Archives of Public Health

Bangladesh's agricultural sector remains heavily dependent on pesticides and chemical inputs, yet limited attention has been paid to how farmers' knowledge of occupational health and environmental sustainability translates into actual practice across the full agricultural value chain. This study aimed to assess the knowledge and practices of farmers in Pabna District, Bangladesh, regarding occupational health, pesticide handling, environmentally sustainable farming, and market sanitation. A cross-sectional survey was conducted among 301 farmers in 2024 using a structured questionnaire covering socio-demographic characteristics, sustainable farming knowledge and adoption, soil testing and organic farming practices, pesticide handling and occupational health and safety behaviours, post-harvest waste management, and market sanitation conditions. Data were analysed using descriptive statistics. The majority of respondents were male (87.04%) and had no formal education (63.46%). Although most farmers reported knowledge of environmentally sustainable farming practices (97.70%) and pesticide label instructions (98.00%), corresponding safety practices were poor: only 10.63% reported wearing any personal protective equipment and 1.33% reported using a mask during pesticide application. Eye irritation was the most commonly self-reported health symptom following pesticide exposure (92.69%). Market sanitation infrastructure was similarly inadequate, with 89.00% of respondents reporting an absence of sanitary toilets. These findings indicate a consistent gap between farmers' knowledge and their actual practices across multiple domains of the agri-food system. Strengthening extension services, delivering practical hands-on occupational safety training, and investing in market sanitation infrastructure are recommended to close this gap and support safer, more sustainable farming practices in Bangladesh.

Purpose: The internship period is a critical stage for nursing students to develop professional values. This study aimed to investigate the current status of professional identity among nursing interns, analyze the effects of social support, perceived stress, psychological resilience, and career adaptability on professional identity, and explore the mediating role of career adaptability between social support and professional identity, so as to provide empirical evidence for enhancing professional identity and optimizing nursing talent training systems. Methods: Using convenience sampling, 407 nursing interns from a tertiary hospital in Quanzhou were selected as participants from May to July 2025. Data were collected using a general information questionnaire, the Social Support Scale, the Perceived Stress Scale, the Psychological Resilience Scale, the Professional Identity Questionnaire for Nursing Students, the Career Adaptability Scale, and the Questionnaire for Nurse Intention to Retention Employed. SPSS 26.0 was used for reliability analysis, descriptive analysis, independent samples t-test, one-way ANOVA, Pearson correlation analysis, and multiple linear regression analysis. The PROCESS macro was employed to test the mediating effect. Results: The total score of professional identity among nursing interns was (61.74{+/-}11.08), with 73.5% showing moderate professional identity. Parents' attitude toward nursing, reasons for choosing the profession, personal attitude toward the major, and employment intention showed statistically significant differences in professional identity scores (p<0.05). Pearson correlation analysis revealed that professional identity was significantly positively correlated with social support (r=0.474), psychological resilience (r=0.389), and career adaptability (r=0.609) (p<0.01), and significantly negatively correlated with perceived stress (r=-0.378) (p<0.01). Multiple linear regression analysis indicated that career adaptability ({beta}=0.309, p<0.001) and social support ({beta}=0.383, p<0.001) were significant positive predictors of professional identity, whereas reasons for choosing the profession ({beta}=-3.603, p=0.001) and employment intention ({beta}=-7.116, p<0.001) were significant negative predictors. The model explained 49.2% of the variance in professional identity. Mediation effect analysis showed that career adaptability played a partial mediating role between social support and professional identity, with a mediation effect value of 0.288 (95% CI: 0.221-0.363), accounting for 40.2% of the total effect. Conclusions: Nursing interns' professional identity is at a moderately high level. Social support and career adaptability are positive influencing factors. Career adaptability plays a partial mediating role between social support and professional identity; social support indirectly enhances professional identity by strengthening career adaptability.

Objectives: To analyse how contextual factors shape the delivery of routine Expanded Programme on Immunisation (EPI) services in the urban Mumbunda Health Zone, Democratic Republic of the Congo, from the perspective of head nurses. Design: Multiple case study conducted from May to June 2026. Setting: Seven health areas in the urban Mumbunda Health Zone, Democratic Republic of the Congo. Participants: Seven head nurses selected purposively; four participants took part in additional follow-up interviews. Methods: Semi-structured individual interviews were analysed using reflexive thematic analysis, with systematic within-case and cross-case comparisons. Findings were organised using the four contextual dimensions of Leichter's framework. Results: Nine subthemes and one cross-cutting theme were identified. Situational factors comprised population mobility, seasonality and time constraints that affected access to, and monitoring of, immunisation. Structural factors included peripheral governance, microplanning and information flows; functional staff availability; operational and logistical resources; and community organisation. Cultural factors included professional norms, variable uptake of EPI requirements, perceptions of vaccination and language-related influences on trust. Exogenous factors reflected dependence on decisions at health-zone level and on external resources, alongside the transfer of some routine costs to facilities and health workers. Across all four dimensions, participants described compensatory local adaptations that helped sustain service delivery despite these constraints. Conclusions: Strengthening routine immunisation requires participatory microplanning, predictable financing for routine operational costs and context-sensitive support for facility teams and community health workers. Policy should enable useful local adaptation while reducing reliance on health workers' personal resources to sustain day-to-day service delivery. Strengths and limitations of this study The multiple case design enabled systematic examination of similarities and differences within and across seven health areas in the same urban health zone. Follow-up interviews with four participants were used to clarify, elaborate and refine their accounts. Leichter's framework provided an explicit structure for analysing contextual factors while allowing a cross-cutting theme to emerge inductively. The findings reflect the perspectives of seven head nurses and do not directly represent those of other EPI stakeholders. Data were collected in a single health zone over a limited period, restricting examination of variation across settings and over time.

INTRODUCTIONThe number of people living with dementia in many African countries is anticipated to treble by 2050. However, data from Uganda are scarce, with no published prevalence studies using a comprehensive approach to dementia diagnosis. We used methods developed by the 10/66 Dementia Research Group to estimate dementia prevalence in rural South-West Uganda, and its association with socio-demographics and functional status. METHODSThe cross-sectional study was nested within the General Population Cohort. In Phase 1, all cohort participants aged 60+ underwent cognitive screening. In Phase 2, we invited all those with impaired cognition, 50% with mildly impaired cognition, and 15% with unimpaired cognition for assessment. We also assessed functional status using WHODAS-12, IDEA-IADL and reported care needs. RESULTSOver 80% of eligible participants underwent screening, and of those sampled, over 90% were assessed. Dementia prevalence was 18.6%, and most cases were mild or very mild. Dementia was associated with increased age and lower educational attainment. People with dementia had lower performance at IADLs, but similar levels of disability and care needs. DISCUSSIONDementia prevalence in Uganda is high, affecting nearly 1 in 5 people aged 60 and over. This is higher than most other estimates from the region, particularly others that have used two-phase approaches and clinical DSM diagnoses, which may under-estimate dementia prevalence due to attrition between study phases and cultural variations in reporting functional impairment by informants. Any planned health and social care services for older people should include support for people with dementia and their families.

Background: Care home research often fails to address issues that matter most to residents, families, and staff. Priority-setting exercises can help reduce this lack of inclusivity, but few have received significant resident responses. Objectives: To identify research priorities of UK care home stakeholders (including residents; relatives; care staff, managers and owners; healthcare professionals; policymakers and researchers), and to assess whether these priorities can be addressed using existing research datasets. Methods: PREACH was an 18-month research priority-setting study involving 1063 stakeholders, across 50 care homes, including 381 residents. Participants submitted ideas of what care home research should focus on through 1) care home activity sessions or 2) an online survey. Responses underwent content analysis to identify themes, and these themes were mapped against a national repository of care home trial data. Results: Fifty-one themes were identified. The most frequent priority across all stakeholder groups was access to meaningful activities for residents (22%). Relatives and residents emphasised social connection and day-to-day experience, whereas staff more often highlighted system pressures. No stakeholder-prioritised topics were directly addressable using existing secondary datasets. Conclusions: Collaboration with care home teams to reach large numbers of residents offers a practical route to producing more relevant and timely care home research. Care home stakeholders consistently prioritise quality of life, meaningful activity and staffing over disease-specific or health-focused research. Existing research datasets measure relatively few of the priorities identified by residents, highlighting the need for resident-centred outcome measures and data collection.

Introduction Bubble Continuous Positive Airway Pressure (bCPAP) is an effective intervention for managing respiratory distress syndrome among preterm newborns. However, its successful utilization depends on healthcare providers possessing adequate knowledge and practical skills. In Tanzania, competency-based equipment user training has been introduced to strengthen providers' capacity to use neonatal technologies, including bCPAP. Despite these efforts, there is limited qualitative evidence on how this training influences healthcare providers' competence and routine clinical practice. This study explored the role of competency-based equipment user training in enhancing healthcare providers' skills in utilizing bCPAP devices for newborn care in Dar es Salaam, Tanzania. Methods A phenomenological qualitative study was conducted in three regional referral hospitals implementing the NEST360 programme. Purposive sampling was used to recruit doctors and nurses who had completed competency-based equipment user training. Data were collected through in-depth interviews using a semi-structured interview guide and analysed using Braun and Clarke's thematic analysis approach. Findings Six major themes emerged. Participants described competency-based training as a great approach for improving practical skills, confidence, and clinical decision-making regarding patient selection, device operation, monitoring, and weaning. Participants also reported improved equipment maintenance practices, reduced preventable equipment damage, and stronger collaboration with biomedical engineering professional . The training promoted positive changes in provider behaviour, including greater autonomy, internal mentorship of newly recruited staff, and increased accountability for equipment management. Participants further perceived improvements in neonatal care through earlier initiation of bCPAP, fewer unnecessary referrals, and better management of preterm newborns within their facilities. Conclusion Competency-based equipment user training strengthened healthcare providers' competence and confidence in utilizing bCPAP for newborn care while improving equipment management and interdisciplinary collaboration. Integrating competency-based training into routine newborn care programmes may enhance the effective implementation and sustainability of life-saving neonatal technologies in resource-limited settings.

Modern contraceptive use in Nigeria remains low and unequally distributed. Existing research has extensively examined socioeconomic and demographic determinants, but less is known about how multiple dimensions of disadvantage coexist and relate to contraceptive use. This study identified distinct profiles of cumulative vulnerability among Nigerian women, examined inequalities in modern contraceptive use across these profiles, and assessed changes between 2018 and 2024. We analyzed pooled cross-sectional data from the 2018 and 2024 Nigeria Demographic and Health Surveys, comprising 80,871 women aged 15-49 years. Latent class analysis was used to identify vulnerability profiles based on six indicators of socioeconomic, informational and empowerment-related disadvantage. Survey-weighted and multilevel logistic regression models were used to examine associations between vulnerability profiles and modern contraceptive use, including differences by survey year. Average marginal effects and adjusted predicted probabilities were estimated. Five vulnerability profiles were identified. The extreme vulnerability profile, characterized by predominantly rural residence, limited education, minimal internet and media access, and low decision-making autonomy, was the largest, accounting for 39.2% of women. Its prevalence increased from 38.3% in 2018 to 40.1% in 2024, while the proportion of women in the most advantaged profile increased from 10.4% to 15.7%. Compared with women in the most advantaged profile, those in the extreme vulnerability profile had a 30.9-percentage-point lower adjusted probability of modern contraceptive use (95% confidence interval: -32.8 to -29.0). This difference was 26.5 percentage points (95% confidence interval: -28.4 to -24.7) after accounting for variation between survey clusters. Adjusted contraceptive use increased across all profiles between 2018 and 2024, but substantial inequalities persisted. Evidence of a differential change for the extreme vulnerability profile was present in the survey-weighted model but not in the multilevel model. Modern contraceptive use in Nigeria is strongly associated with cumulative vulnerability. Despite improvements between 2018 and 2024, substantial inequalities persisted across vulnerability profiles. These findings underscore the importance of addressing overlapping socioeconomic, informational and empowerment-related barriers and monitoring contraceptive-use inequalities across population groups.

Abstract Unplanned Extubation is a frequent adverse event in Neonatal Intensive Care Units (NICUs), that is associated with increased morbidity, prolonged hospitalization and financial costs. Evidence suggests that unplanned extubation (UE) is preventable through the management of its risk factors. Many modifiable UE risk factors are directly related to nursing care, thus empowering nurses through education can improve neonatal safety outcomes. This study aimed to evaluate the effectiveness of a structured educational intervention in improving nurses knowledge and practices related to UE in NICUs. A quasi-experimental pretest-posttest study was conducted in two tertiary hospitals in northern Jordan. One hospital is university-affiliated and one is governmental hospital. Participating Nurses in the selected settings received a four-week multimodal educational intervention related to UE. The intervention comprised of face-face session, WhatsApp-based educational messages, educational videos and placement of a poster in the NICU. Knowledge and practices of 58 nurses were assessed at baseline, post intervention and one month later using a validated questionnaire and direct observation. A baseline rate of UE was also measured in both settings with rate of 5 events per 100 ventilator days in the university-affiliated compared to 32 events per 100 ventilator days in governmental hospital. Repeated-measures and mixed-design ANOVA revealed significant improvements in nurses knowledge in both settings with a large effect size (p{superscript 2} = .60). Also, the observed preventive practices scores also improved significantly and remained elevated at one-month follow-up (p{superscript 2} = .50). Older age was associated with lower baseline knowledge, though this was diminished post study intervention. Whereas no demographic variables were associated with practice scores. The high rates of UE highlight the need for quality improvement. Study findings suggest that UE-focused education is a feasible and cost-effective strategy for strengthening neonate nurses competencies regarding safer care for mechanically ventilated neonates in the NICUs.

Background: Digital mental health applications offer scalable pathways to expand mental healthcare access in low and middle-income countries, yet limited evidence exists on factors predicting willingness to use such applications in South Asia. This study examined associations between digital mental health literacy (DMHL), Technology Acceptance Model (TAM) constructs, mental health symptoms, and willingness to use smartphone-based mental health applications among adults in Bangladesh. Methods: Cross-sectional study conducted from February to June 2026 across urban (Dhaka), semi-urban (Chattogram), and rural (Sylhet) divisions of Bangladesh. Adults aged 18-60 years attending primary care facilities with smartphone access (n = 400) completed a face-to-face interview in Bangla assessing sociodemographic, depression (PHQ-9), anxiety (GAD-7), DMHL (6-item scale, = .762), TAM perceived usefulness (5-item, = .937) and ease of use (5-item, = .924), and willingness to use mental health applications (5-item scale, = .946). Hierarchical binary logistic regression examined associations with willingness (dichotomized at mean [&ge;]3.5). Results: Greater DMHL was associated with higher willingness (adjusted odds ratio [aOR] = 1.24, 95% CI: 1.11-1.38). Both perceived usefulness (aOR = 1.29, 95% CI: 1.18-1.41) and perceived ease of use (aOR = 1.17, 95% CI: 1.07-1.28) independently predicted willingness. Anxiety symptoms were positively associated (aOR = 1.08 per 1-point increase, 95% CI: 1.01-1.15), whereas depression symptoms, age, and sex were not independently significant after adjustment for other variables. Conclusions: Digital literacy, perceived utility of technology, and symptom-specific phenomenology but not demographics alone are associated with willingness to use digital mental health applications. Building DMHL, optimizing the usefulness and usability of the app, and overcoming implementation barriers should all be given priority.

BackgroundModern contraceptive use remains low in many sub-Saharan African countries, including Mozambique, limiting progress towards sexual and reproductive health and Sustainable Development Goals (SDGs). Understanding the prevalence, determinants, and inequalities in modern contraceptive use based on Mozambique-wide national survey is critical to informing effective family planning interventions. MethodWe analyzed the most recent data from the Mozambique Demographic and Health Survey (DHS), 2022-2023, focusing on a total of 11,783 reproductive-aged women (15-49 years). The outcome variable was current use of modern contraceptives. Several individual, household-related and community determinants of modern contraceptives were examined employing multivariable logistic regression. Adjusted odds ratio with corresponding confidence intervals and p-values were reported. Erreygers Concentration Index (ECI) and concentration curves were used to assess wealth-and empowerment-related inequalities. All analyses were conducted on weighted data. ResultOverall, 27.6% of women reported current use of modern contraceptive methods. Younger age, higher education, being employed, higher parity, greater wealth, and a partner with higher education were positively associated with modern contraceptive use. Significant wealth-related (ECI = 0.32, p < 0.001) and womens empowerment-related (ECI = 0.26, p < 0.001) inequalities were observed, indicating that wealthier and more empowered women had higher use of modern contraceptive methods. ConclusionModern contraceptive use in Mozambique is suboptimal and influenced by a combination of individual, household, and contextual factors, with marked socioeconomic and empowerment-related disparities. Policy interventions should focus on improving access to and encouraging use of contraceptives for economically disadvantaged and women with low-empowerment, promoting womens autonomy, enhancing male involvement, and leveraging media and community-based programs to increase awareness and uptake. Equity-focused strategies are essential to achieving national and global family planning targets.

Background: Older adults living with mild cognitive impairment (MCI) or Alzheimer's disease and related dementias (AD/ADRD) and their care partners face substantial daily challenges that evolve with disease progression and extend far beyond the clinical setting, including symptom management, care coordination, healthcare navigation, and planning for future care needs. Understanding these challenges is essential for developing innovative solutions to provide ongoing and targeted support. In this study, we explored questions, challenges, and support needs experienced by dementia dyads following diagnosis to inform the development of an artificial intelligence (AI)-based chatbot designed to provide ongoing support for dementia dyads. Methods: We recruited 11 community-dwelling dyads comprising persons living with MCI or mild AD/ADRD and their care partners, one additional care partner, and 12 dementia care experts from academic medical centers, clinics, and aging organizations in the U.S. We conducted semi-structured interviews and analyzed them using conventional content analysis. Results: Participants described interconnected questions, challenges, and support needs that evolved while navigating life with MCI or AD/ADRD. Questions centered around day-to-day care management, medical concerns, behavioral symptom management, diagnosis and prognosis, safety, and resources and services. Challenges included care partner overwhelm, limited dementia knowledge, condition-related uncertainty, healthcare system navigation difficulties, financial constraints, and technology-related barriers. Participants identified needs for ongoing education, personalized care planning, resource navigation, logistical support and follow-up, culturally responsive care, and social and emotional support. Conclusions: Dementia dyads experience substantial informational, emotional, and practical support needs in the early stages of MCI and AD/ADRD. Findings suggest that post-diagnostic support should extend beyond information provision alone to provide ongoing, personalized, and practical guidance that helps dyads navigate changing needs, resources, and everyday dementia care. These findings are informing the development of an AI-based chatbot intended to complement existing dementia care by extending access to education, practical guidance, and resource navigation between clinical encounters.

Per- and polyfluoroalkyl substances (PFAS) and phthalate metabolites are understudied in follicular fluid of women undergoing assisted reproduction. We characterized these in previously collected follicular fluid from patients at a Nebraska fertility clinic (August 2022 to June 2025) and retrieved demographics and clinical characteristics from fertility records. Spearman correlations and nonparametric tests evaluated PFAS and phthalate correlations and exposure differences by age, race, BMI, and urbanicity. Seven PFAS and four phthalate metabolites were detected in at least half of participants. PFOS and PFHxS concentrations were higher in younger women, and mono-isobutyl phthalate (MiBP) was higher in younger and non-White women. PFAS and phthalate correlations were weak, and exposures did not differ by urbanicity, indicating multiple chemical exposures in follicular fluid with sociodemographic disparities.

Menstrual health remains a neglected public health challenge in India, where persistent stigma, incomplete education, inadequate sanitation, and limited access to menstrual health resources can adversely affect health and social participation. Institution-based educational programs represent an underexplored opportunity to improve menstrual health literacy while promoting more inclusive discussions surrounding menstruation. Bridging this gap, an exploratory, prospective educational evaluation was conducted at a hospital in Coimbatore, Tamil Nadu and an engineering college in Wayanad, Kerala. Anonymous pre- and post-course surveys assessed menstrual health knowledge, attitudes, practices, perceived barriers, and perspectives on emerging digital health technologies. Quantitative responses were summarized descriptively, and open-ended responses were reviewed to identify recurring perspectives that contextualized the quantitative findings. The standardized educational program integrated evidence-based menstrual health education with discussions of bioengineering and wearable technologies. Eighty-three participants completed the pre-course survey, 68 attended the educational program, and 20 completed the post-course survey. Because responses could not be linked at the individual level, the survey cohorts were compared descriptively. At baseline, 80 of 82 respondents (97.6%) recognized menstruation as a biological process, yet only 38 of 82 (46.3%) indicated that it was not solely a woman's issue. The mean agreement that menstruation remained taboo was 7.44 of 10 (SD 1.99; n=78), and 51 of 77 respondents (66.2%) reported that they or others avoided activities during menstruation. Painful periods were identified as a barrier by 56 of 67 respondents (83.6%), and 18 of 67 (26.9%) considered institutional or community toilets insufficiently clean and private for menstrual management. Open-ended responses illustrated how pain, fear of leakage, stigma, and inadequate facilities constrained participation in school, physical activity, and social life. These findings document a marked gap between basic biological recognition and the social normalization and practical support of menstruation in two South Indian institutions, and support further evaluation of gender-inclusive, context-responsive menstrual health education using paired assessments, stronger follow-up, comparison groups, and long-term outcomes.

Introduction: Pesticide exposure has been associated with poorer mental health, yet little is known about whether seasonal fluctuations in agricultural pesticide use are associated with cyclical changes in mood among people living in agricultural communities. We evaluated associations between 10 peak and off-peak pesticide spray seasons and ecological momentary assessment (EMA)-derived mood in a floricultural region in Ecuador. Methods: 496 participants completed repeated EMA surveys across 10 assessment administrations over 2.5 years (2022-2024), including one single-assessment administration and nine 10-day bursts (Nobservations=14,332). Mood outcomes included negative affect (sadness, anxiety, stress, anger, tiredness, difficulty concentrating; overall mean=2.79, Standard Deviation [SD]=1.32), positive affect (happiness, motivation; overall mean=4.21, SD=1.60), and behavioral dysregulation (aggression and impulsivity, overall mean=1.86, SD=1.29). Generalized linear mixed models estimated pooled, between-person and within-person associations between peak pesticide spray seasons and mood, adjusting for demographic and longitudinal factors Effect modification by sex, floricultural occupation, and cohabitation with a floricultural worker was assessed. Results: Peak spray seasons were associated with higher negative affect ({beta}=0.11 [0.06, 0.16]) and behavioral dysregulation ({beta}=0.10 [0.05, 0.15]) but not positive affect ({beta}=0.01 [-0.05, 0.07]). Associations were driven by within-person changes. Sex modified associations with negative affect, which were stronger in males than females. Floricultural occupation modified associations, with poorer mood, greater behavioral dysregulation and lower positive affect among floricultural workers than non-workers. Discussion: Peak pesticide spray seasons were associated with worsening of negative affect and behavioral dysregulation. EMA may provide a sensitive approach for detecting short-term neurobehavioral changes associated with seasonal pesticide exposure.

Abstract Objective To estimate the burden and patterns of multimorbidity and cardiometabolic multimorbidity among university employees undergoing a comprehensive health assessment programme, and to examine demographic and behavioural factors associated with multimorbidity. Design Cross-sectional study. Setting A public university in Maharashtra, India. Participants A total of 266 university employees who underwent a comprehensive health assessment were included. Main outcome measures Multimorbidity was defined as the presence of two or more of nine chronic conditions: hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease, chronic kidney disease, thyroid disease, stroke, chronic obstructive pulmonary disease and cancer. Cardiometabolic multimorbidity was defined as the presence of two or more of hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease and chronic kidney disease. Results Hypertension was identified in 119 participants (44.7%), comprising 50 participants with pre-existing hypertension and 69 newly identified during the assessment. Dyslipidaemia was present in 189 (71.1%) and diabetes mellitus in 45 (16.9%). Overall, 108 participants (40.6%) had multimorbidity and 103 (38.7%) had cardiometabolic multimorbidity. The prevalence of multimorbidity increased progressively with age, from 17.5% among participants aged <30 years to 83.3% among those aged [&ge;]60 years. The predominant exact multimorbidity patterns were hypertension with dyslipidaemia alone (49 participants) and hypertension, diabetes mellitus and dyslipidaemia (27 participants). Overall, 173 participants (65.0%) had at least one newly identified hypertension, diabetes mellitus or dyslipidaemia diagnosis. In multivariable logistic regression, age (adjusted OR [aOR] 1.058 per year, 95% CI 1.027 to 1.091), BMI (aOR 1.163 per kg/m2, 95% CI 1.076 to 1.257) and tobacco use (aOR 3.296, 95% CI 1.377 to 7.888) were independently associated with multimorbidity. The model had an area under the receiver operating characteristic curve of 0.731. Conclusion Multimorbidity affected approximately two in five university employees, with cardiometabolic conditions accounting for most of the observed disease clustering. Comprehensive health assessment identified a substantial burden of previously unrecognised chronic disease. Integrating institutional or occupational health assessment with longitudinal primary care follow-up may provide an opportunity for earlier detection, risk-factor modification and coordinated management of multimorbidity. Keywords: Multimorbidity; cardiovascular diseases; hypertension; diabetes mellitus; dyslipidaemia; occupational health; university employees; India

Introduction:Although the COVID-19 pandemic clearly showed the potential consequences of a world without vaccinations, vaccine hesitancy is likely to be more pronounced in the post-COVID-19 era. The introduction of human papillomavirus (HPV) vaccines in this context is likely to raise particular concerns. In Tunisia, decision-makers have prioritized the introduction of HPV vaccine into the immunization schedule. This study assessed individual barriers and facilitators to HPV vaccine acceptability in Tunisia, with the aim of guiding an effective communication strategy for HPV vaccination campaigns in Tunisia and neighboring countries in a post-pandemic context.Methods: Using a qualitative design, we conducted 14 focus groups (FG) with healthcare professionals (HCP) (N=32) and community representatives (CR) (N=89) in five regions of the country. The discussion followed a semi-structured guide designed on the basis of vaccine hesitancy determinants matrix. Transcripts were deductively analyzed according to the 'social processes' and 'thinking and feeling' of the behavioural and social drivers (BeSD) Framework. Inductive approach was used to analyze participants suggestions for promoting HPV vaccination.Results:The FG analysis demonstrated that the historically strong trust in vaccination in Tunisia has weakened after the COVID-19 pandemic. Mistrust of health system and experts, the pandemic management and vaccine mandates measures had negative influence on the vaccine attitudes in a post pandemic Tunisian context. Persistent concerns about COVID-19 vaccines safety were frequently intertwined with widespread distrust of pharmaceutical companies and their profit motives, perceived as imposing inequitable access and lower-quality vaccines on countries in the Global South. These concerns fueled confusion about vaccines side effects. The weakening of immunity was recurring, as well as memory issues, impacts on fertility, and sudden deaths. Regarding information, our research revealed that although digital platforms were perceived as widely used, a significant part of the population interviewed considered public TV channel, as the most reliable source of health information.Conclusions: Emphasizing how the pandemic has shaped individual and collective perceptions and attitudes toward vaccination, our findings underline the importance of leveraging lessons learned from the pandemic to develop a context tailored and coherent communication strategy for successful HPV vaccine implementation.

Background: Approximately 2.5 billion people require assistive products (APs), yet access remains limited partly because of shortages of trained personnel. eHealth tools may help strengthen workforce capacity and translate evidence into practice. The World Health Organization's Training in Assistive Products (TAP) program is an open-access eHealth tool designed to strengthen AP provision. However, its impact on learner outcomes remains insufficiently evaluated. This study assessed the usability and acceptability of the TAP module and changes in self-efficacy in mobility aid provision. Methods: We conducted a quasi-experimental pre-post study with health science students who completed the WHO TAP "Introduction to Assistive Products" module. We assessed usability using the System Usability Scale, acceptability using the Technology Acceptance Model and Theoretical Framework of Acceptability, and self-efficacy using an adapted version of Bandura's Multidimensional Scales of Perceived Self-Efficacy. We analyzed data using descriptive statistics and paired-samples t-tests. Results: Of 53 participants, 33 completed both assessments. Usability exceeded established benchmarks (76.97 +/- 9.66), indicating a positive user experience. Acceptability findings demonstrated favourable responses across domains, with high ratings for ease of use and intervention coherence, and comparatively lower burden scores. Mean self-efficacy increased across all competencies from 2.32 +/- 0.58 before the module to 4.23 +/- 0.36 afterward (p < 0.001), reflecting substantial gains in confidence in AP provision. Conclusion: The eHealth TAP module demonstrated above-average usability and favourable acceptability, while significantly improving self-efficacy in AP provision. These findings highlight the potential for eHealth training implementation to strengthen workforce capacity and bridge training gaps in global health.

Abstract Background There is limited evidence to demonstrate the impact of training community mental health workers beyond knowledge acquisition. This study evaluated the training, workforce performance, and system-level outcomes of the Hamdard Force, a community mental health intervention, implemented in two districts of Khyber Pakhtunkhwa, Pakistan, as part of a multi-tiered, digital MHPSS service over 8 months. Methods We followed a multi-level evidence approach, guided by the New World Kirkpatrick Model, using a mixed-methods design that combined quantitative and qualitative indicators. We assessed participants' reactions, learning, behavioral outcomes, system-level outcomes of the intervention, and conducted Focus Group Discussions to identify contextual factors that influenced implementation. Results At Tier 1, a total of 403 community workers were trained, who reported satisfaction with the training content and relevance, and demonstrated significant improvement in knowledge post-training. Less than half of the trained workforce remained active in the field and referred people with mental healthcare needs under supervision. A total of 855 people were triaged by clinical psychologists at Tier 2 of the service model, and 549 cases met the criteria of being valid. The results of detailed clinical assessment and management demonstrated encouraging outcomes regarding the effectiveness of the intervention, both at the individual case and at the system-level. The Focus Group Discussions revealed the process of supervision, organizational support and digital tools of learning were significant drivers of the intervention. Challenges with internet connectivity, limited digital literacy, and persistent mental health stigma were identified as implementation barriers. Conclusion Overall, the integrated findings suggest that the intervention helped to build the capacity of the workforce, facilitated their performance through supervision, provided services through a task-sharing approach and strengthened referral pathways. These findings underscore the importance of implementation-focused evaluations for scaling up community mental healthcare in low-and middle-income countries.

BackgroundMultimorbidity is common among U.S. skilled nursing facilities (SNFs) residents and complicates pharmacologic management, yet real-world evidence on treatment patterns in this population remains limited. This study evaluated medication order rates and identified resident- and facility-level factors among SNF residents with multimorbidity. MethodsRetrospective, observational study using electronic health record (EHR) data from PointClickCares Life Sciences database. Participants were 728,222 residents active in a U.S. SNF on April 30, 2025 with at least one documented diagnosis of hypertension, hyperlipidaemia, type 2 diabetes (T2D), depression, or Alzheimers disease and related dementias (ADRD). The outcome was presence of guideline-recommended medication order for each condition, modelled with modified Poisson regression to estimate adjusted prevalence risk ratios (RRs) and 95% confidence intervals. ResultsMedication order rates were 79% for ADRD, 79.1% for T2D, 87.7% for hypertension, 83.3% for hyperlipidaemia, and 90.8% for depression. Rates varied across comorbidity combinations: ADRD was associated with lower medication order prevalence, while cardiometabolic multimorbidity profiles associated with higher prevalence. Black/African American identity had the lowest likelihoods of a medication order for 3 of 5 conditions (RRs of 0.93 to 0.92), while having hypertension or hyperlipidaemia medication order was associated with higher likelihood of having orders for 3 of remaining 4 conditions (RRs of 1.02 to 1.19). ConclusionsMost SNF residents with multimorbidity had a medication order for common chronic conditions, although important variability and disparities remain. Differences by comorbidity profile and social context underscore the need for targeted strategies supporting equitable, integrated prescribing and person-centred care in SNFs.

Recent industry surveys have reported widespread concern about mental health, working conditions, and harassment in the UK film and television industry, but no peer-reviewed empirical study has examined the determinants of occupational burnout in this workforce. The present study tested whether physical health, mental wellbeing, perceived public stigma, intrinsic job quality, and sexual harassment exposure predict burnout in industry professionals. A cross-sectional online survey was completed by 415 individuals across more than 100 job titles, with 286 also completing an optional harassment module. Mental wellbeing sat well below population norms, with 68% scoring in the range indicative of probable depressive symptoms and 82% in the high-exhaustion range on the Maslach Burnout Inventory General Survey. Mental wellbeing and intrinsic job quality were the strongest predictors of burnout (R2 = .56), with meaningfulness accounting for most of the job-quality effect. Working hours independently predicted emotional exhaustion. Harassment exposure was associated with burnout in women but not men, approximately 30% mediated by mental wellbeing; sexist behaviour directly predicted exhaustion in women. Workers with a disability reported higher stigma. Burnout was strongly associated with intent to leave, and the findings collectively indicate an industry-wide occupational health concern requiring structural rather than individual-level intervention.