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IntroductionAntimicrobial resistance (AMR) is a pressing public health threat, and the prevalence of AMR is particularly high in Vietnam. A comprehensive review of AMR in humans, animals and/or the environment in Vietnam has however not been conducted to date. This systematic review aims to address this evidence gap and will collect and aggregate findings from literature on AMR in Vietnam among bacterial pathogens of public health interest from a One Health perspective. The results from this countrywide literature review may serve as a guiding tool for policymakers, medical practitioners, veterinarians and other relevant stakeholders in Vietnam and outside the country. This review will also identify specific areas where critical information is lacking, which will be of value for future surveillance programmes and epidemiological research.Methods and analysisStudies reporting primary data on antimicrobial susceptibility testing from human (both community and hospital settings), animal and environmental samples in Vietnam will be included. The search will be conducted in PubMed, Web of Science, Embase and Scopus. In addition, Google Scholar will be used to retrieve literature published in Vietnamese and Open Access Theses and Dissertations will be used to seek relevant PhD dissertations. More than 18 different pathogens will be included in this review, mainly based on the 2017 and 2024 WHO bacterial priority pathogens list and the WHO Global Antimicrobial Resistance and Use Surveillance System. Risk of bias (quality) assessment of included studies will be conducted using (1) The thirteen mandatory elements of the Microbiology Investigation Criteria for Reporting Objectively checklist and (2) The bias appraisal framework of Hoy et al. The outcome of this literature review will be the prevalence of resistance among selected bacteria, stratified by setting (human (hospital or community), animal and the environment). Pooled prevalence estimates will be calculated for each of the selected antimicrobial-bacterial pathogen combinations. This literature review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Ethics and disseminationEthical approval is not required as no primary data are to be collected. The results from this review will be submitted for publication in a peer-reviewed journal.PROSPERO registration numberPROSPERO CRD420251047399.

Infectious diseases are emerging and re-emerging due to climate change. Understanding how climate variability affects the transmission of infectious diseases is important for both researchers and the general public. Yet, the widespread knowledge of the general public on this matter is unknown, and quantitative research is still lacking. A survey was designed to assess the knowledge and perception of 1) infectious diseases, 2) climate change and 3) the effect of climate change on infectious diseases. Participants were recruited via convenience sampling, and an anonymous cross-sectional survey with informed consent was distributed to each participant. Descriptive and inferential analyses were performed primarily focusing on the occupational background as well as nationality of participants. A total of 458 individuals participated in this study, and most participants were originally from Myanmar, the Netherlands, Spain, United Kingdom and the United States. Almost half (44%) had a background in natural sciences and had a higher level of knowledge on infectious diseases compared to participants with non-science background (mean score of 12.5 and 11.2 out of 20, respectively). The knowledge of the effect of climate change on infectious diseases was also significantly different between participants with and without a background in natural sciences (13.1 and 11.8 out of 20, respectively). The level of knowledge on various topics was highly correlated with nationality but not associated with age. The general population demonstrated a high awareness and strong knowledge of climate change regardless of their background in natural sciences. This study exposes a knowledge gap in the general public regarding the effect of climate change on infectious diseases, and highlights that different levels of knowledge are observed in groups with differing occupations and nationalities. These results may help to develop awareness interventions for the general public.

Minimizing the effect of antimicrobial resistance (AMR) requires an adequate policy response that relies on good governance and coordination. This study aims to have a better comprehension of how AMR is understood and perceived by policy-makers and stakeholders in a multinational context. A digital survey was designed to capture the knowledge, attitudes, and perceptions (KAP) towards AMR, and it was distributed to politicians, policy advisors, and stakeholders. A total of 351 individuals from 15 different countries participated, 80% from high-income countries (HICs) and 20% from low- and middle-income countries (LMICs). The Netherlands, Spain, and Myanmar were the top 3 represented countries. Participants had sufficient knowledge regarding AMR and reported the importance of political willingness to tackle AMR. Overall, LMIC participants demonstrated better knowledge of AMR but showed poor perception and attitude towards antimicrobial use compared to HIC participants. In addition, level of education and field of expertise were significantly associated with knowledge, perception, and practices regardless of demographic characteristics. Inter-regional differences in KAP regarding AMR exist among politicians, policy advisors, and relevant stakeholders. This study captures multinational policy-maker and stakeholder mapping that can be used to propose further policy implementation on various governance levels.

IntroductionIn the Netherlands, approximately 2200 major amputations of the lower extremities are performed each year, the majority in vascular patients. Around 61% of these patients will develop postamputation pain (PAP). PAP is a severe, lifelong, disabling condition profoundly affecting quality of life. During amputations, the common practice is to cut the nerves without employing nerve-surgical techniques to prevent chronic pain due to neuroma formation. In recent years, targeted muscle reinnervation (TMR) has been the most frequently studied technique for treating PAP, inhibiting neuroma formation by rerouting the cut mixed nerve to a functional motor nerve. We hypothesise that a primary TMR procedure during major lower limb amputations will result in a lower prevalence of PAP.Methods and analysisWe propose a national, multicentre, randomised, sham-controlled trial comparing TMR with traction neurectomy in major amputations of the lower extremities in patients with vascular disease. 203 patients will be recruited with an indication for a transfemoral to transtibial amputation as a primary or secondary sequela of vascular disease. The subjects are randomly assigned to the TMR group or the traction neurectomy group. PAP will be evaluated 1 year postoperatively as the primary endpoint. Secondary outcomes include quality of life, mobility, neuropathic pain, hospital anxiety and depression, cost-effectiveness and complications.Ethics and disseminationThis study has been reviewed and approved by the local ethical review body, ‘The Medical Ethics Committee Leiden The Hague Delft’, under the reference: P24.073 on 28 November 2024. Results will be published in peer-reviewed journals.Trial registration numberNCT06719245. Dutch trial registry: NL87196.058.24

There is a discrepancy between successful recanalization and good clinical outcome after endovascular treatment (EVT) in acute ischemic stroke patients. During removal of a thrombus, a shower of microemboli may release and lodge to the distal circulation. The objective of this study was to determine the extent of damage on brain tissue caused by microemboli. In a rat model of microembolization, a mixture of microsphere (MS) sizes (15, 25 and 50 µm diameter) was injected via the left internal carotid artery. A 3D image of the left hemisphere was reconstructed and a point-pattern spatial analysis was applied based on G- and K-functions to unravel the spatial correlation between MS and the induced hypoxia or infarction. We show a spatial correlation between MS and hypoxia or infarction spreading up to a distance of 1000–1500 µm. These results imply that microemboli, which individually may not always be harmful, can interact and result in local areas of hypoxia or even infarction when lodged in large numbers.

ObjectivesExternal risk factors connected to club, team and coaching are believed to be important in the causation of hamstring injuries, but little is known about the preventive measures used. The objective was to analyse the association between preventive factors and hamstring muscle injury burden.Methods14 teams participated in the Union of European Football Associations Champions/Europa Leagues from 2019/2020 to 2022/2023. An open question was sent out in January 2023 to the four teams with the lowest hamstring muscle injury burden, asking why their teams had successfully avoided hamstring muscle injuries and which preventive methods they had used. A questionnaire that investigated the use of these methods was sent to all 14 teams in February 2023. A multiple linear regression model was applied, using injury burden as an outcome variable and the questionnaire responses as possible explanatory variables possibly adjusted for team and season.ResultsThe preventive methods included factors such as the level of communication between the coach, the medical staff and the performance staff. The adjusted multiple linear regression model indicated that communication between the medical staff and the performance staff was negatively associated with an increased hamstring muscle injury burden, where for every ‘higher’ grade of the communication variable, the average injury burden decreased by 4.1 (95% CI −8.2 to −0.04, p=0.048) days per 1000 hours.ConclusionsBetter communication between the medical and the performance staff and continuous involvement of the medical staff in load management was associated with a lower hamstring injury burden in male professional football teams.

IntroductionStriking the balance in 24-hour movement behaviour (sedentary behaviour, physical activity and sleep) is expected to reduce the risk of a new major cardiovascular event or death (MACE). We aim to determine the effectiveness and cost-effectiveness of the RISE (Reduce and Interrupt sedentary behaviour using a blended behavioural intervention to Empower people at risk towards sustainable 24-hour movement behaviour change) intervention by improving 24-hour movement behaviour for prevention of MACE and gaining quality-adjusted life years (QALYs) in community-dwelling people at risk with a first-ever stroke.Methods and analysisThis assessor-blinded multicentre randomised controlled trial includes about 1000 participants with a first-ever stroke, of which 752 participants require secondary prevention based on their 24-hour movement behaviour. Participants will be randomly assigned to the experimental group (RISE intervention + usual care) or control (usual care) group. RISE is a 15-week blended care intervention: primary care physiotherapists coach people in their home setting using behaviour change techniques and the RISE eCoaching system. This system consists of: (1) an activity monitor, (2) a smartphone application that provides real-time feedback and contains e-learning modules and (3) a monitoring dashboard for the physiotherapist. A close relative of the participant is involved during the intervention to provide social support. The primary outcome is the effectiveness of the RISE intervention regarding the prevention of MACE measured at one year post randomisation using survival analysis comparing the experimental and control groups. Secondary outcomes include cost-effectiveness for MACE prevention and QALYs and changes in 24-hour movement behaviour over time using compositional data analysis.Ethics and disseminationEthical approval is obtained from Medical Ethics Review Committee Utrecht, NedMec NL83940.000.23. Findings will be disseminated through international peer-reviewed journals and conferences. A sustainable 24-hour movement behaviour change is needed to gain long-term benefits of lowering MACE in patients with stroke. The RISE intervention offers this foundation by integrating behaviour change techniques, the RISE eCoaching system, involvement of participatory support and extensively trained RISE physiotherapists. Consequently, the RISE intervention is expected to be (cost-)effective compared with usual care, and hence, this study will offer a foundation for implementing the RISE intervention in standard poststroke care.Trial registration numberNCT06124248.

In het Net als jij-project zijn de behoeften onderzocht van jongeren met een beperking in de overgang van kinderzorg naar volwassenenzorg en in de fase van het volwassen worden (12–25 jaar). Met deze informatie is in cocreatie met jongeren en ouders informatiemateriaal ontwikkeld waarin zij zich herkennen en dat aansluit bij hun behoeften. Al deze tools, ervaringsverhalen en aanvullende informatie staan op de openbare website www.netalsjij.nl en geven ook professionals handvatten om de zorg in de transitiefase voor jongeren met een beperking te verbeteren. In dit artikel delen Max en Neeltje (twee jongeren met spina bifida) hun ervaringen en tips.

Samenvatting In het Net als jij-project zijn de behoeften onderzocht van jongeren met een beperking in de overgang van kinderzorg naar volwassenenzorg en in de fase van het volwassen worden (12–25 jaar). Met deze informatie is in cocreatie met jongeren en ouders informatiemateriaal ontwikkeld waarin zij zich herkennen en dat aansluit bij hun behoeften. Al deze tools, ervaringsverhalen en aanvullende informatie staan op de openbare website www.netalsjij.nl en geven ook professionals handvatten om de zorg in de transitiefase voor jongeren met een beperking te verbeteren. In dit artikel delen Max en Neeltje (twee jongeren met spina bifida) hun ervaringen en tips.

In the version of this article initially published, affiliation 38 incorrectly read “ICNU-Nephrology and Urology Department, Barcelona, Spain”; “Renal Division, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain” is the correct affiliation. The error has been corrected in the HTML and PDF versions of the article.