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BACKGROUND: Co-occurring substance use disorders (SUDs) among individuals with opioid use disorder (OUD) are associated with additional impairment, overdose, and death. This study examined characteristics of patients who have OUD with and without co-occurring SUDs in rural primary care clinics. METHODS: Secondary analysis used electronic health record (EHR) data from six rural primary care clinics, including demographics, diagnoses, encounters, and prescriptions of medication for OUD (MOUD), as well as EHR data from an external telemedicine vendor that provided MOUD to some clinic patients. The study population included all adult patients who had a visit to the participating clinics from October 2019 to January 2021. RESULTS: We identified 1164 patients with OUD; 72.6 % had OUD only, 11.5 % had OUD and stimulant use disorder (OUD + StUD), and 15.9 % had OUD and other non-stimulant substance use disorder (OUD + Other). The OUD + StUD group had the highest rates of hepatitis C virus (25.4 % for OUD + StUD, 17.8 % for OUD + Other, and 7.5 % for OUD Only; p

Objective: Patient expectations in the Australian healthcare system are for coordinated, collaborative practice. There is a need for education institutions, health services, accreditation authorities, and consumers to work together to achieve this goal. As part of a larger body of work, we sought to understand how these stakeholders contribute to the development of collaborative healthcare practice. Method: Nineteen focus groups were conducted in 2022 with 84 participants consisting of education providers (n = 62), consumers (n = 10), representatives from the Health Profession's Education Standing Group (n = 8), and health service practitioners (n = 4). Framework analysis was initially undertaken to understand facilitators of, and barriers to, collaborative practice and learning. In a secondary analysis, the themes were re-organised according to the Bolman and Deal domains of organisational practice, to make explicit the structural, human resource, political, and symbolic factors deemed useful for re-imaging a process for learning about and incentivising collaborative practice. Results: There are multiple factors across healthcare settings that both facilitate and challenge the development of collaborative practice. Co-location of professions and participation in formal interprofessional processes such as team meetings and handovers facilitated learning collaborative practice, although traditional cultures which perpetuate siloed models of healthcare, power differentials between the professions, funding structures, and information sharing limited opportunities. The 'value' of collaborative practice was facilitated through both consistent curriculum messages throughout health professional courses and positive role modelling. Conclusions: Education institutions, health service practitioners, accreditation authorities, and consumers can work together to facilitate the development of collaborative practice through attention to policy and processes, curriculum activities, student participation, health service activities and practice, and resource allocation. What is known about the topic? Patients expect coordinated, collaborative practice in the Australian healthcare system. Health services, education institutions, and accreditation authorities must work together to achieve this goal. What does this paper add? While the value of collaborative practice is embedded through consistent curriculum messages and positive role modelling in health professional courses, accreditation authorities, education institutions, health service practitioners, and consumers need to work together to facilitate the development of collaborative practice through attention to policy and processes, curriculum activities, student participation, health service activities, and resource allocation. What are the implications for practitioners? Through working together on curriculum and health service activities and practice, health service providers, education institutions, and accreditation authorities can develop collaborative practice. [ABSTRACT FROM AUTHOR]

Background: There are several strategies used to assess involvement in their healthcare across service providers. However, there is no consensus on the most appropriate measurement tool to use when evaluating patient involvement initiatives. This qualitative study aimed to explore the perspectives of stakeholders from micro, meso, and macro levels within the Danish healthcare system on measuring patient involvement in their healthcare. Methods: This descriptive, explorative study employed semi-structured interviews with open-ended questions to elicit participants' views and experiences of patient involvement and measurement tools. A purposeful sample of participants was identified, to include decision makers, researchers, and health professionals (n = 20) with experiences of measuring patient involvement in healthcare at micro, meso, and macro levels across Danish organizations. Data underwent reflexive thematic analysis. Results: Three main themes were identified: 1) Determining the purpose of patient involvement practices and measurement alignment; 2) Reflecting on the qualities, fit, and usefulness of measures; 3) Recognizing conflicting stakeholder paradigms. Despite the interest in and positive attitudes toward patient involvement innovations, views on the meaning and value of evaluating involvement varied; in part, this was attributable to challenges in selecting criteria, methods, and measures for evaluation. Conclusion: The findings indicate the need to integrate the perspectives of all key stakeholders in designing the evaluation of patient involvement initiatives. The application of a multiple stakeholder approach and co-production of a multidimensional evaluation may provide some common ground for selecting evaluation criteria and measurement tools in the healthcare setting. Trial registration: Danish Data Protection Agency (1–16-02–400-21) 15 October 2021. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) has indicated that the absence of prison health poses a threat to public health, making it important to safeguard access to quality healthcare for incarcerated populations. Although several studies have explored the quality of care in prisons, there is a dearth of empirical evidence on the perspectives of incarcerated individuals. This study investigated incarcerated individuals' perspectives and opinions on the general healthcare services in Ghanaian prisons. Methods: Utilizing a qualitative approach, focus group discussions were conducted with 51 incarcerated individuals in five prisons sited in the Northern, Middle and Southern zones of Ghana. Thematic analysis following the tradition of Braun and Clarke was conducted. Four of the six constructs of the WHO Health Systems Framework – service delivery, health workforce, access to essential medicines, and leadership and guidance – were applied deductively to organise the data into themes and subthemes. Results: Four themes were generated from the analysis: "Health service delivery", "Health workforce in prisons", "Access to essential medicines" and "Leadership; regulating healthcare services". Participants rated health services in prisons as below average compared to those available to the general population. The use of nurses as prescribers in prison infirmaries, though consistent with Ghana Health Service policy, seems to negatively influence prisoners' perceptions of the quality of the health workforce in prisons. Lack of basic equipment and essential medications at the infirmary for common endemic conditions such as malaria coupled with the bureaucratic processes required to access care outside of the prison also negatively affected incarcerated individuals' perceptions of the quality of health care. Conclusions: Incarcerated individuals perceived that the quality of health services provided in prisons was inferior to that provided in the general population. Addressing challenges associated with the unavailability of essential drugs and equipment, improving the number of health staff, and addressing bottlenecks in accessing urgent care will enhance the experiences of incarcerated populations on the quality of care given. [ABSTRACT FROM AUTHOR]

Background: Participation of health service staff in research improves health outcomes and adherence to clinical guidelines. To increase research participation, many health services seek to build research capacity which adds to the development of individual and organisational skills and abilities in order to conduct health research. Numerous approaches to research capacity building have been trialed with inter- and intra-institutional, or university-health service collaborative approaches being frequently described strategies. University-health service research collaborations have potential for high impact and mutual benefit, by harnessing respective strengths across both organisations. However, the range and scope of research capacity building approaches, including their relative value and success have not been consolidated. The aim of this review was to examine and describe the collaborative strategies employed by health services in conjunction with educational partners to enhance the research capability of health service staff. Methods: The scoping review framework by Arksey and O'Malley was used to inform the review method. A systematic search was conducted of four major databases: Medline, CINAHL, Embase, and Cochrane, focusing on publications after 1995. Inclusion and exclusion criteria were established through iterative team discussions. The two-stage screening process and data extraction was managed in Covidence. Collaboration, Research Capacity, Health Services, and Health workforce were the primary concepts, contexts and populations guiding the search. Results: Of the 1462 studies identified, 61 were selected for the review. These studies reported on partnerships between universities and health services with a specific focus on building research capacity of health service staff. Studies predominantly hailed from Australia, USA, UK, and Canada. Collaboration approaches varied and leveraged different activities to build research capacity included training, mentoring, shared funding, and networking. Training partnerships emerging as the most prevalent. Findings emphasised the importance of localisation in approaches, with some studies indicating the intrinsic value of such collaborations for both partners involved. Despite the emphasis on individual interventions like training and mentoring, team-level interventions were notably scarce. Conclusion: This review highlights the diverse range of approaches in research capacity building collaborations between health services and educational partners. It advocates for a shared understanding of goals, highlighting the critical nature of relationship-building and the pivotal role of sustainable infrastructure in long-term collaboration success. Future directions should consider the tangible impacts of these models on clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Telemedicine has emerged as a crucial tool in addressing public health requirements, particularly during a pandemic. This aligns with the third Sustainable Development Goals (SDGs) objective of ensuring healthy lives and promoting well‐being for all ages. The current generation demonstrates a greater proficiency in modern technology, prompting researchers to investigate their views and behavior trends in telemedicine. Methods: This research is aimed at examining the telemedicine adoption patterns of Generation Y and Generation Z by dividing them into two groups. Study Group 1 is comprised of those who have known modern technology but have yet to gain experience in using telemedicine. Meanwhile, Study Group 2 is comprised of those who had used telemedicine services. Utilizing structural equation model (SEM) analysis, this research investigates the magnitude of influence exerted by various determinants on an individual's tendency to utilize telemedicine. Results: Findings from both study groups indicate that younger generations have positive attitudes towards telemedicine, significantly influencing their willingness to use telemedicine. Furthermore, the level of readiness for change emerges as a crucial factor in determining the degree of affective commitment to change, continuance commitment to change, and normative commitment to change. In addition, the participants' affective experience state significantly influences all three dimensions of commitment to change. Conclusion: The results suggest the importance of fostering a positive and pragmatic understanding of telemedicine among young people. This can be achieved by encouraging the use of telemedicine services and fully adopting the shift to telemedicine. Therefore, it is crucial to prioritize the development of a positive view towards telemedicine, provide excellent service experiences, and promote social flexibility to attract a large user base, especially among the younger population. [ABSTRACT FROM AUTHOR]

The aging population, combined with the scarcity of healthcare resources, presents significant challenges for our society. The use of artificial intelligence (AI) and robotics offers a potential solution to these challenges. However, such technologies also raise ethical and cybersecurity concerns related to the preservation of privacy, autonomy, and human contact. In this case study, we examine these ethical challenges and the opportunities brought by AI and robotics in the care of old individuals at home. This article aims to describe the current fragmented state of legislation related to the development and use of AI-based services and robotics and to reflect on their ethics and cybersecurity. The findings indicate that, guided by ethical principles, we can leverage the best aspects of technology while ensuring that old people can maintain a dignified and valued life at home. The careful handling of ethical issues should be viewed as a competitive advantage and opportunity, rather than a burden. [ABSTRACT FROM AUTHOR]

Background: The influence of the coronavirus disease 2019 (COVID-19) pandemic on dental care utilization may have differed according to individual characteristics or type of dental care provision. This study aimed to evaluate the changes in dental care utilization and per-attendance costs by age group and type of dental care during the COVID-19 pandemic in Japan. Methods: This time-series study used healthcare insurance claims data from 01/07/2019 to 09/27/2021 (143 weeks) from nine municipalities in Japan. Dental care utilization rate per week and average dental care cost per attendance by age groups (0-19 years/20-64 years/65-74 years/=75 years) and types of dental care (outpatient/visiting) were used as outcome variables. COVID-19 pandemic waves in Japan were used as predictors: 1st (03/23/2020-05/17/2020), 2nd (06/22/2020-09/27/2020), 3rd (10/26/2020-02/21/2021), 4th (02/22/2021-06/07/2021), and 5th (07/05/2021-09/13/2021) waves. Fixed-effects models were employed to estimate the proportional changes. Results: In the fixed-effects model, we observed large declines in dental care utilization during the 1st (17.0-22.0%) and 2nd waves (3.0-13.0%) compared to the non-pandemic wave period in all age groups. In contrast, the average dental care cost per attendance increased in all age groups by 5.2-8.6% during the 1st wave. Conclusion: During the initial wave of the COVID-19 pandemic in Japan, dental care utilization decreased in all age groups, whereas the average dental care cost per attendance increased. The COVID-19 pandemic may have changed the dental care provision pattern towards less frequent and more concentrated dental care to avoid the risk of infection. [ABSTRACT FROM AUTHOR]

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Background: Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women's health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women's access to SRH services in rural Australia, considering both supply and demand dimensions. Methods: We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the "best fit" approach to framework synthesis using the patient-centred access to healthcare model. Results: Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women's health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility. Conclusion: This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women's diverse needs. [ABSTRACT FROM AUTHOR]

Introduction: The Activating Lived Experience Leadership (ALEL) project was a South Australian participatory action research project that aimed to improve the ways lived experience is recognised, valued and integrated across mental health and social sector systems. ALEL was completed during 2019–2021, where it engaged 182 participants in generating community action and research knowledge. Objective: Our paper discusses the project's processes of building a collective partnership among lived experience leaders and other leaders from within the sector, so that the actions and strategies identified through research could be implemented by systems‐level impact. We describe the collaborative process and key learnings that resulted in eight key action areas for transformative systems change in South Australia. Methods: The project invited a diverse range of self‐identified lived experience and other leaders to be involved in a PAR process featuring formal qualitative research (focus groups, surveys and interviews) as well as community development activities (leaders' summit meetings, consultations, training and community of practice meetings). These processes were used to help us describe the purpose, achievements and potential of lived experience leadership. Project priorities and systems‐level analysis was also undertaken with lived experience sector leaders and project advisors across two leaders' summit meetings, integrating research outcomes with sector planning to define high‐level actions and a vision for transformational change. Results: Participatory action research as informed by systems change and collective impact strategies assisted the project to generate detailed findings about the experiences and complexities of lived experience leadership, and collective responses of how systems could better support, be accountable to and leverage lived experience perspectives, experience and peer‐work approaches. Conclusion: Systems change to define, value and embed lived experience leadership benefits from collective efforts in both formal research and sector development activities. These can be used to generate foundational understandings and guidance for working together in genuine ways for transforming mental health and social sector systems, experience and outcomes. Public Contribution: Members of lived experience communities codesigned the project, and contributed to project governance and the development of all findings and project reports. [ABSTRACT FROM AUTHOR]

Purpose: To explore the longitudinal associations between eight-year trajectories of loneliness, social isolation and healthcare utilisation (i.e. inpatient, outpatient, and nursing home care) in US older adults. Methods: The study used data from the Health and Retirement Study in 2006–2018, which included a nationally representative sample of American adults aged 50 and above (N = 6,832). We conducted latent growth curve models to assess the associations between trajectories of loneliness and isolation and healthcare utilisation over 8 years. Results: Independent of sociodemographic and health-related confounders, social deficits were associated with a lower likelihood of baseline physician visits (loneliness β= -0.15, SE = 0.08; social isolation β= -0.19, SE = 0.08), but there was a positive association between loneliness and number of physician visits (β = 0.06, SE = 0.03), while social isolation was associated with extended hospital (β = 0.07, SE = 0.04) and nursing home stays (β = 0.05, SE = 0.02). Longer nursing home stays also predicted better trajectories of loneliness and isolation over time. Conclusion: Loneliness and social isolation are cross-sectionally related to complex patterns of different types of healthcare. There was no clear evidence that social deficits led to specific trajectories of healthcare utilisation, but nursing home stays may over time help provide social contact, supporting trajectories of isolation and potentially loneliness. Non-clinical services such as social prescribing could have the potential to address unmet social needs and further promote patients' health-seeking profiles for improving healthcare equity. [ABSTRACT FROM AUTHOR]

Abstract Background The World Health Organization (WHO) has indicated that the absence of prison health poses a threat to public health, making it important to safeguard access to quality healthcare for incarcerated populations. Although several studies have explored the quality of care in prisons, there is a dearth of empirical evidence on the perspectives of incarcerated individuals. This study investigated incarcerated individuals’ perspectives and opinions on the general healthcare services in Ghanaian prisons. Methods Utilizing a qualitative approach, focus group discussions were conducted with 51 incarcerated individuals in five prisons sited in the Northern, Middle and Southern zones of Ghana. Thematic analysis following the tradition of Braun and Clarke was conducted. Four of the six constructs of the WHO Health Systems Framework – service delivery, health workforce, access to essential medicines, and leadership and guidance – were applied deductively to organise the data into themes and subthemes. Results Four themes were generated from the analysis: “Health service delivery”, “Health workforce in prisons”, “Access to essential medicines” and “Leadership; regulating healthcare services”. Participants rated health services in prisons as below average compared to those available to the general population. The use of nurses as prescribers in prison infirmaries, though consistent with Ghana Health Service policy, seems to negatively influence prisoners’ perceptions of the quality of the health workforce in prisons. Lack of basic equipment and essential medications at the infirmary for common endemic conditions such as malaria coupled with the bureaucratic processes required to access care outside of the prison also negatively affected incarcerated individuals’ perceptions of the quality of health care. Conclusions Incarcerated individuals perceived that the quality of health services provided in prisons was inferior to that provided in the general population. Addressing challenges associated with the unavailability of essential drugs and equipment, improving the number of health staff, and addressing bottlenecks in accessing urgent care will enhance the experiences of incarcerated populations on the quality of care given.

Abstract Background Participation of health service staff in research improves health outcomes and adherence to clinical guidelines. To increase research participation, many health services seek to build research capacity which adds to the development of individual and organisational skills and abilities in order to conduct health research. Numerous approaches to research capacity building have been trialed with inter- and intra-institutional, or university-health service collaborative approaches being frequently described strategies. University-health service research collaborations have potential for high impact and mutual benefit, by harnessing respective strengths across both organisations. However, the range and scope of research capacity building approaches, including their relative value and success have not been consolidated. The aim of this review was to examine and describe the collaborative strategies employed by health services in conjunction with educational partners to enhance the research capability of health service staff. Methods The scoping review framework by Arksey and O’Malley was used to inform the review method. A systematic search was conducted of four major databases: Medline, CINAHL, Embase, and Cochrane, focusing on publications after 1995. Inclusion and exclusion criteria were established through iterative team discussions. The two-stage screening process and data extraction was managed in Covidence. Collaboration, Research Capacity, Health Services, and Health workforce were the primary concepts, contexts and populations guiding the search. Results Of the 1462 studies identified, 61 were selected for the review. These studies reported on partnerships between universities and health services with a specific focus on building research capacity of health service staff. Studies predominantly hailed from Australia, USA, UK, and Canada. Collaboration approaches varied and leveraged different activities to build research capacity included training, mentoring, shared funding, and networking. Training partnerships emerging as the most prevalent. Findings emphasised the importance of localisation in approaches, with some studies indicating the intrinsic value of such collaborations for both partners involved. Despite the emphasis on individual interventions like training and mentoring, team-level interventions were notably scarce. Conclusion This review highlights the diverse range of approaches in research capacity building collaborations between health services and educational partners. It advocates for a shared understanding of goals, highlighting the critical nature of relationship-building and the pivotal role of sustainable infrastructure in long-term collaboration success. Future directions should consider the tangible impacts of these models on clinical outcomes.

Background: Immigrants who have sustained war-related injuries face unique challenges within the healthcare systems of their new countries. This study aimed to explore the health service experiences of war-injured immigrant populations in Richmond Hill, Ontario, with a focus on identifying the barriers they encounter and the aspects of healthcare that effectively meet their needs. Methods: This qualitative study utilized semi-structured interviews to collect data from 26 war-injured immigrants with severe physical injury residing in Richmond Hill, Ontario from June to October 2023. Participants were selected to represent a diverse range of ages, genders, and countries of origin. Data were analyzed using thematic analysis to extract patterns and insights related to the healthcare experiences of the participants. The qualitative software NVivo, version 15, was utilized to assist in the organization and analysis of the data. Results: Four main themes emerged from the data: Access to health services, quality of care, patient-provider relationship, and health outcomes and satisfaction. Subthemes identified included initial contact, navigation challenges, financial barriers, waiting times, professional competence, patient-centered care, communication, trust building, cultural competence, communication quality, continuity of care, patient advocacy, recovery experience, satisfaction with care, and improvement in health status. Participants expressed significant challenges related to navigating the healthcare system, language barriers, financial constraints, and long waiting times. Positive experiences were often linked to high-quality communication, cultural competence of providers, and continuous care. Conclusion: This study underscores the need for targeted interventions to improve access and quality of care for this vulnerable population, including enhancing cultural competence and communication strategies among healthcare providers.

Abstract Background Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women’s health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women’s access to SRH services in rural Australia, considering both supply and demand dimensions. Methods We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the “best fit” approach to framework synthesis using the patient-centred access to healthcare model. Results Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women’s health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility. Conclusion This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women’s diverse needs.

Abstract Meaningful communication between health service users and providers is essential. However, when stakeholders are unfamiliar with new health services, innovative communication methods are necessary to engage them. The aim of the study was to create, validate, and evaluate a video-vignette to enhance stakeholders’ (physicians, pharmacists, and laypeople) engagement and understanding of an innovative pharmacy-based diabetes screening and prevention program. Also, to assess the video-vignette’s capacity to measure appetite and appeal for such preventive programs. This mixed-methods study consisted of two phases. In phase one, a video-vignette depicting the proposed screening and prevention program was developed and validated following established international guidelines (n = 25). The video-vignette was then evaluated by stakeholders (n = 99). In phase two, the video-vignette’s capacity as a communication tool was tested in focus groups and interviews to explore stakeholders’ perspectives and engagement on the proposed service (n = 22). Quantitative data were analyzed descriptively, while qualitative data underwent thematic analysis. In total, 146 stakeholders participated. The script was well-received, deemed credible, and realistic. Furthermore, the video-vignette received high ratings for its value, content, interest, realism, and visual and audio quality. The focus groups and interviews provided valuable insights into the design and delivery of the new service. The video-vignette compellingly portrayed the novel pharmacy-based diabetes screening and prevention service. It facilitated in-depth discussions among stakeholders and significantly enhanced their understanding and appreciation of such health services. The video-vignette also generated significant interest in pharmacy-based diabetes screening and prevention programs, serving as a powerful tool to promote enrollment in these initiatives.

Abstract Background It is vital that health service delivery and health interventions address patients’ needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach. Methods This multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3. Results Overall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas. Conclusions This study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities.

The delivery of prescription drugs without using any prescription in Indonesian pharmacies is still frequent, such as the delivery of amlodipine (97.7%) and allopurinol (92.0%) without a doctor's prescription (Rokhman, 2017). The studies of Siahaan (2017) and Djawaria (2018) also show a similar trend, highlighting low compliance with BPOM policies. This indicates that the implementation of BPOM policies related to prescription drugs has not been optimal, increasing the risk of irrational drug use and shows public disapproval of the drug and food control system. Improvements in the implementation of BPOM policies are needed to reduce the risk of using hard drugs without a prescription. This research uses qualitative research methods with a descriptive approach. The data was analyzed using content analysts. Interviews were conducted with 5 informants in several agencies, including 2 Key Informants and 3 Ordinary Informants. Effective communication occurs between BPOM, health offices, and pharmacies through offline and online programs. Although resources in pharmacies are considered sufficient, challenges arise from the inadequacy of transportation facilities. Compliance with SOPs, especially related to the prescriptions supervision of prescription drug, is a problem. Improving SOP compliance, coordination, and public education are considered important to improve the effectiveness of BPOM policy implementation in Makassar City pharmacies. The implementation of BPOM policy related to the sale of prescription drugs without any doctor's prescription in pharmacies in Makassar City has been going well, supported by diverse communication and the availability of adequate resources. However, there are still practical obstacles such as transportation problems, lack of public education, budget constraints, lack of formal procedures in some pharmacies, and lack of interaction with relevant agencies. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study aimed to investigate the intensity of needs for home health care services (HHCs) among elderly patients with chronic diseases and to identify the associated factors. Design: A cross‐sectional survey was conducted in Wuhou District, Chengdu, Sichuan Province, China, from April to November 2021. Methods: Convenient sampling was used to screen elderly patients with chronic diseases managed by Yulin Community Health Service Center. The questionnaires included general information and the Chinese version of the Community Healthy Intensity Rating Scale were completed according to patients' conditions. The data were analyzed using descriptive statistics and binary logistic regression. Results: A total of 371 patients (10.40%) completed the survey. The mean age of the elderly patients was 84.04 years (SD = 7.07); these patients suffered from 1 to 7 kinds of chronic diseases, and the most common were hypertension (78.98%) and diabetes (40.97%). The need intensity of patients for HHCs was moderate (41.51%) or severe (58.49%). For each additional chronic disease that patients suffered from, the need intensity increases by 1.289 times (OR = 1.289; 95% CI: 1.055–1.575, p =.013); in additional, those aged more than 90 years, with a personal monthly income less than 2500 yuan ($387.00), with a poor health current status, and with only basic medical insurance presented greater need intensity (p <.05). Conclusion: Our data analysis revealed that economic status, insurance condition, poor health status, and multiple comorbidities may be the most common factors associated with the need intensity for HHCs. These characteristics may help medical staff to identify and help those with urgent health problems. [ABSTRACT FROM AUTHOR]

This study considers a hypothetical global pediatric vaccine market where multiple coordinating entities make optimal procurement decisions on behalf of countries with different purchasing power. Each entity aims to improve affordability for its countries while maintaining a profitable market for vaccine producers. This study analyzes the effect of several factors on affordability and profitability, including the number of non-cooperative coordinating entities making procuring decisions, the number of market segments in which countries are grouped for tiered pricing purposes, how producers recover fixed production costs, and the procuring order of the coordinating entities. The study relies on a framework where entities negotiate sequentially with vaccine producers using a three-stage optimization process that solves a MIP and two LP problems to determine the optimal procurement plans and prices per dose that maximize savings for the entities' countries and profit for the vaccine producers. The study's results challenge current vaccine market dynamics and contribute novel alternative strategies to orchestrate the interaction of buyers, producers, and coordinating entities for enhancing affordability in a non-cooperative market. Key results show that the order in which the coordinating entities negotiate with vaccine producers and how the latter recuperate their fixed cost investments can significantly affect profitability and affordability. Furthermore, low-income countries can meet their demands more affordably by procuring vaccines through tiered pricing via entities coordinating many market segments. In contrast, upper-middle and high-income countries increase their affordability by procuring through entities with fewer and more extensive market segments. A procurement order that prioritizes entities based on the descending income level of their countries offers higher opportunities to increase affordability and profit when producers offer volume discounts. [ABSTRACT FROM AUTHOR]

Background: It is vital that health service delivery and health interventions address patients' needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach. Methods: This multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3. Results: Overall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas. Conclusions: This study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities. [ABSTRACT FROM AUTHOR]

To identify factors influencing the availability and sales of healthy food and drinks in a café located in a hospital setting in a rural area. Three online and 1 in-person group model building workshops were conducted with hospital staff members to develop a causal loop diagram. Four areas in the causal loop diagram were identified, 5 teams were created to implement 15 identified action ideas, and an action registry was created to track their progress. By May 2023, 4 actions were active, 6 inactive, 4 completed, and 1 abandoned. The group model building process identified factors and actions to improve the healthiness of the hospital's café and motivated staff members to act for change. However, progress was limited by staff turnover, recruitment, and inadequate participation from decision-makers. Better leadership and support by senior management can ensure that long-term objectives are achieved and healthier hospital food environments are sustained. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to identify continuing professional development (CPD) needs of allied health professionals (AHP) in regional and rural Victoria. Design: This study was an online cross‐sectional design conducted between December 2022 and February 2023. Settings and Participants: AHPs employed at a large multi‐site regional public health service providing acute, subacute, community and outpatient care in Victoria, Australia. Main Outcome Measure(s): The online questionnaire included four sections investigating satisfaction of CPD, prioritised topics for CPD, preference for CPD sourcing and perceived capabilities in delivering education. To investigate prioritised topics of CPD, a tool was adapted from the Hennessy Hicks Training Needs Analysis questionnaire to align with allied health (AH) career pathways. For organisational alignment, a second questionnaire was sent to AH managers. Results: The response rate was 17% (53/316 AHPs) from members of 10 AH professions. The median years of clinical experience for participants was between 2 and 5 years. Participants with 6–10 years of clinical experience reported the lowest level of satisfaction. Research and education were identified as areas of highest training need. Self‐perceived competence in education delivery was proportionately lower in areas of assessment, developing digital learning and constructive alignment. Conclusion: CPD needs for AHPs in a regional and rural health service were shown to vary by career stage and weighted towards developing research and education delivery capabilities. Findings from this study may support public health sector and policy investment in CPD opportunities to support horizontal career progression opportunities, a balance of internal and externally sourced professional development and strategic investment in education delivery capabilities. [ABSTRACT FROM AUTHOR]

Objectives Patients with cancer often have unmet needs (e.g. physical, psychosocial, and emotional) during their cancer journey, putting them at risk for distress. This study aimed to identify factors associated with distress and to investigate the association between distress and acute health-care services utilization in a cohort of breast and gynecological cancer patients across different survivorship stages. Methods This was a retrospective cohort study of patients who visited National Cancer Centre Singapore between September 2019 and July 2020. Distress was evaluated using the self-reported Distress Thermometer and Problem List, with a distress thermometer score ≥4 signifying high distress. Data were extracted from electronic medical records. Multivariable logistic regression was used to identify demographic or clinical variables associated with distress and estimate the odds of emergency department (ED) visits and hospitalizations within 30 days of distress screening, adjusted for covariates. Results Of the 1386 patients included in the analysis, 510 (36.8%) reported high distress on their first distress screening. Variables associated with high distress included younger age, presence of psychiatric diagnosis, poorer Eastern Cooperative Oncology Group performance status, and shorter duration from cancer diagnosis to distress screening. Patients with high distress were associated with higher odds of ED visits (adjusted odds ratio [OR] = 2.25, 95% confidence interval [CI]: 1.14–4.43) and hospitalizations (adjusted OR = 2.11, 95% CI: 1.27–3.50) within 30 days of distress screening. Significance of results Self-reported high distress was associated with higher odds of increased acute health-care services utilization (ED visits and hospitalizations) in patients with breast and gynecological cancer. Identifying the subgroups at risk of high distress could trigger early interventions that reduce unplanned health-care services utilization and possibly health-care costs. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusions Impact Implications for the Profession and Patient Care Reporting Method Patient or Public Contribution To evaluate a community‐based psychological health and well‐being programme for nurses and midwives.Mixed methods programme evaluation.Four studies were included: observational descriptive study (cross‐sectional survey) of the health, well‐being and experiences of previous programme participants (Study 1); observational exploratory prospective cohort study (longitudinal survey) of health, well‐being and experiences of participants who engaged in the programme from 2020 to 2023 (Study 2); qualitative descriptive study (interviews) of experiences and perceptions of nurses and midwives who have engaged with the programme as participants or clinicians (Study 3); observational descriptive study (cross‐sectional survey) of experiences and perceptions of programme stakeholders (Study 4). Surveys included validated measures. Data were collected online. Descriptive, repeated measures and thematic analyses were conducted.One‐hundred and fifteen participants completed Study 1: 20% (n = 23) reported stress in the severe‐to‐extremely severe category; 22% (n = 25) reported psychological distress in the moderate‐to‐severe category. Thirty‐one programme participants were followed in Study 2: the effect of the programme on participant well‐being over time was not significant. Sixteen programme participants and eight programme clinicians were interviewed (Study 3). Experiences of nurses and midwives engaging with the programme were highly positive and strong attributes of the programme included (1) shared professional experience of clinicians and participants which supported a common language and facilitated understanding, and (2) effective programme leadership, and autonomy and flexibility in the clinicians' role which enabled and supported a positive working experience. Thirty‐nine broader stakeholders participated in a cross‐sectional survey (Study 4). All stakeholders reported high satisfaction with the programme. Participants considered the programme being ‘by nurses and midwives, for nurses and midwives’ critical to the programme's success and value.The community‐based psychological health and well‐being programme developed, led and delivered by nurses and midwives, for nurses and midwives, was a highly valued resource. Levels of stress and burnout in the health workforce are high. A community‐based psychological health and well‐being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. A programme delivered by nurses and midwives, for nurses and midwives, was considered critical to programme success. Programme leadership, and autonomy and flexibility in the programme clinicians' roles, facilitated and supported a positive working experience for programme clinicians. Quality and safety in patient care is directly impacted by the well‐being of nurse and midwives. A community‐based psychological health and well‐being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives.Survey findings were reported according to STROBE (von Elm et al. in Lancet, 370:1453–1457, 2007) and qualitative findings according to COREQ (Tong et al. in International Journal for Quality in Health Care, 19(6):349–357, 2007).No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate changes in pre-diagnostic concentrations of classic and 11-oxygenated androgens in type 2 diabetes (T2DM) cases and healthy controls, associations between androgen concentrations and T2DM, and the potential for androgens to improve the prediction of T2DM when considered in combination with established risk factors. Methods: Androgen concentrations were analysed in serum samples from 116 T2DM cases and 138 controls at 3, pre-diagnostic time-points: 1986/87 (T1), 1994/95 (T2), and 2001 (T3). Generalised estimating equations were used to longitudinally examine androgen concentrations, and logistic regression models were used to estimate the odds ratios (OR) of T2DM at each time-point. Logistic regression models were also used to calculate area under the receiver operating characteristics curve (AROC) from models including established risk factors alone (ERF model) and established risk factors plus each androgen, respectively, which were compared to identify improvements in predictive ability. Results: For women, no significant associations were observed between any of the investigated androgens and T2DM after adjusting for confounders. For men, after adjusting for confounders, concentrations of all investigated 11-oxygenated androgens were higher in cases than controls at one or several time-points. We observed associations between T2DM and concentrations of 11-ketoandrostenedione (OR: 1.59) and 11-ketotestosterone (OR: 1.62) at T1; and 11-hydroxyandrostenedione (OR: 2.00), 11-hydroxytestosterone (OR: 1.76), 11-ketoandrostenedione (OR: 1.84), 11-ketotestosterone (OR: 1.78) and testosterone (OR: 0.45) at T3 in men. The addition of these androgens (including 11-hydroxytestosterone at T2) to the ERF model resulted in an improved ability to predict T2DM in men (AROC: 0.79–0.82). We did not observe significant differences in changes in androgen concentrations over time between cases and controls in either sex. Conclusion: Our results demonstrate that testosterone and 11-oxygenated androgens are associated with T2DM in men before diagnosis and may be potential biomarkers in T2DM risk assessment. [ABSTRACT FROM AUTHOR]

Background/Aims: Increased rates of caesarean sections globally have potential short- and long-term impacts for mothers and babies. Research on models of care and mode of birth has reported varied results. The aim of this study was to analyse the relationship between the midwife-led model of care and mode of birth. Methods: This systematic review and meta-analysis searched PubMed, Scopus and Web of Science. Quantitative full-text open access research articles published between 2010 and 2023 in Indonesian or English were included. Research that assessed the relationship between the model and birth planning were excluded. Results: A total of 16 articles were included. Two were experimental, and the remaining 14 were observational, with a total sample of 125 201 people. The midwife-led model supported spontaneous vaginal birth (odds ratio: 1.64, P=0.01) when compared to other models. Conclusions: Implementing the midwife-led model of care may increase the likelihood of physiological birth and reduce the incidence of caesarean section, especially in low-risk pregnancies. [ABSTRACT FROM AUTHOR]

Introduction: Poor prognosis and higher mortality of chronic kidney disease are linked with cultural beliefs and practices. This study explored cultural beliefs and practices of Javanese people with end-stage renal disease undergoing hemodialysis for ≥5 years. Methods: A qualitative narrative inquiry was applied in this study. Data were collected through in-depth narrative interviews, followed by text messages, calls, and audio-visual calls for 6 weeks. Results: There were 14 participants; their mean age was 51.15 years and hemodialysis duration was 5 years and 2 months up to 10 years and 9 months. Four themes emerged: life-and-death acceptance, expectation of end-of-life care, contemplation of withdrawal from hemodialysis, and wishing for a good death. Discussion: Life values guided the ability to survive for the individual. Adherence to renal disease management regimen clashed with cultural values on occasions, such as social gatherings. Therefore, the unmet needs of patients should be addressed with a transcultural approach to modify personal health behaviors. [ABSTRACT FROM AUTHOR]

Rotational malleolar fractures result in a high prevalence of intra-articular pathologies; therefore, routine arthroscopic assessment may be beneficial in the surgical treatment of ankle fractures. However, the clinical studies regarding the effectiveness of arthroscopy thus far have mixed results. We investigated the efficacy of concurrent arthroscopy during the treatment of malleolar fractures using a large U.S. healthcare data set. Those who had arthroscopy were compared with those who did not, during the surgical treatment of malleolar fractures, while adjusting for covariates of clinical relevance. The analysis showed that concurrent arthroscopy is protective against postoperative repeat surgery (OR = 0.13, 95CI = 0.02-0.41) and wound dehiscence (OR = 0.18, 95CI = 0.03-0.56). The number of added arthroscopy cases needed to avoid one repeat surgery was 74, while that of wound dehiscence was 52. Further studies are needed to determine if routine use of arthroscopy is justifiable in the surgical treatment of malleolar fractures, given the additional costs and time to the healthcare system. [ABSTRACT FROM AUTHOR]

In the provision of health services, preventive, curative, rehabilitative and health promotion services are provided within the scope of primary, secondary and tertiary treatment services in the public and private sectors. It is thought that the health institutions that individuals who want to receive health services apply to vary due to issues such as their social security, economic situation, time of receiving the service, desire to be protected from diseases, desire to heal from the disease, and distance to reach the institution. This study was conducted to determine which institution students studying in the field of health prefer when receiving health services and for what reasons, and to determine what influences the preferences of individuals who will work in this sector in the future. Within the scope of the research, a survey consisting of 21 questions included in the specialization thesis published by Aksoy (2018) was applied to associate degree students studying at the health services vocational school of a private university in Istanbul. The survey was shared via Google forms and filled out by 410 students. Classification scale was used within the framework of quantitative research method and the findings were organized using descriptive analysis and Chi Square analysis in SPSS 25 program. As a result of the analysis, it was determined that the most preferred institution was 'State Hospital (56.3%)', the reason for preference was 'Because It is Close/Easy to Access (39.2%)', the institution they would not prefer was 'Family Health Center (29%)' and the reason was 'Not being able to have every analysis done (24%)'. Within the scope of the findings, it is of great importance to conduct studies on making other health institutions attractive in order to alleviate the high demand for state hospitals. [ABSTRACT FROM AUTHOR]

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Purpose: This study aims to minimize the cost and time of blood delivery in the whole blood supply chain network (BSCN) in disaster conditions. In other words, integrating all strategic, tactical and operational decisions of three levels of blood collection, processing and distribution leads to satisfying the demand at the right time. Design/methodology/approach: This paper proposes an integrated BSCN in disaster conditions to consider four categories of facilities, including temporary blood collection centers, field hospitals, main blood processing centers and medical centers, to optimize demand response time appropriately. The proposed model applies the location of all permanent and emergency facilities in three levels: blood collection, processing and distribution. Other essential decisions, including multipurpose facilities, emergency transportation, inventory and allocation, were also used in the model. The LP metric method is applied to solve the proposed bi-objective mathematical model for the BSCN. Findings: The findings show that this model clarifies its efficiency in the total cost and blood delivery time reduction, which results in a low carbon transmission of the blood supply chain. Originality/value: The researchers proposed an integrated BSCN in disaster conditions to minimize the cost and time of blood delivery. They considered multipurpose capabilities for facilities (e.g. field hospitals are responsible for the three purposes of blood collection, processing and distribution), and so locating permanent and emergency facilities at three levels of blood collection, processing and distribution, support facilities, emergency transportation and traffic on the route with pollution were used to present a new model. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies’ impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited. Objective To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia. Methods Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020–2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods. Results The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies. Conclusion This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures’ intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.

ABSTRACT Introduction The Activating Lived Experience Leadership (ALEL) project was a South Australian participatory action research project that aimed to improve the ways lived experience is recognised, valued and integrated across mental health and social sector systems. ALEL was completed during 2019–2021, where it engaged 182 participants in generating community action and research knowledge. Objective Our paper discusses the project's processes of building a collective partnership among lived experience leaders and other leaders from within the sector, so that the actions and strategies identified through research could be implemented by systems‐level impact. We describe the collaborative process and key learnings that resulted in eight key action areas for transformative systems change in South Australia. Methods The project invited a diverse range of self‐identified lived experience and other leaders to be involved in a PAR process featuring formal qualitative research (focus groups, surveys and interviews) as well as community development activities (leaders' summit meetings, consultations, training and community of practice meetings). These processes were used to help us describe the purpose, achievements and potential of lived experience leadership. Project priorities and systems‐level analysis was also undertaken with lived experience sector leaders and project advisors across two leaders' summit meetings, integrating research outcomes with sector planning to define high‐level actions and a vision for transformational change. Results Participatory action research as informed by systems change and collective impact strategies assisted the project to generate detailed findings about the experiences and complexities of lived experience leadership, and collective responses of how systems could better support, be accountable to and leverage lived experience perspectives, experience and peer‐work approaches. Conclusion Systems change to define, value and embed lived experience leadership benefits from collective efforts in both formal research and sector development activities. These can be used to generate foundational understandings and guidance for working together in genuine ways for transforming mental health and social sector systems, experience and outcomes. Public Contribution Members of lived experience communities codesigned the project, and contributed to project governance and the development of all findings and project reports.

The objective of this study is to ascertain the strategies employed in mitigating fraudulent activities within the realm of health services through the utilization of a whistleblowing mechanism. Methods: The present study employed a systematic review approach to examine relevant literature by utilizing specific keywords such as "whistleblowing system" and "fraud Healthcare." These keywords were then used to search for publications in the Scopus database, focusing on journals that mostly relied on secondary data. The search was conducted using the publish or perish tool. 8. Subsequently, a curation of scholarly publications and articles was conducted, employing a criterion centered on the thematic relevance of their titles. The selected publications have the objective of mitigating fraudulent activities within the healthcare industry and other interconnected industries that contribute to research endeavors. The findings of this study suggest that the implementation of a fraud reporting system is vital inside an organization, particularly within the context of health services. To enhance the caliber of healthcare services, internal healthcare staff and participants may report well, it is imperative to establish a system that ensures the preservation of reporter confidentiality, hence facilitating an increase in the volume of reports.

Abstract Background Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. Methods Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. Results Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents’ utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. Conclusion In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care.

Abstract Background Although school screenings identify children with vision problems and issue referrals for medical treatment at an ophthalmic hospital, the effectiveness of this approach remains unverified. Objective To investigate the impact of ophthalmic clinical services on the onset and progression of myopia in preschool children identified with vision impairment. Methods Using data from the Shanghai Child and Adolescent Large-scale Eye Study (SCALE), this retrospective cohort study evaluated the visual development of children from three districts—Jing’an, Minhang, and Pudong—which are representative of geographic diversity and economic disparity in Shanghai’s 17 districts. Initially, in 2015, the study encompassed 14,572 children aged 4–6 years, of whom 5,917 needed a referral. Our cohort consisted of 5,511 children who had two or more vision screenings and complete personal information over the follow-up period from January 2015 to December 2020. We divided these children into two groups based on their initial spherical equivalent (SE): a High-risk group (SE > -0.5 D) and a Myopia group (SE ≤ -0.5 D). Within each of these groups, we further categorized children into Never, Tardily, and Timely groups based on their referral compliance to compare the differences in the occurrence and progression of myopia. Cox proportional models were applied to estimate hazard ratios (HRs) for myopia incidence per person-years of follow-up in High-risk group. Generalized additive models(GAM) was used to calculating the progression for annual spherical equivalent changes in all children. Results Of the 5,511 preschool children (mean age, 5.25 years; 52.24% male) who received a referral recommendation, 1,327 (24.08%) sought clinical services at an ophthalmic hospital. After six years of follow-up, 65.53% of children developed myopia. The six-year cumulative incidence of myopia in the Never, Tardily, and Timely groups was 64.76%, 69.31%, and 57.14%, respectively. These percentages corresponded to hazard ratios (HRs) of 1.31 (95% CI, 1.10–1.55) for the Tardily group and 0.55 (95% CI, 0.33–0.93) for the Timely group, compared with the Never group. The HRs were adjusted for age, sex, and SE at study entry. Interestingly, the Timely group showed significantly less SE progression than the other groups (P

Objective: With the COVID-19 outbreak in countries around the world, the countries’ healthcare systemsunderwent an unprecedented shock. This study aimed to examine the resilience of the medical service deliverysystem in providing emergency services during the Covid-19 pandemic.Methods: This study was conducted in a reference hospital in Kerman that provided emergency services totrauma patients. It compared service delivery before and after COVID-19, as well as during the COVID-19 peakand non-peak periods. The compared variables were the number of trauma patients admitted to the hospital andthe ICU, the number of patients who died in the hospital due to trauma, and the length of stay in the hospitaland the ICU.Results: The pre- and post-COVID-19 comparisons showed no significant difference in the number of dailyhospital admissions, ICU admissions, and patient deaths. The median length of stay in the ICU was significantlyreduced by almost 2 days during the COVID-19 outbreak. However, the length of stay at the hospital was almostthe same. Furthermore, a comparison of the COVID-19 peaks and non-peak periods indicated no statisticallysignificant difference in the number of admissions in the ICU, hospital and ICU length of stay, and traumainduced mortality.Conclusion: Despite the substantial workload imposed by COVID-19 on hospitals, especially during the peakperiods of the disease, the provision of medical services to emergency trauma patients did not drop significantly,and the quality of services provided to patients was within the acceptable range.

Background: The last decades revealed new scientific knowledge regarding the fertility and potential malignancy of undescended testis AQ2(UDT). Accordingly, many guidelines changed their recommendation concerning timing of therapy, with the goal of an earlier time of surgery. Methods: We analyzed the number of new diagnosis and performed surgeries in predefined age groups provided by the obligatory annual reports of German hospitals in the reimbursement.INFO"-tool between 2006 and 2020. Results: Overall, 124,741 cases were analyzed. We showed a slight increase in performed surgeries in the first year by 2% per year with a main increase till 2011, a constant number of surgeries between first and 4th year and a decrease of surgeries between 5 and 14th year of living with a main decrease till 2009 by 3% per year. Conclusion: Even if our results illustrate an increasing adaption of the guideline's recommendation, there is still a significant number of patients who receive later treatment. More research about the reasons and circumstances for the latter is needed. [ABSTRACT FROM AUTHOR]

Background: Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. Methods: Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. Results: Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. Conclusion: In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care. [ABSTRACT FROM AUTHOR]

The death of a child in the intrauterine stage has legal, psychological, spiritual, and health-related connotations that condition the woman's experience. To understand better the processes set in motion around early pregnancy loss, this ethnographic study explores the experiences of miscarriage in a group of 15 women. The following themes are analyzed: Experience of losing the child, spirituality, health care, and the need to physically recognize the child. The study shows that the need women have to honor the child who did not live may be conditioned by the perception of an uncertain loss and by the absence of a place to honor him/her. Attitudes among professionals are revealed that could be perceived as gender-related abuse. The care of women places emphasis on physical aspects, underlining the lack of comprehensive care during the grieving process. [ABSTRACT FROM AUTHOR]

Objective: An innovative approach by two Queensland health services was taken to establish a shared maternity services' research agenda by partnering with consumers and clinicians. The objective was to set the top five research priorities to ensure that the future direction of maternity research was relevant to end-user and organisational needs. Methods: A modified James Lind Alliance (JLA) methodology was applied between August 2022 and February 2023 across two south-east Queensland Health Services which included five participating maternity units and involved partnership with consumers, healthcare professionals and clinician researchers. The reporting guideline for priority setting of health research (REPRISE) was followed. Results: There were 192 respondents to the initial harvesting survey, generating 461 research suggestions. These were aggregated into 122 unique questions and further summarised into a list of 44 research questions. The 157 eligible interim prioritisation survey respondents short-listed 27 questions ready for ranking at a final consensus workshop. The top five question themes were: (1) maternity care experience, engagement and outcomes of priority populations; (2) increasing spontaneous vaginal birth; (3) experiences and perceptions of woman/person-centred care; (4) best practice care during the 'fourth' trimester; and (5) antibiotic use during labour and birth. Conclusion: Applying an adapted JLA framework can successfully shape and establish a research agenda within Australian health services, through partnership with consumers and practicing clinicians. This is a transparent process that strengthens the legitimacy and credibility of research agendas, and it can form a replicable framework for other settings. What is known about the topic? Establishment of research agendas often neglects the participation of research end-users, consumers and practising clinicians, consequently limiting relevance and translation. What does this paper add? Prioritised specific maternity research questions were jointly generated by consumers and front-line clinicians to highlight areas of focus for research funding and support. What are the implications for practitioners? By partnering with consumers and practising clinicians health service research priorities can be established to optimise patient outcomes and ensure future research is both translational and relevant. [ABSTRACT FROM AUTHOR]

Receiving adequate, timely and effective medical care at the tertiary level hospitals can be a challenge because of the difficulty to reach these hospitals. Many of these facilities are located in central or certain geographic areas. This study describes the geographic distribution of tertiary care hospitals in Bangladesh and assesses their accessibility. Several data sources including the Directorate General of Health Services, National Population Census and Google Maps were used. Geographic inaccessibility ranking was calculated by a method that used data on population and area of the district, travel time and distance to the hospital. Among 35 hospitals, 16 are situated in Dhaka district comprising 10,424 beds, which is almost 41% of the total tertiary care beds. Among the 64 total districts, 46 do not have any such hospital. Around 6.4 million people need to travel more than 3 hours and another 25.4 million need between 2 and 3 hours to reach tertiary care hospitals. Geographic inaccessibility score was found to be high for 5 districts, moderate for 5 districts and low for 19 districts. High centrality of location and skewed distribution of these hospitals may have created health inequity and disparity for a large population segment in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: Although school screenings identify children with vision problems and issue referrals for medical treatment at an ophthalmic hospital, the effectiveness of this approach remains unverified. Objective: To investigate the impact of ophthalmic clinical services on the onset and progression of myopia in preschool children identified with vision impairment. Methods: Using data from the Shanghai Child and Adolescent Large-scale Eye Study (SCALE), this retrospective cohort study evaluated the visual development of children from three districts—Jing'an, Minhang, and Pudong—which are representative of geographic diversity and economic disparity in Shanghai's 17 districts. Initially, in 2015, the study encompassed 14,572 children aged 4–6 years, of whom 5,917 needed a referral. Our cohort consisted of 5,511 children who had two or more vision screenings and complete personal information over the follow-up period from January 2015 to December 2020. We divided these children into two groups based on their initial spherical equivalent (SE): a High-risk group (SE > -0.5 D) and a Myopia group (SE ≤ -0.5 D). Within each of these groups, we further categorized children into Never, Tardily, and Timely groups based on their referral compliance to compare the differences in the occurrence and progression of myopia. Cox proportional models were applied to estimate hazard ratios (HRs) for myopia incidence per person-years of follow-up in High-risk group. Generalized additive models(GAM) was used to calculating the progression for annual spherical equivalent changes in all children. Results: Of the 5,511 preschool children (mean age, 5.25 years; 52.24% male) who received a referral recommendation, 1,327 (24.08%) sought clinical services at an ophthalmic hospital. After six years of follow-up, 65.53% of children developed myopia. The six-year cumulative incidence of myopia in the Never, Tardily, and Timely groups was 64.76%, 69.31%, and 57.14%, respectively. These percentages corresponded to hazard ratios (HRs) of 1.31 (95% CI, 1.10–1.55) for the Tardily group and 0.55 (95% CI, 0.33–0.93) for the Timely group, compared with the Never group. The HRs were adjusted for age, sex, and SE at study entry. Interestingly, the Timely group showed significantly less SE progression than the other groups (P < 0.001), and SE progression was higher in the High-risk group (-0.33 ± 0.37D/year) than in children with myopia (-0.08 ± 0.55D/year). Conclusion: Timely utilization of ophthalmic clinical services among children aged 4 to 6 years who fail school vision screenings can significantly reduce the incidence of myopia and slow SE progression. [ABSTRACT FROM AUTHOR]