Despite implementation of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), screening coverage for oral, breast and cervical cancers remains below 2%. Screening quality is inadequately addressed and delays in diagnosis and treatment initiation continue to persist. This multisite implementation research aims to improve district-level coverage and quality of screening, early diagnosis and timeliness of treatment initiation through a model co-developed within the NP-NCD context.

The study will be conducted in three phases across seven districts in diverse regions of India. In phase I (formative), the current status, barriers and facilitators of cancer screening, diagnosis and treatment initiation under NP-NCD will be assessed. In phase II (optimisation), a model (package of implementation strategies) will be co-developed and iteratively optimised with multistakeholder engagement at the subdistrict level to improve screening coverage and quality and strengthen the referral system for early diagnosis and treatment initiation. In phase III (scale-up and evaluation), the model will be implemented at the district level and evaluated for improvements in screening, early diagnosis and treatment initiation. A convergent mixed-methods design will be used, incorporating household surveys, facility assessments and stakeholder interviews. Implementation Research Logic Model will guide planning, execution and evaluation in the present study. Determinants of screening coverage and quality, early diagnosis and treatment initiation will be assessed using the Consolidated Framework for Implementation Research. Implementation strategies for the model will be finalised using the Expert Recommendations for Implementing Change framework. Implementation and service outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.

Ethical approval has been obtained from all study sites. The study findings will be disseminated at the state, national and global levels through meetings and conferences and submitted to a peer-reviewed journal for publication.

CTRI/2025/08/092672.

The aim of this study was to translate the Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire into Norwegian and assess its psychometric properties among individuals with a history of myocardial infarction.

The study adopted a cross-sectional design. The original questionnaire was translated into Norwegian and adapted for use in the target population. The Norwegian version was pilot tested in a sample of patients and then validated in the target population.

Norway, using a web-based solution to collect data.

A random sample of Norwegian individuals

Internal consistency was tested using Cronbach’s α and test–retest reliability using intraclass correlation coefficient (ICC). Difficulty and discrimination indices were determined for the Knowledge scale. Confirmatory factor analysis (CFA) was used to assess structural validity of the Risk scale.

Data for 746 participants (mean age, SD: 66.4, 10.3 years), of which 26.9% females were analysed. The Norwegian version showed satisfactory internal consistency (Cronbach’s α 0.73–0.79) but modest test–retest reliability (ICC 0.35–0.64). The Knowledge scale showed moderate difficulty (0.39–0.84) and good discrimination power (0.44–0.60). The one-factor model CFA for each scale achieved acceptable fit, and the four-factor model showed moderate fit (root mean square error of approximation=0.05, standardised root mean squared residual=0.07, Comparative Fit Index=0.91, Tucker-Lewis Index=0.88).

The Norwegian translated ABCD Risk Questionnaire demonstrated satisfactory psychometric properties and can be considered a useful instrument for assessing knowledge and risk perception among individuals with a history of myocardial infarction.

South African women are vulnerable to HIV acquisition during the postpartum period which can result in perinatal transmission via breastfeeding; many male partners do not know their HIV status. Biomedical approaches to preventing HIV for postpartum women include pre-exposure prophylaxis (PrEP) and antiretroviral treatment for male partners with HIV. Gaps in implementation include low uptake of PrEP among postpartum women and infrequent testing of men who may be motivated to test for HIV to protect the health of their infant.

We will conduct a randomised pilot trial in KwaZulu-Natal (KZN) Province, South Africa among postpartum women and their male partners. The study will pilot a combination intervention consisting of cognitive behavioural strategies (including communication skills training, motivational interviewing and problem-solving) to promote HIV self-testing (HIVST) for Partners and PrEP uptake for HIV-uninfected Postpartum Women, the ‘H4P’ intervention. The study aims to determine the feasibility, acceptability and preliminary effectiveness of the H4P intervention. We will enrol 60 HIV-uninfected women, aged 18 years and older, in their third trimester of pregnancy and reporting a partner whose HIV-serostatus is unknown. Sixty male partners will also be eligible to enrol. Enrolled women will receive three oral HIVST kits to distribute to their male partners and standard of care information on HIVST and PrEP. Women randomised to the intervention arm will receive additional counselling and reproductive health-centred HIVST information for the male partner, including information about why HIV testing is important during their partners’ postpartum period. To evaluate feasibility, we will calculate screening-to-enrolment ratios for women and men, the number of women who distribute HIVST kits to their male partners and the number of men who test. Acceptability will be evaluated using the Client Satisfaction Questionnaire and qualitative interviews. Effectiveness will be assessed at 3 months by measuring the proportion of women initiating PrEP via self-report and urine tenofovir measurements or receipt of injectable PrEP and the proportion of men who test positive who link to HIV care. Qualitative interviews will explore perceptions of the intervention.

Ethics approval for this study was obtained from the Human Research Ethics Committee at The University of the Witwatersrand, Johannesburg, South Africa (Reference number: 250612) and the Institutional Review Boards at Massachusetts General Brigham (2025P002271, Boston, Massachusetts, USA) and the University of Alabama at Birmingham (300015167, Birmingham, Alabama, USA) in the USA. Site support and approvals were obtained from the health facility and the KwaZulu-Natal Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations.

NCT07194902.

To examine whether Indigenous Peoples’ and Local Communities’ (IPLC) ontologies are associated with knowledge, attitudes and practices (KAP) related to wildlife cohabitation and zoonotic disease transmission in biodiversity-rich areas of Latin America.

Cross-sectional household survey using a standardised KAP questionnaire. Ontologies were classified using latent class analysis. Associations between ontology classes and outcomes were assessed using multivariable logistic regression models.

Urban, rural and protected areas in biodiversity-rich regions of Bolivia, Brazil, Chile and Guatemala.

A total of 2903 individuals aged ≥10 years were recruited through random household sampling (response rate 85%).

Primary outcomes were defined according to the KAP framework. Knowledge outcomes comprised combined knowledge of zoonotic disease transmission from wildlife to humans and knowledge of zoonotic risks associated with wildlife trade. Perceived training needs related to zoonotic disease prevention were analysed as a secondary knowledge outcome measure. Attitudes were measured through risk perception, operationalised as concern about zoonotic disease transmission. Practices included self-reported hunting and slaughtering of wildlife.

The analysis identified three distinct ontology classes: Relational environmentalism (52% of the population), characterised by strong spiritual connections to animals and a tendency to protect wildlife; Dualistic environmentalism (28%), with a weaker spiritual connection to animals but a commitment to wildlife conservation; and Neutral (20%), demonstrating little spiritual connection to animals and a neutral attitude towards wildlife conservation. In the logistic regression analyses, both environmentalism groups exhibited greater knowledge of zoonotic transmission and concern about outbreaks, with members of the Relational class demonstrating higher levels of these attributes. Furthermore, members of the Dualistic environmentalism class were less likely to have close contact with animals.

In Latin America’s biodiversity-rich regions, individuals whose ontology aligns with environmentalism appear to demonstrate a heightened awareness of zoonoses, particularly those who adhere to a Relational environmentalism perspective. Consequently, the integration of IPLC cultural knowledge holds potential to enhance wildlife conservation measures and contribute to the mitigation of disease transmission. Further research is needed to explore causal pathways and the integration of culturally grounded approaches into public health interventions.

To explore healthcare professionals’ perceptions and experiences with point-of-care testing (PoCT) implementation within Australia’s healthcare system and identify potential strategies for effective governance and improvements to regulation and guidelines that facilitate coordinated integration of quality PoCT into healthcare systems.

A descriptive qualitative study with thematic analysis with codes derived inductively from the transcriptions and a structured framework analysis using the six building blocks of the WHO Health Systems Framework exploring barriers and enablers to PoCT implementation.

Healthcare settings in Australia.

Healthcare workers with patient care responsibilities and healthcare administrators with oversight or regulatory responsibility for a service. 18 participants were interviewed with four from hospitals, four from primary care, three from community care, three from pathology laboratories, two from emergency care and two from pharmacy settings.

Healthcare professionals’ perspectives on PoCT implementation were grouped into three main themes: (1) community-centric pathology testing, (2) connectivity and continuity of care and (3) quality and governance. Participants identified insufficient health system financing and health information systems as significant barriers to PoCT implementation. Improved practical guidance for workforce training and health service delivery to interpret the current regulation outside of laboratory settings was viewed as a potential enabler to establishing PoCT within healthcare services.

Participants reflected that Australia has several examples of successful PoCT programmes providing patient-centred pathology to improve healthcare equity. However, the lack of information systems, funding, workforce training and diagnostic strategies prohibits the implementation of PoCT at-scale. It was recommended that adequately financing PoCT to encompass costs for testing, quality management and workforce training would incentivise services to obtain accreditation and ensure quality healthcare delivery. Despite the potential of PoCT to improve equitable healthcare access and patient outcomes, health system strengthening is required to integrate PoCT effectively across Australian healthcare services.

Artificial intelligence (AI)-powered chatbots are increasingly integrated into healthcare to support administrative processes, health education and chronic disease management. These systems simulate human dialogue through natural language processing and machine learning, enabling dynamic and context-aware interactions. Despite their rapid adoption, there is limited synthesis of existing research describing how these technologies are applied across different healthcare contexts and what outcomes have been reported. This scoping review aims to map and describe the existing literature on the use of AI-powered chatbots in healthcare with a focus on clinical outcomes, patient satisfaction and operational efficiency. It will identify the types of studies conducted, their key characteristics and existing research gaps to guide future research.

Following the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, a comprehensive search will be conducted across Medline (PubMed), CINAHL, Embase, Web of Science, The Cochrane Library and MedRxiv from database inception to 10 September 2025. Studies published in English, French, Dutch or German, involving AI-powered chatbots in any healthcare context reporting on clinical outcomes and/or patient satisfaction and/or operational efficiency will be included. Studies without full-text availability, protocols, trial registrations, reviews and studies conducted solely in educational settings will be excluded. Title and abstract screening will be supported by ASReview LAB, an AI-based active learning tool to enhance efficiency. Screening and data extraction will be conducted independently by two reviewers with disagreements resolved by a third reviewer. Findings will be synthesised narratively and presented using structured evidence tables categorised by chatbot type, clinical healthcare context and reported outcomes.

Ethical approval is not required, as this study involves the analysis of published data only. The results of this scoping review will be disseminated through publication in a peer-reviewed journal, presentations at academic conferences and established professional networks.

Open Science Framework (OSF), https://doi.org/10.17605/OSF.IO/8UE3B.

Approximately one-third of people with epilepsy (PWE) experience resistance to treatment, including pharmacological therapies, epilepsy surgery, vagus nerve stimulation (VNS) and dietary interventions such as the ketogenic diet (KD). Emerging evidence suggests that the gut microbiota may influence seizure susceptibility and treatment response through the microbiota-gut-brain axis, potentially contributing to treatment resistance. The MiCrobiota-gut-brain Axis in Resistant Epilepsy project investigates how gut microbial features and associated host epigenetic signatures affect clinical outcomes in PWE undergoing diverse treatment strategies.

This is a multicentre, prospective, longitudinal study involving four clinical centres in Italy and one self-financing partner. Participants aged 3–50 years will be enrolled and stratified into four intervention cohorts: newly diagnosed drug-naïve epilepsy scheduled to start anti-seizure medications, focal drug-resistant epilepsy (DRE) undergoing epilepsy surgery, DRE receiving VNS, and DRE initiating KD. Clinical assessments (including body mass index calculation, self-reported monthly seizure count, dietary evaluation, quality of life scale and gastrointestinal symptoms scale), electroencephalography, MRI and biological sample collection (stool and blood) will be obtained at baseline and longitudinally at two or three timepoints over a 12-month observation period. Gut microbiota changes over time will be assessed via metagenomics (using 16S ribosomal RNA sequencing) and metaproteomics; the associated host DNA methylation profiles will be obtained from blood using Illumina EPIC arrays. Primary endpoints include identification of microbial or host methylation changes predictive of therapeutic response (ie, reduction from baseline in monthly seizure count) to the intervention. Data will be analysed using multivariate models and mixed-effect regression. Further, omics data and corresponding metadata will be integrated using multi-omics approaches to identify molecular signatures biomarkers predictive of treatment response and prognosis in PWE.

The study received ethical approval from the Research Ethic Board (Comitato Etico Territoriale Lombardia 3, ID 4896 – parere numero 4896_17.07.2024_N_bis). All participants or their legal guardians will provide written informed consent. Results will be disseminated through peer-reviewed publications, conference presentations or lay summaries targeting patient organisations.

ClinicalTrials.gov Identifier NCT07010445, registered on 2 May 2025.

Women residing in rural areas or belonging to lower socioeconomic status (SES) strata experience disproportionately low rates of breast cancer screening, contributing to delayed diagnoses and poorer prognoses. In addition, their participation in clinical trials remains markedly limited, reducing opportunities to access preventive and screening interventions. Promoting research preparedness among women before disease onset may empower them to make informed decisions regarding their health and willingness to participate in clinical research with fewer emotional and logistical barriers.

This project applies a community-based participatory research approach to develop and refine the WeCARE (Women’s Engagement for Cancer Awareness, Resources and Education) intervention for women aged 50–74 years who have either never undergone breast cancer screening or have not received screening in the past 5 years and who reside in rural areas or belong to low SES groups. The intervention consists of two components. Component 1 is a single-day, in-person community forum that includes (a) an educational seminar led by an oncologist to address breast cancer risk and screening guidelines, (b) survivor storytelling to enhance emotional engagement and cultural resonance and (c) facilitated navigation to breast cancer screening and future research participation. Component 2 involves structured post-forum follow-up through multiple touchpoints (phone calls and mailed boosters) to reinforce knowledge, address barriers and support screening completion and research enrolment. Quantitative data (eg, screening completion, satisfaction and follow-up engagement) will be summarised using descriptive statistics to assess feasibility and reach on 50 participants. Qualitative feedback from participants will undergo thematic analysis to identify barriers, facilitators and perceived cultural relevance. Integrated mixed-method interpretation will inform iterative refinement of the WeCARE intervention and guide design of subsequent larger trials.

Approved by the Mayo Clinic Institutional Review Board (IRB #25–008934). All participants will provide informed consent. Procedures ensure confidentiality, cultural sensitivity and participant safety. Data will be stored in REDCap and disseminated through publications, conferences, local town halls and community reports.

While compassion is widely recognised as an essential component of high-quality patient care, the compassion needs of clinicians often go unrecognised and unmet. Clinicians face multifaceted sources of workplace suffering, both sources inherent to working with the sick and avoidable sources due to healthcare systems and leadership challenges. Organisational compassion, defined as the continuous and systematic identification, prevention and alleviation of sources of suffering for healthcare workers, offers a paradigm shift in mitigating and preventing clinician suffering and burnout. Yet little is known about how clinicians experience suffering and compassion from their organisations, teams and leaders.

Our overarching goal is to develop a clinician-reported experience measure of organisational compassion. The purpose of this study was to explore how clinicians experience suffering and compassion in healthcare organisations.

This qualitative study used semistructured interviews of interdisciplinary paediatric hospice and palliative care clinicians from across the USA. A moderator’s guide was developed based on the literature of organisational compassion in management and healthcare and validated through practice interviews with clinicians. 22 participants were recruited via national paediatric hospice and palliative care email list serves. Video interviews were conducted via Zoom. Transcripts were analysed using a hybrid grounded theory-thematic analysis methodology to identify themes and to construct a theoretical framework of compassion experiences.

Five major themes of experiencing compassion emerged: (1) Feeling cared about, characterised by authentic, empathetic responses to clinician distress; (2) Dignity, encompassing being valued, respected and recognised as a whole person and professional; (3) Proximal (team) compassion, including camaraderie, shared workload and mutual support within teams; (4) Structural (organisational) compassion, reflecting policies, practices and benefits that alleviate or exacerbate suffering and (5) Compassionate leadership behaviours, such as presence, empathy and connection to frontline staff needs.

Healthcare work includes sources of both inherent and avoidable suffering for clinicians. In this study, we sought to understand how clinicians experience compassion from their organisations, leaders and team members during times of distress. We found five themes of experiencing compassion in healthcare organisations: feeling cared about; dignity; proximal (team) compassion; structural (organisational) compassion and compassionate leadership behaviours. These qualitative data and results will provide an empiric foundation for the development of a clinician-reported experience measure of compassion for use in healthcare settings. Such a measure will enable future research examining how compassion experiences in healthcare may predict workforce outcomes such as burnout, satisfaction, engagement and thriving. Ultimately, this work may support the design of interventions aimed at strengthening compassionate organisational cultures and improving conditions for the healthcare workforce and both experiences and outcomes of the patients they serve.

Older people living in care homes are at increased risk of harm during acute hospital admissions. In England, care home residents have more than twice as many emergency department (ED) attendances as people of the same age living at home. Up to 40% of emergency hospital admissions of older care home residents may be avoidable with different models of care within their homes.

In 2023, National Health Service England introduced the updated Enhanced Health in Care Homes (EHCH) framework, a set of recommendations to support ‘joined up’ and enhanced care for people living in care homes. A stated aim of the framework is to reduce ED attendances and inpatient admissions of residents. There is limited available evidence regarding how implementation of the EHCH framework differs regionally and whether variation in implementation may impact on hospitalisations of care home residents.

We aim to explore regional differences in care elements developed from the EHCH framework and assess how these differences may contribute to variation in hospitalisations of care home residents over the age of 65.

This is a comparative qualitative case study of six care home-containing postcode districts in England embedded within three Integrated Care Boards (ICBs). ICBs are regional organisations responsible for commissioning healthcare services in England. Case study districts and ICBs were selected due to contrasting case-mix adjusted admission rates and other characteristics (eg, deprivation). Data will be collected through semistructured interviews. We will interview health and social care professionals who are responsible for commissioning, overseeing and delivering enhanced care in care homes, care home professionals, residents over the age of 65 and their family and friends. Interview data will be analysed through a framework approach, with comparisons drawn within cases, across cases and across ICBs. Through our analysis, we will characterise the EHCH framework care elements and identify differences in implementation that may cause variation in hospital admissions. We will also identify perceived appropriate, effective and replicable enhanced care models.

Patients and the public have informed the design of this study, and will advise the research practice, support the analysis of data and guide dissemination plans.

This study has received Social Care Research Ethics and Health Research Authority Approval (25/IEC08/0014). All participants will be required to provide informed consent. The findings will inform a national survey of ICBs to map appropriate and effective enhanced care in England. Findings will be shared with key stakeholders and academic audiences.

The BioCaPPE (Biomarkers of Prostate Cancer/Prevention and Environment) study is a multicentre prospective observational cohort designed to identify biomarkers associated with prostate cancer (PCa) risk that may be modifiable through lifestyle factors. This paper describes the cohort, along with the data and bio-samples available for future studies in PCa risk assessment.

Canadian men at risk of PCa were enrolled based on one of two criteria (1) negative first prostate biopsy within 6 months from enrolment (Group 1); or (2) a prostate-specific antigen (PSA) blood level between 2.5 and 10 ng/mL without prior prostate biopsy (Group 2). At baseline, blood samples and comprehensive data were collected. PCa incidence and lifestyle factors were updated for all participants over 2 years, with extended follow-up for those who provided additional consent.

Recruitment was conducted across four health centres in Quebec, Canada. A total of 2053 men were enrolled—1499 in Group 1 and 554 in Group 2. All participants completed the initial visit, which included collection of medical and family history, anthropometric measurements, demographic information, dietary and alcohol intake, physical activity, tobacco use, medication use, and quality of life assessments, and candidate biomarker measurements. At the 2-year mark, 7.2% of participants had developed PCa; this figure has since increased to 15.3% (median follow-up: 6.1 years). Additionally, 84% (n=1718) consented to ongoing annual follow-up.

This large, prospective cohort of men at risk of PCa offers valuable resources for risk stratification and primary prevention. The BioCaPPE biosamples and data are available to support the identification of lifestyle-related biomarkers associated with PCa risk in this population.

ClinicalTrials.gov Identifier: NCT03383016.

Tuberculosis (TB) stigma is a critical barrier to timely diagnosis and treatment, yet few studies have quantified community-level TB stigma or its variability across geographic contexts. This study describes methods for capturing community-level TB stigma and examines stigma variability and correlations with community-level sociodemographic and TB-related factors across urban, periurban and rural communities.

Ecological study.

93 demarcated study communities in Buffalo City Metropolitan Health District, Eastern Cape, South Africa.

3869 heads of household, age ≥18 years, were surveyed in a geographically clustered random sample of households across the 93 study communities.

Validated scales were used to measure perceived TB stigma. Community levels of TB stigma were generated by aggregating individual responses within each study community.

Median community TB stigma scores varied significantly by community location: compared with urban communities, rural communities had lower TB stigma scores (beta=–0.235; 95% CI –0.362 to –0.108) while periurban communities had higher scores (beta=0.136; 95% CI 0.017 to 0.254). Community TB stigma was positively associated with community HIV stigma, with the strongest associations in urban (beta=0.977 (95% CI 0.634 to 1.321) and rural (beta=0.816 (95% CI 0.186 to 1.446) communities. No associations were observed between TB stigma and TB prevalence, TB knowledge or household demographics after adjusting for community location.

TB stigma varied meaningfully across communities and was associated with urbanicity and HIV stigma. Stigma is a complex social process and there may be many other factors shaping TB stigma at the community level. Future research and stigma-reduction interventions should consider local contexts and community-level determinants beyond individual demographics, TB knowledge or community TB burden.

Public health students face academic and training pressures as well as challenges arising from patient and community expectations, which may adversely affect their quality of life (QoL) and contribute to burnout and student dropout. This study aimed to examine psychological self-care, burnout and QoL as well as the factors associated with these outcomes among university students.

A cross-sectional study conducted between January and March 2024.

Universities in northern, southern and northeastern Thailand.

A total of 1426 health-related students aged 18–25 years were recruited using non-probability sampling.

Data were collected using a self-administered questionnaire, which included the Thai version of the World Health Organization Quality of Life-BREF instrument (WHOQOL-BREF-THAI), the Maslach Burnout Inventory to assess emotional exhaustion (EE) and cynicism (CY) and a psychological self-care assessment.

Most participants (79.9%) reported a moderate level of QoL. The prevalence of burnout was 18.9%. Pearson’s correlation analysis indicated statistically significant relationships between psychological self-care, EE, CY and QoL (all p values

Good mental healthcare behaviours and lower levels of burnout are associated with higher QoL among public health students. Universities and programme administrators should implement mental health support strategies, including routine screening, counselling services and self-care promotion, to reduce burnout and improve students’ overall well-being.

Chronic kidney disease (CKD) is highly prevalent in Thailand and imposes a growing burden on the health system, driven by limited nephrology capacity and high rates of unplanned dialysis. The kidney failure risk equation (KFRE) estimates the risk of progression to kidney failure (KF) on age, sex, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio. This study aims to validate and, if required, recalibrate the four-variable KFRE for the Thai population and to assess the potential impact of KFRE-guided referral strategies on clinical care and health system performance.

We will conduct a retrospective cohort study using linked, de-identified national health databases covering approximately 70% of the Thai population. Adult patients with CKD stages 3–5 will be included. KFRE performance will be evaluated at 2 and 5 years for discrimination and calibration. If miscalibration is identified, the model will be recalibrated using Cox-based methods. Simulations (1000 iterations) indicated that approximately 920 KF events by 5 years would be required to achieve the target standard errors for the calibration slope. A subsequent impact analysis will compare KFRE-guided referral with current Thai CKD guideline criteria and real-world practice using a decision-tree and Markov modelling framework.

Ethical approval was obtained from the Ethics Committee of the Institute for the Development of Human Research Protections, Thailand (COA No. IHRP2025110), Imperial College London and the London School of Hygiene and Tropical Medicine. The requirement for informed consent was waived due to the use of anonymised secondary data. Findings will be disseminated through peer-reviewed publications, conferences and policy briefs to supplement evidence-based referral strategies and health system planning.

The Government of India launched the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) to expand access to affordable generics through private retail outlets named as Jan Aushadhi Kendras (JAKs). This study examines the association of PMBJP with out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and impoverishment rate (IR) attributable to medicines.

A cross-sectional observational study was conducted across nine Indian states in 2022–2023.

Outpatient (OPD) and inpatient (IPD) departments of secondary and tertiary government hospitals, private pharmacies and JAKs in 18 districts of India

A total of 10 336 patients were recruited from OPD (n=2881) and IPD (n=1009) departments of government hospitals as well as pharmacy settings (n=6446). Data on sociodemographics, disease severity, number of generic prescriptions, source of acquiring medicines and medicine-related OOPE were collected through semistructured interviews and periodic follow-ups.

Primary outcomes included mean OOPE on medicines, incidence of CHE (≥40% of non-food consumption expenditure on medicines), IR among JAK and non-JAK users were the primary outcomes of the study. Secondary outcomes comprised awareness of JAKs, generic prescribing rates in hospitals and the factors associated with OOPE, CHE and IR.

Patients procuring medicines exclusively from JAKs reported the lower mean OOPE (OPD: 172; IPD: 275; pharmacy: 307), compared with significantly higher spending at private pharmacies (OPD: 1085; IPD: 3165; pharmacy: 1031). After adjusting for covariates, OOPE among exclusive JAK users was significantly lower relative to private pharmacy users by 60.6%–89.3%. Furthermore, matched analysis confirmed 42% lower expenses, compared with private pharmacies. The likelihood of CHE was also significantly greater among private pharmacy users. However, utilisation of JAKs remained limited, mainly due to low awareness, perceived stock shortages and low rates of generic prescribing.

PMBJP is associated with significant reduction in OOPE and financial hardship, positioning it as an effective cost-containment intervention within India’s universal health coverage framework. Strengthening supply chains, promoting generic prescribing and integrating JAKs with public facilities would further maximise its impact.

The rising shift from paper-based to electronic health management information systems (EHMIS) among global health systems has shown promising strides over the past decade. Yet, most African health systems have continued to use paper records with attendant gaps and challenges. Most African governments have now started transitioning from paper to EHMIS but lack adequate guidance to support this shift. There is therefore a need for harmonised regional guidance to ensure that such transitions are carried out systematically and take into account country-specific contexts.

The objective of this study protocol is to conduct a scoping review to generate evidence that will inform the development of a comprehensive guide to support countries in the WHO African Region in transitioning from paper-based to EHMIS.

The review will follow established methodological guidance for scoping reviews as outlined by Arksey and O’Malley and further refined by Levac et al and the Joanna Briggs Institute, with reporting guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search strategy will be developed to systematically identify relevant studies from both published and grey literature sources including PubMed, Cochrane Library, Scopus and African Index Medicus. Other sources will include Google Scholar, Emerald Journal, the WHO Regional Office for Africa Library and websites of WHO, ITU and Ministries of Health. Reference lists of the retrieved published articles will be manually searched to identify additional relevant studies. Descriptive qualitative content analysis will be undertaken using the policy analysis framework and key findings will be summarised and presented using tables, charts and maps.

This study does not involve the collection of primary data; therefore, ethical approval will not be required. On completion of the study, findings will be submitted for publication in a peer-reviewed scientific journal and will also be presented at national, regional and international conferences to support knowledge sharing and policy engagement.

This study aimed to identify the factors that influence access to diabetic retinopathy screening (DRS).

This is a qualitative case study.

Township health units in Shaoguan City, Guangdong Province, China.

This study included two representative patient groups (n=15) and five health-staff groups (n=42).

Focus group discussions were guided by a female ophthalmologist and other ophthalmology staff to determine the contextual factors influencing DRS uptake in people with diabetes mellitus in Qujiang District, Shaoguan City, southern China. Directly observed treatment and short-course (DOTS) components for the assessment of tuberculosis services were referred to for health structure when themes were extracted using deductive thematic analysis.

By referring to DOTS components related to the government, case detection, treatment, drug supply and recording system, we identified 31 factors associated with DRS uptake. Among these, six were from the perspective of service users whereas the remaining 25 were related to providers. From these factors, 10 modifiable themes pertained to policy, financing, interdepartmental coordination, hospital preparedness, primary healthcare staff training and public awareness through health education and quality enhancement of public health services. Two unmodifiable factors were also extracted: discomfort from pupil dilation during the examination and long travel distance to the facility.

This analysis identified contextual factors influencing DRS uptake, including policy, financing and public awareness, which, if addressed, could significantly enhance future screening uptake and disease management.

To study the association between job demands and distress among working adults and to test whether perceived supervisor support moderates this relationship.

Mixed-effects analysis of repeated measures from a population-based cohort study, estimating overall (combined within-person and between-person) associations.

The Netherlands Longitudinal Study on Hearing (NL-SH), an ongoing Dutch cohort with nationwide recruitment and follow-up including four measurement waves.

A total of 989 employed individuals (≥12 hours/week) with 1858 observations had complete data on distress, job demands, supervisor support and covariates.

The dependent variable was distress, measured using the 16-item distress subscale (range 0–32) of the Four-Dimensional Symptom Questionnaire. Job demands and supervisor support were assessed with subscales from the Job Content Questionnaire. Multilevel linear models were used to estimate main and interaction effects, adjusted for age, sex, educational level, hearing impairment, contract type and chronic diseases.

Higher job demands were associated with greater distress (B=0.22, 95% CI (0.17 to 0.27)). Higher supervisor support was associated with lower distress (B=–0.26, 95% CI (–0.38 to –0.15)). The interaction between job demands and supervisor support was statistically significant (B=-0.02, 95% CI (-0.04 to 0.001), p=0.042). Stratified analyses showed that the association between job demands and distress was stronger among employees with low supervisor support (B=0.27, p

Job demands and supervisor support were independently associated with distress. Supervisor support appeared to buffer the impact of job demands, as the association between job demands and distress was stronger among employees reporting low levels of supervisor support. These findings underscore the importance of strengthening supportive supervisor practices, alongside addressing excessive job demands, as integral components of workplace mental health strategies.

To identify socio-demographic subgroups of adolescents through cluster analysis and examine the extent to which these clusters are associated with depression.

This cross-sectional study used cluster analysis and logistic regression.

The Indonesian Health Survey 2023 is a nationally representative survey of Indonesia.

A total of 89,866 adolescents aged 15–24 years were included.

Depression was assessed using the Mini International Neuropsychiatric Interview. Logistic regression models were applied to estimate the association between cluster membership and depression risk, adjusting for behavioural factors (smoking and alcohol use), and geographical distribution.

Five discrete socio-demographic clusters were identified in this study. Two clusters showed a significantly elevated risk of depression compared with the socioeconomically disadvantaged rural male cluster (Cluster 1). Cluster 2 (older, poor, rural females) had an OR 1.58 (95% CI 1.18 to 2.12), while Cluster 3 (younger, urban, affluent females) had an OR 2.60 (95% CI 1.92 to 3.52).

Adolescent depression risk factors are shaped by intersecting socio-demographic vulnerabilities, particularly among females in disadvantaged rural and socioeconomically privileged urban settings. Gender-responsive and context-specific mental health interventions are required.

Scabies is a common skin condition and poses a substantial disease burden in resource-poor tropical settings. The Rohingya refugee camps in Cox’s Bazar, Bangladesh represent one of the world’s largest and most protracted humanitarian crises. Using 3 years of data from 2021 to 2023, this study analysed the seasonality of scabies and examined its association with climatic factors.

This is a retrospective observational study conducted in the Rohingya refugee camps and adjacent host communities in Ukhiya and Teknaf, Cox’s Bazar. All patients clinically diagnosed with scabies and who received treatment at 35 International Organization for Migration (IOM)-supported health facilities between 1 January 2021 and 31 December 2023 were included. Climate data, including daily mean, minimum and maximum temperature and total and maximum rainfall, were obtained from the Bangladesh Meteorological Department. Seasonal–Trend decomposition using LOESS (locally estimated scatterplot smoothing) (STL) was applied. Associations between climatic variables and the decomposed seasonal component of scabies cases and corresponding attack rate, as well as overall scabies case counts and overall attack rate, were assessed using Pearson’s correlation tests.

A total of 323 106 new scabies cases were reported from IOM-supported health facilities between January 2021 and December 2023. Children aged under 5 years and 6–18 years accounted for the highest proportion of cases (32.08% and 38.95%, respectively). The average monthly number of scabies cases was highest in November (12 625) and lowest in May (5862). Case numbers increased from November to February (high season), with a peak between October and November, and declined between April and June (low season). An inverse relationship was observed between temperature and scabies incidence, with higher case numbers during cooler months and lower numbers during warmer months. Pearson’s correlation analysis demonstrated a strong and significant negative correlation between the seasonal components of both scabies cases and attack rate and temperature variables, including maximum (cases: r=–0.492, p=0.002; attack rate: r=–0.484, p=0.003), minimum (cases: r=–0.506, p=0.002; attack rate: r=–0.489, p=0.002) and mean temperature (cases: r=–0.525, p=0.001; attack rate: r=–0.511, p=0.001). No significant association was observed between the seasonal component of scabies cases or attack rate and humidity or rainfall.

This study identified a distinct seasonal pattern of scabies, with higher caseloads and attack rate during late autumn and winter (October to February) and lower caseloads and attack rate during summer months (April to June). Temperature showed a strong negative association with the seasonal component of scabies burden. These findings may inform the timing of public health strategies, including mass drug administration, intensified case management and social and behavioural change communication, in humanitarian settings.