To explore health professionals’ perspectives on the barriers and enablers of healthcare access for older adults in Cambodia.

A qualitative study based on semi-structured interviews conducted in Khmer, recorded, transcribed, translated into English and analysed using an abductive thematic analysis approach.

Phnom Penh, Cambodia.

A purposive sample of 11 health professionals serving in diverse roles and sectors participated in the study.

Three key barriers emerged: (1) institutional barriers, (2) patient-specific access barriers and (3) communication barriers. However, four key enablers were also identified: (1) supportive healthcare environment, (2) reaching out to improve access to health services, (3) peer and community engagement and (4) government direct support to access healthcare. Despite previous policy efforts, gaps in the implementation of healthcare services for older adults persist across all health facilities. Health professionals identified that improving healthcare access for older adults in Cambodia requires a multifaceted strategy involving proactive outreach, health promotion, financial assistance and stronger community and family support.

Effective policy implementation requires collaboration among stakeholders and the active involvement of older adults in programme design to enhance dignity and well-being in Cambodia’s ageing population.

To examine the relationship between job stress and job burnout among healthcare professionals (HPs) in a tertiary hospital in East China following the adjusted COVID-19 prevention policies and to explore the effects of demographic and work environment factors on burnout and its subtypes (emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA)).

Cross-sectional, using a questionnaire-based survey method.

A tertiary hospital located in Qingdao, East China.

A total of 434 HPs were included, with 138 men (31.8%) and 296 women (68.2%); the mean age was 35.05±7.96 years. Participants included physicians (37.1%), clinical nurses (49.5%), clinical pharmacists (3.9%), medical technicians (5.1%) and administrative staff (4.4%). Demographic factors (age, sex, marital status, education level, professional title, length of employment, income) and work-related factors (weekly working hours, sleep duration) were collected.

No specific interventions were implemented; this was an observational study focusing on the burnout assessment and associated factors.

Primary outcomes: burnout levels assessed via the Chinese version of the Maslach Burnout Inventory—Human Services Survey (MBI-HSS), including three subscales: EE (9 items), DP (5 items) and PA (8 items). Severe burnout was defined as meeting ‘high-level’ criteria for all three subscales (EE ≥27, DP ≥10, PA ≤33).

Secondary outcomes: demographic (sex, professional role, length of employment) and work-related (weekly working hours, daily sleep duration) factors associated with burnout.

Among 434 HPs, 74 (17.1%) experienced severe burnout. The median scores of MBI-HSS subscales were 17 (IQR: 9–27) for EE, 3 (IQR: 0–7) for DP and 37 (IQR: 27.75–43) for PA. Multivariate logistic regression showed that: nurses had a higher risk of high EE than physicians (OR=2.86, 95% CI: 1.32 to 6.21, p40 hours (OR=2.30, 95% CI: 1.32 to 3.99, p

A high prevalence of severe burnout (17.1%) was observed among HPs after COVID-19 policy adjustment. Key risk factors include being a nurse, long working hours (>40 hours/week), short sleep duration (

To quantify and describe the use of real-world data (RWD) in National Institute for Health and Care Excellence (NICE) oncology technology appraisal (TA) final appraisal determination documents.

A systematic literature review was conducted on pharmaceutical NICE oncology TAs published between April 2000 and March 2024 (covering financial years 2000/2001 to 2023/2024 inclusive) extracted on 22 August 2023 (2000/2001 - 2022/2023) and 8 August 2024 (2023/2024).

NICE TA final appraisal determination documents.

All pharmaceutical oncology TAs published between April 2000 and March 2024 (financial years 2000/2001 to 2023/2024) that did not go on to be terminated.

The data required for eligibility screening was extracted from an Excel file directly from the NICE website, where data related to each TA was extracted using an automated script derived from published sources. TAs were assessed based on prespecified review criteria covering whether an RWD submission was reported by the committee, and if so, which RWD sources were used, alongside the methods reported and any feedback from the committee regarding the use of RWD. Bias was not assessed as part of the study.

Of 310 TAs identified, 135 (48.0%) used RWD. A variety of RWD types were used, mostly from UK or US data sources. 47 TAs (34.8%) leveraged RWD from multiple sources. RWD was mostly used in comparisons of survival (41.5%), to inform utility values (26.7%) and to compare baseline characteristics (19.3%), with matched adjusted indirect comparisons (MAICs) and external control arms (ECAs), seen from 2015 and 2018, respectively. The committee expressed concerns around the RWD presented by the company in 53 TAs (39.2%), the most common being a lack of generalisability to the UK population and/or National Health Service practice and comprehensiveness of the RWD.

This study quantifies the increasing use of diverse RWD sources in NICE oncology TAs, as well as the shift towards more complex methods like MAICs and ECAs. The feedback of the NICE committee highlights key areas of improvement as the generalisability and maturity of the RWD presented.

This paper examines the impact of India’s National Publicly Funded Health Assurance Scheme, Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY), in Haryana on out-of-pocket (OOP) expenses and catastrophic health expenditure (CHE).

We conducted a case-control study using a stratified random sampling approach.

Six districts in Haryana, based on utilisation, were selected: Mewat, Faridabad, Sonipat, Ambala, Kurukshetra and Karnal.

A total sample size of 772 individuals, that is, 386 PM-JAY beneficiaries (cases) and non-beneficiaries (controls) each.

Data were collected using a semistructured questionnaire covering household demographics and expenditure details. The interview gathered information on hospitalisation within the past year, types of ailments, the type of empanelled facility visited, expenditure details and borrowing/selling of assets for treatment.

Mean OOP expenditure was calculated for beneficiaries and non-beneficiaries based on the type of healthcare provider. The impact of PM-JAY on OOP expenditure was analysed using a generalised linear model controlling for religion, caste, type of house, type of family, morbidity patterns, type of disease, type of health facility, hospital stay duration, average distance to the facility and travel time. CHE was defined as OOP payments ≥30% of household income. Logistic regression was used to assess the determinants of CHE.

We found that direct medical expenses incurred for hospitalisations were 65% lower for beneficiaries (11 131 rupees) compared with non-beneficiaries (31 675 rupees). While OOP expenditures are similar for both groups in public empanelled hospitals, non-beneficiaries incur OOP costs three times higher than PM-JAY beneficiaries in private empanelled hospitals. Factors, including the disease type, average distance from home to the facility, average travel time and type of hospital, significantly influence these expenses. Furthermore, the prevalence of CHE is significantly lower among PM-JAY beneficiaries (13.3%) compared with non-beneficiaries (45.9%), with an OR of 7.15 (95% CI: 4.74 to 10.80; p

Our analysis shows the scheme’s impact on decreasing OOP expenditure and CHE. To enhance the scheme’s effectiveness, the study highlights the necessity of addressing non-medical expenses and expanding coverage for indirect costs, such as food, accommodation and transportation. Additionally, strengthening the supply side through improved drug availability at healthcare facilities is crucial for enhancing financial protection and access to care.

To identify views and establish agreements of key stakeholders on the features of an effective system for declaring and managing conflicts of interest in healthcare.

A modified Delphi study consisting of two surveys and semi-structured interviews. Surveys included closed and free-text questions.

UK, purposefully and generally invited participants including academics, researchers, healthcare professionals, regulators, patients and citizens from 10 countries, during 25 August 2024 and 20 January 2025.

Quantitative and qualitative analysis of two surveys and 21 interviews. Descriptive statistics were used to describe the sample and analyse closed survey questions. Thematic analysis was used to analyse free-text survey responses and interview data. Results were synthesised to describe the perceived importance and purposes of declaration of interest systems.

In the first survey round, 616 invitations were sent, along with social media advertisements. 237 questionnaires were returned and 200 full responses were analysable. 129 respondents consented to recontact on the online form. In the interview round, 37 invitations were sent and 21 interviews completed (response rate 59.5%). Invitations for the second survey were sent to all 129 participants who consented to recontact. 91 responses were received and 89 questionnaires were analysable (response rate 82%). Features of ideal systems to declare and manage the interests of healthcare professionals identified by participants were categorised under seven themes: regulatory issues, the healthcare environment, human vices, professional virtues, the use of judgement, features of a better system and patients and public. There was broad agreement on the need for transparency and clarity in declaration systems. The most agreed features were: clarity on what information was needed; it should be a centralised ‘deposit’ for all declarations; it should be publicly accessible, educating and informing people accessing and using the register. Having a lifelong personal identifier, some flexibility in declarations and some privacy features were also rated highly. Respondents were less concerned about scrutiny or a loss of trust. Small numbers of participants raised concerns about serious adverse effects, including loss of privacy, personal safety and the potential of information to contribute to conspiracy theories. There were also major disagreements between participants concerning whether or not healthcare professionals should work with industry, and whether conflicts of interest from working with industry can be safely managed. Individuals with each perspective felt they were acting ethically.

While many agreements were identified, disagreements were also found. If improved declaration systems are to be accepted by professionals and useful to regulators, patients and citizens, the potential for benefit and harm from new declaration systems must be addressed.

Prepublished, Open Science Framework https://osf.io/fbj5n.

Rapid urbanisation in Bangladesh has posed significant challenges to the urban health system, particularly in the delivery of primary healthcare (PHC). The country’s PHC system is fragmented, involving public, non-government organization (NGO), private and informal providers, leading to inequitable access, high out-of-pocket expenditure and inefficiencies. Strategic purchasing, which links resource allocation to health priorities and outcomes, offers a potential pathway to strengthening urban PHC systems. This study aims to assess the current urban PHC system, examine stakeholders’ perspectives on the feasibility of strategic purchasing, understand community health needs and preferences and develop a policy framework for strategically purchasing PHC services in urban settings.

This study will follow a sequential mixed-methods approach, integrating qualitative and quantitative data. A scoping review will be conducted to assess the characteristics and funding modalities of the existing urban PHC purchasing mechanisms. Key informant interviews with stakeholders, including policy makers and health experts, will explore the strengths and challenges of the current urban PHC system and the feasibility of implementing strategic purchasing. Community healthcare needs and preferences will be examined through in-depth interviews (IDIs), focus group discussions (FGDs) and a discrete choice experiment (DCE) survey in urban informal settlements. Insights from IDIs and FGDs will inform the DCE survey, which will present hypothetical scenarios to participants to identify the most important attributes for improving PHC services. Qualitative data will be coded deductively and inductively, and DCE data will be analysed using latent class models, with sensitivity analyses conducted using the multinomial logit model. Findings will contribute to the development of a strategic purchasing framework, validated through consultation workshops with health system stakeholders.

Ethical approval has been obtained from the ethics committees in both Bangladesh and the UK. Findings will be disseminated through workshops, peer-reviewed publications, policy briefs and conference presentations.

Persons living with multiple sclerosis (MS) may experience various symptoms, and some of these persons may need help in daily life. Previous research shows that informal—that is, unpaid—help is more common among persons with MS than formal help. This study aimed to explore the association between socio-demographic background factors and the use of informal help among persons with MS in Sweden, and to investigate any differences in the amount of informal help used per week.

Cross-sectional survey data combined with Swedish register data.

4412 persons with MS between the ages of 20 and 51 years responded to the survey.

(1) Use of informal help and (2) the number of hours of informal help used per week. Descriptive statistics and logistic regression and linear regression were used for analysis.

It was found that several socio-demographic background variables were associated with the use of informal help, but a higher degree of impairment, indicated by the Expanded Disability Status Scale for Multiple Sclerosis, had the strongest positive association (OR 6.94, 95% CI 4.70 to 10.03). Fewer variables were associated with the number of hours of informal help per week. The birth country had the strongest positive relationship (B 0.50, 95% CI 0.22 to 0.76) while whether one was living alone had the strongest adverse relationship (B –0.65, 95% CI –0.89 to –0.42). Three of the socio-demographic background variables were found to be positively associated with both the use of informal help and the number of hours of informal help used per week, birth country (OR 1.34, 95% CI 1.00 to 1.79; B 0.50, 95% CI 0.22 to 0.76), receipt of sickness benefit (OR 4.22, 95% CI 3.19 to 5.58; B 0.25, 95% CI 0.05 to 0.44) and higher degree of impairment (OR 6.94, 95% CI 4.70 to 10.03; B 0.31, 95% CI 0.02 to 0.60). Persons with MS born outside the Nordic countries, receiving sickness benefit and severely affected by impairment more often used informal help and they used more hours of informal help per week.

The degree of impairment was the most important factor in determining whether informal help was used. However, the importance of the birth country and receipt of sickness benefit may indicate that subgroups of persons with MS are more vulnerable and referred to informal help rather than formal help.

During the COVID-19 pandemic, the clinical development of therapeutics progressed rapidly. However, regions outside the areas where most clinical development occurred experienced delayed access and had fewer options for new therapeutics. To adequately respond to future pandemics, these regions must be prepared to expedite the development of necessary therapeutics. In this study, we compared the clinical development of COVID-19 therapeutics between the USA and Japan and proposed strategies for enhancing global therapeutic deployment in future pandemics.

Cross-sectional analysis.

The regulatory documentation for COVID-19 therapeutics granted Emergency Use Authorization (EUA) in the USA or approved in Japan during the WHO-declared pandemic period (30 January 2020 to 5 May 2023) was analysed.

The development timelines and submitted data in both regions were analysed.

14 therapeutics were authorised in the USA compared with 9 in Japan, of which 8 were authorised in both countries. For all eight therapeutics, authorisation was obtained earlier in the USA, with an average difference of 4 months. The number of clinical studies submitted for authorisation was 1.0 in Japan and 4.0 in the USA. The data packages submitted for approval in the USA generally followed the standard structure for a typical application, including phase 1, 2 and 3 studies, whereas in Japan, phase 3 study data were often the primary focus.

Compared with the USA, fewer therapeutics were approved in Japan, and the approvals occurred later. Most therapeutics approved in Japan had previously received EUA in the USA, with Japanese approvals largely dependent on participation in large-scale global studies and the US review schedule. Application data in Japan were primarily based on data from large-scale global studies that had been submitted for the US application; the observed delay in approval was considered attributable to the time required for application preparation. In preparation for future pandemics, it will be necessary to establish systems that take these characteristics into account.

Despite global efforts, gender disparities in oncology may persist. Understanding these disparities within the context of major conferences can inform strategies to promote gender inclusiveness in the field. This study evaluates the participation of women and men at the American Society of Clinical Oncology (ASCO) 2024 congress, focusing on chairs, speakers and audience questioners.

Observational study.

152 recorded sessions of the ASCO 2024 annual meeting, one of the largest conferences in the field of oncology, available on the ASCO website.

Individuals serving as chairs, speakers and audience members who asked questions.

In this observational study, gender for chairs, speakers and audience questioners across 152 sessions of the ASCO 2024 congress was assessed by two independent reviewers using audio and video recordings. Speaking times for questions and responses were also evaluated. Statistical analyses, including ² and unpaired t-tests, were conducted to analyse the data.

Women were well represented as chairs (n=124) and speakers (n=402) in 66% and 95% of sessions, respectively. However, only 21% of questions from the audience were posed by women, while 37% of questions were asked by men and 42% online or by chairs/speakers. Women were more likely to pose questions when the sessions were chaired by women (71% vs 53%; p=0.047). There were no statistically significant gender disparities concerning speaking time (questions: p=0.30; responses: 0.53). The response dynamics indicated a pattern of gender homogeneity, with individuals more frequently responding to questions from their own gender.

While the balanced representation of women in leadership roles at the ASCO 2024 congress reflects positive development in gender equality, disparities in active participation persist. These findings underscore the need for strategies that not only promote women in visible roles but also foster an environment that supports their active engagement in scientific discussions.

Our study aimed to summarise and reflect on current evidence around patient and surgeon perspectives regarding the use of a central intake system (CIS) as a strategy for managing surgical waitlists.

A systematic review was conducted. Searches were performed on 9 October 2023. The strategies used key words such as ‘central intake’, ‘surgery’ and ‘experience’. Medical and the Web of Science core databases were searched.

Titles and abstracts were assessed by two independent reviewers. Studies were included if: the study population was adult (age >18), and patients were referred for non-emergency surgery assessment.

Data were independently extracted by two reviewers using a standardised form. The Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research was used to assess study quality. Of 2805 studies identified, nine were included with a moderate to high confidence of evidence. Through thematic analysis, four patient and five surgeon themes were identified, with a further two common themes (although conceptualised differently).

Patients value CISs for their potential to create an equitable referral process and clearer timelines, yet they emphasise the importance of preserving autonomy and personalised care by maintaining the option to choose their surgeon. Surgeons recognise the operational benefits of CISs in streamlining referrals and reducing wait times, but also caution that adequate resources, strong leadership and careful case selection are critical to sustain quality and engagement.

These findings highlight the complex balance required to successfully implement CISs. The system-level gains in access and coordination must be carefully aligned with patient-centred values such as choice and trust and supported by organisational culture shifts and leadership commitment. Importantly, the study identifies gaps in end-user involvement and decision-making power that should be addressed to enhance acceptability and effectiveness.

Future actions should consider a framework that incorporates clear governance with continued pilot programmes that include evaluation of patient satisfaction, quantitative and qualitative clinical outcomes, and impact on equity. Additionally, targeted strategies are needed to accommodate complex or specialised cases that may not fit the central intake model. Through careful implementation and continuous stakeholder engagement, central intake models have the potential to meaningfully improve surgical waitlist management while respecting the needs and preferences of both patients and surgeons.

Over the past two decades, initiatives promoting research-policy engagement have increased broadly and in health. Numerous factors influencing the engagement of policymakers in research have been described primarily from the perspective of researchers. This scoping review aimed to identify the enablers and barriers to policymaker engagement across the research process from the perspective of policymakers.

Scoping review following the Joanna Briggs Institute Methods Manual for scoping reviews.

MEDLINE, Cochrane Library, Social Policy and Practice, Campbell Collaboration, Health Systems Evidence and World Bank e-Library, supplemented by grey literature from Google Scholar, WHO Global Index Medicus and VHL Regional Portal.

We included English language studies published after 2007 that involved policymakers at national or subnational levels who were actively engaged in research at any stage. We excluded studies which did not include policymakers, where engagement was passive, or perspectives were marginal or not clearly outlined.

After screening and full-text review, we extracted and coded data using MAXQDA Plus 24. We conducted thematic analysis, categorising findings as enablers or barriers into three levels: individual, organisational and contextual/system. Findings were iteratively reviewed and refined by the research team.

We screened 5384 titles and abstracts, reviewed 59 full-text documents and included 30 articles for analysis. Most studies were published after 2016 and were focused on policymaker engagement at the national level. Organisational factors were the most frequently reported influences on engagement of policymakers in research across different contexts. The most frequent enablers mentioned in the literature were (1) the institutionalisation of partnerships, initiatives and having formal agreements; (2) defining goals, roles, responsibilities and conflict resolution mechanisms; (3) researchers providing practical and expert advice to policymakers; (4) leveraging networks; and (5) having supportive institutions. The most frequent barriers were (1) the lack of regulations, infrastructure, funding and communication channels to support engagement; (2) the lack of skills of researchers to understand policymaking processes and work in collaboration with policymakers; and (3) the mismatch in priorities, values, perspectives and expectations.

Our study highlights the role of institutional support, widespread collaboration opportunities and the interconnected nature of these factors within the research-policy ecosystem.

Open Science Framework (https://osf.io/ynr78/).

Analyse data collected through the WHO Regional Office for Europe to describe the proportion of European Union (EU) member states that have relevant policies related to physical activity (PA) counselling and exercise referral schemes in healthcare settings and the education of health professionals in health-enhancing PA (HEPA).

Cross-sectional survey.

An online survey (LimeSurvey) was sent to nominated government representatives of the 27 EU member states (via the EU PA Focal Point Network) in March 2021. The survey was open for 2 months, with support offered to all national representatives by the WHO Regional Office for Europe throughout. The survey had been developed by a panel of experts and was previously disseminated (and analysed) in 2015 and 2018.

National recommendations regarding (1) PA counselling in healthcare settings and (2) the inclusion of HEPA within teaching curricula.

All 27 countries responded. Of the 18 countries that reported national policies to provide PA counselling by healthcare professionals (HCPs), all reported that counselling on PA was provided through primary care, with an additional half also reporting PA counselling provision as part of secondary care. Twenty-one countries reported that HEPA is taught in the curricula of HCPs, but large variations exist regarding which cadres of HCPs have HEPA integrated within their curricula and whether the HEPA teaching is a mandatory or optional component of training.

Despite PA counselling being a key recommendation for promoting PA at the population level, only two-thirds of EU member states have national policies in place. Although three-quarters of EU member states report healthcare education curricula, including HEPA, more research is required to understand the methods and content of delivery and the subsequent effectiveness on knowledge and clinical outcomes.

To investigate discrepancies in perceptions regarding the accessibility and availability of rest and relaxation (R&R) spaces between hospital doctors in Scotland and NHS Scotland regional health boards (HBs), with the intention of informing best practices for organisational policy on the provision of R&R spaces both now and in the future.

A qualitative study, through an inhabited institutionalism (II) lens, of semi-structured interviews of hospital doctors across the career continuum in Scotland and all NHS regional HBs in Scotland providing written information relating to R&R space provision.

NHS Scotland during the COVID-19 pandemic and beyond.

Hospital doctors (n=30) who had participated in a larger qualitative study and provided specific insights on R&R spaces. All NHS Scotland regional HBs (n=14).

Although HBs reported the provision of R&R spaces, numerous doctors reported R&R spaces had been removed, relocated or were inaccessible. Furthermore, limited awareness of their availability attributed to inadequate communication, compounded the issue. This divergence between institutional reporting and front-line experience can be interpreted through the lens of II, which posits that institutional polices are often interpreted and implemented differently.

This study emphasises how crucial R&R spaces are to promoting doctors’ well-being especially during the time of high stress. HBs must not only guarantee the accessibility and physical availability of R&R spaces but also enhance their communication regarding the provision.

Antimicrobial resistance (AMR) is a critical global public health concern, particularly acute in rural China. Counties, which cover extensive rural regions, face major challenges in AMR governance and thus require priority attention. Yet, AMR governance efforts across sectors are fragmented, with notable gaps in translating policy objectives into sustainable, practical governance measures. This programme will entail a series of studies focusing on county-level cross-sectoral synergy governance for AMR, aiming to identify optimal synergy governance strategies to curb AMR.

The study comprises three phases: (1) understanding and exploring the state of cross-sectoral synergy governance and its internal mechanisms; (2) empirically evaluating AMR synergy governance capability using a developed evaluation indicator tool; and (3) identifying optimal AMR synergy governance strategies through a simulation and prediction model. Phase I involves conducting a content analysis of policy documents and semistructured interviews to understand and explore the state of cross-sectoral synergy governance and internal mechanisms. An evaluation indicator tool for AMR synergy governance capability will be developed through a two-round modified Delphi survey, hierarchical analysis process and percentage weighting method, with a typical case analysis being used for empirical evaluation in phase II. Phase III entails developing a simulation and prediction model using a series of artificial intelligence technologies, such as distributed Scrapy crawler technology, large language models, generative adversarial networks and deep multilayer models, all aimed at identifying optimal AMR synergy governance strategies.

This study was approved by the ethics committee of the Centre for Health Management and Policy Research, Shandong University (No. ECSHCMSDU20240904). The results of the studies will be submitted for publication in peer-reviewed journals, presented at national and international academic conferences.

To provide comprehensive estimates of the prevalence of psychoactive substance use, specifically alcohol, cigarettes and marijuana, and factors associated with their use among school-going adolescents in 25 African countries.

We used a pooled cross-sectional dataset from the publicly available Global School-based Health Survey (GSHS) from 25 African countries. We used descriptive statistics to estimate the prevalence of alcohol, cigarette and marijuana use as well as their dual use among adolescents aged 11–16 years. Additionally, we used logistic regressions to model factors associated with the use of each substance, with adjusted Odds Ratios (aORs) and their 95% Confidence Intervals (CIs) as the measures of association.

The study focused on school-going adolescents aged 11–16 years in 25 African countries that have conducted the GSHS between 2003 and 2017.

The key outcome measure is the proportion of adolescents who have used a specific substance in the past 30 days. These substances include: (1) alcohol, (2) cigarettes, (3) marijuana, (4) alcohol and cigarettes, (5) cigarettes and marijuana and (6) alcohol and marijuana.

The prevalence of alcohol use among adolescents was 9.5% (95% CI 8.4% to 10.7%), that of cigarette smoking was 6.2% (95% CI 5.0% to 7.6%), and it was 3.4% (95% CI 2.7% to 4.2%) for marijuana. The prevalence of dual use of alcohol and cigarettes was 3.1% (95% CI 2.4% to 3.9%), that of alcohol and marijuana was 2.0% (95% CI 1.5% to 2.5%), and it was 1.4% (95% CI 1.1% to 1.8%) for cigarettes and marijuana. The prevalence of cigarette smoking was significantly higher among boys than girls. However, there was no statistically significant difference in the prevalence of alcohol or marijuana by sex. Having parents who smoke any tobacco products, being bullied, missing school without permission and experiencing sadness and hopelessness were positively associated with being a current user, irrespective of substance type.

There is a need for comprehensive, current data on substance use among adolescents. Interventions that tackle bullying, reduce school absenteeism, build resilience against difficult situations and increase self-efficacy to resist the use of these substances have the potential to curb substance use among adolescents in Africa.

This study aimed to (1) assess Lumos data quality, a New South Wales (NSW) statewide linked health data asset; and (2) determine sociodemographic variation in health service utilisation of general practice, emergency department and admitted services.

A retrospective cohort study using Lumos, a linked health data asset.

A representative statewide sample population of NSW, Australia.

People residing within NSW with an electronic health record at a Lumos participating general practice between January 2010 and June 2023.

Data quality indicators of Lumos including completeness, representativeness against NSW population data, consistency and timeliness. Furthermore, variation in general practice visits, emergency department presentations and hospital admission rates stratified by age, sex, rurality and Index of Relative Socio-economic Disadvantage (IRSD)—a measure of socioeconomic status used in Australia, where lower values represent greater relative disadvantage across a range of metrics such as education and income.

At the time of analysis, Lumos included records from 5.2 million unique patients, representing half (49.7%) of the NSW resident population. Limiting data to 2022, the Lumos population distribution broadly aligned with the 2021 Census except for IRSD quintile four and five which were under-represented (15.0% vs 20.4% (standardised difference –0.14)), and over-represented (29.7% vs 19.9% (standardised difference 0.23)), respectively. Age and greater relative disadvantage were associated with higher rates of general practice visits and hospital admissions. Greater relative disadvantage was also associated with higher rates of emergency department presentations.

Lumos’s ability to overcome historical limitations of separately managed health data in Australia and its demonstrated data quality present an opportunity to enhance health system policy and planning in NSW. The variation in service utilisation across primary and tertiary care by population and geography apparent in Lumos reinforces the need for tailored service planning.

The effectiveness of rural outreach remains limited due to the lack of suitable incentives within the county medical community. Based on the Existence, Relatedness and Growth (ERG) theory and work motivation theory, our study explored the incentive mechanisms of rural outreach through a new framework that incorporates external incentives, work-related personality traits and job performance.

An explanatory sequential mixed-methods study comprises a cross-sectional quantitative study (Study 1) and a qualitative study (Study 2).

County hospitals within the county medical community in Hubei province, China.

511 and 20 specialists who participated in rural outreach at county hospitals were recruited for the quantitative study and qualitative study, respectively.

Hierarchical regression analysis was used to explore the relationship among external incentives (suggested by the ERG theory), work-related personality traits and job performance. In-depth interviews were used to explain why the existence factors had no effect on job performance of rural outreach.

In Study 1, our findings showed that relatedness and growth factors significantly improved job performance, with work-related personality traits acting as a mediating factor (p0.05). In Study 2, our findings revealed that existence factors may weaken specialists’ altruism. Most specialists viewed rural outreach as a chance to enhance their clinical skills and advance their career development rather than as an opportunity for financial compensation.

We recommend that policymakers should foster a supportive and growth-oriented environment for rural outreach programmes. Enhancing work-related personality traits may strengthen specialists’ intrinsic motivation and promote sustained engagement in rural service.

Effective health management is critical for patients with tuberculosis (TB), especially given the need for long-term treatment adherence and continuous monitoring. Artificial intelligence (AI)-assisted remote health management services offer a promising solution to increase patient engagement, optimise follow-up and improve treatment outcomes. However, little research has explored TB patients’ preferences for these services, and no discrete choice experiment (DCE) has systematically investigated how they make trade-offs between different service attributes. This study aims to (1) identify key attributes of AI-assisted remote health management services that influence TB patients’ choices, (2) assess how patients with TB evaluate trade-offs between different service options using a DCE and (3) examine whether preferences vary by sociodemographic characteristics and health system factors.

Six attributes were identified through a literature review, focus group discussions and expert consultations. A fractional factorial design was used to generate choice sets while maintaining statistical efficiency and minimising respondent burden. The DCE will be analysed using a multinomial logit model to estimate average preferences. A mixed logit model will be applied to explore preference heterogeneity among participants, incorporating interaction terms with sociodemographic and attitudinal variables. Stratified and latent class analyses will also be considered to further investigate sources of heterogeneity.

This study complies with the Declaration of Helsinki and has been approved by the Ethics Committee of Wuhan Pulmonary Hospital. All participant data will remain anonymous, and individuals may withdraw from the study at any time. The findings will inform the development of patient-centred AI-assisted TB management strategies and contribute to broader policy discussions on AI integration in TB care. The results will be disseminated through peer-reviewed journal publications, policy briefs, conferences and online platforms.

To identify and contextualise evidence-based strategies for implementing deprescribing practices at different levels of healthcare in Brazil, through the development of an evidence brief for policy that includes stakeholder deliberation and considers barriers, facilitators and equity aspects.

This protocol outlines the development of an evidence brief for policy using a mixed-methods design. It involves synthesising evidence for health policies by integrating global research and local evidence through three stages: stakeholder exchange, evidence brief development and external endorsement. The Supporting Policy-Relevant Reviews and Trials tools for evidence-informed health policies will guide both the synthesis of strategies and the facilitation of deliberative dialogues. The synthesis will encompass evidence from systematic reviews and meta-analysis on deprescribing strategies across healthcare levels, focusing on effectiveness, harms, costs, perceptions, barriers, facilitators and equity. Studies proposing strategies not yet implemented will be excluded. Study selection and data extraction will be conducted independently and in duplicate. The methodological quality of included studies will be assessed using the A Measurement Tool for Assessing the Methodological Quality of Systematic Reviews-2 criteria. Synthesised evidence will be used to develop evidence-based strategies, which will then be presented in deliberative dialogues for endorsement by stakeholders and adaptation to the Brazilian context. Endorsement rates will be classified as high, moderate or low based on predefined criteria.

This study was approved by the University of Sorocaba Research Ethics Committee (certificate 82098324.7.0000.5500). Informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications and conference presentations.

CRD42024548845.

It is unclear how mis- and disinformation regarding healthcare policy changes propagate throughout Latino communities via social media. This may lead to chilling effects that dissuade eligible individuals from enrolling in critical safety net programmes such as Medicaid. This study will examine pathways and mechanisms by which sentiment in response to mis- and disinformation regarding healthcare policies on social media differentially impact health disparity populations, thus supporting the design of tailored social media interventions to mitigate this.

We will search social media from X/Twitter, Facebook/Instagram and Reddit for keywords relating to health benefit programmes. Demographic, geographical location and other characteristics of users will be used to stratify social media data. Posts will be classified as fake-news-related or fact-related based on curated lists of fake-news-related websites. The number, temporal dissemination and positive or negative sentiment in reacting to posts and threads will be examined using the Python-based Valence Aware Dictionary and sEntiment Reasoner (VADER). Using a crowd-sourcing methodology, a novel Spanish-language VADER (S-VADER) will be created to rate sentiment to social media among Spanish-speaking Latinos. With the proposed approach, we will explore reactions to the dissemination of fake-news- or fact-related social media tweets and posts and their sources. Analyses of social media posts in response to healthcare-related policies will provide insights into fears faced by Latinos and Spanish speakers, as well as positive or negative perceptions relating to the policy over time among social media users.

Our study protocol was approved by the University of California, Los Angeles IRB (IRB#23–0 01 123). Results from this study will be disseminated in peer-reviewed journals and conference presentations, and S-VADER will be disseminated to public repositories such as GitHub.