Frontiers in Public Health

Ambulatory Care Sensitive Conditions (ACSCs) are conditions for which effective and timely primary health care (PHC) can prevent hospitalizations. They are widely used as a proxy indicator of access to and quality of PHC. Despite their relevance, evidence from Central America remains scarce. This study aimed to quantify the burden, describe the epidemiological profile, and assess temporal trends of ACSCs hospitalizations in Honduras from 2014 to 2024. We conducted a retrospective observational study using national administrative hospital discharge data from all Ministry of Health hospitals. ACSCs were defined using a standardized list of 20 diagnostic groups based on ICD-10 codes. We estimated percentages and sex-age-standardized hospitalization rates per 10,000 inhabitants. Clinical indicators included length of stay (LOS) and in-hospital fatality rates. Temporal trends were evaluated using joinpoint regression models to estimate annual percent changes (APC). Analyses included stratification by age, sex, and disease category. A total of 4,023,944 hospitalizations were analyzed, of which 547,486 (13.6%) were classified as ACSCs. The overall sex-age-standardized rate was 54.1 per 10,000 inhabitants. ACSCs' standardized rates increased between 2014 and 2018 (APC: 2.7%; 95% CI: -2.4; 15.2), declined sharply between 2018 and 2021 (APC: -17.8%; 95% CI: -30.6; -10.3), and increased again between 2021 and 2024 (APC: 15.9%; 95% CI: 4.6; 37.6). Despite this rebound, rates remained below pre-pandemic levels. ACSCs were concentrated among children under 5 years (27.7%) and adults aged 60 years and older (29.9%). Noncommunicable diseases accounted for 56.8% of cases, with diabetes mellitus as the leading cause. Compared with non-ACSCs hospitalizations, ACSCs were associated with longer LOS (4.9 vs. 3.9 days; p <0.001) and higher in-hospital fatality rates (2.4% vs. 1.7%; p <0.001). ACSCs hospitalizations constitute a substantial burden in Honduras and reflect persistent gaps in PHC performance. Strengthening PHC resilience and capacity, particularly for chronic disease management and vulnerable populations, is essential to reduce avoidable hospitalizations and improve health system efficiency and equity.

Based on the 2023 Global Burden of Disease (GBD) database, this study analyzed the global burden of preterm birth from 1990 to 2023 and predicted its development trend by 2050, while exploring the disparities in disease burden across regions with different Socio-demographic Index (SDI) levels, income groups and countries. A retrospective trend analysis was conducted to collect data on preterm birth incidence, prevalence, death and disability-adjusted life years (DALYs) in 204 countries and regions worldwide from 1990 to 2023 from the GBD 2023 database. ARIMA model (p=2,d=1,q=1) and grey prediction model (GM(1,1)) were combined to predict the preterm birth burden from 2023 to 2050. In 2023, preterm birth was the primary cause of the global neonatal disease burden, with its four core indicators significantly higher than other neonatal diseases. From 1990 to 2023, the global incidence, death and DALYs of preterm birth decreased to 0.91, 0.44 and 0.52 times of the 1990 levels respectively, while the prevalence increased to 1.54 times of the baseline. Projection results showed that by 2050, the incidence, death and DALYs of preterm birth would drop to 0.79, 0.08 and 0.32 times of the 2023 levels, and the prevalence would rise to 1.23 times of 2023. Low SDI regions, lower-middle income countries, as well as India and Nigeria, bore the heaviest disease burden. Over the past three decades, the global acute health burden of preterm birth such as death has decreased notably, but the continuous rise in prevalence and severe regional and age disparities remain prominent public health challenges. The 0-6 days and 6-11 months age groups are the key time windows for preterm birth intervention. It is urgent to implement targeted prevention and control measures for low SDI regions and lower-middle income countries to reduce the global burden of preterm birth.

BackgroundWith growing efforts aimed at optimizing health care services by reducing "low value care", medical deprescribing represents a critical policy challenge at the intersection of clinical quality, fiscal sustainability, and environmental stewardship. Despite growing evidence of its benefits, France lacks a comprehensive national framework for systematic medication review and deprescribing implementation. ObjectiveTo identify areas of consensus and divergence among key French stakeholders using an adapted Policy Delphi approach to inform national deprescribing policy development. MethodsAn exploratory survey was conducted among stakeholders across five groups (healthcare professionals, patients, academia, policymakers, and the pharmaceutical industry). Consensus levels were assessed using graded Likert scales and analysed across policy domains, including knowledge and training, collaboration, resources, policy support, and sustainability opportunities. ResultsHigh consensus emerged around knowledge gaps, the need for interprofessional collaboration, and clinical benefits of deprescribing. Moderate consensus existed regarding resource constraints and environmental sustainability. Divergence was observed between professionals/academia and policymakers/industry regarding financial incentives and regulatory readiness. A policy Delphi heatmap revealed specific alignment patterns that could serve as policy entry points. ConclusionsMulti-stakeholder consensus mapping provides an innovative governance tool for identifying actionable policy opportunities and contributes to recent tools aimed at reducing low-value care. High-consensus domains, including training, patient safety, and sustainability, offer immediate entry points for coalition-building. On the contrary, areas of divergence require structured dialogue and iterative policy learning among Frances fragmented governance structures to translate stakeholder alignment into systematic deprescribing implementation.

Background High body mass index (BMI) presents a serious and ongoing global health challenge. However, the difficulty of high BMI intervention has not yet been systematically evaluated. Methods We developed a Generative Artificial Intelligence Meta-Evaluation (GAME) framework, which integrated 18 indicators from 4 dimensions, including "Macro-System Level", "Socio-Cultural Level", "Community-Family Level", and "Individual Level" to evaluate the difficulty of high BMI intervention across 226 locations. The GAME framework applies 8 leading AI models to generate intervention difficulty scores (IDS) of each indicator on a scale from 1 to 5, with higher scores indicating greater difficulty. Meta-analysis was conducted to derive combined scores, evaluate the heterogeneity and sensitivity. Final intervention difficulty scores were calculated as the weighted sum of all 18 indicators. Additionally, SHapley Additive exPlanation (SHAP) values were used to evaluate the importance of each indicator in determining the intervention difficulty. Results The global difficulty of high BMI intervention shows significant imbalance. Norway (IDS = 1.48) exhibited the easiest intervention, while Yemen (IDS = 4.56) faced the greatest challenge. Regions such as Western Europe, Australasia, and High-income Asia Pacific showed lower intervention difficulty, reflecting there are mature public health frameworks, supportive social-cultural environments for healthy lifestyles, and high levels of health awareness. On the contrary, countries in North Africa and Middle East, South Asia, Oceania, and Sub-Saharan Africa faced higher intervention challenges, suggesting the need for long-term, collaborative efforts from multiple sectors. Among the 18 indicators, "Cognition and Awareness" has the most significant impact on intervention difficulty, with the SHAP value of 31.03, followed by "Family life and cognitive patterns" (18.08) and "Health Care System" (11.7). Furthermore, the IDS for high BMI was significantly correlated with Socio-Demographic Index (SDI). Higher SDI values were associated with easier interventions. Finally, the independent external empirical verification demonstrated high consistency between intervention difficulty and increase in annual prevalence of obesity, population mean BMI, and national policies. It supported the GAME framework to characterize global heterogeneity in high BMI intervention challenge. Global results were freely available at http://www.deepburden.com/high-bmi. Conclusion The difficulty of high BMI intervention varies widely across countries and regions, highlighting the need for comprehensive strategies and governance to address the growing health issue effectively.

This study explores the influence of social determinants of health (SDOH) on follow-up behavior among patients referred to community-based organizations (CBOs) in the Emergency Department (ED) of Long Island Jewish (LIJ) Medical Center. A retrospective analysis was conducted on data collected from 342 patients who were screened for SDOH between February and July 2023. Descriptive statistics and Chi-squared tests were used to identify potential associations between demographic and social factors (race, language, age, gender, employment status, and insurance status) and follow-up rates. The results revealed several trends: non-White patients (73.2%) and non-English speakers (81.8%) followed up more frequently than their counterparts, as did older adults (80.0%) and insured patients (77.8%). However, none of the variables reached statistical significance (all p-values > 0.05). The findings suggest that while demographic and social factors may influence follow-up behavior, the lack of statistical significance could be attributed to the limited sample size. These trends align with previous literature on SDOH and follow-up behavior, highlighting the need for further research with larger, more representative samples. Addressing the complex interplay of SDOH, including factors such as language, insurance, and cultural differences, is crucial for improving follow-up rates and ensuring better health outcomes for underserved populations. Future research should focus on refining referral systems, exploring additional socioeconomic factors, and conducting longitudinal studies to develop more effective strategies for integrating SDOH interventions in healthcare systems.

Oral health is a key component of quality of life among older adults, yet maintaining preventive dental care becomes increasingly difficult for those with long-term care (LTC) needs. This study examined patterns of preventive and need-driven dental service use among home-dwelling older adults with LTC needs in Japan and identified the caregiving, functional, and socioeconomic factors associated with these patterns. Data were drawn from a nationwide online survey of family caregivers reporting dental service use among older adults certified under the Japanese Long-Term Care Insurance system (n = 1,055). Poorer financial situations increased the likelihood of a lack of dental visits, whereas need-driven visits were more common among those who received intensive or long-term caregiving and whose caregivers reported a greater burden. Dementia status was not independently associated with dental service use. These findings highlight the importance of promoting preventive dental care within community-based LTC systems, particularly as care needs intensify. Key PointsO_LIFinancial strain was linked to having no dental visits C_LIO_LIMore intensive and longer caregiving, especially with higher caregiver burden, was linked to need-driven dental visits C_LIO_LIDementia status was not independently associated with dental service use C_LI

Background: Nursing education in conflict-affected settings faces significant disruptions that compromise the preparation of a competent and resilient workforce. In regions such as Iraq, prolonged instability, resource constraints, and fragmented health systems challenge traditional educational models, necessitating innovative and context-responsive approaches to ensure continuity, quality, and equity in nursing training. Purpose: This study aimed to explore innovative strategies in nursing education within conflict-affected settings and to examine their implications for leadership development, health policy reform, and the advancement of health equity. Methods: A cross-sectional descriptive study was conducted among undergraduate nursing students across selected universities in the Nineveh Governorate, Iraq, during the 2025-2026 academic year. Data were collected using a structured, self-administered questionnaire designed to assess students educational experiences, engagement with digital learning approaches, perceived barriers, and attitudes toward innovation in nursing education. The instrument captured multiple dimensions of the learning environment, including access to educational resources, institutional support, and exposure to blended and technology-enhanced learning. Descriptive and inferential statistical analyses were performed using SPSS (version 28), including frequency distributions, chi-square tests, and binary logistic regression modeling to identify key predictors of positive educational outcomes, such as engagement, satisfaction, and perceived clinical readiness. Results: The findings indicate that, although students demonstrated a high level of motivation to engage with innovative learning approaches, notable gaps remained in access to digital resources, faculty preparedness, and institutional support. A majority of participants reported engagement with blended and technology-enhanced learning, which was significantly associated with higher levels of engagement, improved critical thinking, and greater perceived clinical readiness (p < 0.001). Multivariable analysis identified institutional support, digital learning access, and learner-centered teaching strategies as significant predictors of positive educational outcomes. Students with access to digital learning resources and supportive educational environments were more likely to report higher levels of satisfaction and competence. Conclusions: Innovating nursing education in conflict-affected settings is essential to building a resilient and future-ready nursing workforce. Integrating digital technologies, flexible learning models, and competency-based approaches can enhance educational outcomes despite contextual constraints. Implications for Nursing Practice and Policy: Strategic investment in nursing education infrastructure, faculty development, and digital transformation is critical to strengthening health systems in fragile contexts. Policymakers and academic leaders must prioritize inclusive, scalable, and sustainable educational reforms to promote health equity and empower nurses as key agents of system-level change.

Comprehensive and responsive interventions are increasingly prioritized to address the diverse and evolving health challenges faced by mothers and children during the first 1,000 days of life. However, evidence remains limited on how such interventions can be operationalized in low-resource settings without overstretching frontline health workers. We developed a comprehensive yet flexible community-based intervention, the Healthy Future program, which integrates a stage-based maternal and child health curriculum with mHealth-enabled infrastructure to deliver targeted, stage-based support through home visits in low-resource settings. We evaluated its impact through a cluster-randomized controlled trial across 119 rural townships in China. The program demonstrated improvements across multiple health, behavioral, and intermediate outcomes, including young child feeding practices, caregiving knowledge, maternal mental health, and perceived social support. Overall, this study illustrates a move beyond stand-alone interventions toward a scalable, multidimensional delivery model capable of providing comprehensive, flexible, and timely support to mothers and children in low-resource communities while remaining feasible for large-scale implementation.

BackgroundArtificial intelligence (AI) is increasingly being integrated into healthcare systems, with growing applications in clinical decision support, workflow optimization, and population health management. While substantial investments have been made in digital infrastructure, the successful adoption of AI in primary care depends critically on the readiness, awareness, and educational preparedness of healthcare professionals. Global health authorities emphasize the need for ethically grounded and workforce-focused approaches to AI integration; however, evidence on clinicians readiness for AI, particularly in primary care settings and in the Middle East region, remains limited. ObjectivesThis study aims to assess the level of awareness, perceptions, attitudes, and educational needs related to AI among healthcare professionals working within Qatars Primary Health Care Corporation (PHCC). In addition, it seeks to examine organizational factors influencing the integration of AI-focused education in primary care and to develop an AI readiness framework that can inform targeted training strategies and policy planning. MethodsThis study will adopt a mixed-methods design guided by the Organizational Readiness for Change (ORC) framework, adapted for AI integration in primary care. The quantitative component will consist of an anonymous, census-style online survey distributed to all healthcare professionals across PHCC health centers and headquarters, assessing AI awareness, attitudes, training needs, and perceived infrastructure readiness. Composite AI awareness and attitude scores will be calculated, and regression analyses will be used to explore factors associated with AI readiness. The qualitative component will include semi-structured interviews and focus group discussions using maximum variation sampling to capture diverse professional perspectives. Qualitative data will be analyzed thematically, following COREQ and SRQR reporting standards. Quantitative and qualitative findings will be integrated to generate an AI readiness profile and an actionable education roadmap aligned with national digital health priorities. DiscussionThis study will provide the first comprehensive assessment of AI readiness among primary care healthcare professionals in Qatar. By identifying knowledge gaps, training priorities, and organizational enablers and barriers, the findings are expected to inform the development of evidence-based AI education strategies within continuing professional development frameworks. The proposed AI readiness framework may also offer a transferable model for other health systems seeking to align workforce development with responsible AI implementation in primary care.

BackgroundHealthcare system disparities have a significant impact on chronic disease management in conflict-affected settings. Vitiligo, a stigmatizing dermatological condition, requires sustained care, yet limited evidence exists regarding how healthcare sector differences affect patient outcomes in Afghanistan. This study addresses this critical knowledge gap in a post-conflict, resource-limited setting. The main objectives of this study were to compare socio-demographic profiles, clinical characteristics, psychological burden, and health-related quality of life (HRQoL) between vitiligo patients attending public versus private hospitals in Kandahar, Afghanistan. MethodsA cross-sectional analytical study was conducted from March 2023 to January 2024 with 402 vitiligo patients (153 [38.1%] from three public hospitals and 249 [61.9%] from five private hospitals). Comprehensive assessment included socio-demographic variables, clinical severity (Vitiligo Area Severity Index [VASI]), psychological distress (General Health Questionnaire-12 [GHQ-12]), anxiety (Hamilton Anxiety Rating Scale [HAM-A]), depression (Quick Inventory of Depressive Symptomatology [QIDS-SR16]), and HRQoL (Dermatology Life Quality Index [DLQI]). Stratified analyses, multivariable linear regression, and interaction testing were performed. ResultsCompared to public hospitals, patients visiting private hospitals were younger (69.3% aged 18- 29 years, {chi}2=21.4, p<0.001), more rural (65.5%, {chi}2=12.7, p<0.001), and less educated (63.9% illiterate, {chi}2=15.2, p<0.001). However, clinical severity (VASI: public M=6.58{+/-}7.47; private M=6.84{+/-}4.64; t=-0.427, p=0.670), psychological burden, and HRQoL showed no significant differences between sectors. Interaction analyses revealed moderating effects: disease severity impacted HRQoL more strongly in public hospitals (VASIxhospital type: B=-0.168, 95%CI: - 0.258 to -0.077, p<0.001, {beta}=-0.515), while psychological distress affected HRQoL more in private settings (GHQxhospital type: B=0.440, 95%CI: 0.094 to 0.785, p=0.013, {beta}=0.442). ConclusionWhile demographic disparities exist in healthcare access, clinical and psychological outcomes are similar across sectors. However, pathways to HRQoL impairment differ significantly, suggesting sector-specific mechanisms requiring tailored interventions. These findings highlight the need for equitable, context-sensitive vitiligo care that addresses both universal and sector-specific determinants of patient well-being in conflict-affected settings.

Background: China has implemented policies to strengthen its pharmacist workforce since the 2009 healthcare reform, yet a comprehensive evaluation of their long-term systemic effects is lacking. Objective: To systematically analyze the evolution of Chinas pharmacist workforce in healthcare institutions from 2007 to 2023 across four dimensions: quantity, quality, structure, and distribution, providing an empirical foundation for policy optimization. Methods: A retrospective analysis was conducted using longitudinal data from the China Health Statistics Yearbooks. Trends were delineated via descriptive statistics. Equity and spatial evolution were assessed using the Gini coefficient, Theil index decomposition, and spatial autocorrelation analyses (Global Morans I and hotspot analysis). Results: From 2007 to 2023, the total number of pharmacists increased from 357,700 to 569,500 (average annual growth: 2.2%). This growth lagged behind physicians (4.6%) and nurses (7.4%), causing the pharmacist-to-physician ratio to decline from 1:5.15 to 1:8.39. The workforce showed trends of feminization (female proportion rose from 59.7% to 70.8%) and aging. While quality improved, 51.1% still held an associate degree or below, and only 6.6% held senior titles. Equity analysis revealed the provincial Gini coefficient improved from 0.145 to 0.093. Theil index decomposition confirmed intra-provincial disparities as the primary inequality driver. Spatial analysis showed a non-significant global Morans I by 2023 (0.154, P*>0.05), down from 0.254 (P<0.01) in 2007. Hotspot analysis confirmed this transition, revealing a contraction of high-confidence clusters and a trend toward balanced distribution. Conclusions: China has made measurable progress in expanding pharmacist workforce size and improving inter-provincial equity since 2007. However, persistent structural challenges remain: relative workforce contraction compared to other health professions, an aging demographic, a shortage of senior talent, and significant intra-provincial inequity. Future policies must prioritize optimizing workforce structure and enhancing clinical service capabilities to catalyze a shift toward patient-centered pharmaceutical care.

Background: Despite the growing global burden of multimorbidity, the patterns of disease combinations, have not been extensively categorized. We aimed to explore the predictors, health consequences, and patterns of discordant and concordant multimorbidity. Methods: We used the 2018 China Health and Retirement Longitudinal Study (CHARLS), a representative database of adults aged >45 years from China. We conducted logistic regression analyses to assess the likelihood of having discordant (conditions from different disease systems) versus concordant (only cardiometabolic, or only respiratory diseases) multimorbidity, and to compare the health status and healthcare utilization between patients with discordant and concordant multimorbidity. Latent class analysis (LCA) was applied to both the entire sample and to patients with discordant multimorbidity to identify clusters of disease combinations. Results: The sample included 1668 patients with concordant (mainly cardiometabolic), and 7306 patients with discordant, multimorbidity. Female patients, patients living in rural settings, former and current smokers, and patients engaging in high-intensity physical activity, were more likely to have discordant instead of concordant multimorbidity. Depression, limitations in daily activities, poor self-reported health, and frequent healthcare use were more common in patients with discordant than concordant multimorbidity. The LCA identified five clusters when all multimorbid patients were included (cardiometabolic, arthritis-digestive, respiratory, multisystem, and arthritis-hypertension classes), and four clusters when restricted to discordant multimorbidity (digestive, arthritis-cardiometabolic, respiratory, and multisystem classes). Conclusion: Discordant multimorbidity is associated with poorer health and increased use of healthcare. Cardiometabolic diseases, arthritis, and digestive diseases have a central role in defining disease patterns.

IntroductionDigital technologies are reshaping how health professionals are trained, and extended reality (XR) has gained attention as a tool for skills development in dental education. Yet, successful integration depends largely on educators perceptions, readiness, and working conditions. This study aimed to explore dental educators views of the educational value of XR, what barriers they experience, and how familiarity with immersive technologies relates to their use in teaching. Materials and MethodsA cross-sectional, web-based survey was conducted among dental educators. The questionnaire included items on demographics, familiarity and frequency of XR use, and perceptions of educational value, barriers, and curricular integration. Descriptive statistics were calculated, and Spearman correlation analyses were performed to explore associations between familiarity, use, and perceived benefits of XR. ResultsRespondents reported positive attitudes toward XR, particularly for improving students understanding of complex anatomy (mean = 6.02/7), skill development (5.68/7), and confidence and preparedness for clinical practice (5.08-5.20/7). XR was mainly viewed as a complement to traditional teaching rather than a replacement (mean = 3.77/7). Strong correlations were observed between perceived improvements in confidence, skills, and clinical readiness (r = 0.71 - 0.89, P < 0.0001). High costs, limited technical support, and time constraints were the most prominent barriers to usage. ConclusionOverall, dental educators appear open to XR but constrained by structural and organizational factors rather than a lack of interest. Faculty development, hands-on training opportunities, and institutional support may therefore be essential to translating positive perceptions into meaningful and sustained integration of immersive technologies in dental curricula.

This study examines the impact of the Drugs for Neglected Diseases initiative (DNDi) on health research capacity and health system strengthening in the Democratic Republic of Congo (DRC) from 2005 to 2023. Using a qualitative approach with semi-structured interviews, stakeholders and beneficiaries shared their perceptions of DNDis interventions. The analysis, grounded in an integrative model of organizational performance, found that DNDis efforts significantly enhanced clinical and operational research capacity, improved healthcare infrastructure, and fostered knowledge exchange among health practitioners. Notably, the partnership contributed to reduced morbidity and mortality from sleeping sickness through the development of safer, more effective treatments such as nifurtimox-eflornithine combination therapy (NECT), fexinidazole, and acoziborole. DNDis support also enabled healthcare providers to expand research capacity beyond sleeping sickness, promoting collaboration and knowledge transfer between institutions. Overall, stakeholders reported positive outcomes for patients, communities, and practitioners, highlighting DNDis role in building sustainable research networks and enabling environments for innovation in resource-limited settings. The study underscores the importance of continued investment in research capacity and collaborative partnerships to address neglected diseases and strengthen health systems in low-resource contexts.

Nurses represent the largest segment of the United States healthcare workforce and played an instrumental role in the countrys response to the COVID-19 pandemic. Yet, little attention has been given to the contribution of this component of the U.S. medical personnel in the nations ability to face public health crisis. We present a cross-sectional, ecological analysis using cumulative annual reports from different national databases to assess the relationship between registered nurse (RN) density at a state level and age-adjusted COVID-19 mortality within the state, using data from 2021 when mortality rates were peaking in the U.S. At the state level, an increase of 1,000 RNs per 100,000 people, was associated with an estimated 24 to 44 fewer COVID-19 deaths per 100,000 residents (B= -0.024, {beta}= -0.146, 95% CI: -0.044 to -0.003, p = .024). In this multivariate analysis including medical co-morbidities, vaccination, health insurance, and poverty level, RN density explained nearly 11% of the variability in COVID-19 mortality among states. Our findings underscore the critical role played by nurses in responding to the COVID-19 pandemic, and the importance of incorporating nursing workforce data into planning for future public health emergencies.

Care workers are central to health systems and the broader care economy, but they often lack the legal protections afforded to other workers. Furthermore, there currently exists no single legal definition of "care worker" under any binding or non-binding international legal instrument. Drawing on the WHO Global Health and Care Worker Compact, we analyzed whether national laws and policies in 10 countries protect care workers. Using comparative legal methods and primary source legal and policy documents, we evaluated both care worker coverage and alignment with four indicators: guaranteed access to protective equipment, protection against discrimination on internationally recognized grounds, unemployment insurance, and the right to join independent unions. We reviewed 43 laws and policies and found that 56% fully or partially met the relevant indicator criteria. The United Kingdom was the only country meeting all four indicators. Overall, we found while many countries recognize these protections in law, care workers are often left outside their coverage, underscoring the need for clearer legal recognition and more inclusive worker protections.

BackgroundHealth behaviors established during young adulthood significantly shape the long-term risk of non-communicable diseases and mental health disorders. Although behaviors such as diet, physical activity, sleep, and substance use are often targeted individually, growing evidence suggests these behaviors function as an interconnected system. However, the organization of lifestyle behaviors at the system level, and which behaviors exert the greatest structural influence, remains poorly understood, particularly in non-Western populations. PurposeThis study aimed to model the interdependence of lifestyle behaviors among university students in China and identify key behaviors with the greatest structural influence within a lifestyle network. MethodsWe analyzed cross-sectional survey data from 5,652 university students in China, assessing seven lifestyle behaviors (diet, physical activity, sleep quality, social engagement, green and blue space exposure, alcohol use, and tobacco use) as well as symptoms of anxiety and depression. A pairwise Markov random field model was used to construct a lifestyle network and identify behavioral clusters and influential behaviors. Network stability and subgroup invariance were evaluated using bootstrap and permutation procedures. ResultsThree stable behavioral clusters were identified: (1) a positive lifestyle cluster (diet, physical activity, social engagement, and environmental exposure), (2) a distress-sleep cluster (sleep problems, anxiety, and depression), and (3) a substance-use cluster (alcohol and tobacco use). Dietary behavior consistently emerged as the most central behavior in the network, with extensive connections to both behavioral and psychological domains. Physical activity played a more peripheral role. Strong coupling between sleep problems and emotional distress was observed, consistent with systems theories of mental health. ConclusionsThese findings support a systems-based framework for understanding health behaviors in young adulthood. Identifying structurally influential behaviors, particularly dietary behavior, can provide leverage points for targeted health interventions. The study highlights implications for public health policy and intervention design, particularly in non-Western university populations.

The COVID-19 pandemic exposed major vulnerabilities of hospital capacity and management worldwide, particularly in intensive care units (ICUs) and emergency rooms (ER), imposing prompt adaptation and resource reallocation. Although SARS-CoV-2 is no longer endangering healthcare systems, winter seasons continue to bring recurrent overload of critical care services, primarily due to respiratory infections. In France e.g., this pattern led to the reactivation of the national emergency response plan during the 2024-2025 seasonal influenza peak, highlighting the continuous need for improved predictive tools. However, forecasting hospitalization surges at a local scale remains a methodological challenge because the (very) low incidence numbers are subject to strong stochasticity and therefore require additional input of information and dedicated approaches. This study investigates the potential for early forecasting of respiratory infection peaks by analyzing ER visit trends. By clustering all-cause ER visits during the 2023-2025 winter seasons from the Nimes University Hospital (France), we identified a strong temporal correlation between early pediatric hospitalizations ([&le;]5 years old) and the following weeks adult hospitalization incidence for respiratory infections. The results suggest that tracking hospital admissions of pediatric ER visits, even without hospital care needs, can serve as a valuable early warning signal for upcoming peaks in respiratory-related hospitalizations. This predictive approach could improve hospital preparedness and resource management during seasonal influenza outbreaks. Author summaryThe epidemics of respiratory viruses present a significant challenge to hospitals in the temperate zone on an annual basis. Frequently, the hospital overload is mitigated by the late reactive allocation of human and material resources that are, hence, suboptimal. This study proposes a statistical framework to assist hospitals in anticipating bed requirements during seasonal influenza waves, despite high noise at the local level, by enhancing hospitalization forecasting with emergency room (ER) visit data. The prediction of the adult epidemic peak is possible through the analysis of the respiratory pediatric ER visits, which facilitates hospital management.

Backgroundworkforce innovative solutions are warranted to respond to the critical global lack of healthcare professionals and sustain delivery of quality patient care. The Patient Care Technician program was one of the strategies implemented to address this challenge by developing a timely pool of workforce who can take non-complex tasks, alleviating workload on other professionals such as registered nurses. However, since this strategy was recently introduced, its implementation and impact on the delivery of care have not yet been sufficiently investigated. ObjectivesThis study examines the motivations, experiences, and career aspirations of patient care technician students, alongside program providers perceptions and challenges in program delivery. Design & MethodsA qualitative phenomenological study was conducted at three institutions in Western Saudi Arabia, including two tertiary hospitals and a university. Semi-structured interviews were conducted with 27 participants; students, lecturers, preceptors, and management staff. Policy documents were also analyzed, and data were examined using Colaizzis seven-step method. FindingsFour key themes emerged: (1) reconciling motivations and influences, (2) training dynamics, (3) career advancement, and (4) navigating acceptance. patient care technician students often felt overqualified for their roles, leading to dissatisfaction and career redirection. The programs effectiveness was hindered by unclear career pathways and the need for greater cultural sensitivity. ConclusionsRecruiting bachelors degree graduates for patient care technician students roles may be inefficient, as these positions could be filled by lower-degree holders, potentially reducing costs. ImplicationsTo enhance workforce stability, healthcare policymakers should establish clear career pathways, align job roles with educational qualifications, and adapt the program to local cultural and professional expectations. Addressing these issues can optimize the roles of patient care technician students within the healthcare system and serve as a model for similar workforce strategies globally.

BackgroundRural emergency departments (EDs) are critical to ensuring equitable access to acute care, yet face persistent systemic challenges. In Quebec, Canada, reforms to healthcare governance, funding and resource allocation, and service delivery have transformed rural ED operations. This study aimed to document characteristics, challenges, and improvement priorities for all rural EDs in the province. MethodsA participatory mixed-methods design was used. 26 rural EDs in Quebec were included. Data sources comprised administrative statistics, structured site surveys, individual stakeholder semi structured interviews, and a validation survey of identified local champions. Analyses comprised a triangulation of the quantitative and qualitative data using transversal thematic analysis to determine common issues. Potential solutions identified were validated through stakeholder questionnaires. The study was reported in accordance with the COREQ reporting guideline. ResultsMost respondents were women (64%) and professionals with more than 5 years of experience. Four main themes were identified: governance, healthcare organization, access to resources, and professional practice. Governance challenges included reduced local autonomy, administrative complexity, and budgeting models poorly adapted to rural realities. Participants emphasized the need for standardized but locally flexible administrative processes, regional emergency service managers, and rural-sensitive performance metrics. Organizational barriers included geographic isolation, limited access to primary care, and difficulties with interfacility transfers due to referral-center capacity and ambulance shortages. Resource constraints centered on shortages of human resources, diagnostic services and specialty coverage, especially anesthesia, obstetrics, and psychiatry. Professional practice was shaped by the need to maintain broad competencies in low-volume contexts, while contending with professional isolation and proximity to patients. Local champions prioritized expanding telemedicine, strengthening prehospital services, enhancing continuing education, and implementing tailored recruitment strategies. ConclusionThis study provides the first province-wide documentation of characteristics, challenges, and improvement priorities for all rural EDs. Findings highlight the need for systemic reforms that restore local decision-making authority, strengthen transfer and prehospital capacity, expand telehealth and specialty access, and support professional development. These results provide a foundation for evidence-based policies and actions to sustain equitable emergency care in rural regions.