National Institute for Health Research

Business performance in financial institutions remains uneven across emerging economies, despite sustained investments in strategic planning and reform initiatives. Attention has increasingly shifted from strategy formulation to execution, yet empirical evidence on how strategy implementation shapes organisational performance in developing financial systems remains limited. This study examines the relationship between strategy implementation and business performance in Nigerian financial institutions, using Wema Bank Plc as an empirical case. Drawing on goal-setting theory and the resource- based view, strategy implementation is operationalised through five core dimensions: strategic leadership, organisational structure alignment, communication clarity, resource allocation, and technology integration. A quantitative survey design was adopted, with data collected from 270 employees across selected branches in Lagos State. Descriptive statistics and regression analysis were used to assess the impact of strategy implementation on business performance. Findings indicate that strategy implementation has a statistically significant positive effect on business performance, with all five dimensions showing strong explanatory power. The study reinforces the centrality of execution in strategic management and offers evidence-based insights for managers seeking to translate strategic intent into measurable organisational outcomes within financial institutions.

Hypertension remains a leading contributor to cardiovascular morbidity and premature mortality worldwide, with increasing prevalence observed among younger populations. Although avoidable lifestyle factors account for a substantial proportion of hypertension risk, prevention efforts depend heavily on adequate awareness and understanding of these factors. This study examines the level of knowledge of avoidable risk factors of hypertension among university students in England and evaluates the relationship between these factors and hypertension status. A cross-sectional quantitative design was employed using a structured questionnaire administered to students at a large English university. Descriptive statistics, chi-square analysis, and multinomial logistic regression were used to analyse the data. Findings indicate a high level of knowledge of avoidable risk factors, including alcohol consumption, obesity, high salt intake, and junk food consumption. Despite this, significant associations were observed between several avoidable risk factors and hypertension status, particularly alcohol use, body mass index, salt intake, and frequent consumption of junk food. The results highlight a clear disjunction between knowledge and health behaviour, suggesting that awareness alone is insufficient to reduce hypertension risk among university students. The study underscores the need for prevention strategies that extend beyond information provision to address behavioural, social, and environmental drivers of risk.

Background: Gastric and gastro-oesophageal junction cancers encompass a heterogeneous group of malignancies with distinct histological and biological characteristics. Histological classification remains central to diagnosis, prognostication, and therapeutic decision-making, particularly in settings where molecular profiling is not routinely available. Objective: This study examined the histological spectrum and classification patterns of gastric and gastro-oesophageal junction cancers diagnosed over a ten-year period in Anambra State, South-East Nigeria. Methods: A retrospective review was conducted of gastric and gastro-oesophageal junction cancer cases diagnosed between January 2011 and December 2020 across four major histopathology laboratories in Anambra State. Archived haematoxylin and eosin–stained slides and paraffin blocks were reviewed. Tumours were classified according to the 2019 World Health Organization classification of gastric tumours, with carcinomas further categorised using the Lauren classification system. Descriptive statistics and chi-square testing were applied, with statistical significance set at p < 0.05. Results: Ninety-three cases met inclusion criteria. Carcinomas constituted the majority of tumours, followed by mesenchymal tumours, lymphomas, and neuroendocrine tumours. Tubular adenocarcinoma was the most frequent carcinoma subtype, while intestinal-type carcinoma predominated under the Lauren classification. Most graded carcinomas were well differentiated. No statistically significant associations were identified between histological subtype and patient age or sex. Conclusion: Gastric and gastro-oesophageal junction cancers in this setting are dominated by epithelial malignancies, particularly tubular and intestinal-type adenocarcinomas. The observed histological profile aligns with patterns reported across Nigeria and other low- and middle-income settings, underscoring the continuing relevance of morphology-based classification in regional cancer practice.

To explore associations of clinic and 24-hour ambulatory blood pressure (BP) monitoring (ABPM) with cardiovascular death (CVD), parameters were modeled for age and sex in this large cohort in primary care. In the Spanish ABPM Registry, 59.124 patients had complete data on mortality, age, sex, and all ABPM. Office, mean, 24-hour, daytime, and nighttime systolic BP (SBP), diastolic BP, and pulse pressure (PP) were related to CVD according to age and sex and were modelled with restricted cubic splines to get trajectories. During a median of 9.7 years, 2361 patients had CVD (1229 males, 1132 females). Nonlinear relationships for office, 24-hour mean, daytime, and nighttime SBP, diastolic BP, and PP (P<0.0001 for all) for both sexes were observed. Until 75 years, SBP was higher in males than females, but differences were minimized after ≈60 to 70 years (P for interaction <0.0001). High SBP and PP are associated with CVD without heterogeneity between sexes and across aging. The increase of SBP and PP was higher at a higher age for females than males (P for interaction <0.0001). CVD was age-dependent, and ABPM, in particular nighttime BP did more closely associated with risk than office BP in younger than in older individuals. Twenty-four-hour mean, nighttime BP, and PP were closely associated with risk being higher in elderly females than males after 75 years, corresponding to a rise in BP in older females. Guidelines should continue to mandate the evaluation of 24-hour ABPM data for risk prediction.

BackgroundChildren and adolescents with autism spectrum disorder (ASD) frequently experience sleep problems. Although various pharmacological, behavioral, and physical interventions have demonstrated efficacy in improving sleep among children with ASD, the relative effectiveness of these interventions remains unclear.MethodsWe will conduct a systematic literature search to identify randomized controlled trials that evaluate the efficacy of pharmacological (e.g., melatonin), psychological (e.g., cognitive behavioral therapy), and physical (e.g., bright light therapy) interventions for sleep problems in children with ASD. We will search PubMed, PsycINFO, Cochrane CENTRAL, major trial registries, and regulatory agency websites. We will assess the Cochrane Risk of Bias 2.0 (RoB 2.0) tool for primary outcome and the Risk Of Bias due to Missing Evidence in Network meta-analysis (ROB-MEN) tool for the bias due to missing network evidence. A network meta-analysis (NMA) will be performed to compare the included interventions. The primary outcome will be sleep onset latency, while secondary outcomes will include other sleep variables, all-cause dropouts, and sleep disturbances assessed using standardized measures. We will assess confidence in NMA(CINeMA).DiscussionOur NMA aims to provide evidence-based insights into the effectiveness of sleep interventions for clinicians, children with ASD, and their caregivers. This information will help guide treatment decisions and improve the quality of life for children with ASD and their families.Systematic review registrationPROSPERO CRD42024592795.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13643-026-03143-8.

Sepsis is a heterogeneous clinical syndrome with a high mortality, requiring personalised stratification strategies. Here, we characterise genetic variation that modulates MTOR, a critical regulator of metabolism and immune responses in sepsis. The effects are context specific, involving a regulatory element that affects MTOR expression in activated T cells with opposite effect in neutrophils. We show that the G-allele of the lead variant, rs4845987, which is associated with decreased risk of type 2 diabetes, reduces MTOR expression in T cells and improves survival in sepsis due to pneumonia, with effects specific to sepsis endotype. Using ex vivo models, we demonstrate that activated T cells promote immunosuppressive neutrophils through released cytokines, a process dampened by hypoxia and the mTOR inhibitor rapamycin. Our work demonstrates an epigenetic mechanism fine-tuning MTOR transcription and T cell activity via the variant-containing regulatory element, which further exhibits an allelic effect upon vitamin C treatment. These findings reveal how genetic variation interacts with disease state to modulate immune cell-cell communication, providing a framework for stratified therapy in sepsis.