Frontiers in Public Health

Background: Health and administrative professionals in tertiary hospitals face high levels of occupational stress, mental illness, and multimorbidity. The integrated measurement of these multidimensional health aspects is essential for informing effective workplace health promotion strategies. Objective: To describe the general health status of federal public hospital staff and correlate the measured health dimensions to inform institutional health promotion initiatives. Methods: A cross-sectional, online survey study was conducted at Hospital Universitario dos Servidores do Estado (HUSE) between November and December 2025. Data collection was performed via online REDCap questionnaires covering sociodemographic profiles and validated instruments (SRQ-20, MIDAS, AUDIT, WHOQOL-BREF, PHI, WHOQOL-SRPB BREF, CBI, GPAQ, and EPSO). Descriptive statistics, comparisons across employment ties (permanent vs. contracted staff), and Spearman correlation matrices were calculated. Results: Among 197 accesses, 117 completed the informed consent, and 86 finished all questionnaires. Participants were predominantly female, aged 40 to 60 years, and Christian. Screening positivity was 25% for common mental disorders, 21% for headache-related disability, and 10% for harmful drinking. Burnout scores clustered in the second quartile, while quality of life, happiness, and spirituality scores were in the upper third. Median physical activity was 670 min/week. Mental symptoms (SRQ-20), headache (MIDAS), and burnout (CBI) correlated positively with each other and negatively with quality of life, happiness, spirituality, and institutional support (EPSO). Conclusion: The set of instruments proved feasible for situational health diagnosis among hospital staff. Although the sample size was limited in this baseline wave, the initiative fostered workplace health awareness, driving concrete initiatives, including an on-site functional gym and workplace vaccination campaigns.

Objectives: Heatwaves drive surges in acute care demand, yet heat-health action plans (HHAPs) lack tools to scale emergency care responses. This study validated a forecasting tool for heatwave-related emergency department (ED) demand across four clusters comprising the emergency care network of Ticino Canton, Switzerland. Methods: This retrospective, ecological, time-series study modeled daily mean temperature and ED presentations using a distributed lag non-linear model framework with autoregressive and calendar adjustment components. The model was trained on summers (June-August) 2016-2024 and tested on summer 2025, defining heatwaves as daily mean temperature >25 {degrees}C for [≥]3 consecutive days. Results: A non-linear temperature-demand association was shown across the clusters, with ED visits increasing at higher temperatures. Model fit varied across clusters (R2 0.389-0.672), and the reference model consistently outperformed naive baselines. During two heatwaves in 2025, prediction errors remained within acceptable ranges. Baseline demand, heatwave occurrence, and model performance varied substantially within the canton. Conclusions: These findings have implications for the design of HHAPs, suggesting that emergency care preparedness should rely on locally calibrated demand forecast rather than standardized activation protocols.

Atopic dermatitis (AD) is a chronic inflammatory skin condition with a multidimensional burden. This study aimed to estimate the socioeconomic burden of the pediatric and adult population with AD in Argentina and explore the health system's response to their needs. We employed a mixed-methods approach, combining a cross-sectional cost-of-illness analysis with a qualitative component to comprehensively assess the social and economic impact of atopic dermatitis in Argentina. We collected data from a survey, focus group and in-depth interviews conducted in Argentina between May 2023 and September 2023. We recruited adult patients and caregivers of children with AD below 18 years of age. We used multivariable ordinal regression to assess associations between sociodemographic and clinical characteristics and burden associated with AD. 1471 subjects participated in the pediatric analysis, and 1412 in the adult analysis. The average annual per capita cost was USD 2639 for adults with AD and USD 8682 for children with AD. Costs increased significantly with disease severity in both groups and were strongly associated with patients' quality of life. Patients and caregivers highlighted the poor response of the health system in terms of adequate and timely access, as well as comprehensive care of the disease. Patients and caregivers suffer from a significant economic burden and quality of life impact associated with AD, which requires urgent attention and comprehensive support from the healthcare system to improve their lives.

Background. Public-health use of influenza surveillance - situational awareness, planning for clinical surge, and issuing advisories or warnings - needs more than an accurate point estimate of next week's count. What matters operationally is whether a rise is caught early, whether the direction of change is right, and whether an alert threshold is about to be crossed, all with honest uncertainty. For such use a forecast must also respect reporting delay, later data revision, and the calibration of its prediction intervals. Using Japan's sentinel surveillance, we evaluated short-term probabilistic forecasts that respect the data release history, and we measured what adding other surveillance series contributes, focusing on the properties that matter for public-health decisions. Methods. The target was the number of influenza reports per sentinel site in each of the 47 prefectures. For each forecast we predicted, as quantiles, the value 1-4 weeks after the most recent observed week. We compared three models: a ridge regression trained jointly across prefectures; a gradient-boosting quantile regression (GBQR) that learns from many surveillance series; and their equal-weight combination on the log scale. Six seasons were used to develop the models. The 2025/26 season was held out as a temporal evaluation period after the specification was fixed; because its epidemic profile had already been seen, it is not a fully independent prospective test. We scored forecasts with the weighted interval score (WIS) and checked prediction-interval coverage. For the Japanese target series we used the value first published for each week; some auxiliary series were taken as retrieved and therefore include later revisions. Results. In 2025/26, the combination's WIS relative to a persistence forecast was 0.841, 0.811, 0.794 and 0.818 at horizons of 1-4 observed weeks - that is, 16-21% lower than persistence. Coverage of the 80% prediction interval was 79.7%, 77.1%, 74.5% and 75.1%, and of the 95% interval 94.3%, 93.4%, 92.6% and 91.8%. Adding auxiliary series improved the GBQR over the development period. However, on the original scale the combination's edge over ridge regression was not statistically clear, and in some low-level rising phases the combination did worse than ridge. Conclusions. Over the period studied, models that share information across regions scored better than a persistence forecast. For public-health use, however, the operative questions are the real lead time once reporting delay is accounted for, whether rises from low levels and threshold exceedances are caught in time, and whether the upper prediction intervals are wide enough; on these, the present evidence is not yet sufficient. The 2025 change to the sentinel system also means that pre-change advisory and warning thresholds cannot be read mechanically. A prospective evaluation with strictly controlled data availability is needed before such forecasts are used to support advisories or planning.

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

Background: General illness-related sick leave among teachers represents a relevant public health and workforce management issue. However, long-term population-based evidence describing its distribution and associated factors in Latin American urban educational systems remains limited. This study aimed to characterize the occurrence, distribution, duration, and sociodemographic, occupational, temporal, and territorial factors associated with general illness-related sick leave among public school teachers in Bogota between 2010 and 2025. Methods: A retrospective cohort study was conducted using integrated administrative databases from the Bogota District Department of Education. The primary outcome was the occurrence of at least one general illness-related sick leave episode in a teacher-month observation. Descriptive analyses were performed to characterize sociodemographic and occupational patterns. A multivariable logistic regression model was used to estimate associations. Month and year were included as temporal fixed effects to account for seasonal patterns, academic-calendar effects, pandemic-related disruption, and secular changes. Results: The cohort included 59,697 unique teachers, contributing 537,025 teacher-year observations from teachers with an active employment record between January 1, 2010, and July 31, 2025. Overall, 41.59% of teacher-year observations included at least one general illness-related sick leave episode, and 83.26% of teachers had at least one episode at any time during follow-up. Respiratory diseases accounted for the largest share of episodes, followed by musculoskeletal and infectious diseases. Mean duration varied substantially by diagnostic category, ranging from short respiratory and infectious episodes to longer absences related to neoplasms, circulatory diseases, injuries, and mental health conditions. In the multivariable teacher-month model, sick leave occurrence was associated with age, sex, occupational role, teaching area, contract type, locality, calendar month, and calendar year. Lower odds were observed among male teachers, principals, and teachers with provisional contracts, while temporal and territorial variation was observed across months, years, and localities. Conclusions: General illness-related sick leave among public school teachers in Bogota showed consistent sociodemographic, occupational, temporal, and territorial patterns. Respiratory and musculoskeletal conditions accounted for the largest share of episodes, while chronic, neoplastic, injury-related, circulatory, and mental health conditions were associated with longer durations. These findings provide population-level evidence to inform occupational health surveillance, seasonal preparedness, and workforce planning strategies within urban educational systems.

Introduction: Antimicrobial resistance poses a major global health threat, yet evidence on its economic impact in low- and middle-income countries remains limited. This study estimated the economic burden of infections caused by ESBL-producing Escherichia coli (E. coli), a key resistant pathogen, in Laos. Methods: A prospective cost-of-illness study was conducted among patients with laboratory-confirmed infections in Setthathirath hospital in Vientiane, Laos, collecting cost data through repeated interviews and medical records. Descriptive analyses and econometric modeling approaches, including inverse probability weighting (IPW) and instrumental variable (IV) analyses, were used to estimate out-of-pocket expenditures, public expenditures, total cost of illness, and length of stay, accounting for potential confounding. Results: ESBL-producing E. coli was consistently associated with higher economic burden across all analyses. The unadjusted per-patient cost was US$ 689.0 for ESBL-producing E. coli, compared with US$ 489.4 for non-ESBL-producing E. coli and US$ 537.6 for non-E. coli. The association remained statistically significant for out-of-pocket cost after IPW-adjustment (US$156.2; 95% CI, 14.3 to 298.1; P = 0.03), while other outcomes were not statistically significant. Instrumental variable analyses showed consistent directional effects but with wide confidence intervals and no statistically significant differences. Conclusions: Findings suggest that ESBL-producing E. coli may be associated with increased economic burden in Laos; however, this association was not consistently statistically robust across analytical approaches. These findings suggest a potential economic impact of ESBL infection, although uncertainty remains regarding the magnitude of the effect. Strengthening antimicrobial stewardship, infection prevention and control, and improved diagnostic capacity remain essential to mitigate the potential AMR burden.

Nineteen individuals with diverse public health leadership experience across different levels and domains, from countries with varying levels of economic development, and who have direct involvement in crises were interviewed. A concise literature review was conducted, examining the intersection of politics and public health leadership, as well as a brief review of relevant existing leadership courses, training programs, and fellowships. The interviews were transcribed in full, anonymized, coded (total 1104 coded excerpts, 762 discrete excerpts), and used as the basis for analyzing findings. Our research identified four thematic areas at the intersection of public health and political leadership in public health crises: attributes and skills; role of and threshold for political engagement; structural elements underpinning effective public health response; and modalities for building public health leadership. Public health leaders need to learn core skills, especially effective communication, diplomacy, and advocacy, and cultivate key attributes, especially integrity and humility, that support their ability to engage with political decision makers. Political leaders need to contribute productively ways, and at the appropriate time, to ensure societal cohesion and facilitate a well-resourced multisectoral response with public health at its core. Pre-established relationships and coordination mechanisms can play a supporting and productive role when crises strike. Strategies that incorporate experiential learning, peer collaboration, and mentorship are central to building the skills public health leaders need to succeed in crises. Many tangible steps can be taken to foster and support public health leadership including: integrating the political dimensions of public health into public health education; tailoring public health trainings to include practical skills such as stakeholder engagement, effective communication, negotiation, policy advocacy, and community engagement; creating supportive ecosystems through peer, mentor, and fellowship approaches; and advocating for strengthening the structural interface between politics and public health.

Background: Overuse of antibiotics accelerates antimicrobial resistance (AMR), threatening public health. Poland faces challenges with high antibiotic use; therefore, understanding people's antibiotic-related behaviours and beliefs would help identify targets for interventions. This study aims to identify sociodemographic and psychosocial correlates of antibiotic use among a representative sample of adults in Poland. Methods: The study employed an exploratory survey design. Adults in Poland (N=1,000) were randomly sampled, ensuring the representativeness of the Polish general population. Data were collected using a pretested questionnaire, administered through computer-assisted telephone interviews. Quantitative data were analysed descriptively and using a logistic regression. Free-text data were analysed using content analysis. Results: 31.6% of respondents used oral antibiotics in the preceding year, most commonly for respiratory tract infections (RTIs). Higher age, higher household income level, and education level were identified as predictors of increased antibiotic use, with increasing age being the most prominent factor. The belief that antibiotics accelerate recovery from RTIs and expectations for antibiotic prescriptions were found to be associated with greater antibiotic use. Encouragingly, 92.9% of respondents reported trusting their doctors, 51.5% that doctors explained why antibiotics were unnecessary for particular infections, and 57.1% were willing to engage in such discussions. While 76.5% of respondents reported awareness of antibiotic resistance, descriptions of the concept were often flawed. Conclusions: Key areas of focus for future interventions include addressing attitudes and behaviours of middle-aged (35-65) and older (66+ years old) adults, managing patient expectations regarding recovery and prescriptions, and correcting fundamental misconceptions about AMR.

Kuwait's government funded universal healthcare system faces escalating fiscal pressure from a high non communicable disease burden, rapid population growth, and sustained capital investment under Kuwait Vision 2035. No peer reviewed study has previously produced quantitative, scenario based fiscal projections for Kuwait's healthcare sector denominated in Kuwaiti dinars and benchmarked against gross domestic product. This longitudinal secondary analysis draws on the WHO Global Health Expenditure Database, World Bank national accounts, and Kuwait Ministry of Health statistical reports to document Kuwait's government healthcare expenditure trajectory from 2020 to 2024 and construct three scenario based fiscal projections through 2035 using a deterministic modelling approach with explicit, fully documented parameters. Government healthcare expenditure grew from KWD 1.48 billion (5.0% of GDP) in 2020 to KWD 2.22 billion (5.2% of GDP) in 2024, a nominal increase of 50%. Under the baseline scenario, expenditure is projected to reach KWD 4.83 billion (6.9% of GDP) by 2035, with a worst case trajectory of 7.9% of GDP in a sustained low oil price environment. Six principal cost drivers are identified, with non communicable disease burden constituting the most significant structural driver projected to account for 40 to 45% of total health expenditure by 2035 in the absence of intervention. The combined implementation of 15 evidence based policy recommendations spanning fiscal reform, system efficiency, and non communicable disease prevention is projected to contain the health to GDP ratio 0.7 to 1.2 percentage points below the baseline trajectory by 2035, yielding annual fiscal savings of KWD 490 to 840 million. These findings provide the first quantitative fiscal forecast for Kuwait's healthcare sector and offer a directly applicable policy framework for all six Gulf Cooperation Council states.

Introduction: Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region of both women and men. Sexual dysfunction remains among the most debilitating and overlooked consequences of the disease, as available patient-reported outcome measures are either restricted to one sex or capture sexual health only partially. The aim of the present work is to validate the Qualisex questionnaire (in its the Italian version) in patients with LS and to evaluate its psychometric properties, factor structure, convergent, discriminant validity, and sex symmetry. Methods: A cross-sectional study was conducted on 211 patients (167 women, 44 men; mean age 52.9 years) with a confirmed diagnosis of LS. Participants completed the Italian Qualisex, Skindex-29, DASS-21, and sexual-health-specific scales, the Female Sexual Function Index (FSFI) for women, and the International Index of Erectile Function (IIEF) for men. Construct validity was assessed via Principal Component Analysis (PCA), and reliability via Cronbach's alpha. Convergent and discriminant validities were evaluated against standard psychometric batteries. Results: Item 2 was removed due to low communality (0.167). PCA on the remaining 9 items revealed a two-factor structure accounting for 72.5% of total variance: Component 1 (Sexual Functioning and Satisfaction, 59.89%) and Component 2 (Partner Devaluation, 12.66%). Internal consistency was high (alpha= 0.911 overall; alpha= 0.841 in women; alpha= 0.899 in men). Qualisex scores correlated strongly with Skindex-29 Social Functioning (r = 0.582) and Emotions (r = 0.531) subscales, as well as FSFI (r = -0.391) and IIEF (alpha= -0.566). Discriminant validity was supported by low-to-moderate correlations with DASS-21 domains (r < 0.38). While FSFI and IIEF showed significant negative correlations with age (p = 0.002), Qualisex remained age-independent across sexes (p > 0.05). Conclusion. The 9-item Italian Qualisex is a reliable, sex-symmetrical, and age-independent patient-reported outcome measure for assessing sexual health impairment in LS, successfully isolating disease-specific distress from physiological aging and general distress.

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.

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: Three San Francisco health system emergency departments have developed Geriatric Emergency Department (GED) models of care programs supporting and providing care for emergency department (ED) patients at risk for or living with dementia. Each system recognized: 1) the high proportion of older adult ED patients and those at risk for dementia, 2) the need to identify cognitive impairment in older adult ED patients, 3) the importance of developing approaches to connect older adult ED patients and their care partners with resources and diagnostic specialty services. Methods: We describe how each hospital adopted and implemented pragmatic GED models of care to support and improve care for ED patients at risk or living with dementia. We also report the proportion of ED encounters made by patients with dementia histories and the number of these reached by GED programs. Results: Three San Francisco hospitals (a tertiary care, critical access, and large integrated health system-community ED) independently implemented GED programs to support and enhance emergency care for patients living with dementia. Each uses screening and assessment tools to identify patients at risk for cognitive impairment. Each captures screening and assessment data to facilitate care and resources for post-discharge care, ensuring coordinated transitions and support for older adults. Programs varied by target patient population age and staff and resource allocation to support program goals. Site-specific pathways differed by location, patient populations, and support from geriatrics, emergency medicine, palliative medicine, neurology, psychiatry, pharmacy, referral processes, and/or pastoral care. Conclusions: Developing GED care interventions that facilitate care for patients at risk of or living with dementia is possible and sustainable when the pathway aligns with health system leadership goals through persistent value demonstration, communication, and promotion. Ultimately, developing and disseminating models of GED care is designed to address geriatric syndromes inclusive of dementia care through continuous quality improvement.

Background: Hypertension (HTN) and Type 2 diabetes mellitus (T2DM) are leading drivers of the global cardiometabolic disease burden and major contributors to preventable morbidity and mortality. In Hong Kong, where population ageing and lifestyle-related risk factors are increasingly prevalent, both conditions and their complications pose substantial challenges to the healthcare system. Although territory-wide prevalence figures are available, small area district-level evidence on the burden of these diseases and their associated complications remains limited. Disparities are likely due to heterogeneity in demographic composition, socioeconomic status, and primary care accessibility across Hong Kong's eighteen administrative districts. There is also a lack of accessible, age-adjusted, district-level disease visualization in Hong Kong. Objectives: This study estimates the age-standardized prevalence rates (ASPR) of HTN, T2DM, and their associated complications across the eighteen districts of Hong Kong, formally evaluate the statistical significance of inter-district disparities, and rank the districts according to disease burden to inform place-based health planning. Methods: This study analyzed the prevalence of chronic diseases from 2014 to 2023 in 18 districts among an adult cohort aged equal or above 35 years using data collected from the Hong Kong Hospital Authority (HA) electronic health records, using the International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes, the International Classification of Primary Care (ICPC) codes, and the disease flags to identify diseases. Sample weights are used to reflect the total population. HTN, T2DM, and their major complications were identified according to standardized diagnostic criteria. ASPR were calculated for each district with the WHO World Standard Population as the standard. Inter-district disparities in disease prevalence were assessed using Cochran's Q test, with statistical significance set at P <0.05. The slope index of inequality (SII) was also used to analyze the socioeconomic inequality between districts. Districts were subsequently ranked according to their ASPR for each condition to identify high-burden and low-burden areas. Results: 1,756,521 patients (52.71% females) contribute 9,906,729 patient-years from 2014 to 2023. Substantial inter-district variation and increasing trend were observed in the ASPR of HTN, T2DM, and their complications. The weighted ASPR of HTN varied by 27.3% from 46,701 (95% CI: 45,691-47,711) per 100,000 population in Tsuen Wan district to 59,445 (95% CI: 58,759-60,130) per 100,000 population in Yuen Long district, and the weighted ASPR of T2DM ranged from 20,464 (Tsuen Wan, 95% CI: 19,803-21,124) per 100,000 population to 28,275 (Yuen Long, 95% CI: 27,792-28,758) per 100,000 population across the districts in 2023. All diseases showed district disparities (all P <0.05). Cochran's Q test demonstrated statistically significant disparities across districts and showed no convergence through the period. The SII test also showed the most serious inequality exists in HTN, with the lower socioeconomic position districts have more burden. Conclusion: Significant geographic disparities exist in the prevalence of HTN, T2DM, and their complications across Hong Kong's eighteen districts. These findings highlight the need for district-specific public health strategies, equitable allocation of primary care resources, and targeted chronic disease prevention and management programs in high-burden areas.

Background Translation of tuberculosis (TB) biomarker and diagnostic research into tools that improve patient and public health outcomes has been slow, partly because no internationally agreed framework exists defining the use cases that new biomarkers and tests should address. We aimed to identify, validate, and prioritise use cases for TB biomarkers and tests across Mycobacterium tuberculosis (Mtb) infection, TB disease, TB treatment, and post-TB care, through an international consensus process. Methods and Findings We conducted a scoping review of the literature, guidelines, and target product profiles (24 documents; 69 candidate use cases consolidated to 13), followed by a hybrid RAND/UCLA modified Delphi consensus process involving 185 identified interest-holders, including clinicians, researchers, diagnostic developers, industry, funders, civil society, national TB programmes, and policymakers (including WHO representatives). Interest-holders completed an online survey rating agreement with each use case, and attended a consensus meeting to discuss use cases with less than 80% agreement, followed by a further validation meeting. Eleven use cases were retained across four TB care pathway stages: three for Mtb infection, four for disease detection, three for treatment optimisation, and one for post-TB care. Highest-priority use cases were detection of drug-resistant TB, prediction of progression from infection to disease, identification of current Mtb infection, and improved diagnosis of active TB disease. Conclusions This consensus exercise provides the first comprehensive, prioritised framework of use cases for TB biomarkers and tests, spanning the full care pathway. These eleven priority use cases can guide investment, focus biomarker discovery, and inform future target product profiles, funding calls, and policy development. Applying the framework to the current biomarker pipeline is a key next step to address gaps between innovation and priority needs.

Background: Patient safety learning systems operate primarily at the national level, yet the potential for international sharing of safety intelligence remains largely unrealised. Other safety-critical industries, including civil aviation, nuclear power, and rail, have developed international incident reporting and learning systems whose design principles may offer transferable insights for healthcare. Objective: To explore the views and experiences of safety-critical industry experts regarding the purpose, key functions and features, transferability, barriers, enablers, and incident priorities of a potential international patient safety learning system. Design: Qualitative phenomenological study using semi-structured key informant interviews analysed with the five-stage framework analysis method. Participants: Eleven international experts purposively sampled from safety-critical industries (healthcare, civil aviation, maritime, and railway) across six countries. Interviews were conducted by telephone or internet-based audio call between May and September 2019. Results: Seven themes were identified: (1) purpose of an international patient safety learning system; (2) key functions; (3) key features; (4) transferability of learning; (5) enablers; (6) barriers; and (7) patient safety incident types appropriate for international sharing. Rare and emerging event detection emerged as the most distinctive value of an international system, a capability that cannot be replicated at national level. Critical functions included robust feedback loops, multidisciplinary analytical capability, and actionable recommendations. Key barriers, including blame culture, inter-organisational mistrust, and cross-border privacy legislation, were each amplified at the international level relative to their national-level equivalents. Conclusions: This study provides the first cross-industry qualitative account of design requirements for an international healthcare patient safety learning system, highlighting transferable lessons from established industries alongside healthcare-specific challenges that require bespoke solutions.

Objectives: A previously published conceptual mapping review integrated fragmented evidence on dental anxiety (DA) into a broader conceptual model of potential causes and consequences. This study focused on consequences, extending from oral health-related behaviours through oral disease to systemic health, and empirically evaluated these hypothesized relationships on the population level. Methods: Cross-sectional data from the 46-year follow-up of the Northern Finland Birth Cohort 1966 (n = 1,859) were analysed using structural equation modelling. DA was modelled as a latent construct; delayed/problem-oriented dental attendance and home oral care as behavioural proxies; periodontal disease burden as the percentage of sites with probing pocket depth >=4 mm; and cardiovascular risk as a Framingham-based risk score. Generalized anxiety, sex, and education were covariates. Smoking-stratified multigroup analyses assessed model robustness. Results: The prespecified associations were observed across behavioural, periodontal, and systemic-risk domains. Higher DA was associated with more delayed/problem-oriented attendance and poorer home care; both were associated with greater periodontal disease burden, which in turn was associated with higher cardiovascular risk. Model fit was good (chi-square(119) = 529.98, CFI = 0.962, TLI = 0.951, RMSEA = 0.043, SRMR = 0.051). The overall association between DA and cardiovascular risk was small (beta = 0.066, p = .004), with a small decomposed indirect association (beta = 0.013, p = .006) and a remaining direct association (beta = 0.053, p = .022). Smoking-stratified multigroup comparisons found no differences in the structural associations by smoking status. Conclusions: This population-based evaluation provides preliminary empirical support for the conceptual model. Findings extend the relevance of DA beyond dental attendance and oral health outcomes to a broader oral-systemic public-health context. Cross-sectional data cannot establish temporal or causal ordering; longitudinal replication is needed.

Occupational ocular injuries are a preventable yet neglected public health problem, particularly in low- and middle-income countries. Maintenance workers are exposed to diverse ocular hazards daily, yet compliance with protective measures is consistently poor. A descriptive cross-sectional study was conducted among 85 maintenance workers at the Maintenance and Essential Services Organization (MESO) of Kwame Nkrumah University of Science and Technology (KNUST), Ghana, recruited through stratified convenience sampling across seven occupational sections. A structured questionnaire assessed knowledge of ocular hazards and protective equipment, attitudes toward ocular safety, and safety practices. Data were analyzed using IBM SPSS version 26 (IBM Corp., Armonk, NY, USA); chi-square and Fishers exact tests assessed associations (p < 0.05). Participants were predominantly male (84/85, 98.8%), with a mean age of 44.5 {+/-} 10.4 years. Overall knowledge was good (mean 9.40 {+/-} 1.59 out of 11), but attitude and practice scores were average (2.78 {+/-} 0.92 and 3.27 {+/-} 0.93, respectively). Most workers correctly identified goggles and face shields as protective, but only about half recognized that ordinary sunglasses and spectacles offer inadequate protection. Although 97.6% (83/85) recognized the need for ocular protection, only 7.1% (6/85) reported consistent protective eyewear use, and fewer than half (45.9%, 39/85) had received formal ocular safety training. Routine general protective equipment use was significantly associated with ocular protection use (Fishers exact test, p = 0.011). Sand and dust particles were the leading causes of injury and only 25% (5/20) of injured workers sought formal care. Workers demonstrated good knowledge but poor attitudes and practices toward ocular safety, suggesting that knowledge alone does not translate into protective behaviour even within a relatively well-resourced institutional setting. Findings suggest that limited access to task-appropriate protective eyewear may represent an important institutional barrier. Institutional PPE supply and section-specific safety training are essential to bridge this knowledge-practice gap.

Abstract Background: In Pakistan approximately 7 million people were living with diabetes in 2014. To address the burden of diabetes, a randomized controlled trial was conducted to evaluate the effectiveness of a standardized care package in improving diabetes outcomes in health care settings of Punjab, Pakistan. A costing study was embedded within this RCT to estimate the cost-effectiveness of the standardized diabetes care package in improving diabetes outcomes. Methods: 166 patients were recruited for the costing study from 14 public health clusters in Sargodha district of Pakistan. Analyses was conducted using the societal perspective, broader societal perspective and sensitivity analyses to explore the uncertainty in analyses. Data was analysed for both 166 participants enrolled in costing study and for the 495 participants recruited in the cRCT, using multiple amputations. Results: Using the societal perspective, standardized diabetes care package was found to be cost-effective as compared to the standardized care and was cost saving as the costs in the intervention arm were lower than those in the control arm whereas greater effects were demonstrated in the intervention arm. As per the broader societal perspective and the healthcare perspective only, the standardized care package was not proven to be cost-effective. Keywords: Diabetes management, health services cost, out of pocket cost, cost-effectiveness.