Trials of behavioural interventions aimed at preventing an Alcohol-Exposed Pregnancy (AEP) before conception report variable effectiveness. Understanding which intervention components, such as Behaviour Change Techniques (BCTs), are effective is essential when adapting for real-world implementation. This review describes the intervention models, the BCTs utilised, and the BCT combinations in effective interventions. An earlier systematic review of studies published from 1970 to 2018 was updated using the same search strategy to identify additional articles published subsequently. Searches were conducted on CINAHL, PsycINFO, Embase and PubMed to identify studies published between 2019 and 2025. Eligible study designs were randomised controlled trials (RCTs), non-randomised comparative studies, cohort studies and before-and-after studies. Studies were included if they were in English, included non-pregnant women of reproductive age or their social networks and aimed to prevent AEP. Outcomes reviewed were measures of knowledge of guidelines and attitudes towards alcohol consumption in pregnancy or when planning a pregnancy, changes in alcohol consumption and changes in behaviours to prevent unplanned pregnancies, such as effective contraception use at every sexual encounter that could lead to pregnancy. Narrative synthesis was used to describe intervention models and annotate BCTs guided by the BCT Ontology (BCTO) and alcohol-specific taxonomy. Risk of bias was assessed using the ROB 2 tool and the Modified Downs and Black Checklist. Twenty-five studies, comprising 18 studies from the previous systematic review and seven published between 2019 and 2025, were identified with 6,020 participants. Three intervention models were identified: (i) alcohol-only educational, (ii) alcohol-only screening and brief interventions (SBIs), and (iii) dual-focused (alcohol and contraception) interventions. Models included single- and multiple-session interventions, which were delivered face-to-face, remotely or digitally. Fifty-one BCTs were coded across all studies. Within the alcohol-only SBIs and dual-focused (alcohol and contraception) models, multi-session interventions generally demonstrated greater effects in intervention groups than controls and utilised more BCTs from the goal-directed and monitoring BCTO groups compared to single-session interventions. These findings deepen our understanding of why some interventions are more effective than others and suggest that tailored interactions with certain goal-directed and monitoring BCTs may enhance their effectiveness. Future research can explore greater incorporation of BCT combinations from these groups into single-session interventions and pathways to identify women who need more intense interventions for referral or support.

Introduction Randomised clinical trials (RCTs) are gold standard in evidence-based medicine, but follow-up typically relies on clinic visits and trial-specific data collection. Much of this information overlaps with routinely collected healthcare systems data (HSD), such as electronic health records and national registries. Leveraging HSD for trial follow-up has the potential to reduce cost, time and resource burden. However, concerns remain about data quality and evidence is needed to show that HSD-based outcomes are reported to an equivalent standard to trial-specific data.The Blood Cancer Clinical Trials Long-term Follow-up Using Integrated Healthcare Systems platform will link data collected from multiple myeloma clinical trials with HSD to create a research database supporting extended follow-up and further methodological and clinical research.Methods and analysis This data-linkage study includes participants from multiple myeloma RCTs conducted by the University of Leeds between 2008 and 2021. NHS (National Health Service) England will link these participants to HSD, including deaths and cancer registrations, systemic anticancer therapy, radiotherapy and Hospital Episode Statistics.We will compare trial-collected outcomes with those derived from HSD, including mortality, treatment, second cancer incidence and major adverse events. Long-term overall survival will be estimated using national mortality data. HSD-derived demographic and clinical variables will be used to assess population representativeness relative to the wider myeloma population. Time to next treatment will be derived and evaluated as a surrogate for progression-free survival. HSD-derived frailty measures will be examined for prognostic utility, and radiotherapy and hospital records will be analysed to characterise bone-related treatments and skeletal complications.Ethics and dissemination Ethical approval has been obtained from the East of England–Cambridge Central Research Ethics Committee, with Section 251 support from the Health Research Authority on advice from the Confidentiality Advisory Group. Findings will be disseminated through publications, conference presentations and engagement with stakeholders and patient groups.Trial registration ISRCTN60123120, ISRCTN49407852, ISRCTN90889843, ISRCTN24989786, ISRCTN08577602, ISRCTN17354232,ISRCTN59395590, ISRCTN24593488, ISRCTN58227268, ISRCTN15028850.

Abstract Background Early detection and diagnosis of cancer are vital to improving outcomes for patients. Artificial intelligence (AI) models have shown promise in the early detection and diagnosis of cancer, but there is limited evidence on methods that fully exploit the longitudinal data stored within electronic health records (EHRs). This review aims to summarise methods currently utilised for prediction of cancer from longitudinal data and provides recommendations on how such models should be developed. Methods The review was conducted following PRISMA-ScR guidance. Six databases (MEDLINE, EMBASE, Web of Science, IEEE Xplore, PubMed and SCOPUS) were searched for relevant records published before 2/2/2024. Search terms related to the concepts “artificial intelligence”, “prediction”, “health records”, “longitudinal”, and “cancer”. Data were extracted relating to several areas of the articles: (1) publication details, (2) study characteristics, (3) input data, (4) model characteristics, (4) reproducibility, and (5) quality assessment using the PROBAST tool. Models were evaluated against a framework for terminology relating to reporting of cancer detection and risk prediction models. Results Of 653 records screened, 33 were included in the review; 10 predicted risk of cancer, 18 performed either cancer detection or early detection, 4 predicted recurrence, and 1 predicted metastasis. The most common cancers predicted in the studies were colorectal (n = 9) and pancreatic cancer (n = 9). 16 studies used feature engineering to represent temporal data, with the most common features representing trends. 18 used deep learning models which take a direct sequential input, most commonly recurrent neural networks, but also including convolutional neural networks and transformers. Prediction windows and lead times varied greatly between studies, even for models predicting the same cancer. High risk of bias was found in 90% of the studies. This risk was often introduced due to inappropriate study design (n = 26) and sample size (n = 26). Conclusion This review highlights the breadth of approaches to cancer prediction from longitudinal data. We identify areas where reporting of methods could be improved, particularly regarding where in a patients’ trajectory the model is applied. The review shows opportunities for further work, including comparison of these approaches and their applications in other cancers.

Pancreatic cancer is notoriously difficult to detect, with diagnosis often relying on symptoms that only develop at advanced stages of the disease. Routine blood tests may signal a developing cancer before these symptoms appear. Limited research has investigated the use of time-varying information from laboratory tests before diagnosis. This study used UK primary care data to compare machine learning approaches for detecting pancreatic cancer at various time-intervals before diagnosis. The machine learning challenge is that such real-world data is irregular and sparse and therefore difficult to use for model creation. In this study, deep learning time-series models (LSTM and GRU-D) were compared to a feature engineering approach. We found that while predictive performance was strongest at diagnosis date (maximum AUROC of 0.85), cases could be detected 18 months before diagnosis, with GRU-D achieving an AUROC of 0.57. Closer to the diagnosis date, where diagnostic signals are stronger, feature engineering approaches outperformed the deep learning models. However, further from diagnosis, the deep learning models, particularly the GRU-D, maintained marginally better performance. Calibration of the models was good at the diagnosis date but was poor across all models at a lead time of greater than 6 months. This study demonstrates that routine blood tests show some predictive capacity for earlier detection of pancreatic cancer. However, this capacity quickly decreases further from diagnosis date, with poor discrimination beyond 6 months. These results should be of interest to researchers interested in using machine learning and electronic health records to support earlier diagnosis of cancer.

Implications for practice and research:• Outcome measures of maternity care are limited in scope to evaluating experiences of intrapartum care, and therefore may not capture women's experiences of care during the entire antenatal period • Research that explores aspects of antenatal care that are important to maternity service-users themselves would be beneficial to inform the development of instruments and measures to capture a broader range of antenatal care experiences. Context:Antenatal healthcare (ANC) is the care given to women by healthcare professionals throughout pregnancy to childbirth, which should commence in early pregnancy.This is the first opportunity for most mothers to encounter their healthcare 1 , and has the potential to support women to enjoy a "positive pregnancy" 2 .As such, high quality ANC has the potential to improve a woman's perception of motherhood, build trust prior to childbirth, and offer emotional and physical support.However, whilst the World Health Organization standards suggest maternity care should be free from mistreatment 3 , currently there is a concerning lack of measurement of women's experiences of ANC more broadly 4 . Methods:The authors conducted a scoping review to identify and evaluate the validity of instruments and measures of women's experiences of ANC.They categorised the instruments according to the WHO (2016) quality of care framework and other relevant literature.This conceptual framework comprised of four typologies: antenatal quality of care, person centred antenatal care, mistreatment of women during childbirth, and respectful maternity care.Each typology captured between 3 and 12 domains.A four-step process was followed where the authors 1) identified papers published or produced (but unpublished) between 2007-2023; 2) described instruments and measures of women's experiences of ANC; 3) mapped the measures to the conceptual framework and 4) discussed the gaps and opportunities for novel measures of women's experiences of ANC. Findings:The authors identified 36 articles, mainly from high income countries, with 591 measures of ANC.Half (292/591) of the measures mapped to women's experiences of care and were included in the scoping review; those examining clinical care were excluded.All included measures mapped to the 'mistreatment of women during childbirth' typology.The respectful maternity care typology had fewer measures (40/292 14%); with no measures identified for the remaining two typologies.The authors suggest that these findings can be used to inform monitoring of care using existing tools and development of future tools for ANC.

Objectives To estimate the time required to undertake consultations according to BMJ’s 10-minute consultation articles.To quantify the tasks recommended in 10-minute consultation articles.To determine if, and to what extent, the time required and the number of tasks recommended have increased over the past 22 years.Design Analysis of estimations made by four general practitioners (GPs) of the time required to undertake tasks recommended in BMJ’s 10-minute consultation articles.Setting Primary care in the UK.Participants Four doctors with a combined total of 79 years of experience in the UK National Health Service following qualification as GPs.Main outcome measures Median minimum estimated consultation length (the estimated time required to complete tasks recommended for all patients) and median maximum estimated consultation length (the estimated time required to complete tasks recommended for all patients and the additional tasks recommended in specific circumstances). Minimum, maximum and median consultation lengths reported for each year and for each 5-year period.Results Data were extracted for 44 articles. The median minimum and median maximum estimated consultation durations were 15.7 minutes (IQR 12.6–20.9) and 28.4 minutes (IQR 22.4–33.8), respectively. A median of 17 tasks were included in each article. There was no change in durations required over the 22 years examined.Conclusions The approximate times estimated by GPs to deliver care according to 10-minute consultations exceed the time available in routine appointments. ‘10 minute consultations’ is a misleading title that sets inappropriate expectations for what GPs can realistically deliver in their routine consultations. While maintaining aspirations for high-quality care is appropriate, practice recommendations need to take greater account of the limited time doctors have to deliver routine care.

OBJECTIVE To examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years. DESIGN Retrospective secondary data analysis. DATA SOURCES Cancer registration data, cancer mortality and national population data from the Office for National Statistics, Public Health Wales, Public Health Scotland, Northern Ireland Cancer Registry, NHS England, and the General Register Office for Northern Ireland. SETTING 23 cancer sites were included in the analysis in the UK. PARTICIPANTS Men and women aged 35-69 years diagnosed with or who died from cancer between 1993 to 2018. MAIN OUTCOME MEASURES Change in cancer incidence and mortality age standardised rates over time. RESULTS The number of cancer cases in this age range rose by 57% for men (from 55 014 cases registered in 1993 to 86 297 in 2018) and by 48% for women (60 187 to 88 970) with age standardised rates showing average annual increases of 0.8% in both sexes. The increase in incidence was predominantly driven by increases in prostate (male) and breast (female) cancers. Without these two sites, all cancer trends in age standardised incidence rates were relatively stable. Trends for a small number of less common cancers showed concerning increases in incidence rates, for example, in melanoma skin, liver, oral, and kidney cancers. The number of cancer deaths decreased over the 25 year period, by 20% in men (from 32 878 to 26 322) and 17% in women (28 516 to 23 719); age standardised mortality rates reduced for all cancers combined by 37% in men (-2.0% per year) and 33% in women (-1.6% per year). The largest decreases in mortality were noted for stomach, mesothelioma, and bladder cancers in men and stomach and cervical cancers and non -Hodgkin lymphoma in women. Most incidence and mortality changes were statistically significant even when the size of change was relatively small. CONCLUSIONS Cancer mortality had a substantial reduction during the past 25 years in both men and women aged 35-69 years. This decline is likely a reflection of the successes in cancer prevention (eg, smoking prevention policies and cessation programmes), earlier detection (eg, screening programmes) and improved diagnostic tests, and more effective treatment. By contrast, increased prevalence of non-smoking risk factors are the likely cause of the observed increased incidence for a small number of specific cancers. This analysis also provides a benchmark for the following decade, which will include the impact of covid-19 on cancer incidence and outcomes.

Behaviour is often the fundamental driver of disease transmission, where behaviours of individuals can be seen to scale up to epidemiological patterns seen at the population level. Here we focus on animal behaviour, and its role in parasite transmission to track its knock-on consequences for parasitism, production and pollution. Livestock face a nutrition versus parasitism trade-off in grazing environments where faeces creates both a nutritional benefit, fertilizing the surrounding sward, but also a parasite risk from infective nematode larvae contaminating the sward. The grazing decisions of ruminants depend on the perceived costs and benefits of the trade-off, which depend on the variations in both environmental (e.g., amounts of faeces) and animal factors (e.g., physiological state). Such grazing decisions determine the intake of both nutrients and parasites, affecting livestock growth rates and production efficiency. This impacts on the greenhouse gas costs of ruminant livestock production via two main mechanisms: (1) slower growth results in longer durations on-farm and (2) parasitised animals produce more methane per unit food intake. However, the sensitivity of behaviour to host parasite state offers opportunities for early detection of parasitism and control. Remote monitoring technology such as accelerometers can detect parasite-induced sickness behaviours soon after exposure, before impacts on growth, and thus may be used for targeting individuals for early treatment. We conclude that livestock host x parasite interactions are at the centre of the global challenges of food security and climate change, and that understanding livestock behaviour can contribute to solving both.

BackgroundThe occurrence of a range of health outcomes following myocardial infarction (MI) is unknown. Therefore, this study aimed to determine the long-term risk of major health outcomes following MI and generate sociodemographic stratified risk charts in order to inform care recommendations in the post-MI period and underpin shared decision making.Methods and findingsThis nationwide cohort study includes all individuals aged ≥18 years admitted to one of 229 National Health Service (NHS) Trusts in England between 1 January 2008 and 31 January 2017 (final follow-up 27 March 2017). We analysed 11 non-fatal health outcomes (subsequent MI and first hospitalisation for heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes mellitus, dementia, depression, and cancer) and all-cause mortality. Of the 55,619,430 population of England, 34,116,257 individuals contributing to 145,912,852 hospitalisations were included (mean age 41.7 years (standard deviation [SD 26.1]); n = 14,747,198 (44.2%) male). There were 433,361 individuals with MI (mean age 67.4 years [SD 14.4)]; n = 283,742 (65.5%) male). Following MI, all-cause mortality was the most frequent event (adjusted cumulative incidence at 9 years 37.8% (95% confidence interval [CI] [37.6,37.9]), followed by heart failure (29.6%; 95% CI [29.4,29.7]), renal failure (27.2%; 95% CI [27.0,27.4]), atrial fibrillation (22.3%; 95% CI [22.2,22.5]), severe bleeding (19.0%; 95% CI [18.8,19.1]), diabetes (17.0%; 95% CI [16.9,17.1]), cancer (13.5%; 95% CI [13.3,13.6]), cerebrovascular disease (12.5%; 95% CI [12.4,12.7]), depression (8.9%; 95% CI [8.7,9.0]), dementia (7.8%; 95% CI [7.7,7.9]), subsequent MI (7.1%; 95% CI [7.0,7.2]), and peripheral arterial disease (6.5%; 95% CI [6.4,6.6]). Compared with a risk-set matched population of 2,001,310 individuals, first hospitalisation of all non-fatal health outcomes were increased after MI, except for dementia (adjusted hazard ratio [aHR] 1.01; 95% CI [0.99,1.02];p = 0.468) and cancer (aHR 0.56; 95% CI [0.56,0.57];p < 0.001). The study includes data from secondary care only-as such diagnoses made outside of secondary care may have been missed leading to the potential underestimation of the total burden of disease following MI.ConclusionsIn this study, up to a third of patients with MI developed heart failure or renal failure, 7% had another MI, and 38% died within 9 years (compared with 35% deaths among matched individuals). The incidence of all health outcomes, except dementia and cancer, was higher than expected during the normal life course without MI following adjustment for age, sex, year, and socioeconomic deprivation. Efforts targeted to prevent or limit the accrual of chronic, multisystem disease states following MI are needed and should be guided by the demographic-specific risk charts derived in this study.

Background There is a known lack of diversity in research participant populations. This impacts on the generalisability of findings and affects clinician prescribing. In the United Kingdom the research community defines those who are underrepresented as under-served. They are commonly those affected by health inequality and disparity. The notion of under-served is complex, with numerous papers identifying multiple factors that contribute to being under-served and in turn suggesting many strategies to improve engagement. Methods Research professionals in the UK were invited to complete an online survey. The broad aim was to explore their views on under-served groups. The findings were analysed using statistical and qualitative methods to identify enablers and barriers to engaging the under-served. Descriptive statistics were utilised with associations compared univariately by chi-square test and logistic regression for multivariable analysis. Results A total of 945 completed responses were received. Those identified as under-served in this study reflected the previous body of works with a broader descriptor of ethnic and cultural minorities and the addition of adolescents and young adults. Language and literacy skills had the most impact on being under-served. Only 13% of respondents said they felt equipped to meet the needs of the under-served. The main strategy to increase diversity was community engagement and movement of research delivery into the community. The barriers were funding and time. Training needs identified were linked to community engagement, cultural competence and consent processes. Conclusions The UK findings from research professionals reflected the previous literature. Adolescents and young people were added to those identified as under-served. Enablers included community outreach and improvement to communication. Barriers were time, funding, organisational processes and lack of focus. Issues were identified with translation and interpretation services. Training requirements focus on methodologies and methods to engage and the consent processes of those from under-served groups.

Abstract Purpose A recent review indicated that physical activity (PA), facilitated by organisations/clubs, may reduce alcohol consumption in early to mid-adolescence. Our study aims were to examine these factors, and identify how health determinants may influence association. Methods Cross-sectional secondary data analysis using UK cohort data from ALSPAC. Ages and sample-size: Time-point (TP) 1: 13-14 (n = 1824), TP2: 15-16 (n = 1334). Variables: minutes per day spent in moderate to vigorous PA > =3 days of accelerometer wear. Ancillary PA variables: Club-type (CT); and frequency of attending club (FAC) collected age 15 only. Risk of alcohol-related harm (RARH) categorised as: no current risk, increasing risk, and at risk (AR). Ordinal regression was conducted at each TP, using PA as a covariate. Explanatory variables (EVs): Psychosocial health (PSH) - Cluster membership numbers generated through K-means cluster analysis (uniquely represented at each TP); Socioeconomic status (SES); Educational attainment; BMI; Smoking status, and Gender. EVs entered into regression model if preliminary X2 tests achieved p Results Regression showed a positive association between PA and RARH at both TPs. Odds of being AR at TP1 were 1.31 greater for each 30 minute increase in PA (95%CI 1.10-1.57; p<0.002). At TP2: OR 1.24 (95%CI 1.01, 1.52; p=.036). TP1: CT (age 15) was not statistically significant at age 13. However, ‘sports club only’ (SCO), had greatest RARH (OR 1.04; 95%CI .806, 1.35; p=.753) vs. no CT. All EVs retained statistical significance at p Conclusions The relationship between PA and alcohol consumption is complex. While facilitated PA can provide many benefits for adolescents, potential unwanted consequences may be an increase in risk-behaviours like alcohol consumption. Further research is needed for greater comprehension of this association.

To reduce the number of alcohol-exposed pregnancies in antenatal care in the UK, the CHAMPION study objective was to design appropriate training and resources to develop the midwifery skills and confidence required to have an effective conversation about alcohol with pregnant women. Women with lived experience of drinking during pregnancy and ‘birth mums’ of a child with fetal alcohol spectrum disorders (FASD) were central to the co-creation process of the CHAMPION study. Some remarkable unintended positive outcomes resulted from this collaboration process for the women involved. They include increased confidence levels from newfound friendships with other mothers of children with FASD, and an acceptance that societal influences had a significant role to play in their personal situations. Reflecting on this authentic co-creation process has elicited important learning outcomes to inform future research design. The significance of excellent communication channels, robust support networks and genuinely valuing and respecting experts by experience as equal partners should not be underestimated.

Background South Asian populations are known to be at an increased risk of non-communicable diseases, such as cardiovascular disease and diabetes. Both greater central adiposity and total higher adiposity for a given BMI compared to White peers may be related to differences. This study aims to explore the adipose tissue overflow hypothesis of Sniderman et. al, which proposes that, compared to White Europeans, South Asians have comparatively small, peripheral, superficial subcutaneous adipose tissue depots in children given the relative paucity of evidence to date. Methods Skinfold measurements from the subscapular, triceps and thighs were collected at 6–41 months from White British (N= 561) and Pakistani (N = 651) ethnic background infants from a subset of the Born in Bradford study, a multi-ethnic cohort based in the North of England. Linear spline models of skinfold growth for all three sites were developed, and results indicated best fitting knot placements were at 13 and 21 months for subscapular skinfolds, 11 and 23 months for triceps skinfolds, and 13 and 16 months for thigh skinfolds. Separate trajectories were created for each ethnic and sex group and models were adjusted for potential confounders such as birthweight, length of gestation and gestational diabetes. Results White British boys had lower skinfold values at six months than Pakistani boys for subscapular skinfolds (mean difference -0.16 mm (95% C.I.-0.24 to -0.08) whilst having higher triceps, 0.51 mm (95% C.I. 0.38 to 0.65) and thigh skinfolds (0.53 mm (95% C.I. 0.25 to 0.80). White British girls also had lower subscapular skinfolds (-0.50 mm (95% C.I.-0.57 to -0.40); and greater triceps compared with Pakistani girls (0.31 mm (95% C.I. 0.16 to 0.46)), but unlike in males, had lower thigh skinfolds (-0.81 mm (-1.13 to -0.50)) compared to Pakistani girls. The modelled trajectories of triceps and thigh skinfold showed higher mean values for White British children compared to Pakistani children of both sexes, from 7 months onwards, though the estimated magnitude of these ethnic differences was larger for triceps. In contrast mean subscapular skinfold trajectories tracked very similarly by sex group, and showed no consistent ethnic differences. Conclusion The results of our study provide some support for the adipose tissue overflow hypothesis in early life, with our findings showing South Asians on average having smaller fat compartments at the periphery and larger truncal deposits. Our findings require confirmation in larger cohorts, and further elucidation of the longer term cardiometabolic impacts of these early life adiposity site differences.

AIM:There are barriers to midwives engaging in conversations about alcohol with pregnant women. Our aim was to capture the views of midwives and service users to co-create strategies to address these barriers.DESIGN:Qualitative description.METHODS:Structured Zoom-based focus group interviews of midwives and service users where we presented known barriers and sought solutions to midwives discussing alcohol use in antenatal settings. Data collection took place between July and August 2021.RESULTS:Fourteen midwives and six service users attended five focus groups. Barriers considered were as follows: (i) lack of awareness of guidelines, (ii) poor skills in difficult conversations, (iii) lack of confidence, (iv) lack of belief in existing evidence, (v) women would not listen to their advice, and (vi) alcohol conversations were not considered part of their role. Five strategies to address barriers to midwives discussing alcohol with pregnant women were identified. These were as follows: Training that included mothers of children with Foetal Alcohol Spectrum Disorder, champion midwives, a service user questionnaire about alcohol for completion before the consultation, questions about alcohol added to the maternity data capture template and a structured appraisal to provide a means of audit and feedback on their alcohol dialogue with women.CONCLUSIONS:Co-creation involving providers and users of maternity services yielded theoretically underpinned pragmatic strategies to support midwives to ask advise assist about alcohol during antenatal care. Future research will test if the strategies can be delivered in antenatal care settings, and if they are acceptable to service providers and service users.IMPACT:If these strategies are effective in addressing barriers to midwives discussing alcohol with pregnant women, this could support women to abstain from alcohol during pregnancy, thus reducing alcohol-related maternal and infant harm.PATIENT AND PUBLIC CONTRIBUTION:Service users were involved in the design and execution of the study, considering data, supporting intervention design and delivery and dissemination.

Lack of sexual and reproductive health (SRH) education contributes to poor SRH outcomes for adolescents and young people in Sub-Saharan Africa. School-based comprehensive SRH education programmes in low- and middle-income countries aim to advance gender equality and human rights and reduce risky sexual behaviours in adolescents. However, the implementation of these programmes in Northern Nigeria is opposed by community and religious institutions because of mistrust of health interventions perceived as being framed on Western ideologies. This study explored perceptions of such programmes among secondary school staff in Northern Nigeria. We focused on knowledge and beliefs about comprehensive SRH education programmes, and views about barriers to delivery and ways to support their inclusion in schools. Sixteen semi-structured in-depth interviews were conducted with teachers and head teachers. Participants were aged 33-54 years and came from four public secondary schools in two states (Kano and Jigawa). Findings showed conflicting gender-based perspectives on the importance of comprehensive SRH education in schools. Barriers to delivery included lack of adequate skills and knowledge, beliefs/cultural norms and wider societal barriers. Involving traditional and religious leaders and schools in the design of tailored approaches could strengthen future delivery.

Background: Elexacaftor/Tezacaftor/Ivacaftor (ETI) modulator therapy is often associated with increased body mass index (BMI) in people with cystic fibrosis (CF). This is thought to reflect improved clinical stability and increased appetite and nutritional intake. We explored the change in BMI and nutritional intake following ETI modulator therapy in adults with CF.Methods: Dietary intake, measured with myfood24 (R), and BMI were collected from adults with CF at baseline and follow-up as part of an observational study. Changes in BMI and nutritional intake in participants who commenced ETI therapy between time points were assessed. To contextualize findings, we also assessed changes in BMI and nutritional intake between study points in a group on no modulators.Results: In the pre and post ETI threapy group ( n = 40), BMI significantly increased from 23.0 kg/m(2) (IQR 21.4, 25.3) at baseline to 24.6 kg/m(2) (IQR 23.0, 26.7) at follow-up ( p < 0.001), with a median of 68 weeks between time points (range 20-94 weeks) and median duration of ETI therapy was 23 weeks (range 7-72 weeks). There was a significant decrease in energy intake from 2551 kcal/day (IQR 2107, 3115) to 2153 kcal/day (IQR 1648, 2606), p < 0.001. In the no modulator group ( n = 10), BMI and energy intake did not significantly change between time points ( p > 0.05), a median of 28 weeks apart (range 20-76 weeks).Conclusions: These findings tentatively suggest that the increase in BMI with ETI therapy may not simply be attributable to an increase in oral intake. Further exploration into the underlying aetiology of weight gain with ETI therapy is needed.(c) 2023 The Authors. Published by Elsevier B.V. on behalf of European Cystic Fibrosis Society. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )