What is known? Hip fractures are debilitating osteoporotic fractures that are increasingly pervasive in our aging population. SES has an overarching influence on health outcomes and well-being, having already been proven in other morbid diseases. What is new? Overall, this study demonstrates that hip fracture patients experience poorer perioperative quality of life at different time points based on SES, though both groups recuperate to attain comparable outcomes by 1 year. What is the impact? Our findings suggest that hip fracture prevention should be emphasised across all socioeconomic strata. Health policies and coverage should be re-examined in the aging population, especially the need for mental health support during immediate recovery.

Hip fractures are increasingly prevalent in our fast-aging population, but effects of socioeconomic status (SES) on these patients' perioperative wellbeing are not well understood. This study aims to investigate the effect of SES, represented by hospital ward class, on perioperative function and health-related quality of life (HRQoL) in hip fracture patients.

Four hundred forty-five hip fracture patients were prospectively followed up and categorised into private (PTE) and government-subsidised (SUB) ward classes as a surrogate for SES. Patients were evaluated using Parker Mobility Score (PMS), EuroQol-5 Dimensions (EQ-5D) and Short Form-36 (SF-36; including Physical Function [PF] and Mental Health [MH]) scores premorbidly, and postoperatively at 3 months, 6 months and 1 year.

Group PTE scored significantly higher in PMS across all time points and in PF at 6 months (42.5 ± 27.3 vs 35.0 ± 29.1, p = 0.033) postoperatively. Group PTE also had superior EQ-5D scores at 3 (0.620 ± 0.282 vs 0.497 ± 0.325, p = 0.002) and 6 months (0.715 ± 0.268 vs 0.576 ± 0.334, p = 0.001) postoperatively. Group PTE had higher MH scores at 3 months (85.9 ± 15.0 vs 80.9 ± 18.1, p = 0.014) postoperatively, though its scores continued to decline by 6 months. Changes over time in EQ-5D scores favoured Group PTE (p = 0.016). Both groups had an overall decline at 3 months before gradually returning towards baseline at 1 year.

This study highlights SES-based disparities in hip fracture patients perioperatively, though both groups converge to comparable outcomes by 1 year. Health policies should consider MH support during recovery for all, regardless of SES.

HIV in the United States disproportionately affects Black sexual minority men (BSMM), including disparities in HIV care engagement and outcomes. During public health emergencies, such as the COVID-19 pandemic, marginalized populations such as BSMM may face additional barriers to HIV care engagement.

We examined associations between HIV care engagement (current antiretroviral therapy use, healthcare visits for HIV, viral load testing, viral load suppression) and experiencing COVID-19-related disruptions to HIV care in a sample of BSMM living with HIV in 2022 (n = 172). We then examined correlates of having experienced a COVID-19-related disruption to HIV care, spanning multiple variable groups: socioeconomic, substance use, mental health, social and structural, and strength and resilience.

Social and structural variables, including transportation, intimate partner violence victimization, and experiences of discrimination showed the strongest associations with experiencing a COVID-19-related disruption to HIV care, followed closely by internalized HIV stigma, and strengths and resilience (treatment adherence self-efficacy, HIV social support). Socioeconomic variables and substance use variables, overall, had less robust associations with COVID-19-related care disruptions than these other variable groups.

Lived experiences and resources that reflect social marginalization are associated with disruptions to HIV care during a period of intense social and economic upheaval. These findings point to important areas for future research, as well as considerations for building more robust, adaptable, accessible, and holistic HIV care systems that promote greater engagement and improved outcomes both during times of relative stability as well as during periods of significant upheaval.

LGBTQ+ youth experience inequitably high risk for bullying, sexual violence (SV), and dating violence (DV), disproportionately disrupting their social, educational, financial, and health opportunities. LGBTQ+ youth may even be targeted for distinct forms of violence based on their LGBTQ+ identity (e.g., unwanted sexual contact to "prove" one's gender or sexual orientation), yet little is known from population-based studies. This study provides prevalences for a range of ways LGBTQ+ youth are specifically targeted for bullying, SV, and DV using data from a population-based sample of 9th and 11th grade LGBTQ+ youth from 30 public schools in California (N = 2,284) in 2021-2022. Generalized estimating equations with robust standard errors were used to estimate the association between LGBTQ+ youths' experiences of LGBTQ+-targeted violence and mental health, academic performance, and school connection. Results indicate that these forms of violence are prevalent, especially among transgender boys and nonbinary youth, and are associated with significantly higher risk for depressive symptoms, suicidality, school absenteeism, worse academic grades, lower school connection, and lower perceived safety while at school. This evidence calls for continued research to better understand the unique ways LGBTQ+ youth experience SV, DV, and bullying to ensure LGBTQ+ youth have access to a safe and supportive education.

The suffering of nurses involved in adverse events, such as medication errors or patient falls, is a growing concern in occupational health. It affects the availability of resources needed to provide sufficient and high-quality care. Literature identifying nurses as “second victims” of such events—after the patient and their family—makes this suffering more visible. In Quebec, as elsewhere, this suffering manifests on psychological, physical, and emotional levels. Nurses require targeted support and interventions to overcome it, receive care, and continue providing patient care.

A descriptive qualitative study was conducted with nurses and managers in Quebec to identify the resources and support they receive following a serious adverse event.

Individual interviews were carried out with 15 nurses involved in serious adverse events and 11 managers involved in event management. The interviews focused on the resources available in the workplace to support affected nurses.

Our findings indicate that resources and support are almost non-existent, and that the subject is completely ignored in risk management policies and protocols. Nonetheless, recognizing the importance of supporting nurses, hospital managers often act informally to provide assistance.

Given the urgency of addressing this issue and the lack of formal resources in health care institutions, we propose interventions aligned with the lived experiences of nurses, particularly targeting the mental and emotional suffering generated by adverse events and their management.

Traumatic brain injury (TBI), a leading cause of global morbidity and mortality, has notably poorer outcomes in resource-poor settings. Managing TBI effectively requires functional integration of several interdependent phases of care which, in resource-poor settings, may be both individually fragile and poorly coordinated. However, there is a paucity of global data quantifying systemic deficiencies in TBI care across varying resource settings which hinders targeted improvement. To address this, we present an analysis of site surveys from centres contributing to the Global Neurotrauma Outcomes Study, to illustrate the global variation in health system performance with respect to TBI management.

The GNOS was a prospective, international, multicentre cohort study conducted between 1 November 2018 and 31 January 2020 across 159 centres that perform emergency surgery for TBI. Participating centres completed a 50-point site survey, assessing local resource availability and guideline usage across the TBI care pathway, including prehospital, intraoperative and rehabilitative care. Responses were stratified by each country's Human Development Index (HDI).

The site survey was completed by 153/159 (96%) centres. Variation in resource availability across HDI strata was least prevalent within operating theatres, whereas the biggest disparities were observed in prehospital and rehabilitation care. Resource-poor settings reported deficiencies in both the capital resources and skilled human resources needed to deliver TBI care. Overall, participants most commonly suggested that improvements in prehospital care would have the greatest impact on patient outcomes in TBI (53/153, 35%), although participants from the more resource-poor settings more commonly suggested improvements in intensive care management (6/14, 43%).

There are profound HDI-associated disparities in the resources for TBI care, which likely account for the global variation in patient mortality. Our study suggests improving the provision of non-operative interventions within TBI care pathways may offer the most successful approach to improve patient outcomes.

NCT04212754.

To further understand young people's perceptions of using online arts and culture and how it impacts on mental health.

This qualitative study was embedded in a proof-of-principle randomised controlled trial (RCT) comparing the effectiveness of two different online arts and culture experiences on mental health in young people (aged 16-24 years). The RCT compared the Ashmolean website (Ash) a generic museum website and Ways of Being (WoB), a codesigned stories based web experience. Three sources of data were analysed; focus group transcripts, free text responses and viewpoints. We adopted an interpretive phenomenological approach allowing deductive and inductive hybrid thematic analysis to gain critical insight into how young people make sense of phenomena relating to mental health in a complex context within a critical realist paradigm.

In total, 117 free text responses relevant to the interventions were received. The first focus group was attended by seven Ash participants and the second by six WoB participants. A total of 108 separate viewpoints were entered. The main themes identified across sources were of human connection, the content and journey of the online experience, the features, setting and when it was used, positive mental health impacts and neutral/negative effects. Positive mental health impacts were often described in association with human connection in WoB participants. Neutral and negative effects were more commonly described in participants allocated to Ash.

Continued development of online arts and culture for diverse populations using participatory and mixed methods to identify potential mechanisms are promising future areas of mental health research.

NCT04663594; Results.

Suicidal ideation is common in young people and increases the risk of suicide. Effective interventions that are relevant and accessible to young people, so-called digital natives, are urgently required. There are key questions regarding the cross-cultural efficacy of suicide prevention applications (apps) for scalability.

This online four-arm parallel randomised controlled superiority trial will enrol 1480 young people aged 16-24 years with current suicidal ideation in New Zealand and Australia. Participants will be randomised to one of three therapeutic apps developed in different countries, Tune In, Bro and LifeBuoy, or to My Mood (attention control). The primary outcome is suicidal ideation severity at 30-day and 90-day post-baseline; secondary outcomes include mental well-being, engagement and acceptability. Emotional regulation will be examined as a mediator of change in suicidal ideation. All outcomes are measured by self-reported scales incorporated in an online questionnaire. Acceptability of the apps for rangatahi Māori (Indigenous youth, New Zealand) will be explored via semi-structured interviews. Linear mixed models with repeated measures analyses, using maximum likelihood estimation, an appropriate covariance structure and consideration of site effects, will be undertaken. Examination of an individual app intervention effects in New Zealand and Australia will highlight the effects of apps developed for a different country.

Approval was obtained (26 February 2025) from the Health and Disability Ethics Committees (Ministry of Health ref 2025 EXP 21500). Participants provide informed consent online. Trial results will be submitted for publication in peer-reviewed journals, shared on relevant websites and via presentation at international scientific conferences; Individial Patient Data will only be shared if requested and subsequent to review.

ACTRN12625000349448.

Adolescence is a critical period marked by physiological and psychological changes that influence long-term health. Establishing healthy behaviours, particularly regular physical activity, is essential during this stage; however, around 80% of young people do not meet the WHO's physical activity recommendations. Digital technologies offer promising opportunities to promote health among youth, yet most physical activity mobile applications (apps) lack scientific validation and usability. Unlike psychology, which has validated repositories to guide users in selecting mental health apps, physical activity lacks validated repository platforms, especially for adolescents. The project has a twofold aim: (1) to co-design a website, named the TeenFit website, that facilitates the selection of physical activity apps tailored to each adolescent's individual needs and preferences and (2) to investigate the barriers and facilitators for the implementation of the TeenFit website in real-world settings.

Adolescents and other stakeholders (ie, caregivers, educators, and health professionals) will be engaged in the development of the TeenFit website app finder through a participatory design approach that involves three workshops, encompassing both a development phase and an implementation phase. Approximately 10-12 participants per group will take part in smaller working groups to collaboratively contribute to the co-design of the TeenFit website. TeenFit will include physical activity apps available in the Spanish market, developed in both English and Spanish. These applications are currently being identified through two ongoing systematic reviews. In addition to qualitative data gathered during the audio- and video-recorded workshops, quantitative data will be collected on participants' co-design experiences and the acceptability of the TeenFit website. Data analysis will involve descriptive statistics, qualitative content analysis for describing participants' perspectives on what aspects (ie, content, features and layout) are important for the design of the website and reflexive thematic analysis to identify barriers and facilitators to implementation.

The study was approved by the Research Ethics Committee in the province of Málaga (Spain) (REC ref: SICEIA-2024-003172). Research findings will be disseminated primarily via national and international conferences and publication in peer-reviewed journals. Patient and public involvement will inform further dissemination activities.

This trial aims to evaluate the impact of the IMPROVA intervention programme in improving mental health, quality of life, and well-being in adolescents enrolled in secondary schools in four European countries.

The IMPROVA intervention will be evaluated using a two-arm parallel group pragmatic cluster randomised controlled trial with an intervention and a wait-list control group. Secondary schools in France, Germany, Romania, and Spain were recruited. Originally, we estimated to enrol a total of 6000 students within 64 schools; that is, 16 schools per country. The IMPROVA programme is a multi-level intervention that provides tailored content for adolescents, families, and school staff. This content creates a unified and supportive framework that promotes mental health and social-emotional development among adolescents. A series of implementation strategies was planned to support the uptake of the programme into the education setting and among participants. Study outcomes were assessed at baseline, mid-term (during the intervention), postintervention (primary end point), and will be assessed at postintervention (secondary end-point; 6 months after postintervention). Overall mental health (Strengths and Difficulties Questionnaire) is the primary outcome. Secondary outcomes include: health-related quality of life, depression, anxiety, social isolation, and self-esteem. The trial will be evaluated regarding its effectiveness, cost-effectiveness, implementation, and social return on investment analysis.

This study has received the approval of human research ethics committees in France (Comité de Protection des Personnes Ile-de-France VIII", No. 2024-A00201-46), Germany (Ulm University Ethics Committee, No. 186-24), Romania (The Research Ethics Subcommittee of the Babeș-Bolyai University of Cluj-Napoca, No. 14.146/23.09.2024), and Spain (CEIm Fundació Sant Joan de Déu, No. PIC-61-24). Results will be disseminated through peer-reviewed open-access publications and presentations at national and international conferences. Non-technical summaries will be shared with public health authorities, participants, and stakeholder organisations. All findings will be reported in aggregate form, ensuring no individual participant can be identified.

NCT06556576.

Dysarthria secondary to acquired brain injury (ABI) is a motor speech disorder characterised by impaired coordination of the respiratory, phonatory and articulatory subsystems, with a negative impact on communication and quality of life. Previous studies have largely examined these components separately, which limits understanding of their functional interactions. An integrated approach combining respiratory and acoustic-articulatory measures may improve the characterisation of dysarthria and support the identification of objective markers of severity. The aim of this study is to jointly analyse respiratory function and speech acoustic parameters in adults with ABI and to examine their association with the presence and severity of dysarthria.

A cross-sectional observational study will be conducted in adults with a confirmed diagnosis of ABI, both with and without dysarthria, with an estimated sample size of 97-101 participants. The protocol will include collection of sociodemographic and clinical data, cognitive assessment using the Mini-Mental State Examination, swallowing assessment using the Eating Assessment Tool-10, acoustic and aerodynamic analyses following standardised procedures, respiratory function assessment using spirometry and perceptual evaluation of dysarthria using the Frenchay Dysarthria Assessment-2. Between-group comparisons and multivariate analyses will be performed to examine associations between respiratory, acoustic, aerodynamic and dysarthria severity measures.

The study has been approved by the Ethics Committee for Research with Medicines of the Salamanca Health Area (CEIm PI 2025 04 1897-TD) and will be conducted in accordance with the Declaration of Helsinki. Written informed consent must be provided by all participants prior to inclusion. Findings will be disseminated at scientific conferences and in peer-reviewed journals. Anonymised data will be made available following publication of the main results, in compliance with data protection regulations.

NCT07435155.