Adverse childhood experiences (ACEs), including maltreatment (abuse, neglect) and household challenges, have been identified as risk factors for various health conditions in adulthood.1 Chronic pain, particularly chronic widespread pain, is increasingly linked to ACEs.2 Theoretical frameworks propose that ACEs contribute to chronic pain through interconnected biological, psychological and social pathways, each triggering a cascade of effects that lead...

Investigate interprofessional medication safety risk management from the perspective of physicians in healthcare settings.

Qualitative, semistructured interview study. Data analysed with an inductive content analysis.

Wellbeing Services County in Central Finland.

17 physicians working in different healthcare settings or specialties.

Physicians’ overall perception of interprofessional medication safety risk management was generally positive. They considered their own responsibility for medication safety as both comprehensive, encompassing the safety of the entire unit and limited, focused primarily on prescribing the correct medication. Organisational barriers to participating in medication safety promotion comprised insufficient healthcare resources and unclear distribution of tasks and responsibilities. Personal barriers included prioritisation of clinical work, considering medication safety as an administrative task and experiencing the process to be slow and complex. Strong leadership, increased visibility of medication safety, framing the topic positively, targeted education and fostering physicians’ intrinsic motivation were identified as means to increase physicians’ participation in medication safety risk management.

This study emphasises the importance of integrating physicians into interprofessional, systems-based medication safety risk management as a core element of high-quality care. Despite recognising their broad role, physicians face barriers such as organisational constraints and limited identification with medication safety advocacy. Addressing these challenges requires enhancing their understanding of the medication management and use process and fostering shared responsibility through time allocation and interprofessional leadership structures.

Large differences exist in chronic kidney disease (CKD) rates between countries, but differences within diverse populations living in the same setting with universal healthcare are not well understood.

To compare dialysis prevalence, CKD risk factors and control, and CKD progression by ethnicity and birth country in an ethnoculturally diverse setting with high rates of kidney disease and universal healthcare.

Scarborough, Toronto’s most diverse region and site of Canada’s largest regional dialysis programme.

Double observational cohort study of 2397 participants: a retrospective cohort of 1116 residents who received dialysis between 2016–2019, and a prospective cohort of 1281 individuals with non-dialysis CKD followed for 3 years between 2010–2015 in Scarborough.

Dialysis prevalence, calculated by comparing frequencies of birth countries and ethnicities in the dialysis cohort with census-derived community frequencies. Secondary outcome measurements were traditional CKD risk factor prevalence (diabetes, hypertension, cardiovascular disease) and control (haemoglobin A1c, blood pressure); and CKD progression (estimated glomerular filtration rate decline, proteinuria) adjusted for socioeconomic status in the non-dialysis cohort.

Dialysis prevalence was 4.2 times higher in immigrants (p

Despite universal healthcare access, marked disparities in CKD risks and rates exist within ethnoculturally diverse immigrants living in this Canadian kidney disease hotspot. More focused research and tailored interventions are required.

Although the health impacts of floods are well described, there is limited research on how flooding affects health systems, services and the health workforce—despite their central role in mitigating and responding to these impacts. This scoping review examines the nature and extent of existing research evidence on the impact of flooding events on Australia’s health system.

A scoping review following the Johanna Briggs Institute methodology.

MEDLINE, Embase, CINAHL, Scopus, Web of Science, ProQuest Central and PsycINFO were searched through to 22 October 2024. Reference lists of included publications were screened for additional publications.

We included studies that reported any health system or health service disruption associated with flooding in Australia. Disruptions encompassed impacts on hospitals, primary care, health information systems, infrastructure, public health and health promotion activities, and the health workforce. We included peer-reviewed publications, including original research, commentaries, perspectives, editorials, letters to the editor, modelling studies and reviews. Grey literature was excluded.

Screening of full texts and data extraction were completed by two independent reviewers. A health system disruption analytical framework was iteratively developed and was used to categorise the findings.

Our search identified 6687 publications, of which 28 were included in the final review. 13 publications were original research publications and 15 were commentaries or reviews, with the majority published in the past ten years. Of the publications included, most focused on disruptions to hospital services and transport systems, including a reduction in health workforce availability, primarily due to the latter. Less than one-third reported impacts on health services for socially vulnerable populations. Floods affect multiple levels of the health system, intersecting with impacts across three key domains: infrastructure and health information systems, access to healthcare and the health workforce.

Original research on how floods impact Australia’s health system, its services and workforce has been limited, particularly in relation to general practice, allied health and the differential impacts on socially vulnerable populations. Further research is needed to inform targeted disaster preparedness and response strategies and to understand the complex and intersecting impacts. The analytical framework developed in this review provides a way to conceptualise how floods disrupt different components of the health system and offers a foundation for future research and policy development to strengthen system resilience in the face of increasing flood risk.

Encephalitis is brain parenchyma inflammation, frequently resulting in seizures which worsens outcomes. Early anti-seizure medication could improve outcomes but requires identifying patients at greatest risk of acute seizures. The SEIZURE (SEIZUre Risk in Encephalitis) score was developed in UK cohorts to stratify patients by acute seizure risk. A ‘basic score’ used Glasgow Coma Scale (GCS), fever and age; the ‘advanced score’ added aetiology. This study aimed to evaluate the score internationally to determine its global applicability.

Patients were retrospectively analysed regionally, and by country, in this international evaluation study. Univariate analysis was conducted between patients who did and did not have inpatient seizures, followed by multivariable logistic regression, hierarchical clustering and analysis of the area under the receiver operating curves (AUROC) with 95% CIs.

2032 patients across 13 countries were identified, among whom 1324 were included in SEIZURE score calculations and 970 were included in regression modelling. The involved countries comprised 19 organisations spanning all WHO regions.

The primary outcome was measuring inpatient seizure rates.

Autoantibody-associated encephalitis, low GCS and presenting with a seizure were frequently associated with inpatient seizures; fever showed no association. Globally, the score had limited discriminatory ability (basic AUROC 0.58 (95% CI 0.55 to 0.62), advanced AUROC 0.63 (95% CI 0.60 to 0.66)). The scoring system performed acceptably in western Europe, excluding Spain, with the best performance in Portugal (basic AUROC 0.82 (95% CI 0.69 to 0.94), advanced AUROC 0.83 (95% CI 0.72 to 0.95)).

The SEIZURE score performed best in several countries in Western Europe but performed poorly elsewhere, partly due to differing and unknown aetiologies. In most regions, the score did not reach a threshold to be clinically useful. The Western European results could aid in designing clinical trials assessing primary anti-seizure prophylaxis in encephalitis following further prospective trials. Beyond Western Europe, there is a need for tailored, localised scoring systems and future large-scale prospective studies with optimised aetiological testing to accurately identify high-risk patients.

Falls are among the most common adverse events in hospitals, causing significant harm to patients and increasing healthcare costs. In 2023, over 160 000 falls were reported in China, with 62.5% of hospitalised patients suffering fall-related injuries. Falls not only prolong hospital stays but also negatively impact nursing quality and healthcare system efficiency.

This study explored the lived experiences of nurse managers in preventing and managing inpatient falls in hospital settings and examined the contextual and managerial factors influencing fall prevention practices.

We conducted a qualitative study using a phenomenological approach to explore the lived experiences of nurse managers in managing inpatient falls. Semistructured interviews were conducted with 16 participants from a tertiary hospital in Shanghai. While data collection followed phenomenological principles to elicit rich experiential narratives, thematic analysis was guided by grounded theory coding techniques to inductively identify and categorise themes. NVivo 12 software was used for data management.

Six interrelated themes emerged, reflecting nurse managers’ experiences across the stages of patient admission, hospitalisation and discharge. At admission, participants emphasised the limitations of existing fall risk assessment tools and the need for multidisciplinary collaboration and intelligent technologies to achieve precise stratification. During hospitalisation, they described ongoing challenges in conducting dynamic reassessments, implementing personalised interventions, managing limited staffing and environmental constraints and promoting patient compliance through effective education. In the discharge phase, nurse managers reflected on the emotional and ethical tensions between ensuring patient safety and respecting autonomy, underscoring the importance of cultivating a strong safety culture and reinforcing nurses’ sense of responsibility. Collectively, these findings reveal that fall prevention is not merely a procedural task but a dynamic, interpretive process shaped by professional accountability, emotional strain and systemic limitations.

Nurse managers’ experiences reflect the complex interplay between managerial responsibility, cultural caregiving norms and organisational limitations in fall prevention. Strengthening multidisciplinary collaboration, integrating intelligent technologies and promoting a proactive safety culture are crucial for improving fall management. Policymakers should also consider China’s evolving caregiver-free ward initiatives to transition towards more nurse-led and patient-centred safety systems. Future research should further explore patient and family perspectives and evaluate strategies for sustainable cultural and structural change in fall prevention.

Increased popularity of stepped-wedge cluster randomised trials (SW-CRT) highlights the importance of understanding and appropriate mitigation of sources of bias within this trial design. While current evidence suggests that ‘conventional’ cluster randomised controlled trials (RCTs) are at a higher risk of recruitment bias than individually randomised trials, this review aims to estimate the risk of recruitment bias in SW-CRTs.

Systematic review with search conducted on four databases. Risk of bias (RoB) was assessed using subdomain 1a (randomisation process) and 1b (timing of identification or recruitment of participants) of the Cochrane RoB tool 2.0 (extension for cluster RCTs).

MEDLINE, Embase, CINAHL, Cochrane Library were searched on 9 February 2024.

SW-CRTs published in 2023 were included.

Two independent reviewers screened and extracted all eligible papers. RoB was assessed with the Cochrane RoB tool.

Overall, 808 papers were screened, and 64 studies were included in the review. Most studies were deemed to have a high RoB (n=35, 55%), some concerns were noticed in 20 studies (31%), and 9 (14%) were considered to have a low RoB. The description of the randomisation process in the included papers was sometimes poorly reported (in 15 studies (23%) problems with the randomisation process were identified), and 21 studies (33%) had issues with sampling strategy (recruiting participants after randomisation by unmasked staff).

The review revealed that SW-CRTs are prone to recruitment bias, but the risks are comparable to cluster RCTs. When SW-CRTs are unable to recruit prior to randomisation, mitigation strategies could be implemented to reduce bias. A separate tool for RoB assessment in SW-CRTs is required to address the complexities of this trial design.

The objective of this study was to explore medical practitioners’ understanding of antimicrobial resistance (AMR) and its aspects, such as its causes, possible outcomes and how doctors can contribute to its prevention.

This qualitative study was conducted in Sri Lankan healthcare settings.

Using convenience sampling, the study included allopathic medical practitioners aged 18–60 years, excluding intern-medical officers, until data saturation.

One-on-one interviews were conducted online or in person, depending on each participant’s preference. A structured questionnaire was used to triangulate the information.

Data were categorised into four: (1) understanding, awareness and identifying AMR as an issue among medical practitioners, (2) knowledge and understanding of factors that contribute to AMR development among medical practitioners, (3) knowledge and understanding of the outcome of AMR and (4) knowledge and understanding of preventive measures against AMR among medical officers. Interviewees showed an awareness of AMR; however, their knowledge was not up to date. Key reasons for inappropriate antibiotic use included unavailability and poor quality of antibiotics and unawareness of updated guidelines, especially in the government sector. In the private sector, patient pressure, the need to attract patients and the high cost of investigations contributed to misuse. Additionally, low patient literacy about AMR was a significant factor.

This study revealed that although medical practitioners in Sri Lanka are aware of AMR, their knowledge remains limited in certain areas. Several challenges contributed to inappropriate antibiotic use, including the availability and quality of antibiotics, external pressures from patients and financial constraints. The findings of this study highlight the urgent need for continuous medical education and public awareness campaigns to improve both practitioner and patient understanding of AMR. Addressing these issues is essential for effectively preventing and managing AMR in healthcare settings in Sri Lanka.

Sense organ diseases (SODs) are among the leading causes of disability worldwide. They severely impact communication, mobility and quality of life, with rising prevalence and widening inequalities across populations. This study aims to provide an updated, comprehensive assessment of the global, regional and national burden and trends of SODs, and to inform strategies for prevention, treatment and health policy development.

This is a population-based observational study using secondary data from the Global Burden of Disease (GBD) 2021 study. SODs, defined in the GBD framework as age-related and other hearing loss (AHL), blindness and vision loss (BVL), and other sensory impairments, were analysed in terms of prevalence and disability-adjusted life years (DALYs). We focused on SODs overall and conducted specific analyses for AHL and BVL, stratified by age, sex and sociodemographic index (SDI).

Global dataset covering 204 countries and territories across all regions and sociodemographic strata from 1990 to 2021.

This study covered the global population represented in the GBD 2021 dataset, using aggregated population-level estimates with no direct individual recruitment.

Not applicable.

Primary outcomes were prevalence (cases and age-standardised prevalence rates) and DALYs (number and age-standardised DALY rates). Secondary outcomes included age–period–cohort effects, decomposition of contributors (population growth, ageing and epidemiological change), inequality metrics and burden projections to 2030.

Between 1990 and 2021, the global age-standardised rate (ASR) of DALYs for SODs increased from 884.07 to 912.8 per 100 000 population. The ASR of prevalence rose from 25 297.36 to 28 050.29 per 100 000. The disease burden increased across all age groups, with females experiencing a higher prevalence of SODs, and population growth and ageing as the leading contributors. AHL emerged as the predominant category of SODs. Socioeconomic disparities widened, with the slope index of inequality for DALYs rising from 128.82 in 1990 to 418.62 in 2021. In 2021, China reported the highest DALYs and case numbers. Predictive analysis showed a stable ASR of DALYs and prevalence, but a continued rise in cases through 2030, with COVID-19 further exacerbating the burden.

The global burden of SODs continues to rise, driven primarily by population ageing and growth, with widening disparities across sociodemographic levels. These findings emphasise the need for targeted prevention strategies, improved early detection and equitable access to sensory healthcare services. Monitoring the long-term impact of COVID-19 and demographic shifts remains a priority.

Not applicable. This study is a secondary analysis of GBD data and is not linked to a clinical trial.

To provide the first national estimate of syphilis prevalence among people who inject drugs (PWID) in Georgia, alongside updated HIV prevalence and associated risk behaviours, and to identify factors associated with infection.

Cross-sectional Integrated Bio-Behavioural Surveillance Survey conducted in 2022. Respondent-driven sampling was used to recruit PWID. Data were collected through standardised face-to-face interviews using structured questionnaires, and venous blood samples were collected for laboratory testing. HIV was diagnosed by serology, and syphilis was assessed using a two-step algorithm (Rapid Plasma Reagin screening with Treponema pallidum haemagglutination assay confirmation). Logistic regression models were applied to identify correlates of infection.

The study was conducted in community settings across seven major cities of Georgia that represent the main urban centres with large PWID populations. Survey implementation was supported by local peer-led and community-based harm reduction organisations with established trust and access to PWID networks, facilitating participant recruitment and ensuring feasibility.

HIV prevalence was 0.9% and syphilis prevalence 2.1%. Coinfection with HIV and syphilis was observed in 0.2% of participants. HIV infection was significantly associated with longer duration of injection drug use (adjusted OR (aOR) 0.2; 95% CI 0.5 to 0.9) and lack of access to HIV prevention services (aOR 2.8; 95% CI 1.1 to 7.8). Syphilis prevalence was significantly lower among PWID who had not had casual or paid sex in the past year (OR 0.06; 95% CI 0.02 to 0.2). Unsafe sexual behaviours were common: 25.8% reported sex with a casual partner in the past year, 12.3% reported a paid partner, and only around half used condoms consistently with these partners.

Despite a relatively low HIV prevalence, syphilis prevalence among PWID in Georgia highlights ongoing sexual risk behaviours. Current harm reduction programmes primarily address injection-related risks, with limited sexually transmitted infection (STI) prevention efforts. Expanding sexual health interventions within harm reduction services, including STI screening, structured counselling and safe sex education, is essential to reduce STI transmission and improve health outcomes among PWID.