Persisting disparities in the control of chronic diseases are linked to several barriers to health prevention, including cultural norms, insufficient attention to health education, lack of access to physical activity, large serving portions, and excess added sodium and sugar by the food industry and restaurants [1]. In line with lifestyle modifications proposed for several decades [2, 3, 4, 5], the goal of this study is to develop and evaluate the efficacy of a Lifestyle Immersion intervention for chronic disease control. The study will be conducted in two settings, the community and the health facility, thus addressing the individual, interpersonal, and organizational levels. This study introduces the team concept in health behavior modification. It will compare the effectiveness of interventions among participants in the study's intervention arm (Team Arm) and the control group (Individual Arm). Participants will undergo a 6 month intervention adapted from the Centers for Disease Control and Prevention and the American Heart Association's recommendations for blood pressure control and cardiovascular health. Participants will receive education to increase relevant knowledge and training to develop the necessary skills, in addition to strategies for successfully adhering to LS7 and the DASH [6]. The primary study outcomes are systolic and diastolic blood pressure changes measured at enrollment and follow-up at 6 and 12 months. The secondary outcome measures include LS7 and DASH adherence scores at 6 and 12 months, as well as other pre-specified outcomes such as A1c, which assesses nutritional status at 6 and 12 months. The evidence for the effectiveness of lifestyle modification and the primary outcome of the study is controlling blood pressure through lifestyle modifications and promoting optimal health, particularly concerning African American populations [3, 10].

Older patients with cardiovascular disease face a high burden of thromboembolic disease but are often underrepresented in clinical trials. Biological aging increases both thrombotic and bleeding risk. Individualized strategies, such as risk scores, procedural choices, medication selection, and improvements in medication adherence are essential across conditions like acute coronary syndrome, atrial fibrillation, and venous thromboembolism. Direct oral anticoagulants are generally safer than vitamin K antagonists but require dose adjustment in older adults. When bleeding occurs, prompt management and carefully timed anticoagulation resumption are critical. A balanced, patient-centered approach remains key to optimizing outcomes in this complex, high-risk population.

Hypertensive disorders in pregnancy are significant contributors to maternal and perinatal morbidity and mortality. They include chronic hypertension, gestational hypertension and pre-eclampsia. Definitive management of these disorders is planned early birth. The alternative is expectant management with close monitoring, if severe complications are not present. There are benefits and risks associated with both policies, so it is important to establish the safest option.

To assess the benefits and risks of planned early birth versus expectant management in pregnant women with hypertensive disorders, from 34 weeks' gestation onwards.

An Information Specialist within the Cochrane Central Executive Team searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov and WHO ICTRP. The searches were run from 1 January 2016 to 16 January 2026 with no language restrictions. Reference lists of retrieved studies were also searched.

We included randomised controlled trials comparing planned early birth (by induction of labour or by caesarean section) with expectant management for women with hypertensive disorders from 34 weeks' gestation. Cluster-randomised trials would have been eligible for inclusion in this review, but we found none. Studies using a quasi-randomised design were not eligible for inclusion in this review. Studies using a cross-over design were not eligible for inclusion, because they are not a suitable study design for investigating hypertensive disorders in pregnancy.

The prespecified critical outcomes (based upon a core outcome set agreed via Delphi consensus) were (1) a composite outcome of maternal mortality and morbidity; (2) a composite outcome of perinatal mortality and morbidity; (3) maternal death; (4) fetal death; (5) neonatal death. The prespecified important maternal outcomes were: caesarean section, maternal admission to a high dependency unit, eclampsia, pulmonary oedema, severe renal impairment, and HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. The prespecified important perinatal outcome was neonatal unit admission. Additional maternal and perinatal outcomes were also analysed in accordance with the review protocol, including maternal quality of life measures and health resource use.

Two review authors independently assessed risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. The Cochrane trustworthiness screening tool was applied to all eligible studies at full-text review stage.

Two review authors independently assessed eligibility and risk of bias. Two review authors independently extracted data using a prespecified data extraction form. Data were checked for accuracy. Statistical analysis was carried out in RevMan using a random-effects meta-analysis. We assessed the certainty of evidence using GRADE.

We included six studies involving 3491 women. All six studies were randomised controlled trials evaluating planned early birth compared to expectant management. Planned early birth was evaluated at between 34 and 37 weeks in four studies, between 36 and 38 weeks in one study and between 36 and 41 weeks in one study. One study took place in low- and middle-income countries, whilst five took place in high-income countries. Three studies included only women with pre-eclampsia, two studies included women with a mixture of hypertensive disorders in pregnancy and one study included only women with chronic hypertension.

Planned early birth reduces the risk of maternal mortality and morbidity compared to expectant management (RR 0.54, 95% CI 0.37 to 0.77; I² = 0%; 6 studies, 3491 participants; high-certainty evidence). There was no increased risk of caesarean section associated with planned early birth (RR 0.94, 95% CI 0.83 to 1.06; I² = 25%; 6 studies, 3539 participants; high-certainty evidence). Planned early birth likely results in a large reduction in the risk of stillbirth (fetal death) (RR 0.25, 95% CI 0.07 to 0.87; I² not applicable; 5 studies, 3407 participants; moderate-certainty evidence), but probably results in little to no difference in rates of neonatal unit admission (RR 1.11, 95% CI 0.90 to 1.37; I² = 41%; 6 studies, 3560 participants; moderate-certainty evidence). Planned early birth may result in little to no difference in maternal death (RR 0.33, 95% CI 0.05 to 2.10; I² = 0%; 6 studies, 3491 participants; low-certainty evidence) or neonatal death (RR 1.40, 95% CI 0.45 to 4.35; I² not applicable; 5 studies, 3407 participants; low-certainty evidence). The evidence is very uncertain about the effect of planned early birth on composite perinatal mortality and morbidity due to high variation between the trials (RR 1.06, 95% CI 0.75 to 1.51; I² = 83%; 6 studies, 3576 participants; very low-certainty evidence). Five of the six trials included in this analysis were at low risk of bias. We graded the evidence as high, moderate, low, or very low certainty based upon GRADE criteria. Where we downgraded the evidence, it was typically due to higher levels of heterogeneity or due to imprecision, whereby the confidence interval crossed the line of both appreciable benefit and harm or the number of events was low.

For women with hypertensive disorders of pregnancy beyond 34 weeks' gestation, planned early birth is associated with a lower risk of maternal complications, and probably a reduced risk of fetal death (stillbirth), with no increased risk of caesarean section and probably no clear differences in the rate of neonatal unit admission or short-term neonatal morbidity. It is important that the timing of delivery takes into account the woman's preferences, the type of hypertensive disorder and the presence or absence of severe features. Further information is needed to establish the longer-term infant outcomes associated with late preterm birth and longer-term maternal cardiovascular health.

This Cochrane review had no dedicated funding.

The original review and review protocol can be accessed via the following links. Protocol (2011): DOI: 10.1002/14651858.CD009273 Original review (2017): DOI: 10.1002/14651858.CD009273.pub2.

Patients with metabolic (dysfunction)-associated fatty liver disease (MAFLD) are frequently multimorbid, putting upward pressure on healthcare costs compared to other liver diseases. As Australian data are limited on expenditures in managing MAFLD, we evaluated hospital-related costs and predictors of costs in patients managed in a dedicated MAFLD clinic.

We conducted a retrospective review of adults attending a MAFLD clinic in Melbourne, Australia between January 2017 and December 2020. A control cohort of chronic hepatitis B (CHB) patients provided disease context. We analysed direct healthcare utilisation and costs categorised by specialty, hospital setting and fibrosis stage. Multivariate Poisson regression identified independent predictors of increased healthcare utilisation. Multivariate linear regression analysis identified independent predictors of healthcare cost.

A total of 310 MAFLD and 261 CHB patients were followed up over a median 1.93 vs 4.06 years (P < 0.001). Advanced fibrosis/cirrhosis (F3-4) represented 26% MAFLD patients and 9% CHB patients accounting for 54.9% and 18.2% total expenditure respectively. Inpatient utility was greater in MAFLD compared to CHB (6.1% vs 0.4%, P < 0.001), as was proportion of hospitalisation costs (48.3% vs 0.8%, P < 0.001). Independent predictors of cost in MAFLD were obstructive sleep apnea (P < 0.01), cardiovascular disease (P = 0.04) and F3-4 (P < 0.001), which also predicted liver-related outpatient appointments and radiology (P < 0.001 for both).

The greatest healthcare-related costs for MAFLD clinic patients are incurred through hospitalisation, with F3-4 predicting a disproportionately high economic burden. Our findings demonstrate the association between metabolic comorbidities and liver disease progression in MAFLD, highlighting a research gap of integrated care provision to optimise resource allocation.

Perinatal mood and anxiety disorders (PMADs) are a serious concern in the United States, as indicated by the high rate of pregnancy-related deaths due to mental health causes. Doulas, trained birth companions, are a potential and promising intervention for preventing, identifying, and responding to PMADs.

This research explored the role of doula support for preventing and mitigating the negative impacts of PMADs.

Qualitative semistructured interviews were conducted with 33 participants in Montana. Participants included doulas, perinatal people with lived PMAD experience, and maternal and mental health providers.

The results demonstrated how the support provided by doulas is advantageous for perinatal people's mental health and that doulas are well-positioned to identify PMADs and connect people to the needed care. These findings indicated that doulas are a trusted source of support for people who give birth and experience poor mental health. Moreover, in providing continuous, at-home care for perinatal people, doulas are well-positioned to fill gaps in the current maternity care, especially surrounding the postpartum period.

Implications of this study include the need to support a growing and equitable doula workforce and improve access to PMAD-specific training and resources.

Executive functioning challenges, including difficulties with flexible thinking, goal setting and planning, are common among neurodivergent children, especially those identified with autism and/or attention-deficit/hyperactivity disorder. Executive functioning problems are linked to poorer academic achievement and are exacerbated by poverty. Importantly, executive functioning is responsive to intervention.

This pragmatic study compared the effectiveness of two school-based executive functioning interventions for children with autism and/or attention-deficit/hyperactivity disorder in Title 1 (low-income-serving) school settings to improve accessibility of effective interventions.

148 children (82% male) in 3rd-5th grades were cluster-randomized by school (N = 24) to receive Unstuck and On Target (Unstuck), a cognitive-behavioral program, or Parents and Teachers Supporting Students, a behavior-management program considered best practice for children with attention-deficit/hyperactivity disorder. Both programs targeted executive functioning, were matched for dosage, and were delivered in small groups by school staff, with parent and teacher training to support generalization. The sample (attention-deficit/hyperactivity disorder N = 98; autism N = 50) was ethnically and socioeconomically diverse. The primary outcome was executive functioning behaviors assessed through masked classroom observations. Secondary outcomes were masked executive functioning tasks, and a parent report measure. Treatment fidelity, acceptability, potential moderation of family income, age, and cognitive functioning were assessed.

Both interventions were implemented with high fidelity and were well-liked by children and parents, with Unstuck receiving higher acceptability ratings. Child executive functioning improved across both interventions and on all outcomes. There was limited moderation by income, and outcomes improved following intervention, even after accounting for income.

School staff can effectively deliver both Unstuck and Parents and Teachers Supporting Students in low-income community schools to improve executive functioning. These accessible, low-cost options address income-based health disparities by providing an alternative to clinic-based care. The interventions show promise for broader applications in schools.

Community Based Intervention for Children with ADHD and ASD; clinicaltrials.gov (NCT03003286) 9/13/2014.

Beyond longer diabetes duration, uncertainty remains regarding the factors that contribute to a higher risk of developing complications in younger vs older people with type 2 diabetes. We investigated whether younger age was associated with a more adverse risk-factor profile compared with older age among people with type 2 diabetes.

We conducted cross-sectional analyses of demographic and clinical data from individuals with type 2 diabetes participating in national health surveys from four countries: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), the US National Health and Nutrition Examination Survey (NHANES), the Mauritius Non-Communicable Diseases Survey (Mauritius Survey), and the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Type 2 diabetes was defined according to each study's criteria, including previously diagnosed and newly diagnosed (screen-detected) diabetes (NDM). Individuals with normal glucose tolerance (NGT) were included for comparison. Regression analyses with natural splines assessed association between age at survey and cardiometabolic risk factors in each cohort.

There were 903 participants with type 2 diabetes from AusDiab, 7086 from NHANES, 2682 from the Mauritius Survey and 10,151 from ICMR-INDIAB. In three of the four studies (excluding ICMR-INDIAB), BMI decreased with increasing age. Younger individuals had higher low-density lipoprotein cholesterol (in NHANES and AusDiab) and lower high-density lipoprotein cholesterol (in all studies except ICMR-INDIAB) compared with older individuals. In AusDiab, NHANES and the Mauritius Survey, triglycerides were highest in younger adults, declining with age. In AusDiab, the Mauritius Survey and ICMR-INDIAB, fasting plasma glucose (FPG) increased with age until 45-55 years, after which it declined. In NHANES, younger individuals with diabetes had higher FPG than older individuals. In all four studies, haemoglobin A_1c (HbA_1c) increased with age, peaking around 50-60 years, before declining. In NDM, 2 h plasma glucose did not vary across age. Systolic blood pressure (SBP) and urinary albumin/creatinine ratio (UACR) were higher in older individuals. Comparing diabetes with NGT, differences in FPG, HbA_1c, triglycerides and diastolic blood pressure (DBP) were greater at younger than older ages in most cohorts. The same was observed for BMI and SBP, but only in two studies (AusDiab and NHANES).

Younger individuals with type 2 diabetes have higher BMI and triglycerides (observed in three out of four studies) but lower SBP and UACR than older individuals with type 2 diabetes. FPG and HbA_1c peak in middle age. Differences relative to individuals without diabetes were more pronounced at younger than older ages for FPG, HbA_1c, triglycerides and DBP, and were possibly greater for BMI and SBP. These age-related patterns likely influence the overall risk of diabetes-related complications.

Surveys of healthcare infrastructure for inborn errors of immunity across the Asia-Pacific region reveal significant diagnostic and therapeutic disparities. These data provide a framework for regional policy improvements and highlight the need for equitable resource distribution.

Health policies and public services are increasingly expected to be evidence-based, equitable and accountable at the population level. Yet the forms of evidence most commonly prioritised in policy-making often fall short of capturing how health risks, services and prevention strategies are experienced and navigated across social groups and communities. This gap contributes to persistent mismatches between policy intent and lived social realities, with tangible consequences for population health outcomes, equity and public trust. Drawing on democratic accounts of policy legitimacy, scholarship on civil society as a knowledge intermediary and emerging regulatory recognition of experiential evidence, we propose Listening-Informed Policies (LIP) as a governance-oriented approach to population health decision-making. We argue that listening constitutes a methodologically grounded epistemic practice oriented toward collective knowledge production. When institutionalised, listening can inform population-level problem definition, policy design, implementation and evaluation, rather than serving merely as a legitimacy-enhancing exercise. Using liver health as an illustrative context, we outline the core principles of LIP and consider their relevance for the prevention of non-communicable diseases. Embedding experiential knowledge alongside biomedical and economic evidence-through organised civil society acting as an institutional intermediary-can strengthen population health governance on three complementary grounds: (i) democratically, by enhancing the legitimacy of decisions through the inclusion of affected populations; (ii) epistemically, by rendering visible social mechanisms and constraints not captured by conventional indicators, and (iii) pragmatically, by improving the alignment between policy design and real-world implementation. LIP integrate these dimensions by positioning listening as a structured form of population-relevant evidence. Public and Patient Contribution: This viewpoint article was developed in collaboration with representatives and stakeholders engaged in the liver disease community, including perspectives emerging from patient advocacy and public engagement initiatives promoted within the European liver health landscape. The reflections presented in this paper were informed by ongoing dialogue with people living with liver conditions, patient advocates, clinicians, and researchers involved in initiatives aimed at strengthening meaningful patient involvement, communication, and advocacy in hepatology. These experiences contributed to shaping the focus and critical reflections discussed throughout the viewpoint.

The inaugural 2025 Cardiometabolic Summit in Saclay, France, aimed to (i) disseminate the latest research on cardiometabolic diseases (CMDs) from the Maghreb and/or Middle East and North Africa region; (ii) discuss CMD management and provide clinical practice suggestions for improving adherence and reducing clinical inertia; and (iii) suggest policy and clinical practice initiatives to improve outcomes in patients with CMDs. Cardiovascular disease (CVD) is the leading cause of death worldwide, with 80% of CVD fatalities occurring in low- and middle-income countries. This trend is mirrored in Algeria, Morocco and Tunisia, three countries in the Maghreb region. In these countries, CMDs, such as type 2 diabetes mellitus (T2DM) and hypertension, have high prevalence and are undertreated. At the Cardiometabolic Summit, attended by 110 clinicians from Algeria, Morocco and Tunisia, regional CMD epidemiology and management data were presented, along with evidence on regional research initiatives to reduce the burden of CMDs and CVD and how Ramadan fasting affects adults with T2DM. Context-specific holistic strategies to improve the management of patients with multimorbidities were reviewed, including targeting modifiable risk factors to prevent T2DM and hypertension. Two barriers to optimal CMD management were addressed: (i) poor patient treatment adherence and (ii) clinician-related therapeutic inertia, noting the latter may be a greater contributor to poor outcomes. Prescription of single-pill combinations was recommended for initial blood pressure control, and a cost-effective sulfonylurea plus a sodium-glucose cotransporter 2 inhibitor or glucagon-like peptide 1 receptor agonist (whenever feasible) was recommended for glycaemic control plus cardiorenal protection. Polypills may be appropriate where intervention for additional CMDs is required. Strategies for enhancing patient adherence and opportunities for reducing therapeutic inertia were presented. Finally, policy actions and clinical practice priorities were suggested. These steps provide a realistic path towards reducing CMD and CVD burden in the Maghreb.