Irrational prescribing is a major global health concern, contributing significantly to increased morbidity, mortality and antimicrobial resistance (AMR). Despite existing knowledge and awareness, irrational antibiotic use remains prevalent among healthcare professionals.

This qualitative study aimed to explore the contributing factors to irrational antibiotic prescribing, understand healthcare professionals’ perceptions, identify barriers to rational use and gather suggestions for improving rational antibiotic use.

A qualitative study using semi-structured interviews was conducted with participants. A total of 60 healthcare professionals (20 physicians, 20 pharmacists and 20 nurses) participated after providing verbal consent.

Semi-structured interviews were conducted with healthcare professionals across various clinical settings in Pakistan until data saturation was reached. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure transparent reporting. An inductive thematic analysis approach was employed and themes and subthemes were developed from the data.

The findings revealed a generally good understanding of irrational prescribing. Contributing factors included prescriber-related issues, patient expectations, weak regulatory oversight and underutilisation of pharmacists. Key barriers identified were financial constraints, lack of awareness and insufficient resources. Suggestions for improvement included regular audits, public awareness campaigns, an integrated healthcare system, interprofessional collaboration, drug utilisation reviews, adverse drug reaction reporting, standardising hospital policies and strengthening regulatory frameworks.

This study highlights critical factors and barriers contributing to irrational antibiotic prescribing and presents practical suggestions to improve rational use. Implementing evidence-based approaches, updating clinical guidelines, and promoting awareness among healthcare professionals are essential steps toward improving prescribing practices and combating AMR.

Obsessive-compulsive disorder (OCD) is characterised by obsessive thoughts and compulsive actions. These obsessive-compulsive symptoms (OCS) are subclinical manifestations that do not meet the full diagnostic criteria for OCD and are associated with anxiety, depression and lower quality of life (QoL). Medical students are vulnerable to developing OCS due to stress in medical school. This study assessed OCS prevalence and its association with the mental well-being and QoL of medical students in Egypt.

A nationwide cross-sectional study was conducted across 15 Egyptian medical schools. Using convenience sampling, 1850 students participated by completing a self-administered questionnaire that used validated scales. We assessed OCS with the Obsessive-Compulsive Inventory-Revised (OCI-R) using a screening cut-off of ≥21, QoL with the Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-QSF), and anxiety and depression with the 4-item Patient Health Questionnaire (PHQ-4). Descriptive statistics and logistic regression were employed.

Clinically significant OCS prevalence among medical students was 51.1%. Significant predictors for OCS included being female (adjusted OR (AOR)=1.25), attending a private university (AOR=1.64), and having personal (AOR=2.05) or combined personal and family history of mental illness (AOR=2.69). OCS presence was associated with a lower QoL score (Q-LES-QSF: 41.00 vs 43.97) and higher psychological distress score (PHQ-4: 5.93 vs 3.57) compared with students without OCS (p

OCS are prevalent among Egyptian medical students, especially females, private university attendees and those with a personal or family history of mental illness. These symptoms are associated with higher psychological distress and a lower QoL. As OCS were identified using a screening cut-off, and given the cross-sectional design, findings should be interpreted cautiously, warranting further longitudinal investigation. Universities should consider implementing mental health support, screening and awareness programmes to address these issues.

This study aimed to evaluate the impact of a social prescribing intervention (the Central Locality Integrated Care Service (CLICS)) on unplanned hospital usage in the city of Bradford.

A quasi-experimental study applying a dynamic staggered difference-in-differences (DID) analysis on a propensity matched cohort between 2019 and 2023, using data from the Connected Bradford dataset, a pseudonymised linked health dataset on the whole Bradford population.

CLICS was delivered within general practices in deprived and ethnically diverse inner-city areas of Bradford, Yorkshire, UK.

In total, 1304 CLICS patients were matched to 5216 control patients on key characteristics including ethnicity, deprivation, age, gender and health conditions.

A proactive social prescribing intervention that integrates clinical and non-clinical services, including an individualised approach to tailor support based on the patient’s needs, both within primary care services and by linking them to appropriate community-based assets/services.

The primary outcome was the rate of unplanned hospital admissions and the secondary outcome was unplanned accident and emergency (A&E) attendances.

CLICS patients were 2.1% (95% CI –3.8% to –0.4%, p=0.013) less likely to have an unplanned hospital admission and 2.4% (95% CI –4.6% to –0.2%, p=0.03) less likely to have an unplanned A&E attendance compared with the matched control. The DID analysis demonstrated a gradual increase in the association over time. Subanalyses revealed heterogeneity by ethnicity, the reduction in unplanned hospital admissions was observed only in patients of the Pakistani group, whereas the reduction in A&E attendances was statistically significant only in the white British group.

The CLICS intervention was associated with a reduction in unplanned hospital usage. Social prescribing may be a valuable component of strategies to reduce health inequalities in unplanned hospital usage.

To assess the level of alarm fatigue among intensive care unit (ICU), cardiac care unit (CCU) and emergency room (ER) nurses, identify associated demographic and occupational factors, determine the most frequent sources of alarms and evaluate nurses’ psychological reactions to alarms.

A cross-sectional, descriptive–analytical study.

ICUs, CCUs and ERs of six public teaching hospitals affiliated with Tehran and Kashan Universities of Medical Sciences in Iran.

Using a multistage stratified random sampling method, 285 nurses were approached, of whom 260 completed and returned the questionnaires (response rate: 91%). Participants were registered nurses with at least a bachelor’s degree or higher and 3 months of experience in ICUs, CCUs or ERs.

The primary outcome was the level of alarm fatigue measured using the validated Nurses’ Alarm Fatigue Questionnaire. Secondary outcomes included factors associated with alarm fatigue and nurses’ reported psychological responses to frequent alarms.

The mean score of alarm fatigue was 26.4±7.9, indicating a moderate level. After adjusting for confounders and hospital-level clustering using multivariable mixed-effects regression, higher monthly income was significantly associated with lower alarm fatigue (β=–0.15, p=0.03), and nurses working rotational shifts reported significantly higher fatigue compared with those with fixed shifts (β=0.18, p=0.02). Other demographic and occupational factors were not significant. Reported psychological reactions to alarms included indifference (14%), irritability (18%) and anxiety/stress (15%).

ICU, CCU and ER nurses experience a moderate level of alarm fatigue, with income and shift type as independent associated factors. The association between income and alarm fatigue may reflect the role of financial stress as an additional job demand that compounds the burden of frequent alarms, particularly in contexts where low base salaries lead nurses to rely on overtime and multiple shifts. These findings underscore the need for targeted managerial and educational interventions, including shift schedule optimisation and attention to workload-related stressors, alongside alarm prioritisation strategies. Due to the cross-sectional design, causal inferences cannot be drawn.

To assess cardiovascular health (CVH) metrics using the American Heart Association’s Life’s Simple 7 (LS7) tool as a comprehensive measure of several metabolic and behavioural risk factors for cardiovascular diseases.

Cross-sectional study, nationally representative Iran STEPwise approach to non-communicable diseases risk factor surveillance (STEPS) survey 2021.

Iran, 2020–2021.

25 202 adult individuals aged 25 years and older participated in the STEPS survey.

Using the LS7 framework, seven factors were assessed: current smoking, body mass index (BMI), physical activity level, modified healthy diet score components, total cholesterol, blood pressure and fasting plasma glucose (FPG). Each factor was categorised into three levels of poor, intermediate and ideal, according to the LS7 methodology.

The study participants had a sex distribution of 55.5% females. The findings revealed a high prevalence of ideal levels of smoking (80.1%; 95% CI 79.3 to 81.0), total cholesterol (69.4%; 95% CI 68.5 to 70.4) and FPG (61.0%; 95% CI 60.0 to 62.1). BMI and blood pressure were ideal in about one-third of the population (33.0%; 95% CI 32.1 to 34.0, and 30.5%; 95% CI 29.6 to 31.4, respectively). However, only 13.3% (95% CI 12.6 to 14.0) of participants achieved ideal levels of physical activity, and a mere 0.4% (95% CI 0.3 to 0.6) adhered to an ideal healthy diet. Modest disparities in CVH metrics were observed across provinces and between two sexes. Ideal CVH status was significantly associated with lower risks of major diseases such as ischaemic heart disease, diabetes and chronic kidney disease.

Despite favourable scores in some CVH metrics, critical gaps in diet and physical activity highlight the need for intensive public health efforts to enhance CVH in Iran. The study emphasises the urgency of implementing region- and sex-specific public health policies.

Paediatric kidney transplantation, while life-saving, presents significant academic challenges for children. Frequent hospitalisations, medical treatments and the psychosocial impact of chronic illness can severely disrupt educational trajectories. This study aimed to explore the post-transplant academic experiences of children from the perspective of their parents.

A qualitative phenomenological study. Data were collected through in-depth, semistructured interviews and analysed using inductive thematic analysis.

The study was conducted in Lahore, Pakistan, with participants recruited from the registry of the Punjab Human Organ Transplantation Authority (PHOTA).

Thirteen parents of children who had undergone a kidney transplant and were enrolled in a formal school.

Five major themes emerged from the analysis: (1) academic disruption and coping, detailing declines in performance and motivation alongside efforts to maintain engagement; (2) cognitive fatigue and emotional strain, encompassing reduced focus, memory difficulties and psychological distress; (3) school attendance, participation and support, highlighting frequent absenteeism, limited engagement in activities, and the critical role of institutional flexibility; (4) social identity and peer exclusion, revealing fears of stigma, self-isolation and misunderstanding from peers and (5) navigating the future, reflecting parental anxieties about long-term educational and career prospects alongside adaptive hope. The findings underscore that formal support systems in schools and healthcare settings are currently underdeveloped to meet these children’s complex needs.

This study illuminates the profound and multifaceted academic challenges faced by children after kidney transplantation. The results emphasise that a transplant is not merely a medical event but a life-altering experience with significant educational consequences. There is a critical need for integrated, targeted interventions that provide robust psychological support, flexible educational policies and comprehensive school reintegration programmes to ensure these children can achieve their full academic and personal potential.

Childbirth readiness can reflect women’s childbirth readiness in terms of knowledge, psychological aspects and planning. The purpose of this study was to evaluate childbirth readiness, its related factors and consequences in Iranian pregnant women.

This longitudinal study was the first stage (quantitative stage) of a sequential explanatory mixed-method study. It followed women during late pregnancy (from 37 weeks of gestation) and the postpartum period (4–6 weeks after childbirth) from March to September 2023.

Health centres of Tabriz, Iran.

This study involved 360 pregnant women with a gestational age of 37 weeks and above, selected via cluster sampling. Participants were excluded for high-risk pregnancies, unfavourable incidents in the last 3 months, mental-psychological diseases or a prior caesarean section.

Childbirth readiness and its related factors were assessed using several instruments completed from the 37th week of pregnancy onward, including the Childbirth Readiness Scale, a sociodemographic questionnaire, the Pregnancy Experience Scale and the Wijma Delivery Expectancy/Experience Questionnaire Version A. The consequences of childbirth readiness were then evaluated 4–6 weeks post partum using the Childbirth Experience Questionnaire, the Edinburgh Postnatal Depression Scale and the Postpartum-Specific Anxiety Scale.

The mean (SD) childbirth readiness score was 67.83 (9.41) out of 90. In the adjusted general linear model (GLM), several factors were significantly associated with lower readiness. These included a higher fear of childbirth score (β –0.12, 95% CI –0.16 to –0.08, p

Key factors associated with readiness included fear of childbirth, obstetric history (gravidity, parity, history of abortion and participation in childbirth readiness classes), maternal education, home ownership, husband’s occupation—though several associations showed small effect sizes. After adjustment, readiness did not independently predict childbirth experience or postpartum mental health. The low participation rate in readiness courses highlights a major service gap. Integrating readiness assessment into prenatal care and expanding access to targeted education are recommended to improve outcomes such as birth satisfaction and caesarean rates.

In Canada, many families want to breastfeed, but there are several common challenges they may encounter. Currently, 91% of Canadian families initiate breastfeeding after giving birth, yet only 38% of babies are breastfed exclusively to 6 months. In 1991, the Breastfeeding Committee for Canada (BCC) was established to implement the World Health Organization’s Ten-Step Baby-Friendly Hospital Initiative, a series of evidence-based in-hospital practices to support families to breastfeed. Then, in recognition of the need to support breastfeeding beyond the hospital setting, the BCC expanded the Baby-Friendly Initiative (BFI) to apply the Ten Steps to both hospitals and community health settings. However, uptake of the BFI Ten Steps in community settings has been low and methodology on how to optimise implementation of the Ten Steps in community is not well developed. Therefore, the objective of this project is to develop and evaluate a quality improvement collaborative with 25 community health services from across Canada to learn how to best support the implementation of the BFI Ten Steps in community, with the ultimate goal of improving breastfeeding outcomes.

This protocol describes the activities of the Community Baby-Friendly Initiative Collaborative (CBFI-C) and the methods used to evaluate its effectiveness. We will use the Institute for Healthcare Information Breakthrough Series (IHI-BTS) model, a proven quality improvement model that has been widely used in clinical settings, but is not yet widely used in community settings. The IHI-BTS combines three virtual learning sessions with action cycles that allow the participating sites time to test and track small practice changes. Sites will be asked to track care indicator and breastfeeding outcome data, engage in monthly webinars, receive coaching from trained mentors, participate in focus groups and participate in a final summative workshop. We will use a multi-site case study approach, combining aggregate care indicator data and qualitative data from webinars, focus groups and workshops to evaluate how the CBFI-C model supports community sites in the process of implementing the BFI Ten Steps.

Ethics approval for this evaluation was obtained from the CHIPER Health Research Ethics Board (Number HS26947-H2025:157)). The results of the CBFI-C evaluation will be shared in a report, peer-reviewed publications and presentations to government and academic audiences. The findings will inform effective quality improvement strategies to enhance uptake of the BFI in community health settings.

The study aims to explore the experiences of adolescent girls with the onset of their first menstruation in the context of Pakistan and to highlight the sociocultural aspects that shape those experiences.

The study employs an exploratory phenomenological approach.

This study has been conducted at a public sector higher education institute, University of the Punjab, Pakistan. Female students enrolled in the first semester of the undergraduate degree programme were included in the study using a predefined inclusion and exclusion criteria.

Data was collected from six 18 years old girls who had their menarche in the last 6 years through face-to-face in-depth interviews using a semi-structured interview guide from June 2024 to August 2024. The interviews were audio-recorded given the written consent of the participants. Transcripts were analysed thematically following Braun and Clarke’s framework.

Thematic analysis of six interviews revealed three major themes: (1) Experience of first blood: emotional, social and practical difficulties; (2) The problem of mismanagement of first menstruation and the strategies used; and (3) Restrictions during menstruations. The study found that adolescent girls are provided with little to no prior knowledge regarding menarche and menstruation that causes various complexities and vulnerabilities. The social and cultural expectations and the gendered norms construct the experiences of the adolescent girls regarding their first menstruation, while the idea of womanhood is preserved in the society by restricting, isolating and alienating the adolescent girls and modifying their conduct and behaviour accordingly.

Menarche is often experienced as distressing, secretive and isolating for adolescent girls in Pakistan. Educational interventions in families and schools are needed to provide accurate, timely information and to support girls in navigating this transition with confidence and dignity.

This study aims to develop a methodology to retrieve, harmonise and evaluate the completeness of national body mass index (BMI) data from linked electronic health record (EHR) sources to build a longitudinal research-ready data asset (RRDA).

A longitudinal study of BMI records spanning 23 years (1 January 2000 to 31 December 2022) from four data sources.

The national BMI RRDA is created within the Secure Anonymised Information Linkage (Databank), encompassing the entire population of Wales, UK.

We built a methodology that provides a reproducible framework for extracting and harmonising BMI data from four major linked EHRs across two age groups: children and young people (CYP; 2–18 years old) and adults (19 years and older). The methodology is adaptable across different trusted research environments. We evaluated the completeness and retention of records over 1-, 5- and 23-year periods by calculating the proportion of missing data relative to each year’s population.

We retrieved 53.4 million records for 3.2 million individuals across Wales from 1st January 2000 to 31 December 2022. Among these, 3% of CYP and 34% of adults had repeat BMI measurements recorded over periods ranging from 5 to 23 years. Throughout the entire population of Wales during this period, 49% of CYP and 26% of adults had at least one BMI reading recorded, resulting in a missingness rate of 51% for CYP and 74% for adults. Preserving BMI information by retaining the most recently recorded BMI over 1-, 5- and 23-year intervals from 2022 showed coverage rates of 10%, 33% and 68%, respectively, for CYP, and 25%, 51% and 73%, respectively, for adults.

Our findings highlight substantial variations in BMI data availability and retention across CYP and adults, as well as time periods within EHR in Wales. Wider adoption of this approach can enhance standardised approaches in using accessible measures like BMI to assess disease risk in population-based studies, strengthening public health initiatives and research efforts.

This study aimed to estimate the frequency of depression in mothers during the antepartum and postpartum periods and identify predictors of perinatal depression in the tertiary care hospital of Karachi, Pakistan.

Analytical cross-sectional study.

Public Tertiary Care Hospital, Civil Hospital, Karachi, Sindh, Pakistan.

The study involved 262 mothers for the assessment of frequency and predictors of perinatal depression in Pakistan.

The Edinburgh Postpartum Depression Scale (EPDS) was used as the tool to screen for depression. The data were collected through a structured questionnaire encompassing the sociodemographic factors, pregnancy and birth-related information, newborn characteristics sections, family relationship and marital status and psychosocial and psychological history. Mean and SD were computed for continuous data, whereas frequencies and percentages were determined for categorical data. Pearson ² test was applied to determine the association between categorical variables. Predictors of perinatal depression were identified through multivariate logistic regression.

Out of 262 enrolled mothers, 198 screened positive for depressive symptoms using EPDS with a cut-off value ≥10. The mean age of participating mothers was 27.4±5.95 years. Approximately 39.7% of the mothers were illiterate, 75% were housewives and about 42% had a family income of less than US$126. Women with access to a healthcare facility had higher odds of antepartum depression symptoms, possibly due to poor healthcare experiences during antenatal visits. Emotional support by husband reduces the odds by 45.8% while experiencing abuse increases odds by three times. Significant predictors of postpartum depression symptoms included decision-making power, which reduced the odds of postpartum depression symptoms by 72.5% and emotional support by 80%.

The study concluded that maternal decision-making power is a significant protective factor against postpartum depression. Strikingly, access to health facilities by the mother was associated with higher odds of antepartum depression. Other factors, including household income, husband’s employment status, domestic violence, emotional support and family abuse, did not show significant associations with either antepartum or postpartum depression. These findings emphasise the importance of routine screening to identify women at risk during the perinatal period.