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.

Background: Vaccine hesitancy and logistical barriers continue to limit influenza vaccination uptake among healthcare personnel. The STRENGTH initiative evaluated employee drivers of influenza vaccine acceptance in healthcare workgroups with lower vaccination compliance. Methods: This mixed-methods program evaluation used a custom Epic electronic medical record dashboard to identify workgroups with lower influenza vaccination rates, followed by focus groups, targeted worksite vaccination clinics, and an anonymous survey. Survey data from 73 respondents were analyzed using descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests, chi-square or Fisher exact tests, and Spearman rank correlations. Results: Respondents had a mean age of 44.8 years (SD 11.3); 36 of 70 respondents reporting binary gender were male. Convenience of worksite vaccination received the highest importance ratings (mean 4.72/5), followed by protection from influenza (mean 4.38/5). Both were rated significantly above the neutral midpoint of 3 (Wilcoxon p<0.001). The strongest observed Spearman correlations were between peer pressure and leadership participation (rho=0.47) and between protection from influenza and willingness to receive a future combined influenza/COVID-19 vaccine (rho=0.42). Conclusions: Convenience and perceived protection were the most important vaccination drivers. Employer-sponsored workplace vaccination programs can reduce logistical barriers while providing opportunities for targeted education and trust-building. Keywords: influenza vaccination; healthcare workers; vaccine hesitancy; occupational health; workplace vaccination; employer-sponsored vaccination

Between 2024 and 2025, Colombia universalized the Electronic Health Invoice with embedded Individual Health Services Delivery Records (RIPS -- Registro Background Between 2024 and 2025, Colombia universalized the Electronic Health Invoice with embedded RIPS records (FEV-RIPS) as the standard for financial and clinical data exchange. ADRES -- the entity responsible for administering the resources of Colombia's General Social Security Health System -- faced the challenge of processing information from multiple heterogeneous sources generated by more than 55,000 healthcare providers. Health systems in high-income countries converge clinical-financial data in consolidated platforms; Colombia started from a fragmented architecture with incompatible historical sources, no cross-database standardization, and no centralized analytical infrastructure until 2023. Objective We describe the design, technical challenges of integrating heterogeneous data, and operational performance of the analytical infrastructure built by ADRES to centralize large-scale processing of Colombian health system information, and derive transferable lessons for health system resource administrators in Latin America facing equivalent digitalization mandates. Methods Technical-descriptive report based on operational metrics from the ADRES Azure/Databricks environment during January-November 2025. We report indicators of data volume, processing speed, computational capacity, concurrent use by functional group, and governance structure. The architecture integrates VPN connectivity with MinSalud, automated processing of multiple formats (XML, relational tables, flat files), and a medallion data lake (Bronze/Silver/Gold). Data quality challenges include structural inconsistencies across sources, coding incompatibilities (municipalities, dates, diagnoses), format heterogeneities in unstructured data, and absent technical documentation. Results The platform manages 21 catalogs, 1,183 tables, and over 110,645 million stored records, with cumulative production exceeding 1 trillion processed records. It executes queries on 100 billion records in ten seconds using clusters of up to 32 TB RAM and 4,096 vCPU. During September-October 2025, monthly query peaks reached 78,028 across eleven functional groups. Integration required Python/PySpark parsers for variable-depth XML, equivalence tables for incompatible municipality codes, cleaning routines for extreme dates used as nulls (1900-01-01, 9999-12-31), and transformation logic bridging classic RIPS and FEV-RIPS. The platform supported econometric analyses, judicial mandate responses, and public interactive dashboards. Conversational AI integration (Genie, Copilot) extends analytical access to users without SQL knowledge. Conclusions ADRES built in one year an analytical infrastructure that provides, to our knowledge, the first published documentation of the systemic technical challenges of integrating heterogeneous data sources in a middle-income social security health system. Centralizing health system information at national scale is technically feasible under public institutional constraints -- but requires solving cross-source standardization problems the implementation literature does not document with quantitative precision. The derived lessons are transferable to health system resource administrators in Latin America facing equivalent challenges.

Background: Healthcare workers (HCWs) are at increased risk of exposure to vaccine-preventable diseases, including hepatitis B, tuberculosis (TB), and tetanus, due to their occupational environment. Despite the availability of safe and effective vaccines, vaccination coverage among HCWs remains suboptimal in many low- and middle-income countries. This study aimed to determine the vaccination coverage for hepatitis B, tuberculosis, and tetanus among HCWs in district hospitals in Yaounde, Cameroon, and to identify factors associated with incomplete vaccination. Methods: A cross-sectional analytical study was conducted from January to June 2024 across all seven district hospitals in Yaounde. A total of 406 HCWs were enrolled using a structured, self-administered questionnaire. Incomplete vaccination status was defined as nit having received three doses for hepatitis B, at least two doses for TB, and at least three doses for tetanus. Data were analyzed using R Statistics version 4.3.3. Bivariate and multivariate logistic regression models were used to identify predictors of incomplete vaccination, with statistical significance set at p < 0.05. Results: Most of participants were female (75.6%) and aged 30-44 years (65.5%). Full vaccination coverage was 36.2% for hepatitis B, 15.8% for tuberculosis, and 53.4% for tetanus. Unvaccinated proportions were 43.1% for hepatitis B, 0.5% for tuberculosis, and 17.2% for tetanus. Multivariate analysis revealed that HCWs aged 55-66 years were significantly less likely to be incompletely vaccinated against hepatitis B compared to those aged 19-29 years (aOR = 0.07; 95% CI: 0.01-0.39; p = 0.004). Nurses and laboratory technicians were more likely to be incompletely vaccinated than doctors (aOR = 7.06; 95% CI: 3.82-13.6; p < 0.001 and aOR = 3.78; 95% CI: 1.73-8.52; p = 0.001, respectively). Longer professional experience was protective against incomplete vaccination for all three vaccines (p < 0.05). The main barriers to vaccination included high cost, doubts about the need for vaccination, and concerns about side effects. Conclusions: Vaccination coverage for hepatitis B, tuberculosis, and tetanus among HCWs in Yaounde remains suboptimal, particularly for hepatitis B. Addressing financial barriers, improving access to vaccines, and implementing targeted educational interventions are essential to enhance vaccine uptake and protect both HCWs and their patients from preventable occupational infections.

Aim This study aims to design, implement, and evaluate a virtual exchange programme in global health and primary care, with a focus on building capacity and fostering collaboration between European and Sub-Saharan African institutions. Methods A mixed-methods approach will be adopted across three phases. First, a scoping review will synthesise evidence on the implementation, outcomes, barriers, and facilitators of virtual exchanges in global health. Second, a virtual exchange curriculum will be co-developed through surveys and focus groups with medical students and educators. Third, the programme will be evaluated using pre- and post-course surveys, and semi-structured interviews to measure changes in knowledge, global health competencies, and intercultural awareness. Quantitative data will be analysed using descriptive and regression analyses, while qualitative data will undergo reflexive thematic analysis. Conclusion This study will generate evidence on the design and impact of virtual exchanges for global health education, contributing to the development of sustainable and equitable curricula in PHC. By disseminating findings across academic, policy, and professional networks, the VICTORY project seeks to advance global collaboration, support workforce development, and promote health equity.

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: 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.

Background The outbreak of COVID19 in Greece prompted extensive public health measures, including the first national lockdown and the suspension of in-person schooling. Recognizing the significant role of children in community transmission due to their contacts in schools, school absenteeism data began to be systematically recorded as a potential indicator of outbreak patterns. Objectives This study aims to explore the utility of incorporating school absenteeism data in an early warning surveillance system for respiratory infections, particularly in predicting the onset and spread of diseases such as COVID19 and influenza. Methods We utilized school absenteeism data from primary schools and kindergartens in the Municipality of Larissa for the 2022 2024 school years, alongside health data from the University Hospital of Larissa (UHL). These included incidence rates of respiratory infections, COVID-19, and flu cases, which were cross-referenced with absenteeism patterns. Results The analysis showed that peaks in absenteeism often preceded increases in cases of respiratory infections, COVID19, and flu, suggesting absenteeism as a potential early warning indicator. Notable divergences in patterns were observed during school closures for holidays, which posed challenges in data continuity and surveillance effectiveness. Conclusions School absenteeism data significantly enhances the capability for early detection and monitoring of respiratory disease outbreaks. To improve future surveillance and outbreak prediction, integrating more comprehensive data sources and refining predictive models to accommodate educational calendar variations is recommended.

Early identification of patients with advanced chronic conditions (MACA) remains a critical challenge in clinical practice, often relying on retrospective criteria or clinical judgment, which may delay timely and personalized intervention. The increasing availability of electronic health records (EHR) enables the application of Machine Learning (ML) techniques to support more proactive detection. This study aimed to develop and internally validate a ML-based approach for the identification of MACA patients using collected data from Hospital Universitario Parc Tauli (Sabadell, Spain). A retrospective observational study was conducted using a sample of 163 patients. A total of 80 candidate variables were extracted, including clinical, functional, and healthcare utilization indicators. Feature selection methods were applied, reducing the dataset to ten key predictors. Fourteen supervised classification algorithms were evaluated, including linear, probabilistic, and ensemble methods. Model performance was evaluated using various metrics like accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC-ROC). The final cohorts include 80 MACA patients and 83 controls. The bagging classifier achieved the most consistent performance with a sensitivity of 0.91 and an AUC of 0.90. Key predictors include absolute dependency, advanced frailty, functional decline, and healthcare utilization indicators. Cross-validation (CV) confirmed the stability of model performance, with mean AUC values exceeding 0.95. These findings highlight the potential of ML-based tools for early detection and the high discriminative capacity for identifying MACA patients.

Introduction: Child health and well-being in Kalaallit Nunaat (Greenland) remain a major public health concern, yet systematic, population-level research is limited. Previous studies have focused on isolated indicators such as vaccination coverage and infant mortality, without capturing the broader structural and social determinants shaping childrens lives. The Meeqqat Peqqissut project addresses this gap by developing a cross-sectoral, register-based approach to identify both risk and health promoting factors influencing child health and well-being for alle children in Kalaallit Nunaat. Grounded in the Indigenist Ecological Systems Model (IESM) and complemented by the Peqqissuserput framework, the project adopts a strengths-based perspective that emphasizes resilience and culturally embedded determinants of well-being. Methods: Meeqqat Peqqissut is a collaboration between the Centre for Public Health in Greenland and Statistics Greenland. The study integrates longitudinal register data linked via personal identification numbers, combining healthcare records (COSMIC), socio-economic data from Statistics Greenland, municipal case management systems (Get Organized), and police records. Additional sources include education and social services. Data will be combined and analysed on Statistics Greenlands secure platform using advanced methods such as latent class and trajectory analyses. A participatory approach ensures continuous dialogue with practitioners to validate data quality and contextual relevance. Results: The project supports evidence-based strategies for improving child health and well-being in Kalaallit Nunaat and contributes to the national public health strategy Inuuneritta III. It aligns with the Kalaallit Nunaat governments research strategy for 2022-2030, as it aims to support sustainable societal development by contributing to improved public health and reducing social health inequalities. Ethical approval has been obtained from the Scientific Ethics Committee in Kalaallit Nunaat (VEK 2025-12). Conclusion: The Meeqqat Peqqissut project will provide a robust, cross-sectoral evidence base to strengthen efforts to improve child health and reduce social health inequalities in Kalaallit Nunaat. By integrating administrative data and applying an Indigenous, strengths?based framework, the study advances understanding of structural and social determinants of well?being. The project establishes a sustainable approach to equity?oriented child health monitoring and will inform policy, practice, and long?term public health action.

OBJECTIVES: Population aging is a major contributor to increasing demand for emergency medical services (EMS), yet EMS workforce projections based on population data remain limited. This study projected future EMS incident volume and clinician workforce requirements in Florida from 2026 to 2035 based on historical data on EMS response records to inform workforce planning. METHODS: We conducted a retrospective, population-based secondary analysis and forecasting study using de-identified state-wide emergency EMS response records from Florida's Emergency Medical Services Tracking and Reporting System (EMSTARS) spanning January 1, 2017 through December 31, 2025. Incidents were assigned to seven age cohorts and aggregated into monthly time series. We used Seasonal Autoregressive Integrated Moving Average models with exogenous inputs (SARIMAX) to project age and cohort-specific incident volume for 2026 through 2035. Projected future incident volumes were translated into EMT and paramedic full-time equivalent (FTE) requirements using observed EMSTARS staffing configurations and target operational parameters. RESULTS: Annual EMS incidents increased from 4.10 million in 2017 to 5.22 million in 2025 and are projected to reach 7.76 million by 2035, a 48.8% increase over the 2025 baseline. By 2035, adults aged 60 and older are projected to represent 31.2% of Florida's population while accounting for 61.6% of all EMS incidents. Total estimated EMS workforce requirements are projected to increase from 9,542 FTEs in 2025 to 14,195 FTEs by 2035, requiring approximately 4,654 additional FTEs (a 48.8% increase). CONCLUSIONS: Florida's aging population is projected to drive a nearly 50% increase in EMS incident volume and associated workforce requirements over the next decade, with demand disproportionately concentrated among older adults. With a substantial concentration of adults aged 80 and older and a rapidly expanding oldest-old cohort, Florida is confronting the demographic conditions projected to emerge in other states over the next decade. The findings offer researchers and policymakers a replicable framework and a directly applicable planning reference for jurisdictions across the United States.

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.

Abstract Effective health communication is central to patient-centred care and improved health outcomes, particularly in culturally diverse healthcare settings. In clinical and assistive practice, communication breakdowns may negatively affect diagnosis, treatment adherence, and preventive care. A qualitative phenomenological design was employed, utilizing Semi-Structured interviews with purposively sampled twenty patients and healthcare professionals from Tamale Teaching Hospital, Yendi Hospital, and Bimbilla Hospital. The researchers adopted Content Analysis as the tool of analysis for the data. The findings of this study revealed that language discrepancies Poor attitudes of healthcare providers hinderer patient openness and the quality treatment. Logistical issues, such as inadequate medicines and medical supplies, resulted in delayed treatment and additional financial burden on patients and their relatives. Cultural and social factors discourage patients from discussing certain health conditions with healthcare providers, leading to delayed treatment. These hurdles adversely impact on treatment and assistive practice, specifically in culturally diverse environment and preventive care. The study recommends training and capacity-building programs for healthcare providers in cultural competence, fostering effective and ethical health communication between patients and healthcare providers, and recruiting professional interpreters to bridge the linguistics gap between patients and providers. Abstract Effective health communication is central to patient-centered care and improved health outcomes, particularly in culturally diverse healthcare settings. In clinical and assistive practice, communication breakdowns may negatively affect diagnosis, treatment adherence, and preventive care. A qualitative phenomenological design was employed, utilizing semi-structured interviews with twenty purposively sampled patients and healthcare professionals from Tamale Teaching Hospital, Yendi Hospital, and Bimbilla Hospital. The researchers adopted content analysis as the tool of analysis for the data. The findings of this study revealed that language discrepancies Poor attitudes of healthcare providers hinder patient openness and quality treatment. Logistical issues, such as inadequate medicines and medical supplies, resulted in delayed treatment and additional financial burden on patients and their relatives. Cultural and social factors discourage patients from discussing certain health conditions with healthcare providers, leading to delayed treatment. These hurdles adversely impact treatment and assistive practice, specifically in culturally diverse environments and preventive care. The study recommends training and capacity-building programs for healthcare providers in cultural competence, fostering effective and ethical health communication between patients and healthcare providers, and recruiting professional interpreters to bridge the linguistics gap between patients and providers.

This scientific study aims to assess the level of awareness, nutritional knowledge, and actual behavioral practices among pregnant women in the Capital District of Sanaa, Republic of Yemen, and to determine their impact on the health and clinical indicators of the mother and fetus under complex conflict conditions. The study employed a descriptive-analytical approach based on a simple random sample of 200 pregnant women attending government-run hospitals and specialized medical centers in the Capital District. Field data were collected during December 2025 using a structured and validated questionnaire consisting of 42 items measuring demographic variables, awareness, practices, barriers, and health outcomes. The results of the statistical analysis using SPSS software showed a high level of nutritional awareness (87%) and healthy dietary practices (80%) among the sample participants. Simple and multiple linear regression tests revealed a statistically significant effect of awareness and practices in explaining 20.2% of the variance in the health status of the mother and fetus (R{superscript 2}= 0.204, p < 0.001). The study demonstrated that actual behavioral practices have greater predictive power ({beta}=0.316, p=0.001) compared to theoretical cognitive awareness ({beta}=0.232, p=0.005) in determining clinical outcomes for the mother and fetus, highlighting the widening gap between knowledge and behavior under structural pressures. "Morning sickness" (80%) and the deterioration of "family economic status" (71%) emerged as the greatest physiological and material barriers to proper nutrition. With their inferential impact established as an extension of the maternal-fetal resource allocation conflict in a physiologically and economically challenging environment, the study also identified significant differences in nutritional behavior and health outcomes in favor of housewives and mothers who are more educated and have higher incomes, while no significant differences were recorded attributable to obstetric variables such as stage or order of pregnancy. The study offers a unique theoretical and practical contribution by formulating an integrated causal model that demonstrates that the fetus acts as a biological drain on the mothers cellular and mineral reserves in a war environment, which necessitates directing antenatal care and support programs toward effective behavioral empowerment and nutritional support to overcome the structural and material barriers faced by pregnant women.

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.

Aims To explore how workplace environments and racialised hierarchies shape racial inequities in career progression and how the Covid-19 pandemic response influenced these inequities. Design Longitudinal and cross-sectional qualitative study using semi-structured interviews. Methods Semi-structured interviews were conducted with 27 student nurses, healthcare assistants and qualified nurses and 24 senior leaders and management staff recruited in England between January 2019 and March 2021. Data were analysed using thematic analysis. Results Data from 51 healthcare professionals were included in the analysis. Guided by sociological theory on inequality diversions and racialised organisations, three main themes were identified: (1) hidden pipelines to career progression highlights how racial positioning influences unequal career trajectories shaped by informal networks, organisational norms and perceptions of competence; (2) impact of the response to the Covid-19 pandemic illustrates how the pandemic disrupted and reinforced racialised career barriers and (3) psychological effects of racialised inequities on racially minoritised staff captures the emotional burden of navigating these inequities. Conclusion NHS staff perspectives on racialised inequities in career progression highlight the power informal networks have in staff accessing managers who control opportunities. While some staff found new opportunities during the Covid-19 response, others, particularly senior racially minoritised staff, felt redeployments and remote working further hindered their development.

Antimicrobial resistance (AMR) is a global threat to public health and development. Failure to address it could return society to a pre-antibiotic era with increased morbidity and mortality. Because human behaviour is crucial to AMR management, interventions modifying knowledge, attitudes, and practices are therefore essential. Modifying health-related behaviours presents a significant challenge, yet it is crucial for public health. Engaging populations during periods of shifting perceptions can address this challenge and ensure the sustainability of interventions. Adolescents and young people attending school represent a key demographic. The primary objective of this study is to evaluate student's awareness, perceptions, and behaviours concerning antimicrobial resistance (AMR) and hygiene, while enhancing and empowering children as agents of change within the community. In this study, students from Allied Health Sciences (AHS) across various disciplines were recruited to serve as peer educators for an evidence-informed educational workshop. A pilot delivery of these activities was conducted among a few students in a school before the final delivery was executed in three schools. Schools following a comparable educational board and curriculum were selected for inclusion in the study. A structured questionnaire was employed to assess the effects before and after the intervention. Statistically significant improvements were observed in participant's knowledge, attitudes, and practices (p < 0.001). Additionally, feedback was collected from participants, teachers, and the school nurse attending the session. By triangulating these findings, a notable immediate improvement was observed in students' knowledge, attitudes, and practices. This study provides evidence that employing multimodal teaching led by peer education is a valid and effective method for delivering health messages. It further underscores the mutual benefits for stakeholders (peer educators and peer learners) by offering a two-way learning opportunity. The benefits extend beyond academic and core scientific learning to include increased confidence as effective health educators and future-ready healthcare professionals.

Aims: The COVID-19 pandemic has significantly impacted global mental health. At the onset of the pandemic (2020), Belgians experienced increased anxiety, depression, and psychological distress compared to 2018 due to the outbreak and the associated public health measures. Understanding the drivers of this distress is crucial for mitigating mental health effects in future crises. This study examines determinants of psychological distress in Belgium during the March 2020 lockdown, using data from the Great Corona Study (GCS). Methods: Data were drawn from the second wave of the GCS, a citizen science initiative conducted in Belgium on March 24, 2020, with 332,169 respondents. Psychological distress was measured using the General Health Questionnaire-12 (GHQ-12), applying a 2/3 cutoff to classify distress levels. To identify predictor variables, a random forest algorithm and literature review reduced 207 initial variables to 16. A generalized linear model was then used to examine associations between predictors and psychological distress Results: Psychological distress was significantly associated with various demographic, social, occupational, and health-related factors. Younger individuals, women, and residents of Wallonia or Brussels exhibited higher odds of distress. Household composition, and the frequency of real-life social interactions significantly influenced distress levels. Occupational status played a key role, with part-time employees and working students exhibiting higher levels of distress. At the same time retired individuals with no current occupation showed lower odds. Perceived workplace safety and compliance with public health measures also significantly impacted distress levels. Lastly, individuals experiencing influenza-like or COVID-19 symptoms had substantially higher odds of psychological distress. Conclusions: Our findings highlight significant sociodemographic, occupational, and health-related predictors of psychological distress during the initial COVID-19 lockdown in Belgium. Young adults, women, individuals with limited in-person interactions, and those experiencing influenza-like illness or COVID-19 symptoms were particularly vulnerable. Additionally, perceptions of others' adherence to preventive measures played a crucial role in mental well-being. These results highlight the complex interplay between individual and environmental factors in shaping psychological distress, providing valuable insights for future public health policies and mental health interventions during crises.

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.