Inside CKD aims to assess the burden of chronic kidney disease (CKD) and the cost-effectiveness of screening programmes in Belgium.

Microsimulation-based modelling.

Data derived from national statistics and key literature from Belgium.

Virtual populations of ≥10 million individuals, representative of Belgian populations of interest, were generated based on published data and cycled through the Inside CKD model. Baseline input data included age, estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR) and CKD status.

Outcomes included the clinical and economic burden of CKD during 2022–2027 and the cost-effectiveness of two different CKD screening programmes (one UACR measurement and two eGFR measurements or only two eGFR measurements, followed by renin-angiotensin-aldosterone system inhibitor treatment in newly diagnosed eligible patients). The economic burden estimation included patients diagnosed with CKD stages 3–5; the screening cost-effectiveness estimation included patients aged ≥45 years with no CKD diagnosis and high-risk subgroups (with cardiovascular disease, hypertension, type 2 diabetes or aged ≥65 years).

Between 2022 and 2027, CKD prevalence is estimated to remain stable and substantial at approximately 1.66 million, with 69.9% undiagnosed. The total healthcare cost of patients diagnosed with CKD is expected to remain stable at approximately 2.15 billion per year. The one UACR, two eGFR measurement screening programme was cost-effective in all populations, with an incremental cost-effectiveness ratio of 3623 per quality-adjusted life year (QALY) gained in those aged ≥45 years, well below the estimated willingness-to-pay threshold of 43 839 per QALY gained.

Without changes to current practice, the disease burden of CKD in Belgium is predicted to remain substantial over the next few years. This highlights the need for timely diagnosis of CKD and demonstrates that, in line with guideline recommendations, implementing a CKD screening programme involving UACR and eGFR measurements followed by treatment would be cost-effective.

To develop a context-specific health technology assessment (HTA) framework tailored to the healthcare needs and system of Iran, to improve evidence-based decision-making, optimise resource allocation and support progress towards universal health coverage.

A mixed-methods Delphi consensus study conducted using a three-phase, sequential approach: document review, qualitative focus group discussions and Delphi consensus rounds. The study reporting follows the Accurate Consensus Reporting Document guideline to ensure transparent reporting of consensus methods.

A national-level study conducted in Iran’s healthcare system between January 2023 and March 2024, including perspectives from public and academic institutions, policy bodies and patient organisations.

The study involved 18 purposively selected stakeholders in three focus group discussions, including policymakers, healthcare professionals, researchers and patient representatives. Subsequently, 20 HTA experts participated in three iterative Delphi rounds to refine and reach consensus on the framework components.

Identification of core components and operational steps required to develop and implement a comprehensive HTA framework in Iran.

The final HTA framework includes nine core components: (1) establishing a national HTA body; (2) engaging stakeholders; (3) building capacity through training and research; (4) developing standard HTA methodologies; (5) implementing prioritisation and evaluation processes; (6) ensuring sustainable funding; (7) enhancing transparency and accountability; (8) promoting continuous improvement and (9) fostering innovation. Detailed operational steps and micro-activities were developed for each component. The framework achieved an 84% consensus among Delphi panellists, indicating strong agreement on its content and applicability.

This tailored HTA framework provides a structured roadmap to institutionalise evidence-based decision-making in Iran’s healthcare system. Its implementation can strengthen the efficiency, equity and sustainability of healthcare planning and policy. Pilot testing is recommended to assess feasibility and scalability, with potential to serve as a model for other low-income and middle-income countries.

To identify the barriers and facilitators towards deceased organ donation among Pakistanis living globally.

Systematic review using narrative synthesis.

CINAHL, Medline with Full Text, Global Health and PsycINFO via EBSCO; Scopus via Elsevier; Web of Science via Clarivate; and PubMed through the US National Library of Medicine and the National Institutes of Health were searched between 1 January 1995 and 31 July 2024 and limited to English.

We included qualitative and cross-sectional studies involving Pakistani participants aged 18 years and above, conducted both within Pakistan and internationally across settings such as universities, religious venues, hospitals and workplaces.

Four independent reviewers were involved in screening, quality assessment and data extraction. A narrative synthesis method was employed to synthesise and integrate the data from qualitative and cross-sectional studies. The Joanna Briggs Institute tool was used to assess the quality of the included studies.

Out of 11 944 studies retrieved, 26 studies were included in the current review. Based on the narrative synthesis, the findings are presented under the following five themes: (1) knowledge of deceased organ donation, (2) willingness towards deceased organ donation, (3) collective decision-making overriding individual’s preferences, (4) religious uncertainty and its impact on deceased organ donation and (5) trust and the healthcare systems.

This review shows that decisions about deceased organ donation are shaped by family dynamics, religious beliefs and trust in healthcare. More diverse research is needed to uncover new gaps and improve donor registration and consent rates in Pakistan. A whole-systems approach, considering families, religion and trust, is essential for effective strategies.

CRD42022346343.

International migrants comprise 3.6% of the global population and face systemic barriers to accessing sexual and reproductive health (SRH) services, such as contraception, safe abortion care and sexual function support. In high-income countries, policy frameworks vary widely, with migration status significantly influencing entitlement and access to host countries. This protocol outlines a planned study to systematically analyse SRH policies in high-income countries with strong migrant integration frameworks, aiming to identify policy gaps, assess inclusivity and inform recommendations to strengthen Australia’s SRH policy landscape.

This study employs a systematic policy analysis using the Joanna Briggs Institute scoping review methodology. Countries with ≥10% migrant populations and a Migrant Integration Policy Index health score ≥70 will be included. 13 countries meet these criteria, including Australia, Canada and Sweden. A comprehensive search of academic databases (PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ProQuest Public Health) and grey literature from governmental and non-governmental sources will be conducted. Data extraction will follow Bacchi’s ‘What’s the Problem Represented to Be?’ approach. Thematic analysis will combine deductive and inductive methods to examine the extent to which SRH policies address migrant and refugee needs, including sexual function, safe abortion care and fertility care. A comparative policy matrix will identify strengths, limitations and best practices.

As this study analyses publicly available policy documents, ethics approval is not required. Findings will be disseminated through peer-reviewed publications and policy briefs targeting stakeholders involved in SRH policy and migrant health.

This protocol is registered with the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/AYZ6P

National Immunization Technical Advisory Groups (NITAGs) are multidisciplinary groups of national experts who provide independent advice to policy makers on issues related to immunisation and vaccines, based on evidence and the national context. On the other hand, academic institutions can be described as organisations dedicated to education and research. These include schools, colleges, universities and research centres that offer formal education, conduct scholarly research and contribute to knowledge in various fields. NITAGs can enhance their capacity by linking with academic institutions and leveraging scientific expertise in research, data analysis, modelling, resource procurement and management, and policy formulation. The proposed landscape analysis will explore the links between NITAGs and academic institutions, especially in the sub-Saharan African context, and, where such exist, document their characteristics and identify benefits, challenges and best practices for fostering such linkages.

This landscape analysis will use an adaptation of the WHO’s quick guide manual on ‘Performing a landscape analysis: Understanding health product research and development’. The planned landscape analysis will be conducted in two parts. The first part will entail a review of published literature to identify relevant documents on linkages between NITAGs and academic institutions. The second part will entail conducting key informant interviews with NITAG members, partners and other identified key stakeholders in two study countries: Ethiopia and Zambia. The transcribed scripts will be thematically analysed. The findings from both parts will be synthesised and presented as a descriptive landscape analysis report.

The protocol of the parent study has been reviewed and approved by the Human Research Ethics Committee of the University of Cape Town (Reference 417/2025). It has also been approved by the Biomedical Research Ethics Committee of the University of Zambia (REF. NO. 6760-2025) and the Ethiopian Public Health Association (EPHA/06/392/25). The landscape analysis report will be submitted to the commissioning funder (Gavi, the Vaccine Alliance) and will also be published in a peer-reviewed journal.

https://osf.io/vprka

Epidemics pose significant challenges for fragile health systems, particularly in humanitarian emergencies. Recent responses to epidemics such as cholera in Yemen and Ebola virus disease in the Democratic Republic of the Congo have highlighted the lack of effective and integrated coordination. We review existing global models for addressing large-scale epidemics in humanitarian emergencies, identify gaps and inefficiencies, and propose operational recommendations to enhance response mechanisms.

A two-pronged approach was used to identify and critically assess current response coordination frameworks. Using the Arksey and O’Malley framework, a scoping review was undertaken, which was complemented by key informant interviews with humanitarian emergency response experts. The interviews focused on identifying the existing challenges and potential strategies to improve epidemic response in humanitarian contexts.

The scoping review included 51 documents (13 peer-reviewed articles and 38 grey literature documents). We conducted in-depth interviews with 28 respondents representing 17 different agencies and donors.

We focused on two major response architectures: the Incident Management System (IMS) and the cluster system. IMS is an important coordination and response instrument increasingly being used to respond to infectious disease threats.

Outcome measures of interest included the gaps in the current mechanisms to address infectious disease threats in complex humanitarian emergencies.

Unlike the cluster system model, which relies on consensus decision-making, IMS has a command-and-control approach, ensuring rapid decision-making. However, it can also lead to vertical responses that neglect the cross-sectoral and complex needs of affected communities. In addition, we found that the absence of context-specific response coordination mechanisms, with clear roles and responsibilities for involved stakeholders, was a common shortcoming. Fragmented response efforts that sidelined national and local stakeholders and a lack of reliable funding were also identified as important weaknesses.

We recommend the integration of coordination mechanisms into a sufficiently flexible framework that can be adapted to local contexts, while empowering national and local actors and ensuring the continuity of essential humanitarian services. We propose a paradigm shift towards mechanisms that respect humanitarian principles, effectively addressing the epidemic threats while remaining focused on deploying community-centric response efforts.

Research indicates that leadership in the health professions can facilitate improvement of quality and efficiency of healthcare services. In the Philippines, leadership in the health professions plays a critical role in driving improvements in healthcare delivery and health professions education. Thus, the landscape of leadership in the health professions merits continuous exploration and deeper understanding. This scoping review aims to explore the landscape of leadership in the health professions in the Philippines. The scoping review will include published and unpublished research papers of any kind, such as primary research studies, systematic reviews, meta-analyses, letters, guidelines, websites, blogs and grey literature that report about leadership in the health professions in the Philippines. Exclusions are leadership studies on the health professions that discuss the professions outside the scope and context of the practice.

The Joanna Briggs Institute (JBI) methodological framework for scoping review will be used in this review. A three-step search strategy will be used consisting of an initial search, full search and screening of reference lists. The databases that will be included are Cinahl Ultimate, Cochrane Library, Scopus, Embase, Emcare, Web of Science, JBI Evidence-based Practice Database, PubMed/Medline, ERIC, local journals and grey literature to determine pertinent sources about the topic. Sources searched will be screened by two independent reviewers and data will be extracted using a data extraction table. Disagreements will be resolved by a discussion through a third reviewer. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review flow diagram. Search strategy using the included databases started in August to September 2025, data extraction will start by October 2025, data analysis will start by November 2025 and the review is expected to be completed by December 2025.

This study does not involve human participants and has been reviewed and classified for exempted review by the University of the Philippines Manila Research Ethics Board, which is a committee whose task is to make sure that research participants are protected from harm. The findings of the scoping review will be disseminated through conference presentations and publication in a scientific journal.

To design and validate a comprehensive, expert-informed national framework to prevent and control fraud and misconduct in Iran’s health system. Fraud in this context refers to practices such as false claims, overbilling, unnecessary prescriptions, informal payments and beneficiary manipulation, which undermine efficiency and trust.

A sequential mixed-methods study, including an exploratory qualitative phase followed by a two-round Delphi consensus process.

National-level study across multiple sectors of Iran’s health system, including insurance, governance and health policy institutions.

In the qualitative phase, 12 experts (senior managers, auditors and policymakers) were interviewed, achieving data saturation. In the Delphi phase, 31 experts participated in Round 1 and 27 completed Round 2. All had ≥5 years of relevant experience in health management, fraud detection or policy-making.

Framework analysis of interviews identified six strategic categories: cultural, educational, legal, technological, insurance-related and structural interventions. These were validated and prioritised through the Delphi process. High consensus (≥75%) was achieved for most items, with unanimous agreement on legal clarity, enforceable sanctions and electronic identity verification. The final framework comprised three overarching domains—capacity building, strengthening oversight systems and modernisation of operational infrastructure—operationalised through six strategic pillars.

This study proposes a validated and context-specific anti-fraud framework tailored to Iran’s health system. By combining qualitative exploration with structured consensus, the framework offers practical strategies for enhancing transparency, accountability and resilience. It may also serve as a model for other low- and middle-income countries facing similar governance challenges.

Not applicable.

To evaluate the impact of the Medicaid Balancing Incentive Programme (BIP) on long-term services and supports utilisation among older adults, focusing on differences in living arrangements.

Quasi-experimental study using a generalised difference-in-differences approach.

States that participated and completed BIP (treatment group: 18 states) and states that were eligible but did not participate (control group: 17 states).

Older Medicaid beneficiaries from the Health and Retirement Study (2006–2018) across states that participated in BIP and those that did not. A negative control analysis was conducted using non-Medicaid beneficiaries.

We examined the probability of long-term nursing home stays (over 100 days), professional home healthcare and three types of home care services for activities of daily living: paid professional caregiving, paid informal caregiving and unpaid informal caregiving. Analysis was stratified by living arrangement (living alone vs with others).

BIP participation was associated with a 5 percentage point (pp) decrease in long-term nursing home stays among Medicaid beneficiaries living alone (average treatment effect on the treated, ATT=–0.06, 95% CI –0.10 to –0.02; p

BIP contributed to a reduction in institutionalisation for individuals living alone while increasing support for family caregivers in multiperson households. These findings highlight the importance of tailoring long-term care policies to the specific needs of populations based on their living arrangements.

To alleviate the shortage of qualified physicians in rural areas, since 2010, the Chinese government has launched a National Compulsory Service Programme (NCSP) to enrol medical students for future work in township health centres (THCs) as general practitioners (GPs). The educational background of NCSP GPs is the best at THCs. This study aims to evaluate whether NCSP GPs have contributed to improving the quality of patient care at THCs and in what way.

This is an explanatory sequential mixed methods study.

NCSP GPs are assigned to THCs in the rural areas of central and western China, where assistant physicians are permitted to practice independently as licensed physicians. The contribution of NCSP GPs was defined as the extent to which they were perceived to improve the quality of care at THCs. Job performance was defined as the aggregated value to the organisation of discrete behaviour episodes that an individual performs.

For the quantitative component, nine provinces were selected by using a stratified random sampling method based on NCSP admission numbers. A total of 2815 THC leaders completed the survey (response rate, 32%). For the qualitative component, 33 NCSP GPs were recruited for semi-structured interviews through purposive and snowball sampling method.

The contribution of NCSP GPs to improvements in the quality of care at THCs was assessed as a key outcome measure.

68% of THC leaders reported that NCSP GPs contributed considerably to improving the quality of care. The contribution of NCSP GPs was significantly and positively associated with the performance of NCSP GPs themselves (β=0.789, 95% CI 0.724 ~ 0.854) and THC remoteness (β=0.144, 95% CI 0.067 ~ 0.222), but negatively associated with the percentage of licensed physicians at the THC (β=–0.340, 95% CI –0.483 ~ –0.197) and with the turnover of NCSP GPs (β=–0.119, 95% CI –0.221 ~ –0.016). The percentage of licensed physicians has a mediating role between THC remoteness and the contribution of NCSP GPs. Interviews revealed that NCSP GPs contributed to the THC as individual clinicians, and a majority also contributed by influencing others or participating in THC management, such as by improving diagnosis and treatment performance of others, standardising patient care, teaching and training and implementing safety processes.

NCSP GPs have a positive impact on the quality of care at THCs. In addition to working as individual competent physicians, they can contribute to the THCs in many ways. Adjustments in NCSP curriculum design, more supportive measures and better allocation processes are recommended to maximise this programme’s potential.

To estimate condition-specific patient travel distances and associated carbon emissions across common chronic diseases in routine National Health Service (NHS) care, and to assess the potential carbon savings of modal shifts in transportation.

Retrospective population-based cohort study.

NHS Greater Glasgow and Clyde, Scotland.

6599 patients aged 50–55 years at diagnosis, including cardiovascular disease (n=1711), epilepsy (n=1044), cancer (n=716), rheumatoid arthritis (RA; n=172) and a matched control group based on age, sex and area-level deprivation (n=2956).

Annual home-to-clinic distances and associated carbon emissions modelled under four transport modes (petrol car, electric car, bus, train) across five time points: 2-year prediagnosis, diagnosis year and 2-year postdiagnosis.

Mean annual travel distances to hospital varied by condition and peaked at diagnosis. Patients with cancer had the highest travel distances (161 km/patient/year for men; 139 km/patient/year for women), followed by RA (approximately 78 km/patient/year). The matched control group travelled 2/patient/year to 8.0 kg CO₂/patient/year. Bus travel resulted in intermediate emissions, estimated between 10.5 and 8.0 kg CO₂/patient. When travel was modelled using electric vehicles, emissions dropped between 3.5 and 2.7 kg for all conditions. Train travel produced similarly low emissions. Reducing petrol car travel from 100% to 60% lowered emissions up to 6.6 kg CO₂/patient.

Condition-specific estimates of healthcare-related travel emissions provide baseline understanding of the opportunities and challenges for decarbonising healthcare. Emission reduction is most achievable through modal shift, yet such shifts depend on factors beyond NHS control—such as transport infrastructure, digital access and social equity. Multisectoral strategies, including targeted telemedicine and integrated transport and urban planning, are critical to achieving net-zero healthcare while maintaining equitable access to care.

In response to the high maternal mortality in Afghanistan, the government emphasised enhancing antenatal care (ANC) coverage to improve skilled birth attendance and reduce maternal mortality. This study aimed to explain how and why ANC interventions worked, for whom, and under what circumstances in Afghanistan between 2000 and 2024.

A rapid realist review was conducted to identify underlying programme theories and examine contextual factors and key mechanisms influencing ANC outcomes, with input from a panel of national experts. Data were extracted using context–mechanism–outcome (CMO) configurations to develop and refine theories for policy recommendations.

From 3502 papers, 1860 duplicates were removed, 63 were screened for full text and 25 were included in the final review. In total, 29 CMOs were inferred across nine interventions, classified at individual, interpersonal, community and institutional levels. We found that ANC interventions could work best by empowering women and healthcare workers (HCWs), involving husbands, hiring female community health workers (CHWs), ensuring regular contact with the same HCWs, endorsing health messages by the government, incentivising CHWs and designing and implementing interventions using participatory approaches. Interventions are less successful when there is a lack of community trust in service quality or HCW qualifications, low decision-making ability among women, discomfort during travel to health facilities, adherence to traditional practices and beliefs, hiring CHWs from outside the community, chronic stress and lack of support among HCWs and unrecognised incentives.

Our evidence synthesis can inform donors, policymakers and implementers on how to design more effective ANC interventions to achieve better health outcomes in Afghanistan. By emphasising intervention evaluation and ANC quality improvement, it highlights the importance of key social elements, such as cultural norms, power dynamics, relationships, beliefs and trust, which are likely to maximise impact. Community involvement is essential for designing and implementing effective and sustainable ANC interventions.

This study aimed to construct a patient evaluation index system for health literate healthcare organisations (HLHOs) within the Chinese context. Based on this, a patient self-assessment instrument—the Patient Evaluation of Health Literate Healthcare organisations (PEHLHO) scale—was developed to systematically assess and improve patients’ health literacy.

This study employed a modified Delphi method to construct a patient evaluation index system for HLHOs and used the precedence chart method to determine the weights of the indicators. Based on this system, the PEHLHO scale was developed. Its validity and reliability were tested using exploratory factor analysis and confirmatory factor analysis.

Delphi experts were selected from secondary and tertiary hospitals and public health administrative institutions in Jiangsu Province, China. The empirical survey was administered in representative cities across China, including Shanghai, Chengdu, Guangzhou, Beijing and Wuhan.

A total of 53 experts were invited to participate in the Delphi process, with 35, 23 and 30 valid responses obtained in rounds 1, 2 and 3, respectively. In the empirical study, a total of 6411 questionnaires were collected, of which 5206 were valid, yielding a valid response rate of 81.20%.

An evaluation index system for HLHOs was successfully established, which included 7 primary indicators and 19 secondary indicators. The weight analysis results revealed that organisational management (26.53%), doctor–patient communication (20.41%) and care delivery processes (20.41%) were the most influential domains. The PEHLHO scale showed good psychometric performance, with a Kaiser-Meyer-Olkin of 0.918. The average variance extracted for the three dimensions was 0.651, 0.703 and 0.744, and the composite reliability was 0.903, 0.876 and 0.897, respectively. The Cronbach’s α was 0.928, indicating excellent internal consistency and reliability.

This study has constructed an evaluation index system for HLHOs within the Chinese context, including indicators such as organisational management, doctor–patient communication and care delivery processes. The index system and the PEHLHO scale fill a significant research gap in China, providing measurement tools and guidance for HLHOs to improve patient health literacy and service quality.

Health systems must guarantee access to quality, safe and effective medicines. Essential medicine lists (EMLs) are crucial prioritisation tools to inform coverage decisions and steward limited health resources under the context of universal healthcare. This study aims to develop a consolidated framework for prioritising the assessment of health technologies to review and update EML for treating diseases or health problems managed in primary healthcare (PHC).

A mixed-methods approach was designed to validate the framework. An initial scoping systematic review will be conducted to search for studies that describe criteria used to prioritise the assessment of health technologies for PHC. The relevant studies will be examined using the Joanna Briggs Institute methodological framework for scoping review studies. A comprehensive search was conducted in the following sources: PubMed, Embase, Cochrane Library, Virtual Health Library (LILACS, WHO IRIS, IBECS, PAHO-IRIS, PAHO, LIS, BRISA), Health System Evidence, Global Healths, Health Evidence and Epistemonikos from the inception until February 2025. Two review authors will screen and extract data independently. The extracted data will be qualitatively analysed and presented in a diagrammatic or tabular form, alongside a narrative summary, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews reporting guidelines. An iterative process online using the Delphi hybrid with stakeholders through predetermined consensus thresholds, a combination of a four-point Likert scale and open-ended questions will be conducted to select and validate the criteria identified in the scoping review.

We will provide a consolidated framework to inform decision-makers for prioritising the assessment of health technologies for the national EML for PHC. This is an important step in using evidence to inform public health policies. We plan to share findings through a variety of means, including publications in peer-reviewed journals, presentations at national conferences, invited workshops and webinars, email discussion lists affiliated with our institutions and professional associations, and academic social media.

The aim of this study is to identify and analyse research priorities across the osteopathic profession internationally, to determine how different interested parties conceptualise research importance and to examine how contextual factors influence research prioritisation.

A mixed methods sequential exploratory design combining an umbrella review, a thematic analysis, an expert consensus agreement and an international cross-sectional survey was used to define, validate and evaluate research priorities.

An international online survey, available in nine languages, was distributed through professional osteopathic organisations and network worldwide, a patient representative organisation and social media.

2229 respondents including patients (7.4%), practitioners (42.1%), students (17.4%), educators (13.5%), researchers (5.0%) and policy makers (4.3%) from across 42 countries.

Primary outcomes were interested party’s conceptualisation of research importance and validation of the priorities in Research for Osteopathic Care (PROCare) framework. Secondary outcomes included current research priorities across interested parties groups and influence of contextual factors on prioritisation.

Three distinct approaches to priority-setting emerged: conservative (42.9%), sceptic (20.2%) and enthusiast (36.9%). Organising research priorities as a construct built from domains and subdomains was shown to be internally valid (Cronbach’s α=0.911). ‘Patient safety’ (nominated by 82% of relevant countries) and ‘physical activities and mobility’ (51.0%) were the most prioritised subdomains. ‘Digital health’ ranked lowest (28th of 28 subdomains). Significant geographic variations were observed mainly for the overall importance to most research domains. Strong consensus emerged around core priorities including patient safety, physical activity promotion and understanding treatment mechanisms.

The PROCare framework provides a validated structure for evaluating osteopathic research priorities across diverse interested parties. While geographic variations exist in priority emphasis, fundamental agreement on key research domains suggests potential for internationally coordinated research strategies. Future work should focus on developing mechanisms to ensure balanced representation of conservative, sceptic and enthusiast perspectives in research planning.

To evaluate the safeguarding impact of government commitment (defined as the proportion of government expenditure relative to total expenditure) to health and immunisation financing in mitigating the disruptions to routine childhood vaccination during the COVID-19 pandemic.

A quasi-experimental difference-in-differences study with country fixed effect, leveraging the COVID-19 pandemic as a natural experiment.

Low-income and middle-income countries.

A cohort of 131 low- and middle-income countries from 2010 to 2023.

Our primary outcomes included the coverage rates for the third dose of the diphtheria-tetanus-pertussis containing vaccine (DTP3) and the first dose of the measles containing vaccine (MCV1).

Both high government commitment countries (ie, above the upper 20th percentile) and low government commitment countries (ie, below the upper 20th percentile) experienced declines in immunisation coverage over the 4 years following the COVID-19 pandemic, with DTP3 and MCV1 decreasing by 4 and 5 percentage points, respectively (p

Greater government commitment to health and immunisation financing may not be sufficient on its own to mitigate pandemic-related disruptions in routine childhood vaccination.

To better inform dementia management, it is important to understand how individuals experience, interpret and respond to dementia policy in real life. This study aimed to explore key stakeholders’ perspectives on the critical determinants of effective implementation of the first dementia policy in Macao, and the impact of policy implementation on dementia care.

Semi-structured individual interviews were conducted in person with key stakeholders identified in earlier phases of the research. The participants were encouraged to share their opinions on the significance and objectives of the dementia policy, the changes in dementia care related to the launch of the policy, and how to better implement the policy for continuous improvement.

Interviews were conducted face-to-face at the participants’ office or at a location of their choice.

Individuals involved in the planning, establishing, leading, managing, operating, implementing, participating in, using and/or advocating for dementia policies and/or comprehensive dementia care models.

All participants perceived the Macao Dementia Policy as a landmark initiative that raised public awareness, fostered inter-professional collaboration and established a foundational service network. At the service level, they reported improvements in the accessibility of diagnostic pathways and greater attention to caregiver support. Nevertheless, implementation challenges remained, including fragmented service information, inadequate non-pharmacological treatment options and limited service capacity. Participants recommended that future actions should focus on optimising long-term policy planning and resource allocation, strengthening the direct support network for caregivers, and enhancing public education and research-informed innovation.

Macao’s experience suggests that the successful implementation of a dementia policy requires not only the establishment of formal service structures but also a concerted focus on optimising resource allocation and strengthening caregiver support. To further enhance the policy’s effectiveness, future efforts should prioritise designing and assessing targeted interventions.

The perspectives of stakeholders directly affected by mental health services for autism spectrum disorder (ASD) are essential for the quality of these services. However, it is crucial that these perspectives are informed by the best available evidence and adapted to the local context. This study aims to analyse barriers related to mental health services for children and adolescents with ASD from the perspective of families and caregivers, considering social, racial and gender aspects.

Three steps will be taken: stakeholder engagement through an online meeting to refine the research question and understand the magnitude of the problem; (b) qualitative evidence synthesis using five databases and grey literature to identify studies that have collected and analysed qualitative data on barriers to mental health services for children and adolescents with ASD in Brazil. Only studies conducted in Brazil that consider the perspectives of family members and caregivers will be included. (c) A citizen panel with families of children and adolescents with ASD will be used to discuss and validate the synthesis findings.

We will provide a set of evidence-informed and stakeholder-experienced barriers to mental health services for children with ASD in Brazil. This represents an effort to engage stakeholders in evidence descriptions to inform policy. We plan to disseminate the findings through various means, including peer-reviewed journal publications, presentations at national conferences, invited workshops and webinars, patient associations and academic social media platforms. The project was approved by the Ethics Committee for Research at the University of Sorocaba (approval number 78747224.7.0000.5500).

Open Science Framework—10.17605/OSF.IO/DVAKG.

The study aims to assess the associated influencing oncology nurses’ perceptions of managers’ empowering leadership style and to examine the influence of sex, work experience, shift work, membership of an oncology nursing association or a scientific society, nursing educational level and specialised nursing training in oncology on oncology nurses’ perceptions of managers’ empowering leadership style and its subdimensions.

Descriptive cross-sectional study.

In March 2024, oncology nurses employed in oncology settings were invited to participate.

All Italian oncology nurses who were currently employed were eligible to participate.

The Italian version of the Empowering Leadership Questionnaire was used to assess nurses’ perceptions of managers’ performance in leading by example, participative decision-making, coaching, informing and demonstrating concern/interacting with the team.

A total of 298 nurses agreed to participate. The associated factors for an empowered leadership style across all subdimensions were sex (p=0.006) and the educational level in nursing (p=0.004). Participative decision-making, coaching, informing and demonstrating concern/interacting with the team subdimensions were associated with shift work. Participation in scientific associations (p=0.005) was also influential.

Exploring the data according to the nursing specialisation appeared intriguing, since it could be a more indicative suggestion for future interventions to implement an empowering leadership style in clinical nursing practice and better inform health policymakers to achieve the right solution in their health organisations.

Health systems’ (HS) adaptations to climate change (CC) cover two major, and interrelated dimensions: (1) Environmental sustainability—actions aimed at limiting the negative impact of HS on the environment (eg, by reducing greenhouse gas emissions) and (2) Climate resilience—adaptations focused on improving HS’ ability to cope with the impact of CC (eg, by improving HS preparedness to climate-induced natural disasters). Within both dimensions, a diversity of actions, at different HS levels, can take place. The general objective is to provide health policy makers with a comprehensive evidence-based set of recommendations on the scope and effectiveness of HS adaptations to CC.

An umbrella review will be conducted. Systematic reviews will be included if: (1) They focus on HS adaptations to CC (including both environmental sustainability and climate resilience strategies/actions), (2) Were published since 2015 and (3) Report a quality appraisal of included studies. Five databases were searched: (1) MEDLINE via PubMed, (2) Scopus, (3) Web of science core collection, (4) ProQuest Central and (5) The Cochrane Database of Systematic Reviews. Two reviewers will independently assess studies’ eligibility, conduct quality appraisal and perform data extraction. Data will be synthesised using both quantitative and qualitative methods. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses will guide the reporting of results.

Ethical approval is not required, as this study involves the collection and analysis of secondary data only. The results will be submitted for publication in a peer-reviewed journal and disseminated via dedicated research channels and social media platforms.

CRD420251052647.