Aims The primary aim of the Action on Hip Fracture Management Quality Improvement (ACTIVE) trial is to evaluate whether a context-tailored quality improvement programme improves health-related quality of life at 120 days after hospital admission, among adults aged 65 years or older with a hip fracture, in less-resourced hospitals in China. Secondary aims are to compare health-related quality of life at 30 days, complication and morbidity at 30 and 120 days, proportion of patients receiving surgery, proportion of patients on full weightbearing at one week after surgery, time from admission to surgery, length of hospital stay, 120-day mortality, and inpatient costs between the two groups, and to evaluate the implementation and cost-effectiveness of the intervention. Methods This is a multicentre, open-label, pragmatic, parallel-group, cluster-randomized controlled trial conducted in 80 less-resourced county- or district-level public general hospitals across ten provinces in China (all hospitals are graded 3B or below; 3A is considered the most high-ranking or well-resourced hospital). Hospitals are randomized 1:1 within each province to either intervention or the control group. Eligible participants are adults aged 65 years or older with acute unilateral hip fracture confirmed by radiography or CT. The intervention consists of optimization of in-hospital management processes, empowerment of surgeons and physicians, and health education for patients and their family members. Hospitals allocated to the control group continue usual orthopaedic-led care. Participants are followed up at 30 and 120 days after admission. The primary outcome is health-related quality of life at 120 days after admission. A total of 8,800 participants will be recruited. Conclusion The results of the ACTIVE trial will inform whether a context-tailored quality improvement programme, consisting of interventions on health administrators, health providers, and patients, can improve outcomes for older adults with hip fracture in less-resourced hospitals in China, and many countries beyond with emerging burden of ageing population. Cite this article: Bone Jt Open 2026;7(8):1101–1109.

BACKGROUND AND AIMS:Hip fractures are a leading cause of morbidity and mortality among older adults, with significant consequences for recovery and refracture risk. While recovery experiences have been explored and interventions established, limited understanding exists of how individual, social and cultural factors influence engagement with recovery and secondary prevention in multicultural systems. We explored these factors among culturally diverse older adults and caregivers following low trauma hip fracture. METHODS:A qualitative study embedded within a prospective cohort at a metropolitan Australian trauma hospital. Participants included older adults with recent low-trauma hip fracture and their caregivers, purposively sampled for cultural diversity. Semi-structured interviews were conducted in English, Arabic, Assyrian or Vietnamese. Data were thematically analysed using a two-step inductive-deductive approach, mapping codes to Andersen's Behavioural Model before theme development. RESULTS:Twenty participants (mean age 74 years, 60% women, 75% culturally diverse) were interviewed. Three interconnected themes emerged: (i) 'normalisation of pathological ageing', shaping expectations and engagement with preventive care; (ii) 'cultural orientations' shaping motivations, expectations and family roles; and (iii) 'care continuity,' with refracture prevention clinics valued but access hampered by logistical and system barriers. These themes interacted across individual, social and health system levels to shape recovery trajectories and refracture prevention. CONCLUSIONS:Recovery and refracture prevention after hip fracture are strongly shaped by age-related beliefs, cultural context and care structures. By examining cross-cultural experiences in a multicultural setting, this study highlights the need for person-centred, culturally responsive and better-coordinated models to optimise engagement and outcomes in diverse ageing populations.

Objective To characterize the disease burden and trends of road injury-related traumatic brain injury (RI-TBI) in China from 1990 to 2021.Methods Using data from the Global Burden of Disease Study 2021, the RI-TBI incidence, prevalence, and years lived with disability (YLD) for China and its 33 provincial-level administrative divisions between 1990 and 2021 were estimated. Temporal trends were evaluated by calculating the estimated annual percentage change (EAPC) in age-standardized rates. Stratified analysis was conducted by age, gender, province, and road-user category.Results In 2021, the age-standardized incidence rate (ASIR) of RI-TBI for China was 86.63 per 100,000, and the age-standardized prevalence rate (ASPR) was 197.23 per 100,000, age-standardized YLD rate (ASYR) was 29.70 per 100,000 person-years. From 1990 to 2021, the ASIR decreased in females [EAPC=-0.88, 95%CI (-1.35, -0.40)] but remained essentially stable in males [EAPC=0.09, 95%CI (-0.24, 0.41)]. Similarly, the ASPR declined in females [EAPC=-0.72, 95%CI (-1.03, -0.41)] and showed a slight, non-significant increase among males [EAPC=0.18, 95%CI (-0.03, 0.40)]. Provincial trend analyses showed increasing ASPR of RI-TBI in Jiangsu and Shanxi provinces. By road-user category, the disease burden of pedestrian-related RI-TBI was the greatest.Conclusion From 1990 to 2021, the absolute burden of RI-TBI in China increased, whereas age-standardized rates were generally stable or declined. The burden of RI-TBI in China varies markedly across provinces and by injury type. Targeted interventions and prevention strategies that account for demographic and geographic heterogeneity should be developed and implemented to reduce incidence and overall disease burden.

BACKGROUND:Older adults with cardiovascular disease (CVD) have a high risk of falls, yet evidence for scalable fall-prevention programs in this population is limited. METHODS:This secondary analysis of the Fall Prevention for Rural Community-Dwelling Elderly open-label cluster randomised trial included rural Chinese adults aged 60 years or older with self-reported physician-diagnosed hypertension or heart disease at baseline from 128 villages. Villages were randomised 1:1 to a 12-month village doctor-led intervention comprising balance and functional exercise and health education, or to usual care. The primary outcome was reporting at least one fall over 12 months. Secondary outcomes included falls rate, fall-related injury, functional mobility and health-related quality of life. RESULTS:Participants were recruited between 19 September 2023 and 15 November 2023. Compared with usual care, the intervention reduced the proportion reporting at least one fall [31.6% vs 42.7%; OR, 0.60; 95% confidence interval (CI), 0.43 to 0.84], falls rate (0.9 vs 1.6 per person-year; RR, 0.62; 95% CI, 0.43 to 0.89) and fall-related injury (15.9% vs 24.9%; OR, 0.57; 95% CI, 0.42 to 0.78). The intervention also improved chair stand performance, balance performance and health-related quality of life score, but not Timed Up and Go. Benefits were generally consistent across subgroups, with a greater effect in men. CONCLUSIONS:A village doctor-led fall-prevention program integrated into rural primary care reduced falls and fall-related injuries and improved functional outcomes among older adults with CVD. These findings support integrating scalable nonpharmacological fall-prevention strategies into routine cardiovascular management in rural primary care.

First Nations Australians consistently exhibit lower bowel screening participation rates than non-First Nations Australians. However, limited studies have been conducted to understand the factors associated with bowel cancer screening participation among First Nations Australians. This study aims to identify factors associated with bowel cancer screening participation among older First Nations Peoples receiving home health care services in New South Wales (NSW), Australia. A cross-sectional study among older First Nations customers receiving Australian Unity Aboriginal home health care services in NSW was conducted from June to September 2023. Data were collected through face-to-face interviews administered by trained First Nations staff, using a structured, culturally appropriate online survey. Multivariable logistic regression was performed, and adjusted odds ratios (aOR) with 95

It has been demonstrated in multiple randomized trials that the PAX Good Behavior Game is an effective school-based program for reducing the severity and progression of childhood emotional and behavioral problems that are prognostic of mental disorders, personality disorders, and self-harm behavior in adolescence and early adulthood. Embedding effective programs into routine practices of frontline settings is a global priority for mental health prevention, however, little is known about what strategies effectively support program implementation in schools. The purpose of this study was to test the effect of a multicomponent implementation strategy on the adoption and efficacy of the PAX Good Behavior Game, using a cluster randomized controlled trial with a type-3 implementation-effectiveness design. The trial was conducted in 25 primary schools across New South Wales, Australia. Schools were randomly assigned to receive the PAX Good Behavior Game plus an implementation toolkit to support adoption (intervention group) or the PAX Good Behavior Game only (control group). The primary outcome was change in rate of program adoption, measured as current use or support of the PAX Good Behavior Game, first measured at 6 weeks post-registration (T0). The secondary effectiveness measure was change in students’ emotional and behavioral problems, using the teacher-reported Strengths and Difficulties Questionnaire (SDQ). The first measure of the SDQ occurred at trial registration, prior to program implementation (T0). Both adoption and effectiveness were re-measured at 6 months post-registration (T1). All data were analyzed using intention-to-treat methods. Early program adoption was higher in the intervention group compared to control group (93.6

Background Hip fractures are a significant health issue for ageing populations, with high mortality and severe long-term effects, placing a substantial burden on healthcare systems worldwide, including in China. Although a multidisciplinary co-management model is regarded as best practice for hip fracture management, it typically involves shared care between orthopaedic teams and perioperative medical specialists such as geriatrics or internal medicine, working closely with nursing and rehabilitation staff. Its success depends on well-established medical and human resources, making implementation challenging in many settings. This study investigates the current management practices for hip fractures in county-level hospitals in China to inform development of targeted quality improvement interventions aimed at improving care. Methods This qualitative study was conducted in three sequential steps. In the first step, focus group interviews were conducted with multidisciplinary healthcare providers and hospital administrators from ten county-level hospitals across China. Guided by national clinical guidelines, these interviews aimed to identify barriers and facilitators influencing the quality of hip fracture management in older adults. The second step employed patient journey mapping to systematically analyze the treatment and management processes for hip fractures within these hospitals. In the third step, two rounds of clinician- and manager-led, evidence-informed co-design workshops were held, bringing together clinical staff including orthopaedics, internist and general practitioners, public health professionals and health management professionals to collaboratively identify areas to be intervened and develop specific interventions. Findings A total of ten focus group discussions were conducted, one in each province, involving 137 participants. These discussions identified ten key barriers and ten facilitators influencing the quality of hip fracture care. The patient journey mapping documented the treatment process for hip fractures in older adults across ten county-level hospitals, highlighting issues such as surgical delays and inadequate multidisciplinary collaboration. The co-design workshops led to the development of three interventions: (1) optimization of in-hospital management processes, (2) empowerment of surgeons and physicians, and (3) enhancement of awareness among patients and their families. Interpretation This study provides a comprehensive understanding of the challenges related to the management of hip fracture in resource-constrained county-level hospitals in China. The proposed interventions are expected to improve care quality and outcomes for patients with hip fractures in resource-constrained settings. Future efforts will focus on conducting randomized controlled trials to evaluate the effectiveness of these interventions. Funding This study was supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (code: ZLRK202310).

INTRODUCTION:Despite reductions in tobacco smoking among Aboriginal and Torres Strait Islander peoples since 2004, particularly among youth, smoking remains elevated in Indigenous communities - highlighting the importance of understanding why some Aboriginal and Torres Strait Islander people never take up smoking. METHODS:Taking a strength-based approach and using data from 474 Aboriginal and Torres Strait Islander youth aged 16-24-years joining the Next Generation Youth Wellbeing Study (Western and Central Australia, New South Wales), 2018-2020, age-, sex- and family-adjusted prevalence ratios (PR) for never-smoking relative to sociodemographic, health, social and other factors across socioecological levels were estimated through Poisson regression. RESULTS:Overall, 45% of participants had never smoked tobacco; 31% reported current daily/weekly/monthly smoking, indicating a normative shift. Among those who ever smoked, mean initiation age was 15. Never-smoking was greater with: younger age [16-17-years (PR=1.9; 95% Confidence Interval=1.5-2.5), 18-20 (1.3;1.0-1.8)]; completing ≥Year 10 (1.8;1.1-3.0); no interaction with (1.9;1.5-2.5) or being charged by police (2.3;1.5-3.3); never being imprisoned (2.5;1.2-4.8); not having friends imprisoned (1.7;1.3-2.2); having non-smoker friends (1.8;1.4-2.2); never vaping (5.7;3.2-10.1) or smoking marijuana (7.9;4.9-12.8), never having tried alcohol (2.4;2.0-3.0); higher physical activity (1.4;1.1-1.7); lower psychological distress (1.3;1.1-1.6), never being diagnosed with depression (1.5;1.1-2.1) or anxiety (1.7;1.2-2.4) and having 'good-to-excellent' perceived health (1.5;1.1-2.1), compared with not having these attributes. CONCLUSION:These findings highlight the importance of strengthening family, community, and social environments that protect against smoking initiation and support smoking cessation and call for sustained structural and policy reforms to address systemic drivers of tobacco use.

BackgroundThe enactment of child restraint systems (CRSs) legislation is highly effective in increasing CRS practices. However, evidence from low- and middle-income countries is still lacking. This study aimed to assess the changes in CRS practices in Shenzhen, China following the implementation of CRS legislation.MethodsData from two cross-sectional surveys conducted in community health service centres and kindergartens 1 year before and 3 years after the enactment of mandatory CRS legislation in 2015 were used to assess the changes in CRS practices in Shenzhen, China. Temporal changes in CRS practices were investigated, and logistic regression models were performed to examine the differences in CRS practices 3 years after the legislation compared with the period before the legislation.ResultsThe proportion of CRS possession and use increased from 27.8% (1047/3768, 95% CI: 26.4% to 29.3%) to 72.6% (4900/6748, 95% CI: 71.5% to 73.7%) and from 22.9% (864/3768, 95% CI: 21.6% to 24.3%) to 56.3% (3800/6748, 95% CI: 55.1% to 57.5%), respectively, with a decrease of appropriate CRS use from 75.9% (656/864, 95% CI: 72.9% to 78.7%) to 69.7% (2649/3800, 95% CI: 68.2% to 71.2%) after the implementation of CRS legislation.ConclusionsThe findings indicate a significant improvement in CRS possession and use in Shenzhen, 3 years after the enactment of mandatory CRS legislation. Further efforts to update the local legislation to provide specific guidelines for appropriate CRS use and implement targeted multifaceted interventions are needed to increase optimal CRS practices for better child passenger safety in Shenzhen.

Introduction Falls are a major health risk for older Australians, causing most injury-related hospitalisations and deaths in this age group. Despite growth in Australia's older culturally and linguistically diverse (CALD) population, limited data exist on the availability and suitability of falls prevention programmes for this group. This study examines the availability and suitability of such programmes for CALD populations in local government areas (LGAs) in Greater Sydney, NSW. Methods An audit of publicly available demographic data and falls prevention programme offerings from 20 LGAs was conducted, based on language diversity and Socio-Economic Indexes for Areas (SEIFA)-Index of Relative Socio-Economic Disadvantage (IRSD) score. Seven LGAs with the highest and lowest SEIFA-IRSD scores, plus seven LGAs with the most and least linguistic diversity were included. Data are presented using column charts to identify trends. Results Fewer programmes were found in areas of greater disadvantage and higher linguistic diversity. Least disadvantaged areas offered more programmes, whilst the most disadvantaged and linguistically diverse areas offered fewer. Only one programme was offered in a language other than English, in a least disadvantaged LGA (Ku-Ring-Gai). These trends suggest that programme availability does not align with community needs. Conclusions Disparities exist in falls prevention programme availability across LGAs, with fewer programmes in areas of higher disadvantage and linguistic diversity, highlighting access inequities for older CALD populations. So What? Older CALD populations in high-need LGAs have reduced access to falls prevention programmes, signalling a need for targeted, culturally and linguistically appropriate health promotion initiatives.

BACKGROUND:Prevention of falls aids healthy ageing, but there are few Aboriginal-led and designed programs. OBJECTIVES:This study aimed to evaluate the effect of Ironbark, an Aboriginal co-designed fall prevention program, on functional mobility, a key indicator of falls. METHODS:This controlled pre-post study was conducted in organisations delivering services to Aboriginal people aged 45 years and older in New South Wales and Western Australia. A co-designed fall prevention program incorporating exercises and yarning circles targeting fall risk factors ('Ironbark Standing Strong and Tall') was compared to a social program ('Ironbark Healthy Community'). Data were collected at baseline and after 12 months of follow-up. RESULTS:The 'Ironbark Standing Strong and Tall' program was delivered at 16 sites and the 'Healthy Community' program at three. Due to lower recruitment than anticipated, combined analysis was not possible. There were significant improvements in the 'Ironbark Standing Strong and Tall' participants for the primary outcome of functional mobility (Short Performance Physical Battery; a change of 0.8 points, 95% CI: 0.4-1.1), reductions in stepping times, improvements in leg stance and increased incidental and planned exercise. There were no significant changes in falls, health-related quality of life (HRQoL) or psychological distress. Participants in the 'Healthy Community' sites had no change in functional mobility but saw declines in HRQoL, physical activity and stepping time. CONCLUSIONS:A co-designed and delivered program for older Aboriginal people, implemented in community settings aligned with stated priorities of Aboriginal older people, improved functional mobility.

Background and Objectives To better inform service provision and social services, Australia has long needed a comprehensive national ageing study that is comparable with international ageing studies and eligible to join the register of harmonized cross-national studies of ageing. We conducted a pilot study to fill this gap in Australia's social and health data collection on ageing.Research Design and Methods We utilized online computer-assisted web interviewing (CAWI) and a follow-up Telephone Interview for Cognitive Status (TICS) screening. Participants were drawn from a Roy Morgan Consumer Panel using random probability sampling. Data collected were compared with the national Census data.Results Among 1172 online CAWI survey participants (mean age: 65.8 years; 51.0% female), 46.8% had a chronic health condition or disability, 26.1% were full-time employed, and 46.8% were fully or partially retired. Compared with 2021 Australian Census data, the sample was broadly representative by age, sex, geographic region, and health, but respondents tended to have higher education levels (66% reported completing secondary schooling vs 42% in the Census) and underrepresented culturally and linguistically diverse backgrounds (21% born overseas vs 39%; 4% speak a language other than English at home vs 23%); 804 respondents completed TICS (mean[SD] = 33.6[2.8]; range: 22-41), with 71.4% classified as cognitively normal, 27.7% ambiguous, and 1.1% cognitively impaired.Discussion and Implications This pilot demonstrated the feasibility of online and telephone-based data collection with cognitive screening to capture demographic and health profiles of older Australians, providing a strong foundation for future large-scale national ageing studies.

Despite the growing popularity of electric bicycles (e-bikes) in China, there has been limited systematic evaluation of national e-bike safety policies. This study aims to comprehensively review national e-bike policies issued between 2003 and 2025 and assess them using an adapted analytical framework informed by the World Health Organization (WHO) Safe System approach and the Decade of Action for Road Safety 2021–2030. Policies were mapped across four substantive road safety domains and four implementation domains. This study retrieved policy documents from the websites of the State Council and 75 affiliated ministries. A total of 24,227 records were identified, of which 104 policies met the inclusion criteria. The number of policies issued notably increased after 2015, with a shift from single agency to multi-sectoral collaboration as part of China’s 14th Five-Year Plan period. Most policies focused on the “safe vehicles” domain, particularly enforcement related to product standards and technical specifications. In contrast, fewer policies addressed the “safe users” and “safe roads” domains. No directly relevant national policy content on “post-crash response” specific to e-bikes was identified. Evidence on the implementation and effectiveness of these policies remains limited. Future policy efforts should go beyond standard setting by addressing the limited attention to user behavior, enforcement, and post-crash response identified in current policies. This could be achieved through targeted enforcement and helmet-use legislation, expanded public education programs, and inter-agency coordination to strengthen post-crash preparedness.

Background Falls are a leading cause of injury and loss of independence among older Aboriginal people. The Ironbark program is a culturally co-designed, community-based fall prevention initiative, incorporating exercises and Yarning circles, a culturally grounded form of group discussion. This paper presents a process evaluation of the program, examining fidelity and key factors influencing implementation across settings.Methods Sixteen sites across two Australian states implemented the Ironbark Standing Strong and Tall program. Process data were collected from 15 sites through structured session observations and semi-structured interviews with exercise facilitators. Fidelity and dose were assessed quantitatively, with adherence scored using a summative checklist score. Qualitative data were thematically analysed and mapped onto the Consolidated Framework for Implementation Research (CFIR).Results The program was delivered with high fidelity to 117 participants with median adherence scores consistently above 80%. Sessions were implemented as planned, with strong participant engagement in both exercise and Yarning components. Key facilitators included Aboriginal leadership, trusted site managers, program flexibility and supportive service structures. Challenges included managing varying physical abilities, maintaining engagement over time and external disruptions (e.g. Coronavirus -19 pandemic, weather). Content repetition was noted as a barrier to sustained attendance by participants in later stages. Facilitators recommended additional training, mid-program assessments and access to site-collected data. Sustainability was linked to workforce capacity and securing ongoing funding, particularly to support Aboriginal staff and transport.Conclusion This process evaluation indicated that a culturally-relevant fall prevention program for older Aboriginal people can be implemented with fidelity across community settings. Findings provide practical guidance for exercise facilitators and on sustaining and expanding the Ironbark program and inform broader efforts to embed culturally safe, community-led health programs in routine practice.

OBJECTIVES:To evaluate the implementation of the Australian Hip Fracture Clinical Care Standard for patients with low-trauma hip fracture. This study aimed to (1) document facility-level adoption, (2) explore healthcare providers' perspectives on Standard delivery and (3) describe patient engagement with post-acute discharge care recommendations, including outcomes for culturally and linguistically diverse (CALD) and limited English proficiency subgroups. METHODS:A mixed-methods approach was undertaken. Community-dwelling adults who underwent surgical treatment for low-trauma hip fractures at a tertiary hospital over 1 year were included. Facility-level adoption was determined by auditing medical records against the Clinical Care Standard. Patient engagement with post-discharge recommendations was assessed by structured telephone follow-up at 16 weeks and English proficiency. An electronic survey explored healthcare providers' perspectives of Standard implementation. RESULTS:Of 189 patients admitted, 136 (72%) were eligible; 127 completed follow-up assessment. The cohort was predominantly female (66%), with a mean age of 79 years and 80% migrants. Most components of the Care Standard were implemented with high fidelity (> 90% for four of seven indicators). Acute care data indicated effective implementation of most components of the Care Standard, supported by responses from 28 healthcare providers (28% response rate). However, healthcare providers highlighted the need for enhanced interprofessional training and resourcing for refracture prevention. Patient engagement with refracture prevention recommendations was low (44% participated in strength exercises, 26% in balance, 11% sought dietary advice and 44% consumed calcium supplementation), with no significant differences by CALD status or English proficiency. CONCLUSIONS:Despite high facility-level implementation of the Care Standard, patient adoption of post-discharge refracture prevention strategies remains suboptimal. Bridging this gap requires multi-faceted, consumer-centred solutions and improved interdisciplinary training to enhance outcomes and reduce refracture risk, particularly in diverse and multicultural populations.

Continuing antiplatelets during hip fracture surgery may be safe for older adults, while early surgery after discontinuation reduces hospital stay without adverse outcomes. The safety of continuing antiplatelets or direct oral anticoagulants (DOACs) before surgery in older patients with hip fractures remains uncertain. The feasibility of timely surgery after discontinuation also warrants further investigation. We included studies of hip fracture patients aged ≥ 65 years taking antiplatelets or DOACs, comparing continuation versus discontinuation, or early versus delayed surgery. MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched to November 2024. Risk of bias was assessed using the Newcastle–Ottawa Scale. Meta-analyses were conducted using a random-effects model to pool effect estimates. This study was registered with PROSPERO (CRD42022378334). Thirteen observational studies from nine countries involving 885 patients were included. There were no significant differences in transfusion rates in patients who continued the medication (Odds Ratio [OR] = 0.87; 95

Purpose In Australia, smoking accounts for half of all Aboriginal and Torres Strait Islander (First Nations) deaths aged ≥45 years. Regular smoking is more common among First Nations than non-Indigenous peoples in Australia. Smoking primarily commences during adolescence and young adulthood. Preventing uptake is important for long-term health outcomes. This study aimed to identify the protective factors that support young people to be smoke-free, to inform prevention programs and strategies. Methods The ‘Next Generation Youth Wellbeing Study’ is a mixed-methods cohort study. It includes First Nations adolescents aged 10–24 years and living in urban, rural and remote communities in central Australia, Western Australia and New South Wales. This study analysed self-reported data on smoking from young people aged 10–15 years, collected during 2018–20, using Poisson regression to investigate the relation of various factors to never-smoking. Main findings Among 682 participants, 54% were female, 90% had never smoked tobacco and 79% lived in smoke-free homes. Factors independently associated with never smoking were: having friends who did not smoke (prevalence ratio [PR] 1.22, 95% confidence interval [CI] 1.15–1.30); daily school attendance (PR 1.14, 1.06–1.22), never drinking (PR 1.84, 1.38–2.46), self-reported good/excellent health (PR 1.12, 1.00–1.26), good mental health (PR 1.12, 1.04–1.20), never been questioned by police (PR 1.24, 1.14–1.34) and never interacting with the justice system (PR 1.23, 1.13–1.33), compared with participants without these exposures. There was no association between never smoking and sex, available money or physical activity. Principal conclusions Most First Nations young people had never smoked; this was related to multiple smoke-free influences, good health and wellbeing and positive social engagement and experiences. Alongside opportunities in home, school and community settings to support smoke-free behaviours, broader system-wide changes are required.

Importance:With rapidly aging populations globally, there is a lack of evidence on effective fall prevention strategies among community-dwelling older people in resource-constrained areas. Objective:To assess the effectiveness of a fall prevention program integrated in primary health care systems on the risk of falls among Chinese rural older adults. Design, Setting, and Participants:A 12-month, open-label, cluster randomized clinical trial, conducted in 128 rural villages from 4 Chinese provinces, involving adults 60 years or older at risk of falls (recruitment from September 19, 2023, to November 15, 2023; last follow-up, January 15, 2025). Interventions:The fall prevention intervention, consisting of balance and functional exercises and community-engaged health education, was integrated with the rural primary health care system. The control group received usual care, health education alone, without active involvement with the communities. Main Outcomes and Measures:The primary outcome was the proportion of participants who reported at least 1 fall in 12 months following the intervention. Six secondary outcomes included the rate of falls, 3 measures of functional mobility, the proportion of participants who reported fall-related injury, and health-related quality of life. Fall-related data were collected via quarterly participant self-reports supported by a calendar; functional mobility was measured at baseline and 12-month follow-up using validated measures. Results:Of the 2616 participants recruited, 6 died before randomization and 2610 (median age, 70.0 years [IQR, 66.4-74.2]; 1553 female [59.5%]) were randomized either to the intervention group (1311 from 64 villages) or to the control group (1299 from 64 villages). During a mean follow-up of 358.0 (SD, 31.3) days, 388 participants (29.7%) in the intervention group reported falling at least once during the 12-month follow-up compared with 497 (38.3%) in the control group (odds ratio, 0.67; 95% CI, 0.48-0.91; P = .01). All secondary outcomes favored the intervention except the Timed Up and Go Test (for functional mobility), which showed no significant difference. Conclusions and Relevance:This cluster randomized trial found that integrating a fall prevention program in a primary health care system was associated with a significant reduction in the risk of self-reported falls among Chinese rural older people. This intervention, comprising balance and functional exercises and community-engaged health education, has the potential to be scaled-up in China and other low- and middle-income countries with rapidly growing aging populations. Trial Registration:Chinese Clinical Trial Registry Identifier: ChiCTR2300075879.

Background : Physical activity benefits adolescent health and well-being, known holistically as social and emotional well-being (SEWB) to Aboriginal people. However, little is known about the associations between physical activity and SEWB among Aboriginal adolescents. The “Next Generation: Youth Well-Being (NextGen) Study” is a cohort study of Aboriginal people aged 10–24 years in Australia. We aimed to examine associations between physical activity and SEWB, and cultural engagement and community connection among NextGen participants. Methods : Prior to recruiting participants, partnerships and relationships were developed with Aboriginal community organizations. Participant recruitment and self-reported data collection through questionnaires using established tools were led by Aboriginal youth peer researchers. Logistic regression estimated odds ratios for engaging in higher levels of physical activity (3–7 d vs 0–2 d) according to SEWB, culture, and community factors; models were adjusted for sex, age, and state/territory. Results : Of 1154 adolescents, 517 (45%) engaged in 3 to 7 days of physical activity. Factors associated with higher odds of physical activity were having good to excellent self-rated health; higher resilience; a lower risk Strengths and Difficulties Questionnaire score; regular community group/club participation, team sport, individual sport, or church/religious activities in the past 12 months; and perception of activities for young people to do in their community. Conclusion : Physical activity participation was favorably associated with a holistic range of measures of adolescent health and well-being. These findings provide valuable insights for Aboriginal adolescent program and policy design and delivery. The follow-up of participants in this cohort study will allow for examination of causal associations.

Clinical quality registries indicate that adherence to clinical practice guidelines for the management of hip fracture patients is often not as recommended. The aim of this systematic review is to evaluate interventions that improve adherence to hip fracture guideline recommendations for time to surgery and early mobilization. A systematic review and meta-analysis of English language studies published between 1st January 2000 and 12th March 2025, available from Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science was conducted. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Studies were included if they reported on interventions designed to improve time to surgery or early mobilization in the acute care period for patients aged 50 years and older admitted to hospital with a proximal femoral fracture. Ten studies met inclusion criteria. Interventions to improve time to surgery and early mobilization included care pathways (n = 5), orthogeriatric models of care (n = 2), audit and feedback (n = 1), clinical supervision (n = 1), and pay for performance (n = 1). Interventions were associated with an overall small to moderate positive effect on time to surgery (n = 6, SMD 0.47, 95