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Abstract Background Suicide-related presentations to pediatric emergency departments (PED) have increased in recent years. PED providers have the opportunity to reduce suicide risk by counseling on restricting access to lethal means. Supplementing lethal means counseling (LMC) with safety device distribution is effective in improving home safety practices. Data on PED-based LMC in high-risk patient populations is limited. The objective of this study was to determine if caregivers of children presenting to PED for mental health evaluation were more likely to secure all household firearms if given cable-style gun locks in addition to LMC. Methods In this randomized controlled trial, caregivers completed a survey regarding storage practices of firearms and medication in the home. Participants were randomized to receive LMC (control) or LMC plus 2 cable-style gun locks (intervention). Follow-up survey was distributed 1 month after encounter. Primary outcome was proportion of households reporting all household firearms secured at follow-up. Secondary outcomes included: removal of lethal means from the home, purchase of additional safety devices, use of PED-provided locks (intervention only), and acceptability of PED-based LMC. Results Two hundred participants were enrolled and randomized. Comparable portions of study groups completed follow-up surveys. Control and intervention arms had similar proportions of households reporting all firearms secured at baseline (89.9% vs. 82.2%, p = 0.209) and follow-up (97.1% vs. 98.5%, p = 0.96), respectively. Other safety behaviors such as removal of firearms (17.6% vs. 11.8%, p = 0.732), removal of medication (19.1% vs. 13.2%, p = 0.361), and purchase of additional safety devices (66.2% vs. 61.8%, p = 0.721) were also alike between the two groups. Both groups held favorable views of PED-based counseling. Within the intervention group, 70% reported use of provided locks. Preference for a different style of securement device was the most cited reason among those not using PED-provided locks. Conclusions PED-based LMC is a favorably-viewed, effective tool for improving home safety practices in families of high-risk children. Provision of cable-style gun locks did not improve rate of firearm securement compared LMC alone—likely due to high baseline rates of firearm securement and preference for different style of lock among non-utilizers. Clinical Trial Registration ID: NCT05568901 . Clinicaltrials.gov. https://clinicaltrials.gov/ . Retrospectively registered October 6, 2022. First participant enrollment: June 28, 2021.

Abstract Background Firearm injuries are the leading cause of death for U.S. adolescents. Given the prevalence of firearm ownership in the U.S., particularly among parental figures in homes with children and teens, and the relationship between firearm access and injury outcomes, it is vital to shed light on potential parental motivations for keeping firearms in their homes. The purpose of this analysis was to examine whether exposure to community violence is associated with parental firearm ownership. Methods Data from the Firearm Safety Among Children and Teens Consortium’s National Survey (6/24/2020-7/24/2020) was examined. The survey sample comprised parents/caregivers of high-school-age teens (age 14–18). The survey examined various measures, including firearm ownership, storage, community violence exposure, and sociodemographic characteristics. Stepwise logistic regression was used to examine the association between community violence exposure and parental firearm ownership. Results The study included 2,924 participants, with 45.1% identifying as male, 12.9% identifying as Hispanic, and 25.3% identifying as non-White. Among these participants, 43.1% reported firearm ownership, and 49.9% reported exposure to community violence. Regression models demonstrate that community violence exposure is associated with an increased likelihood of firearm ownership among parents/caregivers of high-school age teens (OR = 1.08, p

Abstract Background The occurrence of potential drug‒drug interactions (pDDIs) is a serious global issue that affects all age groups, with the elderly population being the most vulnerable. This is due to their relatively high rates of comorbidity and polypharmacy, as well as physiological changes that can increase the potential for DDIs and the likelihood of adverse drug reactions. The aim of this study was to estimate the prevalence of pDDIs and associated factors among elderly patients in Ethiopia. Methods A comprehensive literature search using the preferred reporting items for systematic review and meta-analysis statement was conducted on HINARI, Science Direct, Embase, PubMed/MEDLINE, Google Scholar, and Research Gate. Data were extracted via a Microsoft Excel spreadsheet and analyzed via STATA version 11.0. Egger regression tests and funnel plot analysis were used to check publication bias, and the I2 statistic was used to evaluate statistical heterogeneity. Sensitivity and subgroup analyses were also conducted to identify potential causes of heterogeneity. Results Seven articles were analyzed, and a total of 1897 pDDIs were identified in 970 patients, resulting in an average of 1.97 DDIs per patient. The number of DDIs per patient ranged from 0.18 to 5.86. The overall prevalence of pDDIs among elderly patients was 50.69% (95% CI 18.77–82.63%). However, the prevalence of pDDIs ranged widely from 2.80 to 90.1%. When the severity of the interactions was considered, the prevalence of potential DDIs was found to be 28.74%, 70.68%, and 34.20% for major, moderate, and minor pDDIs, respectively. Polypharmacy and long hospital stays were identified as factors associated with pDDIs among elderly patients in Ethiopia. Conclusions The overall prevalence of pDDIs among elderly patients was high, with a wide range of prevalence rates. Moderate-severity interactions were the most prevalent. Polypharmacy and long hospital stays were identified as factors associated with pDDIs among elderly patients. The study suggests that DDIs identification database itself could have modified the DDIs prevalence rate. As a result, a single DDIs identification database needs to be authorized; otherwise, clinical knowledge should be taken into account when interpreting the information obtained.

Abstract Background Increasingly intense weather anomalies associated with interannual climate variability patterns, like El Niño-southern oscillation (ENSO), could exacerbate the occurrence and transmission of infectious diseases. However, research in China remains limited in understanding the impacts and intermediate weather changes of ENSO on bacillary dysentery (BD). This study aimed to reveal the relationship between ENSO, weather conditions, and the incidence of BD, and to identify the potential meteorological pathways moderated by ENSO in the ENSO-BD connections. Methods BD disease data and meteorological data, as well as ENSO index, from 2005 to 2020 were obtained for 95 cities in the Yangtze River Basin. We first established the associations between ENSO events and BD, ENSO and weather, as well as weather and BDs using two-stage statistical models. Then, we applied a causal mediation analysis to identify the specific meteorological changes in the ENSO-BD relationship. Results In the Yangtze River Basin, both El Niño (IRR: 1.06, 95%CI: 1.04 ~ 1.08) and La Niña (IRR: 1.03, 95%CI: 1.02 ~ 1.05) events were found to increase the risk of BD. Variations of ENSO index were associated with changes in local weather conditions. Both the increases in regional temperatures and rainfall were associated with a higher risk of BD. In the casual mediation analyses, we identified that higher temperatures and excessive rainfall associated with La Niña and El Niño events mediated the ENSO’s effect on BD, with mediation proportions of 38.58% and 34.97%, respectively. Conclusions Long-term climate variability, like ENSO, can affect regional weather conditions and lead to an increased risk of BD. We identified the mediating weather patterns in the relationship between ENSO and BD, which could improve targeted health interventions and establish an advanced early warning system in response to the BD epidemic.

Abstract Background There is an increased demand for quality treatment and rehabilitation services for people who use drugs (PWUDs) in the Philippines. In response, the Philippines Government’s Department of Health (DOH) has established a new residential treatment model, Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET), and integrated it into the existing treatment service platform of 21 DOH-owned Treatment and Rehabilitation Centers (TRCs). We conducted a qualitative study to identify the changes engendered by the implementation of this treatment model. Methods Data were collected through individual face-to-face interviews. We interviewed purposefully selected 29 patients and 35 facilitators of INTREPRET group sessions in seven TRCs. We transcribed the interview records and organized the narrative information into key themes using thematic analysis during the coding process. Results The changes perceived by the study participants included the attitude and behavior of patients, attitude and competency of facilitators, relationship between facilitators and patients, treatment planning and review process, efficient and standardized treatment services, and monitoring mechanisms of the patient’s recovery process. Participants also noted challenges in INTREPRET implementation, including family participation in therapy sessions, lack of facilitators, securing a conducive place for conducting sessions, and reproducing workbooks. Conclusions The results imply that the introduction of INTREPRET could improve treatment service quality and the effectiveness of treatment, which were primarily associated with behavioral changes in patients, improved relationship between patients and facilitators, and INTREPRET’s alignment with key international treatment standards. However, despite the positive changes perceived by the participants, certain challenges pertaining to family participation in therapy sessions and the lack of resources were identified. These criticisms must be addressed by DOH, along with an integration of INTREPRET into its policy and strategic framework, to ensure the effectiveness and sustainability of the new treatment model.

Abstract Background The COVID-19 pandemic led to significant excess mortality in 2020 in Belgium. By using microlevel cause-specific mortality data for the total adult population in Belgium in 2020, three outcomes were considered in this study aiming at predicting sociodemographic (SD) and socioeconomic (SE) patterns of (1) COVID-19 specific death compared to survival; (2) all other causes of death (OCOD) compared to survival; and (3) COVID-19 specific death compared to all OCOD. Methods Two complementary statistical methods were used. First, multivariable logistic regression models providing odds ratios and 95% confidence intervals were fitted for the three study outcomes. In addition, we computed conditional inference tree (CIT) algorithms, a non-parametric class of classification trees, to identify and rank by significance level the strongest predictors of the three study outcomes. Results Older individuals, males, individuals living in collectivities, first-generation migrants, and deprived SE groups experienced higher odds of dying from COVID-19 compared to survival; living in collectivities was identified by the CIT as the strongest predictor followed by age and sex. Education emerged as one of the strongest predictors for individuals not living in collectivities. Overall, similar patterns were observed for all OCOD except for first- and second-generation migrants having lower odds of all OCOD compared to survival; age group was identified by the CIT as the strongest predictor. Older individuals, males, individuals living in collectivities, first- and second-generation migrants, and individuals with lower levels of education had higher odds of COVID-19 death compared to all OCOD; living in collectivities was identified by the CIT as the strongest predictor followed by age, sex, and migration background. Education and income emerged as among the strongest predictors among individuals not living in collectivities. Conclusions This study identified important SD and SE disparities in COVID-19 mortality, with living in collectivities highlighted as the strongest predictor. This underlines the importance of implementing preventive measures, particularly within the most vulnerable populations, in infectious disease pandemic preparedness to reduce virus circulation and the resulting lethality.

Abstract Introduction The Irish Prostate Cancer Outcomes Research (IPCOR) Study collected longitudinal data on men newly diagnosed with Prostate Cancer (PC). Understanding the nuances of disease presentation is essential, considering the high incidence of PC in Ireland. This study aims to characterise disease presentation features, identify factors related to socio demographic disparities in presentation following opportunistic screening, and shed light on potential inequality challenges within Ireland’s healthcare structure. Methods Data were collected on demographics, diagnosis, and treatment of 6,816 men newly diagnosed with PC across 16 hospitals in the Republic of Ireland from February 2016 to January 2020. A complete case analysis was carried out, complemented by a sensitivity analysis for addressing sites with high rates of missing values. Multivariable logistic regression was conducted to examine the association between various predictor variables and the initial presentation to the urology clinic subsequent to opportunistic screening. Results A multivariable logistic regression model revealed that the type of hospital was a key determinant in post-opportunistic screening presentation, with patients in public hospitals 45.7% more likely to be presented following screening compared to those in private hospitals. Urban residents were 34% more likely to present following screening than rural ones. Age negatively influenced presentation following screening likelihood, decreasing by 3.4% yearly. Discussion Our research has highlighted the key features of PC presentation in Ireland, revealing potential inequalities affecting mainly urban populations, middle socioeconomic groups, and individuals with inadequate healthcare coverage. While the differences we observed in various groups may appear subtle and may indicate the success of the Rapid Access Prostate Clinics, they are still significant in pinpointing specific populations that require special attention. Conclusions By addressing these nuanced differences in access to healthcare, socioeconomic status, and urban versus rural residence and implementing tailored strategies, we can work towards closing disparity gaps in PC, ultimately leading to improved health outcomes and equity across all population segments.

Abstract Background Functional disability significantly burdens healthcare services, negatively affecting older adults’ social interaction and quality of life. This study aims to identify the association between functional disability and mental health, and examine the moderating effects of social participation and physical exercise on the association. Methods The data were drawn from 2018 wave of Chinese Longitudinal Healthy Longevity Survey, and ordinary least squares regression model was exploited to explore the association between functional disability and mental health. Results Activity of daily living (ADL) disability negatively predicted mini-mental state examination (MMSE) score. Furthermore, social participation and physical exercise moderated the association between ADL disability and MMSE score. Conclusion The results highlight the importance of social participation and physical exercise for the older adults with ADL disability.

Abstract Background Prenatal care is a critical component of maternal and child health, providing essential preventive, diagnostic, and therapeutic services to pregnant women. Adequate antenatal care has been linked to reduced maternal and infant mortality and improved birth outcomes. Despite its importance, disparities in antenatal care coverage persist globally, including Sierra Leone, with significant implications for maternal and child health. This study examined the trends and inequalities in antenatal care utilisation in Sierra Leone. Methods We used data from the 2008, 2013, and 2019 Sierra Leone Demographic and Health Surveys. Simple inequality measures (Difference and Ratio) and complex measures (Population Attributable Risk and Population Attributable Fraction) were computed using the World Health Organization’s Health Equity Assessment Toolkit software. Inequality in antenatal care was calculated on six stratefiers: age groups for women, birth order, educational levels, economic status, residential areas, and sub-national province. Results There was a significant increase in adequate antenatal care coverage from 2008 (15.2%) to 2013 (36.5%) but a decrease in 2019 (22.1%). The inequality in age increased over time from a Difference of 2.7 percentage points in 2008 to a Difference of 5.3 percentage points in 2019, indicating age-related inequalities. The Population Attributable Fraction decreased from 2.7% in 2008 to zero in 2013, indicating no further improvement in the national average of adequate antenatal care coverage can be achieved in the absence of age-related inequalities. However, it increased to 7.7% in 2019, indicating that the national average of adequate antenatal care coverage would have increased by 7.7% in the absence of age-related inequalities. The birth order inequality increased from a Difference of − 5.2 percentage points in 2008 to 2.6 percentage points in 2019. The Population Attributable Fraction was zero in 2008 and 3.4% in 2019, showing that the national average of adequate antenatal care coverage would have increased by 3.4% if there was no parity-based inequality. Inequality in economic status decreased from 32.1 percentage points in 2008 (Difference = 32.1) to 2.8 percentage points in 2019 (Difference = 2.8). The Population Attributable Fraction revealed that the national average could have been 164.4% higher in 2008 and 20.8% higher in 2013; however, it was zero in 2019, indicating that no further improvement can be achieved in the national average if there was no inequality related to economic status. Inequality for education decreased from 49.9 percentage points in 2008 (Difference = 49.9) to 11.0 percentage points in 2019 (Difference = 11.0). Inequality decreased from a Difference of 20.8 percentage points in 2008 to a Difference of 1.7 percentage points in 2019 for place of residence inequality, showing a reduction in inequality. Provincial inequality decreased from a Difference of 33.9 percentage points in 2008 to 8.5 percentage points in 2019. Conclusion While there have been notable improvements in antenatal care coverage in Sierra Leone, adequate antenatal care coverage is still below the WHO target of 78% in 2016, and significant inequalities persist. Addressing these inequalities requires a multifaceted approach considering demographic, economic, educational, and geographic indicators considered in this study. Sustained efforts and targeted interventions are critical by the Sierra Leone government to ensure that all women, regardless of their background, have access to essential antenatal care services up to at least eight visits.

Abstract Background The global health crisis of obesity has prompted a need for better indicators of abdominal obesity than body mass index, with sagittal abdominal diameter emerging as a potential candidate. Nonetheless, the association between sagittal abdominal diameter-to-height ratio (SADHtR) and mortality remains inadequately established. Our objective was to contribute novel evidence to this association. Methods This study encompassed 12,572 participants aged 18–80 years from the National Health and Nutrition Examination Survey 2011–2016. Mortality data were tracked until December 31, 2019. Weighted multivariable Cox proportional hazard models were employed to evaluate the association between SADHtR and all-cause mortality, with subgroup analyses conducted for result robustness. Results Following a median follow-up period of 69 months, each standard deviation (SD) increase in SADHtR was consistently associated with a higher risk of all-cause mortality across three models, yielding a hazard ratio (HR) and 95% confidence interval (CI) of 1.51(1.29,1.76) in model 3. Additionally, compared to the first tertile of SADHtR, the third tertile exhibited a higher risk for all-cause mortality, with HRs(95%CIs) of 1.58(1.25,2.01) in model 1, 2.01(1.33,3.02) in model 2, and 1.74(1.19,2.57) in model 3. Notably, subgroup analysis revealed persistent positive associations between SADHtR and all-cause mortality among subgroups based on age-at-risk (

Abstract Background Amid high youth out-migration, India’s older parents face severe social, economic, psychological, and health crises due to their children’s separation. However, remittances from their migrant children alleviate economic hardships, improve healthcare access, and partially compensate for their absence. So, this study examines how adult-child migration affects older parents’ physical and mental health and how remittance support helps mitigate these challenges. Methodology This study used the 2011 Building a Knowledge Base on Population Ageing in India (BKPAI) dataset, the current study (n = 5122) employs bivariate statistics, logistic regression, and mediation analysis to address the objectives. Logistic regression determines the factors of self-rated health and depression, while mediation analysis is implied to understand the intermediate effect of financial support i.e. remittance on left-behind older adult health. Results The findings indicate that approximately 43% of the study populations were left behind, meaning they have at least one migrant child. Notably, 20% of these left-behind older adults report poor health conditions, and 17% exhibit depressive symptoms, while the poor health and having depressive symptoms were lower among the non-left-behind older adults i.e., 13% and 12% respectively. The mediation analysis indicates that the likelihood of good self-rated health increased 1.35 times through the effect of remittance, which compensates for around 55% of the total adverse effect of migration. Conclusion The consistent inflow of remittances serves to alleviate the impact on household finances, ensure food security, and address medical expenses. However, it is crucial to recognize that while remittances contribute significantly to economic stability, they cannot fully replace the physical presence of adult children, especially in terms of caregiving.

Abstract Background Assessing maternal health care utilisation is imperative for the health of both mother and her child. Maternal education is an important determinant in subsequent maternal health care usage, according to research. There is a dearth of research on the causal relationship between maternal education and maternal health services as well as examining the performance of different propensity score methods for estimating absolute effects. Therefore, this study aims to estimate the effect of maternal education on usage of maternal health services minimising the confounding effect and to compare different propensity score approaches to estimate absolute effects of maternal education on usage of maternal health services. Methods We used data from a cross-sectional study conducted by icddr,b in Bangladesh. A total of 1300 recently delivered mothers were included in this study. We used different propensity score (PS) methods to estimate the causal effect of maternal education on receiving maternal health services, including PS matching, PS weighting, covariate adjustment using PS, as well as used modified log-Poisson regression with and without multiple covariates. Results The study revealed highly imbalanced possible confounding factors for mother's educational level, which might lead to erroneous estimates. All methods indicated a significant effect of higher maternal education, whether measured as a continuous scale or a binary variable (secondary or higher vs. below secondary) on maternal health services, significantly increased the likelihood of receiving four or more ANC, delivered at facility, PNC within 42 days and receiving all maternal health services compared to the mothers with lower level of education. The PS weighting provided precise estimates with a low range of confidence interval. Conclusions The results provided important insights on how well these techniques worked to reduce effect of confounding variables and achieve precise estimates. Propensity score weighting method performed better in terms of providing more precise estimates with a narrower range of confidence intervals, indicating that this method may be a reliable approach for estimating the causal effect of maternal education on maternal health service utilisation. However, careful consideration should be given to selecting the most appropriate method.

Abstract Background This study protocol outlines the phased construction of a questionnaire, data collection, and a strategy for analysis within the framework of the ATTAS project. This study has two primary objectives. First, it allows us to map the duration of the various phases of the abortion trajectory for women presenting for abortion in Flanders, Belgium. Second, it identifies barriers that cause delays within these phases. Methods The questionnaire was distributed to all women seeking abortion care at one of the five Flemish abortion centers; specifically, the LUNA centers, which are located in Ostend, Ghent, Antwerp, and Hasselt, as is the VUB-Dilemma center in Brussels during the fall and winter of 2023–2024. Ethical clearance for the described research was obtained from the University of Antwerp’s Ethics Committee for the Social Sciences and Humanities (reference numbers: SHW_2023_48_1 and SHW_2023_48_2). Discussion The collected data provide a dataset on the abortion trajectories of Flanders women who presented for abortion. This study protocol outlines the ATTAS project’s rationale, phased development, and implementation of the questionnaire, as well as the upcoming data analyses. To our knowledge, this is the first study within the Flemish context to investigate abortion trajectories, timing, and access. Furthermore, this study protocol provides a phased and systematic approach to adapt validated research instruments to fit within diverse legal and cultural contexts. Building on this protocol, future research will seek to advance reproductive justice for all women in Belgium.

Abstract Purpose The growth in life expectancy (LE) slows down recently in several high-income countries. Among the underlying dynamics, uneven progress in LE across social groups has been pointed out. However, these dynamics has not been extensively studied, partly due to data limitations. In this paper, we explore this area for the 2010 decade using recent French data. Methods We utilize the recent change in French census mortality follow-up data (EDP) and apply P-spline models to estimate LEs across five occupational classes (OCs) and indicators of lifespan heterogeneity (edagger) within these OCs, for seven triennial periods (2011-2013 to 2017-2019). Results First, we found a similar ranking of OCs along the LE gradient over time and across sexes, from manual workers to higher-level OCs. Noteworthy, the lowest LE in women overlaps with the highest one in men drawing a sex-OC gradient. Second, we observe varying progress of LEs. In women, LE increases in higher-level OCs meanwhile it levels off in manual workers, so that the OCs gap widens (up to 3.4 years in 2017-2019). Conversely, in men LE stalls in higher-level OCs and increases in manual workers so that the gap, which is much larger than in women (+5.7 years in 2017-2019), is tending to narrow. Finally, the lifespan homogenizes in OCs only when LE is low. Conclusion Overall, the limited LE progress in France results from LE stalling in the middle of the sex-OC gradient, though LE increases at both ends. At the lower end, LE progress and lifespan homogenization suggest that laggards benefit recently improvements achieved earlier in other OCs. At the upper end, LE progress may come from a vanguard group within higher-lever OC, benefiting new sources of improvements. These findings underscore the need for further research to explore the diverse mortality dynamics coexisting in the current health landscape.

Abstract Background Niger is a large country with many distant locations that can be difficult to access because the Sahara Desert covers 80% of the country’s land. In Niger, just 49% of residents have access to a health centre within 5 km of their house. Health care may be difficult to access in the Diffa region of Niger, as non-state armed groups strike on a regular basis and floods cause a high rate of vulnerability. This study looked at how mobile clinics can improve healthcare accessibility for vulnerable populations in the Diffa region. Methods This was a descriptive-comparative study conducted over the period from 15 August 2022 to 15 October 2022, using three months’ mobile outreach clinic to improve health outcomes in five districts of the Diffa region, including Bosso, Diffa, Goudoumaria, Mainé Soroa, and N’guigmi. Results During the three months of mobile outreach clinic, 42,251 people were sensitized about mobile outreaches and 12,004 were treated. A total of 18,708 vaccine doses were delivered to children aged 0–11 months, with Maine Soroa, Goudoumaria, Bosso, Diffa, and N’guigmi districts accounting for 29.24%, 24.62%, 18.54%, 18.05%, and 9.5%, respectively. In the same line, Goudoumaria, Bosso, and Maine Soroa districts recorded relatively high antenatal clinic (ANC) attendance percentages of 27.85%, 25.62%, and 21.89%, respectively. Furthermore, mobile clinic outreach provided a variety of healthcare treatments, both curative and preventative. Mobile Clinic 2 increased vaccine dose received among children aged 0–11 months by 1.11% (95%CI: 0.15%-2.06%, P = 0.023) when compared to Mobile Clinic 1. In the same line, mobile clinic showed a statistically significant increase of ANC between the three clinical rotations (P = 0001), showing an increased ANC update over time. Conclusion This study found that mobile outreach clinic can play an important role in improving healthcare access for vulnerable populations in the Diffa region. However, well-designed, and frequent mobile clinic outreach should be planned and included in the country’s public health policy.

Abstract Background People with disabilities frequently experience barriers in seeking healthcare that lead to poorer health outcomes compared to people without disabilities. To overcome this, it is important to assess the accessibility of primary health facilities – broadly defined to include a disability-inclusive service provision – so as to document present status and identify areas for improvement. We aimed to identify, adapt and pilot test an appropriate tool to assess the accessibility of primary health facilities in Luuka District, Uganda. Methods We conducted a rapid literature review to identify appropriate tools, selecting the Disability Awareness Checklist (DAC) on account of its relative brevity and development as a sensitization and action tool. We undertook three rounds of adaptation, working together with youth researchers (aged 18–35) with disabilities who then underwent 2 days of training as DAC facilitators. The adapted tool comprised 71 indicators across four domains and 12 sub-domains. We also developed a structured feedback form for facilitators to complete with healthcare workers. We calculated median accessibility scores overall, per domain and per sub-domain, and categorised feedback form suggestions by type and presumed investment level. We pilot-tested the adapted tool in 5 primary health facilities in one sub-district of Luuka, nested within a pilot healthcare worker training on disability. Results The median overall facility accessibility score was 17.8% (range 12.3–28.8). Facility scores were highest in the universal design and accessibility domain (25.8%, 22.6–41.9), followed by reasonable accommodation (20.0%, 6.7–33.3). Median scores for capacity of facility staff (6.67%, 6.7–20.0), and linkages to other services were lower (0.0%, 0–25.0). Within the feedback forms, there were a median of 21 suggestions (range 14–26) per facility. Most commonly, these were categorised as minor structural changes (20% of suggestions), with a third categorised as no (2%) or low (33%) cost, and the majority (40%) medium cost. Conclusions Overall accessibility scores were low, with many opportunities for low-cost improvement at the facility level. We did not identify any issues with the implementation of the tool, suggesting few further adaptations are required for its future use in this setting.

Abstract Background There are avoidable differences (i.e., inequities) in the prevalence and distribution of chronic pain across diverse populations, as well as in access to and outcomes of pain management services. Digital pain self-reporting tools have the potential to reduce or exacerbate these inequities. This study aimed to better understand how to optimise the health equity impact of digital pain self-reporting tools on people who are experiencing (or are at risk of) digital pain inequities. Methods This was a qualitative study, guided by the Health Equity Impact Assessment tool—digital health supplement (HEIA-DH). We conducted three scoping focus groups with multiple stakeholders to identify the potential impacts of digital pain self-reporting tools and strategies to manage these impacts. Each group focused on one priority group experiencing digital pain inequities, including older adults, ethnic minorities, and people living in socio-economically deprived areas. A fourth consensus focus group was organised to discuss and select impact management strategies. Focus groups were audio-recorded, transcribed verbatim, and analysed using a framework approach. We derived codes, grouped them under four pre-defined categories from the HEIA-DH, and illustrated them with participants’ quotes. Results A total of fifteen people living with musculoskeletal pain conditions and thirteen professionals took part. Participants described how digital pain self-reports can have a positive health equity impact by better capturing pain fluctuations and enriching patient-provider communication, which in turn can enhance clinical decisions and self-management practices. Conversely, participants identified that incorrect interpretation of pain reports, lack of knowledge of pain terminologies, and digital (e.g., no access to technology) and social (e.g., gender stereotyping) exclusions may negatively impact on people’s health equity. The participants identified 32 strategies, of which 20 were selected as being likely to mitigate these negative health equity impacts. Example strategies included, e.g., option to customise self-reporting tools in line with users’ personal preferences, or resources to better explain how self-reported pain data will be used to build trust. Conclusion Linked to people’s personal and social characteristics, there are equity-based considerations for developing accessible digital pain self-reporting tools, as well as resources and skills to enable the adoption and use of these tools among priority groups. Future research should focus on implementing these equity-based considerations or strategies identified by our study and monitoring their impact on the health equity of people living with chronic pain.

Abstract Background The growing number of vulnerable migrants and refugees (VMRs) in the European Union presents challenges to healthcare systems, emphasizing the need for enhanced intercultural competence training for healthcare professionals. Educational escape rooms, using gamification-based principles, may offer an innovative solution to improve these competencies. Objective This pilot study evaluates the acceptability and preliminary effectiveness of an educational escape room aimed at improving intercultural competence, self-efficacy, and knowledge among healthcare students and professionals caring for VMRs. Methods A pre-post, single-group pilot study was conducted with 101 healthcare students and professionals, recruited through convenience sampling. Participants engaged in an educational escape room simulating a migratory crisis, designed to foster collaborative problem-solving under pressure. A newly validated questionnaire was administered before and after the intervention to measure changes in intercultural competence, self-efficacy, and knowledge. Paired t-tests were used to analyze pre-post differences, and thematic analysis explored participant feedback on the learning experience and the acceptability of the intervention. Results Significant improvements were observed in intercultural competence (d = 1.13, p

Abstract Background The patient’s experience of care is critical in determining how satisfied the client is with the quality of health services offered by the health facility. Understanding health needs aids in identifying gaps in service provision as well as potential avenues for planning and improving health care services. The primary goal of this study was to explore the attributes of quality healthcare in South Sudan from the perspective of healthcare recipients. Nonetheless, South Sudan’s health system has remained inadequate since the country’s independence in 2011, with 85% of deliveries performed by unskilled health personnel, high maternal and child death rates, and a lack of vital lifesaving drugs in health facilities. Political unrest, natural disasters, poor infrastructure, and budgetary limits are among the additional factors impeding the provision of high-quality care services to the population in need. However, the South Sudan government, with the support of international health partners, continues to work towards ensuring that basic health needs are met in accordance with SDG-3 recommendations. Method This was a facility-based cross-sectional descriptive study conducted in four selected health facilities in Yambio County, Western Equatoria State, from July 1st to September 30th, 2023. A sample size of 422 was included, and a randomized sampling procedure was used, with 60% of public health facilities supported by non-governmental organizations utilizing the lottery method. Data were collected and entered into SPSS version 25 for descriptive and regression analysis. Results A total of 422 participants were solicited for the study, with a response rate of 99.81 percent. Of the 421 responders, 72% (303/421) were female and 28% (118/421) were male. The overall satisfaction with the experience of quality of health care delivered was 84.8%. A preliminary analysis found that the assumption of multicollinearity was met (Age, sex, feeling of having chance to fully explain a problem to care provider, physical examination, provider’s technical capacity in diagnosis and treatment, provider attitude, client respect) among others, were all associated with the client’s experience of care and satisfaction with the quality of health care. Conclusion The clients who sought health care at the public health facilities in Western Equatorial State were quite satisfied with the quality of health services (84.8%). Provider’s behaviors, attitudes, and technical skills, among other major factors, were found to be associated with the client’s positive experience of care. To uphold health ethics, the study recommends including medical ethics training and client center care into continuing medical educations at health facilities.

Abstract Background Clinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines. Methods Our development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs. Results We introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines. Conclusions Our novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well.

Abstract Background Although telemental health can make suicide prevention treatments more scalable and accessible, limited evidence demonstrates successful reductions in suicidality when interventions are administered through telehealth platforms. To address this limitation, the current work investigated the effects of two suicide prevention treatments – a clinician-guided Crisis Response Plan and a self-guided Safety Planning approach. Methods After completing the screening process, 82 participants with high suicide ideation and/or a lifetime history of suicidal behavior were randomly assigned across the two groups. Trained research clinicians administered the interventions using a videoconferencing platform. After the intervention delivery was complete, participants reported the therapeutic alliance they experienced with their clinician using an online survey. Participants also reported their overall suicidality 45 days after receiving the intervention. In addition, participants’ perceived usefulness of the received intervention and actual use of the plan were recorded. Linear and logistic regression models predicted how suicidality, perceived utility, and actual use of their intervention protocols varied depending on the high (Crisis Response Plan) versus low (self-guided Safety Planning) level of clinician-led collaboration the two treatments entailed. Results Both Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services. At the same time, those who received the Crisis Response Plan (the more collaborative form of therapy) reported experiencing a stronger therapeutic alliance with the clinician, utilizing the plan more often and perceiving it as more useful. These findings demonstrate the additional benefits of adopting a more collaborative approach because of its effectiveness and perceived utility, which has implications for suicide-related distress reduction in the short and long term. Conclusions Evidence from this randomized control trial suggests that Crisis Response Plan is a suitable candidate for delivering suicide prevention via telehealth platform because of its effectiveness in reducing suicidality and its collaborative approach to building a strong therapeutic alliance, perceived usefulness, and actual utility in everyday life. Trial registration This paper was part of a registered RCT: https://clinicaltrials.gov/study/NCT04888845 . Registration date: Date: 2021-04-22.

Abstract Background Physiotherapy is effective to reduce pain and improve the quality of life of people living with chronic pain. To offer high-quality physiotherapy services, these services must be patient-centred and respond to patients’ needs. However, few studies seem to target patients’ perceived needs, whereas more studies tend to focus on needs assessed by healthcare experts, which are not always in line with patients’ perceived needs. In addition, people living with chronic pain are often faced with several health inequities and may have varied perceived needs depending on their personal conditions. To offer services that truly meet patients’ needs, it is therefore crucial to understand these needs. This scoping review aims to identify and map the perceived needs of people living with chronic pain towards physiotherapy services. Methods To conduct this review, we followed the six stages framework proposed by Arksey and O’Malley. We searched four databases (Medline, Embase, CINHAL and APA PsycINFO) as well as the grey literature. We included all studies describing the needs, demands, preferences or expectations of adults living with chronic pain towards physiotherapy. We then performed an inductive thematic analysis of the results and discussion sections of these studies to identify the perceived needs. Once those needs were identified, we mapped them into the seven dimensions of the patient-centred healthcare delivery framework. Results Our review included 96 studies. Various perceived needs were identified through the thematic analysis, such as the needs for an empathetic relationship; for a clear, adapted and supervised exercise program; and for personalized treatment. Our mapping into the patient-centred healthcare delivery framework showed that most studies reported needs associated with the dimensions of interpersonal care, individualized healthcare and professional care. Needs associated with the other dimensions of the framework (access; coordination and continuity; services and facilities; data and information) were less frequently mentioned. Conclusions The results of this review have enabled us to identify and better understand multiple needs perceived by people living with chronic pain regarding physiotherapy services. The perceived needs identified through this scoping review were mapped within the seven dimensions of the Patient-centred healthcare delivery framework.

Abstract Background Health care staff should be given the opportunity to participate in research, but recruiting clinicians via their employing organisation is not always straightforward or quick in the UK. Unlike many countries outside the UK, very low-risk survey, interview or focus group studies can be subject to some of the same governance approval procedures as interventional studies. An exemplar study carried out by the NIHR funded Palliative Care Research Partnership North West Coast is used to highlight the challenges still faced by researchers and health care organisations when setting up a low-risk staff study across multiple NHS and non-NHS sites. Methods A study database was created and information was collected on the first point of contact with the clinical site, Health Research Authority (HRA) and local organisational approval times, time from trust or hospice agreement to the first survey participant recruited and overall site survey recruitment numbers. Descriptive statistics (median, range) were used to analyse these data. Results Across participating NHS trusts, it took a median of 147.5 days (range 99–195) from initial contact with the local collaborator to recruitment of the first survey participant and hospice sites mirrored these lengthy timescales (median 142 days, range 110–202). The lengthiest delays in the HRA approval process were the period between asking NHS trusts to assess whether they had capacity and capability to support the research and them granting local agreement. Local approval times varied between trusts and settings which may indicate organisations are applying national complex guidance differently. Conclusions There is the potential for HRA processes to use more NHS resources than the research study itself when recruiting to a low-risk staff study across multiple organisations. There is a need to reduce unnecessary administrative burden and bureaucracy to give clinicians and research staff more opportunities to participate in research, and to free up NHS R&D departments, research nurses and clinicians to focus on more demanding and patient focused research studies. Hospices need standardised guidance on how to assess the risk of being involved in low-risk research without adopting the unnecessarily complex systems that are currently used within the NHS.

Abstract Background Quality assurance in hospitals is essential for ensuring patient safety, quality of care and efficiency. The nursing profession is a key contributor to healthcare quality, yet, a comprehensive overview and comparison of the role and scope of nursing as part of accreditation and certification schemes has been lacking. The aim was to identify if and to what extent international accreditation or certification schemes focus on nursing, and to compare their conceptual models and outcome indicators. Methods A scoping review was conducted. A search strategy was developed together with a librarian and carried out in January 2024 in Medline, CINAHL, Web of Science Core Collection, Cochrane Reviews and Google Scholar. Additionally, authoritative websites of accreditation/certification holders were searched. Inclusion criteria were studies on international accreditation or certification schemes for hospital settings with relevance to nursing published in English or German. Screening and data analysis adhered to the Joanna Briggs Institute’s methodology, with reporting following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline (PRISMA-ScR). Results The search identified 17.315 records. After removing duplicates and screening of titles/abstracts, 336 full-texts remained. A total of 124 studies were included, identifying seven international accreditation/certification schemes: European Foundation for Quality Management, Evaluation and Quality Improvement Program, International Organization for Standardization 9001, Joint Commission International®, Magnet Recognition Program®, Pathway to Excellence® Program, Qmentum®. The different schemes ranged from nursing-specific to having no specific focus on, but relevance for, nursing and varied in their topics, focus on structure, process and outcome quality and structure and content of requirements. Additionally, outcome indicators varied, with differences in the extent to which indicators were nurse-sensitive, compulsoriness of data collection, and use of external benchmarking. Conclusions The seven international schemes show large conceptual variations as to their focus on nursing and differences in the degree of nurse-specific outcome indicators. Hospital and nursing managers, policymakers, patients and the public need to understand the content and outcome dimensions of the schemes when making decisions or assessing hospital quality data.

Abstract 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 Background The vaccine supply chain (VSC) integrates all activities from production to dispensing, characterized by complexity and low responsiveness. This study aims to define key performance indicators (KPIs) to evaluate the logistic and operational performance during the COVID-19 National Vaccination Plan in Colombia. Methods This study employed the design science research (DSR) methodology to develop a dashboard for monitoring COVID-19 vaccination progress. DSR is a problem-solving paradigm focused on conceiving, testing, and evaluating artifacts to tackle specific challenges. The dashboard integrated a set of Key Performance Indicators (KPIs) that incorporated three dimensions: epidemiological, humanitarian, and logistical. Both, the dashboard and the KPIs underwent validation through three iterative DSR cycles, in collaboration with both private and public health stakeholders. Results A set of 38 validated KPIs, grouped into eight categories, was consolidated into an online dashboard. This tool enabled real-time tracking of the National Vaccination Plan at both national and departmental levels, providing stakeholders with a comprehensive view of the vaccine supply chain. It also allowed for the assessment and comparison of the execution and effectiveness of public policies. Conclusions These KPIs supported decision-making from a logistical standpoint, enhancing the planning, preparation, and continuous improvement of mass vaccination processes, thereby increasing their potential impact even further.

Abstract Background This study aimed to contribute to a better understanding of the context, mechanisms and outcomes in the implementation process of an eHealth video consultation program in primary care. The study focused on how the program is normalized in the primary care setting. The primary research question for this study is “in what ways is the implementation of video consultation normalized in primary care?”. Methods The qualitative design and content analysis of primary data from the transcripts were based on in-depth interviews, complemented with free-text answers to open-ended survey questions and various documents. The study focuses on the large-scale implementation of the public eHealth program Närhälsan Online, which represents more than 100 health centers in Sweden’s largest region of Västra Götaland. Multiagent perspectives on how the program is normalized were drawn from expressed perceptions by professions directly linked to both strategic and functional implementation, as well as administration and clinical operation. Results This study both confirms and enhances the field with a theoretical contribution in six ways to the reviewed previous research, as well as showing practical implications. It also provides multi-agent perspectives on the rapid normalization of the implementation program studied. Conclusions In relation to the rapid progression of different initiatives in eHealth, this study contributes to perspectives on specific challenges as expressed by professions directly linked to both strategic and functional implementation as well as administration and clinical operation.

Abstract Background Despite medication being the most common healthcare intervention and medication-related incidents being common in hospitals, many rural and remote hospitals in Australia lack onsite pharmacy services due to resource constraints. A Virtual Clinical Pharmacy Service (VCPS) staffed by two senior, rural generalist hospital pharmacists assigned to four hospitals each was implemented in rural and remote facilities to determine whether the VCPS increased adherence to National Safety and Quality Health Service Standards (NSQHS). Methods A stepped-wedge randomised controlled trial was employed to sequentially implement a telehealth pharmacy service at one-month intervals in eight hospitals. The primary outcomes were patient-level medication reconciliation completion rates on admission and discharge. Secondary measures evaluated compliance with other NSQHS standards (including Best Possible Medication History, Medication Reconciliation and venous thromboembolism risk assessment), patient outcomes (including representation within 48 h, readmission within 28 days and length of stay), and detection of potential medication-related harms (including pharmacist identified medication related problems, reported medication errors and falls). Patients were invited to complete a patient-reported experience questionnaire. Data were collected from electronic medical records and analysed using mixed logistic regression models to estimate the effectiveness of the VCPS. Antimicrobial usage, falls, and medication errors were analysed at the facility level, while other data were analysed at the patient level. Results Compared to control (n = 535), patients in the intervention period (n = 527) were more likely to have an admission medication reconciliation completed (Odds Ratio (OR) 11.16, 95% confidence interval (CI) 5.59–22.30, p

Abstract Background To ensure workforce stability in China’s healthcare system and maintain high-quality care, it is essential to comprehensively understand the interplay of factors contributing to turnover intention of healthcare workers. This study aims to examine the associations between potential factors and turnover intention in healthcare workers and explore the mediating effect of job satisfaction and work engagement in the association between them. Methods In this cross-sectional study, a random sample of 1060 healthcare workers working in 98 public medical institutions were recruited to rate their turnover intention in 2018 in Shenzhen, China. Information on socio-demographic characteristics, job-related factors, turnover intention, job satisfaction, work engagement, work stress and doctor-patient relationship of participants were collected. Pearson’s chi-squared tests and binary logistic regression analyses were performed to explore the association between these factor and turnover intention. Mediation analysis was used to explore the roles of potential mediators and moderators. Results The results showed that age (OR: 0.35, 95%CI: 0.16 to 0.72), tenure (OR: 0.98, 95%CI: 0.96 to 0.99), administrative positions (OR: 0.33, 95%CI: 0.16 to 0.63), and night shift frequency (OR: 1.84, 95%CI: 1.26 to 2.67) were significantly associated with turnover intention. We identified the mediating effect of job satisfaction and work engagement in the relationship between administrative positions and turnover intention, while the suppressing effect in the relationship between professional titles and turnover intention. Additionally, we found that monthly income plays a moderating role in the relationship between work engagement and turnover intention, and in the association between professional titles and turnover intention. Conclusions Greater job satisfaction and engagement, along with reasonable remuneration, were found to be associated with lower turnover intention among healthcare workers. Employers should proactively monitor the dynamic interactions among these factors and then develop more tailored interventions in order to alleviate the ongoing loss of healthcare workers.

Abstract Background Implementation of screening brief intervention and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) remains low in primary care. ANTECEDENT (Partnerships to Enhance Alcohol Screening, Treatment, and Intervention) was a practice-facilitator led implementation study to increase SBIRT and MAUD use in diverse primary care clinics. Methods From November 2019 – April 2023, we conducted a convergent parallel mixed methods evaluation. Participants were small and medium-sized primary care clinics in the Northwestern U.S. Clinics received foundational support (i.e., baseline/exit assessment, access to SBIRT Oregon website) and the option for supplemental implementation support (e.g., practice facilitation, expert consultation) over the 15-month intervention to improve SBIRT and MAUD. Qualitative and quantitative data regarding clinic characteristics, implementation strategies, and SBIRT/MAUD outcomes were collected through practice facilitator interviews, periodic reflections and clinic contact logs, interviews, pre-post surveys, and electronic health record (EHR) queries. Quantitative analyses included descriptive statistics, logistic regression, and the Wilcoxon sign-ranked test. Qualitative analysis took an immersion crystallization approach. Data were reviewed in a matrix to evaluate intervention adoption, implementation, and effectiveness. Results We recruited 75 unique clinics; 66 participated and 48 (73%) completed the study. Eight participating clinics chose to receive foundational support only (12%) while 58 chose to engage in supplemental support (88%) activities. Clinics that received supplemental support and completed the intervention (n = 42) engaged in practice facilitation (Mean: 293 min, range: 75–550 min); data review (38%), HIT support (31%), expert consultation (19%), and peer-to-peer learning (5%). Pre- and post-intervention assessments showed significant improvement in self-reported SBIRT process outcomes. Performance data improved among the subset of completing clinics able to produce data (n = 17). Clinics described positive experiences with ANTECEDENT support and highlighted remaining barriers to SBIRT and MAUD implementation. Conclusions Participating clinics engaged in a diverse range of supportive activities. A flexible approach using practice facilitation and implementation support could be helpful for low-resourced primary care clinics in improving SBIRT and MAUD for unhealthy alcohol use.

Abstract Background In the wake of the coronavirus disease-19 (COVID-19) pandemic, research on the difficulties faced by epidemiologists conducting epidemiological investigations has been progressing steadily. However, few studies have developed applications (apps) that can directly support epidemiological investigations via information and communication (ICT) technology, and conducted usability evaluations on them via user responses. This has caused difficulties when developing such technologies. We introduced and evaluated two mobile apps that support epidemiological investigations. This study attempted to identify the predictors affecting the acceptance of infectious disease self-management apps. Methods We developed two infectious disease self-management smartphone apps for epidemiological investigations: KODARI (the Korean version) and MEDARI (in English version). We collected data from 248 users of KODARI by surveying Korean citizens. This study was conducted from November 15 to December 14, 2022. We used multiple regression analysis to identify the variables that affected continuous intention to use the KODARI app. We conducted two independent-samples t-tests to determine whether there were any differences in the perception of each variable in relation to demographic and COVID-19-related user characteristics. Results The factors that affected continuous intention to use the KODARI app, in order of relative importance, were: price value, satisfaction, performance expectancy, and facilitating conditions. Overall, male participants were more satisfied with the KODARI app than female ones, and more willing to continue using it. The male participants also evaluated facilitating conditions more positively than the female ones did. Married participants rated the app higher than single ones in terms of price value, performance expectancy, and continued intention to use. Conclusions The study suggests factors that increase the use of health apps and suggests that use of these apps may increase further in the event of a future pandemics. These results are expected to help researchers study other infectious disease apps in the context of public health surveillance.

Abstract Background The success of an electronic health records (EHR) system is dependent on the effectiveness, satisfaction, and efficient use of these systems by health professionals. This paper explores the interdependency among effectiveness, satisfaction, and efficient use of Lightwave Health Information Management Systems (LHIMS) which is an EHR by health professionals. Methods A non-interventional descriptive cross-sectional study design was employed for this research. The study used stratified random sampling for the selection of participants. The population for the study was all the health professionals in the Central Region of Ghana. The number of health professionals who responded to the questions was 1126. Results The findings suggest that understanding the interdependency of efficiency, effectiveness and satisfaction is crucial for the successful implementation and adoption of LHIMS in healthcare organisations. The study investigated the interdependence among effectiveness, satisfaction, and efficient use of the LHIMS by health professionals, and found a positive but weak significant relationship between these factors. Conclusion In conclusion, this study aimed to assess the interdependency among effectiveness, satisfaction, and efficient use of LHIMS by health professionals. The. results support a positive but weak significant relationship between satisfaction, effectiveness, and efficient use of the LHIMS. These findings have implications for policymakers and hospital management in their efforts to improve the use of LHIMS. Policymakers can focus on any one of the three usability areas to enhance LHIMS use, with visible effects across the other two domains.

Abstract Background Raising the quality of health services is key to continued progress in improving child health, however, data on service quality are limited and difficult to interpret. The relationship between facility readiness and the quality of care is complex. Methods Using publicly available data sets from five low- and middle-income countries (LMICs), we assessed the relationship between structural factors and the clinical quality of care for managing sick children. We developed indices for readiness and quality accounting for available indicators, expert opinion, and alignment with integrated management of childhood illness (IMCI) guidelines. In each country, we assessed the association between readiness and quality, with and without adjusting for other factors. We considered associations overall, by domain, and by provider type, explored non-linear associations, and compared associations at the individual and facility-level. Results The analysis included data from 3,149 health facilities and 11,159 sick child observations. In four of the five countries included in the analysis, we observed for every 10%-point increase in readiness, quality increased by about 1% point after adjusting for facility type and managing authority. There was little evidence of a non-linear relationship or a threshold effect altering the relationship between readiness and quality of care. Beyond readiness, younger child age, higher cost of care, and having a respiratory, digestive, or febrile diagnosis were most often associated with a higher quality of care. Higher “human resources” readiness domain scores were most consistently associated with better quality of care, while the quality of care domain of “treatment” was the least influenced by readiness. Facility-level associations did not vary greatly from individual-level associations. Conclusions The weak correlation observed suggests readiness plays an important role in quality but as currently measured cannot be used to characterize clinical quality of care. Data for assessing quality of health services are limited, presenting challenges for understanding impediments, assessing interventions, and gauging changes in the quality of care over time. We need better data to assess the quality of care being delivered in LMICs to understand what factors drive quality, with the goal of improving the management of sick children.

Abstract Background Electronic patient-reported outcome (ePRO)-based symptom management improves cancer patients’ outcomes. However, implementation of ePROs is challenging, requiring technical resources for integration into clinical systems, substantial buy-in from clinicians and patients, novel workflows to support between-visit symptom management, and institutional investment. Methods The SIMPRO Research Consortium developed eSyM, an electronic health record-integrated, ePRO-based symptom management program for medical oncology and surgery patients and deployed it at six cancer centers between August 2019 and April 2022 in a type II hybrid effectiveness-implementation cluster randomized stepped-wedge study. Sites documented implementation strategies monthly using REDCap, itemized them using the Expert Recommendations for Implementation Change (ERIC) list and mapped their target barriers using the Consolidated Framework for Implementation Research (CFIR) to inform eSyM program enhancement, facilitate inter-consortium knowledge sharing and guide future deployment efforts. Results We documented 226 implementation strategies: 35 ‘foundational’ strategies were applied consortium-wide by the coordinating center and 191 other strategies were developed by individual sites. We consolidated these 191 site-developed strategies into 64 unique strategies (i.e., removed duplicates) and classified the remainder as either ‘universal’, consistently used by multiple sites (N = 29), or ‘adaptive’, used only by individual sites (N = 35). Universal strategies were perceived as having the highest impact; they addressed eSyM clinical preparation, training, engagement of patients/clinicians, and program evaluation. Across all documented SIMPRO strategies, 44 of the 73 ERIC strategies were addressed and all 5 CFIR barriers were addressed. Conclusion Methodical collection of theory-based implementation strategies fostered the identification of universal, high-impact strategies that facilitated adoption of a novel care-delivery intervention by patients, clinicians, and institutions. Attention to the high-impact strategies identified in this project could support implementation of ePROs as a component of routine cancer care at other institutions. Trial registration ClinicalTrials.gov. NCT03850912. February 22, 2019. https://clinicaltrials.gov/ct2/show/NCT03850912?term=hassett&draw=2&rank=1

Abstract Background Suicide is the fourth leading cause of death among young people aged 15–29 worldwide. Young people often present to emergency departments (EDs) with self-harm and suicide-related behaviors. The period following discharge from the ED is recognized as one of elevated risk for both repeated self-harm and suicide. During this critical time, suicide prevention aftercare services are recommended. Despite their increased popularity, evidence demonstrating the effectiveness of these models is very limited. Methods Using a hybrid effectiveness-implementation type I design, this evaluation will assess the effectiveness and implementation of a suicide prevention aftercare (Hospital Outreach Post-suicidal Engagement; HOPE) service designed to reduce risk of self-harm and suicide in young people aged 12–25 who are referred to the service following an ED presentation for self-harm or suicide attempt. Two complementing theoretical frameworks will guide this evaluation, specifically the design, data collection, analysis, and interpretation of results. The RE-AIM evaluation framework will be used to assess Reach, Effectiveness (including cost-effectiveness), Adoption, Implementation and Maintenance of the HOPE aftercare service. The PRISM implementation framework will be used to assess multi-level contextual factors hypothesized to affect the RE-AIM outcomes. Several data sources will be used to assess the changes in primary and secondary outcomes from baseline to post–intervention, and at follow-up, including user and provider self-report surveys, semi-structured interviews, and routinely collected hospital data. An historical control study will also be conducted using data from the Self-Harm Monitoring System for Victoria to examine the impact of the service on rates of self-harm and suicide-related presentations to ED, and compare trends prior to and following commencement of the HOPE aftercare service. In addition, dynamic systems modelling will be used to assess the future scalability of the service. Discussion Findings from this evaluation will determine the effectiveness, including cost-effectiveness, of the HOPE aftercare service and describe the implementation context. They will inform the future development and sustainability of this and other similar services across Australia and internationally. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 19th December 2023 (Registration number ACTRN12623001332617). We do not foresee any amendments to this protocol however, if any unforeseen modifications are required, they will be submitted to ANZCTR. Trial sponsor Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia.

Abstract Background It often takes a long time before a rare disease is diagnosed. Without a diagnosis, the right therapy often cannot be carried out and without the right therapy, the patients are denied the opportunity for a cure or relief from their symptoms. In addition, rare diseases can also have economic consequences for those affected. This study aimed to investigate the extent to which a rare disease affects the income and work performance of the patients concerned and whether the use of AI in diagnostics would have the potential to reduce economic losses. Methods The work performance and income of 71 patients of the outpatient clinic for rare inflammatory systemic diseases with renal involvement at Hannover Medical School were analyzed during the course of the disease. The WHO Health and Work Performance Questionnaire (HPQ) was used to collect data. During the patient interviews, the questionnaire was completed four times: at the onset of the first symptoms, when a diagnostic decision support system (DDSS) would have suggested the correct diagnosis, at the time of diagnosis and at the current status. Results With the onset of the diagnostic odyssey, the monthly net income of the patients under study dropped by an average of 5.32% due to lower work performance or work absenteeism. With the correct diagnosis, the original or even a better income of 11.92% could be achieved. Loss of income due to illness was more massive in patients with a rare disease with joint, muscle and connective tissue involvement than in patients with rare vasculitides. If a DDSS had been used, the loss of income would have been 2.66% instead of the actual 5.32%. Conclusion Rare diseases resulted in temporary or existing income losses in 28.17% of the patients. Losses in work performance and income were related to the type of disease and were more pronounced in patients with joint, muscle or connective tissue disease than in patients with rare vasculitides. The use of a DDSS may have the potential to reduce the negative income effects of patients through earlier correct diagnosis. Trial registration Retrospectively registered.

Abstract Background Sexual abuse among street children is a problem that renders a burden of sexually transmitted diseases, HIV infection, and early pregnancy. Literature shows that globally 95 million children experience sexual abuse with 1 in 5 girls and 1 in 7 boys exposed to sexual abuse before 18 years of age in Malawi. Malawi adopted the World Health Organization guidelines for providing emergency health services for victims of sexual abuse, which include HIV Post Exposure Prophylaxis (PEP) and Emergency Contraceptive Pills (ECP) within 72 h of exposure, Sexually Transmitted Infections (STI) treatment, and psychosocial services. However, there are challenges associated with the services that limit access and utilization among street children. This study explored the factors associated with access and utilization of sexual abuse emergency healthcare services among street children in Zomba. Methodology This was a cross-sectional phenomenological qualitative study conducted in Zomba City from 2022 to 2023 using in-depth and key informant interviews. We purposively selected street children between 10 to 17 years who have been exposed to sexual abuse on the streets and social actors working with street children. The study employed a thematic analysis approach. Results The study found that street children did not utilize sexual abuse emergency health services. The major factors associated with utilization included the knowledge of sexual abuse, its associated health risks and sexual abuse emergency health services, and perceptions of utilizing sexual abuse emergency health services. The barriers to utilization of sexual abuse emergency health services included perceived shame, fear, discrimination, prolonged treatment process, and attitude of the health service providers. Conclusion Sexual abuse and its health risks continue to be a challenge among street children. The absence of adequate connections and secure environments for street children to report sexual abuse and seek help without facing judgment has created significant obstacles for them in accessing sexual abuse emergency health services. To curb this challenge it is crucial for successful interventions to specifically address the health needs of street children and involve them in the decision-making processes related to their interventions.

Abstract Background The rate of 30-day all-cause hospital readmissions can affect the funding a hospital receives. An accurate and reliable readmission prediction model could save money and increase quality-of-care. Few projects have explored formulating this task as a survival prediction problem, where models can exploit a real-valued time-to-readmission target. This paper demonstrates the effectiveness of a survival-inspired readmission model, especially when paired with a longitudinal patient representation that is agnostic to disease-cohort and predictive task. Methods We forecast readmissions for a population-level cohort of 421,088 patients discharged in 2015 and 2016 from hospitals in Alberta, Canada. Clinical features and sequences of historical medical codes (calculated from at least four full years prior to discharge) from linked administrative sources serve as model inputs. We trained binary 30-day readmission models (XGBoost and a Deep Neural Network) and time-to-event readmission models (CoxPH and N-MTLR) with and without machine-learned medical knowledge at initialization, then compared against the popular LACE-based model using the AUROC score at 30 days (AUROC@30). Survival models are additionally evaluated using concordance, Integrated Brier, and L1-loss scores. Results All models that utilize sequence features markedly out-perform even the best models trained on only clinical features. Further, a time-to-event target improves predictive performance at 30 days, given the same model inputs and architecture. N-MTLR, using solely sequence inputs and initialized with pre-learned medical knowledge, achieves an average AUROC@30 of 0.8460 over five folds with a standard deviation of 0.003. All trained models match or out-perform the LACE baseline of 0.6587±0.003. Conclusion Sequences of administrative medical codes contain rich predictive information for forecasting readmissions, and embedding medical knowledge a priori using machine learning provides readmission models an advantageous foundation for training. When combined with a model that can leverage a time-to-event target, excellent performance is possible on the 30-day all-cause readmission task using only administrative data.

Abstract Background Although several training courses for Health Care Workers (HCWs) on COVID-19 were conducted in Yemen, no evaluation has been done to assess the effectiveness of such training on the Knowledge, Attitude and Practice (KAP) of HCWs. Therefore, this study aimed to assess the effectiveness of training on the KAP of HCWs toward infection prevention and control (IPC) for COVID-19, determine the relationship between the change in the KAP of HCWs, and identify the associated factors with the change in KAP. Methodology A cross-sectional study was conducted from April to December 2021. It was conducted among 186 HCWs working at COVID-19 isolation centers and caring for COVID-19 patients, in all Yemen’s governorates. The data were collected one week before and immediately after the training session. SPSS version 26 was used for data entry and analysis. The median, interquartile range (IQR) and median difference were calculated. The Wilcoxon Signed Ranks Test was used to estimate the significant difference between KAP pre- and post-training scores. Kurskal-Wallis and Mann-Whitney U tests were used to assess the associated factors. Spearman’s correlation coefficient test was used to assess the statistical relationship between the change in KAP. A P value

Abstract Background In 2016, Uganda introduced services for hypertension and diabetes in selected HIV clinics. We evaluated the costs associated with scaling up these services in HIV clinics in Mbarara and Ibanda districts, Uganda. Methods We estimated the annual costs of providing hypertension and diabetes services using an activity-based costing approach from the health system perspective in ten randomly selected HIV clinics in Mbarara and Ibanda districts. Cost inputs included 2023 data on costs of medications, health provider time, salaries, training costs, and monitoring costs. We determined the average annual cost and medication costs for hypertension and diabetes treatment per enrolled adult patient, stratified by type of health facility. Results The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 − 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 − 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13–58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10–75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 − 97) annually; $13 at public facilities and $50 at private not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 − 35); $11 at public facilities and $22 at private not-for-profit facilities. Conclusion Adding hypertension and diabetes management to routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities. This variation was primarily driven by higher medication procurement prices at private facilities, revealing a potential area for optimizing costs through improved procurement practices.

Abstract Background Language barriers in healthcare lead to miscommunication between professionals and patients, thereby reducing the quality of and equitable access to healthcare. In African countries, the recognition and formal study of these barriers is severely limited despite Africa having more languages than any other continent. Our study investigates language barriers in healthcare facilities in Zomba district in Malawi, where three major local languages are spoken. Methods We employed a mixed methods approach and conducted a questionnaire-led study. Data were gathered at 22 health facilities, from 79 healthcare professionals and 312 outpatients using a semi-structured questionnaire. Findings were corroborated using document analysis to review legislation and policies, curriculum documents and patient notes. Results Language discordance emerged as a problem for professionals and patients. Both faced challenges due to vocabulary limitations for medical terms in English and Chichewa. Professionals did not receive training on how to effectively communicate medical concepts in local languages. Most patients did not speak English, which was used for all written records. Patient understanding of the information given to them verbally during consultations or in written health notes was very low, and this diminished their confidence in the diagnosis or treatment they received. Social factors including gender, age or patient experience, as well as patient literacy or perceived low literacy, poor rapport between healthcare professionals and patients, and a lack of privacy during consultations all exacerbated communication issues. Consequences of language barriers included unsatisfactory care experiences and compromised exchanges of health information. Strategies used by professionals to cope with these challenges were flexibility in the choice of language, reliance on physical checks and non-verbal communication indicators and the occasional use of ad-hoc interpretations. Conclusion Language barriers in healthcare facilities in Malawi have serious implications on the quality of healthcare provided. We propose solutions such as the development of dictionaries with phrases for symptoms and conditions, sensitisation courses that incorporate language considerations for both professionals and patients. Policies such as the provision of interpreters and staff allocation are discussed. We recognise that coordinated efforts at national and international levels are key to securing significant funding for effective interventions.

Abstract Background The number of older adults with complex healthcare needs is growing alongside limited resources available in health services. To meet this challenge, it is urgent that healthcare staff are motivated and able to continuously translate new knowledge and working methods into daily practice. To facilitate such implementation, supportive measures responding to the healthcare personnel’s needs seem essential. The present study aims to translate, contextualize and test a Swedish version of the Implementation Process Assessment Tool (IPAT) for measuring the facilitation needs among staff implementing a new working process in municipal elderly care. Methods A mixed-method design was used. First, the existing instrument was translated into Swedish. Thereafter, twelve staff members with different professions working in healthcare and at the municipal elderly care were interviewed using Think-aloud interviews to contextualize and test the face validity of the translated instrument. Lastly, the adjusted instrument (Swe-IPAT) was psychometrically evaluated through a cross-sectional survey among 305 staff members working in municipal elderly care. Results The psychometric evaluation of the Swe-IPAT revealed satisfying properties. Three factors, largely in line with the original IPAT, are suggested. Internal consistency assessed using Cronbach’s alpha was 0.93 for the factor individual phases for behavioral change and perception of the intervention, 0.84 for the factor individual activities, and 0.95 for the factor collective readiness and support. Conclusions The 27-item Swe-IPAT, translated into Swedish and contextualized, demonstrated satisfactory psychometric properties when tested in an elderly care context. The instrument is suggested to be useful in providing feedback to managers in tailoring support and assessing implementation efforts among healthcare staff in elderly care. However, more research is needed to evaluate its properties throughout the entire implementation process and to test the usability of Swe-IPAT in other settings.

Abstract Background Healthcare workers in dental hospitals frequently experience repeated occupational exposures (ROEs). In our study, we aim to analyze these repeated exposures among dental healthcare workers (DHWs), assess the risk levels of different risk factors, and explore the significance of ROE data for infection control in dental hospitals. Methods Based on hospital statistical data, we categorized the occupational exposure incidents at West China Hospital of Stomatology over the past seven years into initial and repeated exposures. We analyzed the association of various risk factors, including personnel types, gender, treatment locations, timing of occupational exposure, and pathways of occupational exposure, with the occurrence of repeated exposures. The Statistical Package for Social Sciences (SPSS) 21 was used to conduct chi-square analysis and binary logistic regression analysis, with the significance level set at p

Abstract Introduction Surgery, even on an elective-basis, often induces significant stress in patients, characterized by preoperative anxiety and heightened stress levels due to anticipation of the unknown. However, the primary objective of preoperative counseling is to mitigate these concerns, particularly when delivered in a structured and comprehensive manner. While previous research has highlighted the beneficial impact of preoperative counseling on patient-reported outcomes, none have specifically explored the implementation of a structured checklist-based approach during counseling sessions. To bridge this gap in the literature, our study aims to investigate the effects of implementing a checklist-based structured counseling approach on patient-reported outcomes following elective surgery. Methods In this prospective cohort study conducted over one year from January to December 2023, a total of 600 patients undergoing elective surgery across three specialties—orthopedic surgery, general surgery, and urology—were examined. The patients were divided into two groups: an intervention group consisting of 300 patients and a control group with an equal number of patients. The study evaluated three key outcomes—postoperative pain, anxiety, and satisfaction—at three specific time points following surgery: 24 h, 48 h, and 72 h. Results Patients receiving structured checklist counseling showed significantly lower pain scores (24 h: 6.6 vs. 7.03, p = 0.041; 48 h: 5.62 vs. 6.55, p = 0.029; 72 h: 2.54 vs. 2.90, p = 0.035) and anxiety scores (24 h: 8.58 vs. 9.25, p = 0.039; 48 h: 7.50 vs. 8.45, p = 0.030; 72 h: 4.53 vs. 5.98, p = 0.031), as well as higher satisfaction scores (24 h: 5.99 vs. 5.06, p = 0.043; 48 h: 6.99 vs. 6.02, p = 0.033; 72 h: 9.10 vs. 8.20, p = 0.039) compared to controls. These improvements were consistently significant across all three surgical specialties studied (p

Abstract Background Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study’s goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. Methods This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Results Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients’ mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient’s death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, “It is not the fault of the health care team - it is the way the system works.” Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, “It seems like everything is like an isolated incident… there’s no overall, big picture viewpoint.” (2) Administrative burdens, “In the end I gave up [scheduling care] because I was tired of calling.” (3) Financial burdens, “This oncologist wanted to put him on a drug…but it was $4000 a month.” Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. Conclusions These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families.

Abstract Background Despite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of chronic illness, holistic care, and counteracting the adverse effects of conventional therapies. This study aims to determine the prevalence of CAM use and its associated factors among patients undergoing hemodialysis (HD) in Taiwan. Methods This quantitative study was conducted from August 2022 to July 2024 in the HD unit at Kaohsiung Chang Gung Memorial Hospital in Taiwan. Face-to-face questionnaire-based interviews were held with 154 of 163 eligible patients (response rate, 94.5%) at the bedside during HD. The completed questionnaires were entered into a secure computer database. Data was performed by descriptive analysis, Chi-square, and Fisher tests. Results More than half of the patients were CAM users (n = 86; 56%), and women was associated with significantly more usage of CAM. Fifty-six CAM users took Chinese herbal medicine (CHM), 52.3% (n = 45) used dietary supplements, and 19.8% (n = 17) used acupuncture. The benefit in the effectiveness of CAM was the main reason for use, the need of CAM to improve the well-being and HD-related complication was high. 32.7% of patients had used CAM based on recommendation from their family and friends. More than one-third (33.7%) of patients did not disclose their use of CAM to their doctors, most of them think it is unnecessary. Conclusions The use of CAM by patients with maintenance HD was relatively frequent. Of these, most used CHM, of which are shown to the trend into routine HD care is inevitable by high coverage and utilization in Taiwanese national health insurance system. These findings indicate that it is important for health care providers working in dialysis to assess CAM use.

Abstract Background Musculoskeletal pain and disability are leading causes of reduced health and significant economic costs worldwide. Individualised, and evidence-based treatment approaches for specific musculoskeletal conditions aimed at improving patient outcomes and costs have not been successful. Recently authors have suggested that the ‘process’ of how care is implemented within a health system needs to be considered as an influencer on patient outcomes. With the rising prevalence of musculoskeletal conditions and the burgeoning costs associated with their treatment, it seems timely that new research focusing on process variables and their influence on patients with musculoskeletal conditions is explored. Before such studies can take place, a modern definition of a process variable within a musculoskeletal care pathway is needed to anchor future research endeavours. Therefore, the aim of this study was to establish a consensus-based definition of a process variable within a musculoskeletal care pathway, based on a New Zealand setting. Methods This study used a virtual nominal group technique and took place in July 2023 using a Microsoft Teams platform. A nominal group technique employs a structured approach to generate information and solutions to problems that can then be prioritised through group discussion and consensus. It is unique because it allows expert participants to explore using in-depth inquiry, areas previously unidentified or not yet investigated. There was an inclusion criterion and the participants completed pre-work before the two-hour five stage virtual meeting. The Auckland University of Technology Ethics Committee (AUTEC) approved this study (AUTEC 23/94). Results The study included eight participants (five male, three female) who had extensive experience with the New Zealand ACC insurance scheme and the design, implementation, and administration of musculoskeletal care pathways. The consensus definition was ‘A health process variable is any modifiable factor in a health process or pathway that can be quantified and measured and that if varied may achieve a different operational or patient outcome’. Conclusions This study of New Zealand-based experts has formed a consensus-based agreement for a definition of a process variable in a musculoskeletal care pathway. This is an important first step in developing our understanding of process variables, and further research is needed to establish the link between process variables and their influence on the outcomes of patients with musculoskeletal conditions.

Abstract Background While evidence of efficacy, safety, and technical feasibility is crucial when introducing a vaccine, it is equally important to consider the psychological, social, and political factors influencing vaccine acceptance. This study aims to identify the factors contributing to COVID-19 vaccine hesitancy among adults in Tehran, Iran. Methods The study employed a descriptive and analytical cross-sectional design carried out from 2021 to 2022. It involved 260 eligible individuals residing in the catchment areas of Tehran and Shahid Beheshti Universities of Medical Sciences who declined to receive the COVID-19 vaccine, selected through systematic sampling. Data collection was accomplished through a researcher-developed questionnaire and analyzed using SPSS 26 software. The analysis utilized descriptive statistics and non-parametric tests including Mann-Whitney U, Kruskal-Wallis, and Multiple Linear Regression, to examine the relationships between variables. Results The average scores (SD) across dimensions were as follows: the individual’s health status and perceived risk, 15.53 (1.70); contextual and social effects, 17.68 (2.53); awareness, 14.81 (2.34); and beliefs and concerns. 14.91 (2.64), indicating a concerning situation regarding contextual and social impacts and a moderate status as to other areas. The primary reasons for vaccine refusal included fear, lack of belief in the vaccine, concerns about its reliability, illness, and lack of access or time. Acceptance of the vaccine was associated with education, occupation, marital status, number of children at home, and income reduction due to COVID-19. Conclusion The findings indicate that fear, lack of belief in the vaccine, concerns regarding its reliability, illness, and lack of access or time were the most important factors influencing reluctance to receive the vaccine. Health organizations should consider these factors when encouraging the population to receive the COVID-19 vaccine.

Abstract Background The efficiency of medical services directly impacts the economic burden of healthcare, making it crucial to analyze the input-output efficiency of various types of medical institutions. However, while hospitals had been extensively analyzed for their efficiency, other types of medical institutions had received limited attention in this regard. Methods In this study, we employed data envelopment analysis (DEA) methods based on time series and internal benchmarks to autonomously assess the efficiency of 18 distinct categories of healthcare facilities in China over the past decade. The verification was conducted through the utilization of the critical incident technique (CIT). Additionally, we utilized the Delphi process (AHP) method to evaluate suppliers of medical consumables, implemented a multi-population genetic algorithm for managing these consumethod and analytic hierarchymables efficiently, and applied stakeholder theory to manage medical personnel efficiency. Results Our findings indicated that medical institutions capable of providing clinical services exhibited higher levels of efficiency compared to those unable to do so. Multiple indicators suggested redundancy within these institutions. Notably, comprehensive benefit evaluation revealed that clinical laboratory had performed poorly over the past decade. We selected an inefficient medical institution for intervention in reagent management and the work efficiency of medical staff. After implementing the Delphi method and multi-population genetic algorithm for consumable replenishment, the reagent cost was reduced by 40%, 39% and 31% respectively in each of the three experimental groups, compared to the control group. By applying stakeholder theory and process reengineering methods, we were able to shorten quality control management time for medical staff in the experimental group by 41 min per day, reduce clinical service time by 25 min per day, and extend rest time by 70 min per day, while the quality indicators were all meeting the targets. Conclusion By employing various mathematical models as described above, we were able to reduce costs associated with medical consumables and enhance medical personnel work efficiency without compromising quality objectives.

Abstract Background Access to equal health services is a key issue in most European countries. In the coming years, immigrants will constitute an increasing proportion of older adults in Europe, and their need for healthcare services will likely increase. Healthcare services must prepare for such encounters to make them equitable. Older immigrants’ hospitalization experiences require elucidation. Their patient experiences can provide important knowledge when the healthcare system is working toward equal and equitable healthcare services. Methods This study employed an exploratory qualitative design. Data were collected through narrative interviews with a purposive sample of eight older adult immigrants, aged 61–79 years. Patient narratives were analyzed using thematic analysis with a reflexive approach, as outlined by Braun and Clarke. Results The analysis created three themes that shed light on older adult immigrants’ experiences as hospital patients. The themes conveyed experiences related to challenging involvement and interaction, notions of what an ideal patient should be like, and participants not feeling valued as a person. Conclusion The findings indicate that communication between healthcare professionals and older adult immigrant patients is deficient: older immigrants in this study did not make their voices heard nor were they invited to participate by healthcare professionals. This contributes to limited involvement in assessment, treatment, and care. The older immigrants felt that they were not valued nor met as unique individuals. The findings indicate that health policy goals regarding patient participation and person-centered care are not met when older immigrants are patients. Consequently, the experiences of older adult immigrants in this study indicate that equal health services are at risk.