a decreased kidney function (p=0.887). Additionally, the relative risk for the presence of DR, as assessed by quartiles of SSS-J scores and a logistic regression analysis, was significantly increased in the Q4 group with the highest SSS-J score after adjustment for sex, age and HbA1c (OR=3.91, 95% CI 1.49 to 10.3, p=0.006). The relative risk for the presence of albuminuria as a DKD significantly increased in the Q4 group immediately after adjustment for sex and age (OR=2.45, 95% CI 1.04 to 5.81, p=0.042). However, this association was attenuated and became non-significant after additional adjustment for HbA1c levels. In contrast, no significant association was observed between the SSS-J score quartiles and decreased kidney function.

The presence of DR was more strongly associated with self-stigma than DKD. Although the causality between self-stigma and the presence of DR could not be elucidated due to the cross-sectional nature of the study, the present study suggests that addressing self-stigma may aid in glycaemic management and the prevention of DR, emphasising the need for healthcare providers to recognise self-stigma as a barrier to optimal diabetes care.

Sympathetic crashing acute pulmonary oedema (SCAPE) is a menacing medical emergency and a severe form of acute heart failure that requires urgent intervention. Nitroglycerin (NTG) is commonly used in SCAPE management, but the optimal dosing remains uncertain. This meta-analysis compared the efficacy and safety of high-dose vs low-dose NTG in SCAPE patients, assessing mechanical ventilation need, symptom resolution, hospital stay and major adverse cardiovascular events (MACE).

Systematic review and meta-analysis conducted per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, registered in Prospective Register of Systematic Reviews (CRD42024527486).

A comprehensive search in PubMed, Europe PMC and ScienceDirect up to November 2024. Reference lists of included studies were also reviewed.

Randomised controlled trials (RCTs) and observational studies comparing high-dose NTG (≥100 mcg/min) with low-dose NTG (

Two authors independently screened the titles and abstracts of identified studies for eligibility. Full texts of potentially relevant articles were then reviewed. Any discordance or disagreements were resolved through discussion, with final decisions made by consensus. Risk of bias was assessed using the Newcastle–Ottawa Scale. Meta-analysis was performed using STATA 17.0 and Review Manager 5.4. The Mantel–Haenszel method was applied for dichotomous outcomes, and the inverse variance approach for continuous outcomes. Heterogeneity was assessed via I-squared (I)², with a random-effects model applied when needed.

Four studies (one RCT, three observational) with 185 SCAPE patients met inclusion criteria. High-dose NTG reduced mechanical ventilation need (RR=0.31, 95% CI: 0.10 to 0.96; p=0.04, I²=0%, high certainty) and increased symptom resolution within 6 hours (RR=3.88, 95% CI: 1.95 to 7.71; p2=27%, moderate certainty). Hospital stay was shorter (MD=–47.49 hours, 95% CI: –93.76 to –1.21; p=0.04, I²=78%, low certainty). No significant difference was found in MACE risk (RR=0.41, 95% CI: 0.06 to 2.68; p=0.35, I²=72%, very low certainty). Hypotension incidence was 0% in both groups.

High-dose NTG improved clinical outcomes in SCAPE, reducing mechanical ventilation need, symptom duration and hospital stay without increased adverse events. These findings suggest high-dose NTG as a promising treatment strategy. Further large-scale studies are needed to optimise dosing protocols.

This study aimed to explore the experience of online sexual abuse among school-going Bangladeshi youth.

A convergent parallel mixed-method study. The quantitative strand employed a self-administered questionnaire survey conducted in classroom settings, while the qualitative strand used in-depth interviews guided by semistructured protocols. Data from both strands were analysed separately and then merged.

Grade 9–10 students from four randomly selected schools in both an urban and a rural area of Bangladesh participated in the study. A total of 456 students participated in the quantitative survey, and 16 were subsequently interviewed for qualitative data.

The frequency of online sexual abuse along with its contributing factors and patterns, including victim’s characteristics, perpetrator’s identity, potential avenue of abuse, knowledge and psychosocial consequences.

About 88% of the participants reported using the Internet, and nearly 53% reported being victims of online sexual abuse at some point in their lives. The occurrence of common sexual abuses included online grooming (53%), cyberflashing (38%), sexting (35%), sexual solicitation (18%) and sextortion (12%) among Internet users. The odds of being sexually abused online were higher among urban children (OR=2.04, 95% CI 1.21–3.45), who spent more hours daily on the Internet (OR=1.09, 95% CI 1.01–1.18), who visited more social media (OR=1.42, 95% CI 1.27–1.59) and who used more Internet devices (OR=1.93, 95% CI 1.25–2.98). Many participants were aware of these incidents but did not know how to respond to online sexual abuse. Social media, chat groups and video games were described as primary avenues for abuse, while unemployed male young adults and partners in love affairs were identified as the possible perpetrators. Psychosocial consequences such as anxiety, depression, helplessness, stress, distrust, lack of concentration, social isolation, self-hate and suicidal attempts were reported by the victims. Encountering online sexual abuse also manifested in academic underperformance.

Urgent multisectoral measures are needed to address online sexual abuse to safeguard children’s right to be protected on online platforms.

To examine how relationships between physicians, pharmacists and patients associate with generic drug (GE) utilisation in Japan’s healthcare system.

Observational study using longitudinal medical claims from April 2015 to March 2021.

Pharmacies across Japan serving beneficiaries of the National Health Insurance Association.

69 395 pharmacies, resulting in 322 097 pharmacy-year observations.

Quantity share of GEs dispensed by pharmacies.

Higher hospital prescription concentration was consistently associated with increased GE usage (1.1–2.3 percentage points higher for moderate to very high concentrations compared with low). The relationship between patient prescription concentration and GE usage varied, showing a positive association (0.3–0.6 percentage points higher) overall, but negative in settings with low hospital concentration. Smaller pharmacies exhibited a stronger positive association between hospital concentration and GE usage, while larger pharmacies and those in less urbanised areas showed a stronger positive association between patient concentration and GE usage.

This study reveals that pharmacy-stakeholder relationships significantly influence GE utilisation in Japan’s healthcare system. Our findings demonstrate that hospital-pharmacy relationships consistently drive generic usage, while patient-pharmacy relationships show contextual effectiveness. By measuring these relationships through concentration rates, we provide evidence that stakeholder interactions may affect medication dispensing decisions. These findings suggest that policies promoting GEs may benefit from considering the specific characteristics of pharmacies and their existing relationships with hospitals and patients. These insights can inform more effective policy design for GE promotion across different healthcare contexts.

This study aimed to evaluate survival outcomes and identify key mortality predictors among patients with breast cancer in Ethiopia.

A systematic review and meta-analysis.

The study used 11 primary studies, involving a total of 4131 participants.

We searched PubMed, Embase, Web of Science, Scopus and Google Scholar until 7 March 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

All observational studies that had reported the survival status and/or at least one predictor of mortality of women patients with breast cancer were considered.

Three independent reviewers (HA, HKN and DGA) used a structured data extraction form to extract the data. To compute the pooled survival and mortality rates, the survival rates at different observation periods and the mortality rates reported in the included studies were extracted.

Eleven studies were analysed. All studies were of good quality based on Newcastle-Ottawa Scale. However, heterogeneity was high (I² = 98.2%, p=0.00). Funnel plots showed significant publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations assessment indicated moderate certainty for mortality rates and predictors, limited by heterogeneity and regional data gaps. The pooled mortality rate was 36% (95% CI: 25% to 46%). The survival rates at 1, 3 and 5 years were 85% (95% CI: 75% to 96%), 66% (95% CI: 48% to 84%) and 22% (95% CI: 1% to 43%), respectively. Key mortality predictors included advanced clinical stage (Adjusted Hazard Ratio (AHR): 4.14; CI: 2.53 to 6.78), rural residence (AHR: 1.65; 95% CI: 1.27 to 2.14), positive lymph node status (AHR: 2.85; 95% CI: 1.50 to 5.44), no hormonal therapy (AHR: 2.02; 95% CI: 1.59 to 2.56), histologic grade III (AHR: 1.76; 95% CI: 1.29 to 2.41), hormone receptor negativity (AHR: 1.54; 95% CI: 1.05 to 2.25) and comorbidities (AHR: 2.24; 95% CI: 1.41 to 3.56).

Breast cancer in Ethiopia poses a high mortality rate primarily due to late-stage diagnosis, rural residency, histologic grade III, positive lymph node status and comorbidities. To improve survival outcomes, it is crucial to expand access to early screening, particularly in rural areas, implement comprehensive treatment protocols and strengthen healthcare infrastructure to address these critical factors.

CRD42024575074.

Effective management of type 2 diabetes mellitus (T2DM) consists of lifestyle modification and therapy optimisation. While glycaemic monitoring can be used as a tool to guide these changes, this can be challenging with self-monitoring of blood glucose (SMBG). The FreeStyle Libre 3 (FSL3) is a real-time continuous glucose monitoring (CGM) system designed to replace SMBG. The evidence for the benefit of CGM in people with T2DM on non-intensive insulin regimens is limited. This study aims primarily to assess the glycaemic impact of FSL3 in people with suboptimally controlled T2DM treated with basal-only insulin regimens plus sodium-glucose cotransporter-2 (SGLT-2) inhibitor and/or glucagon-like peptide (GLP)-1 agonist.

This is an open-label, multicentre, parallel design, randomised (2:1) controlled trial. Recruitment has been offered across 24 clinical centres in the UK and nationally through self-referral. Adults with T2DM treated with basal-only insulin regimens plus SGLT-2 inhibitor and/or GLP-1 agonist and with screening HbA1c from ≥59 mmol/mol to ≤97 mmol/mol are included. Eligible participants will be randomised to either FSL3 (intervention) for 32 weeks or continuation of SMBG (control). The study is split into two phases, each of 16 weeks duration: phase 1 consisting of self-management with basal-insulin self-titration and phase 2 where additional therapies may be initiated. Control group participants may subsequently enter an optional extension phase to receive FSL3. The primary endpoint is the difference between treatment groups in mean change from baseline in HbA1c at 16 weeks. Secondary outcomes include HbA1c at 32 weeks, CGM-based metrics, therapy changes, physical activity levels and psychosocial measures. An economic evaluation for costs and patient outcomes will be undertaken.

The study was approved by the Health Research Authority, Health and Care Research Wales and the West Midlands-Edgbaston Research Ethics Committee (reference: 23/WM/0092). Study results will be disseminated in peer-reviewed journals.

NCT05944432.

Identifier assigned by the sponsor: ADC-UK-PMS-22057.

Revision D. Dated, 13 December 2024.