JMIRx Med

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

Background A culture of patient safety is a significant determinant of healthcare quality and the prevention of patient harm. The objective of this study was to evaluate patient safety culture among healthcare workers at a tertiary-care hospital in India using the Indian-adapted Hospital Survey on Patient Safety Culture (I-HSOPSC 2.0). Method The survey was descriptive and cross-sectional, carried out among 96 healthcare practitioners, comprising 32 doctors, 32 nurses, and 32 allied health professionals. Also, a validated version of the Hospital Survey on Patient Safety Culture (I-HSOPSC 2.0) was used to measure patient safety culture in India. Descriptive statistics, Shapiro-Wilk test, Kruskal-Wallis test, Fishers exact test, and positive response rate analysis were used for the data analysis. Result The overall patient safety culture score was 3.72 {+/-} 0.52, indicating a positive view of patient safety culture. In terms of domains, Communication about Errors, Management Support for Patient Safety, and Teamwork scored highest, while Staffing, Work Pace, and Response to Errors scored lowest. Considerable discrepancies were observed across professions, with allied health professionals giving more favourable answers than nurses. Conclusion Overall, the culture around patient safety was good, but areas such as staffing, pace of work, and error response need targeted attention to sustain patient safety and improve the quality of care in healthcare services.

This study examined the prevalence of domestic elder abuse and examined factors in a province with a high aging index in Vietnam in 2025. Elder abuse was measured using the validated Vietnamese Domestic Elder Abuse Scale, covering psychological abuse, physical abuse, financial exploitation, neglect/abandonment. Logistic regressions identified factors associated with abuse. 29.44% of participants reported at least one abuse subtypes, with psychological abuse being the most common subtype (24.73%) and 9.82% experienced polyvictimization. Higher educational attainment was consistently associated with lower odds of all abuse subtypes. Having [≥]4 chronic conditions was associated with higher odds of psychological abuse compared with having none (OR= 2.79, 95%CI: 1.29-6.00). Difficulties in daily basic activities were associated with physical abuse (OR=5.42, 95%CI: 1.80-16.36), financial exploitation (OR=3.66, 95%CI: 1.34-10.01), and neglect/abandonment (OR=4.09, 95%CI: 1.72-9.70) compared with no difficulties. Findings highlight the need for stronger policy implementation and lifelong learning to prevent elder abuse in Vietnam.

Background: Adolescents frequently consult online resources regarding sensitive health topics, including suicide. Although content analyses demonstrate that online platforms contain both suicide-preventive and pro-suicide material, they rarely incorporate subjective data from adolescents at elevated suicide risk. Aims: This exploratory study examined associations between reasons for seeking suicide-related information online and the digital media used to access such content among adolescents with suicidal ideation. Method: Over one year, 131 adolescents aged 13 to 18 with current or past suicidal ideation were recruited from the Emergency Department of an urban pediatric hospital to complete a cross-sectional survey. Participants reported whether they had sought suicide-related information online, the type of information sought, and the online locations used. Mixed-effects regression models examined associations between reasons for online searches and digital media used. Results: Of 131 enrolled adolescents, 113 completed the survey; 69 (61.1%) reported ever seeking suicide-related information online. Searches were more often intended to assist with acting on suicidal thoughts than to reduce suicidal thoughts (63.7% vs. 55.1%). Social media were used for help-seeking searches slightly more often than professional health organization websites (42.1% vs. 31.6%). Among adolescents who used social media for their searches, discussion forums were significantly more likely to be used when seeking information to act on suicidal thoughts (OR=7.0, p=.02). Conclusion: The majority of adolescents with suicidal ideation may seek out suicide-related content online, particularly to facilitate suicide planning. Social media may be used as frequently as professional mental health websites like 988 or The Trevor Project for suicide-related searches.

Background. Many Indian special newborn care units (SNCUs) cannot offer amplitude-integrated EEG (aEEG) or early MRI, so bedside judgement decides which newborns receive closer neurological attention. Earlier work found that asphyxiated newborns cry with a higher pitch and shorter phonation than healthy newborns, and a meta-analysis reported higher fundamental frequency, dysphonation and atypical melody in infants with neurological dysfunction, with wide differences between studies. Aim. To determine whether basic acoustic features of a smartphone-recorded pain cry (following a heel prick) can differentiate term newborns with HIE from control newborns. Also, to track changes in cry acoustics over the first 72 hours of life and evaluate their association with the clinical severity and short-term outcomes of encephalopathy. Design. A prospective, single centre diagnostic accuracy and cohort study in a tertiary SNCU. Three groups of term newborns are recorded: newborns with HIE, healthy comparators, and sick comparators who do not have HIE. Every newborn is recorded after the same stimulus, the first clinically indicated heel-prick. Newborns with HIE and sick comparators are recorded again at 24 hours, 72 hours and before discharge. A cry that is late or absent counts as a result and not as a missing value. Three clinicians blinded to group also classify the cries by listening, so the phone-based measures can be compared with the human ear. Analysis. The primary outcome is the area under the ROC curve of a logistic model with five pre-specified acoustic predictors. The target is 180 analyzable newborns (70 with HIE and 110 comparators). Reporting follows STARD and TRIPOD+AI. Relevance. In a South Asian trial, cooling did not reduce death or disability at 18 months and increased death alone. A cry tool in this setting is therefore proposed to help prioritize EEG, seizure surveillance, closer observation and referral. It is not proposed as a trigger for cooling. Keywords: neonatal encephalopathy; infant cry; acoustic analysis; smartphone; diagnostic accuracy; low-resource setting.

Youth are increasingly engaging with generative AI beyond its use as a productivity tool, with a growing share turning to AI for social interaction and emotional support. This leads to unknown risks for their well-being and development. Online community discussions reveal that youth already perceive risks that caregivers have not recognized.

Background. Regulatory pressure to avoid confusingly similar drug names appears to have pushed manufacturers to coin more distinctive proprietary names, but no one has quantitatively analyzed this trend. Objective. To determine whether proprietary drug names became more orthographically distinctive (unusual in spelling) over time. Methods. We examined 1,321 US Food and Drug Administration (FDA) new molecular entity (NME) names (1985-2024), 2,769 FDA Orange Book trade names (1982-2026), 177,337 US pharmaceutical trademarks (1980-2026), and 1,273 generic names (1982-2025). Compared to prior names (including those already marketed) and ordinary English, we scored each name's character trigram (three-letter sequence) surprisal (statistical unexpectedness) and its edit-distance similarity to the closest existing names. Linear regression tested time trends, controlling for name length. Results. Mean NME trigram surprisal rose in every decade between the 1980s and 2020s, from 7.21 to 8.50 nats (natural-logarithm units, higher meaning less predictable), an 18% increase (b = 0.038, p < .001, R2 = 0.34). Half of 2020s names (7% in the 1980s) contained a letter sequence found in no common English word (e.g., Jesduvroq, Omvoh). Nearest-neighbor similarity fell after the early 1990s. Trademark data showed the same trend (b = 0.016, p < .001). Generic names showed a weaker trend (b = 0.011, R2 = 0.063). Conclusions. Over four decades, drug names became more orthographically distinctive, consistent with namespace crowding, deliberate efforts to avoid confusing names, and branding strategy. Because unfamiliar letter sequences can introduce other error pathways, increased distinctiveness does not necessarily imply improved safety.

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.

Depression is one of the most prevalent mental health disorders globally. Social media content can reflect emotional states, offering real-time signals of depressive symptoms. This study aimed to develop a deep learning model to predict depression using Twitter/X data, and to characterize potential causes of depression using a large language model (LLM). Twitter/X posts from April 20, 2023, to July 24, 2024, were obtained using the key phrase ("I" or "me") and "diagnosed with depression". After data cleaning and GPT-4o labelling, 2,275 depressive Twitter users, and an additional 1,661 non-depressive users from tweets using the keyword "today", were identified. A deep learning RoBERTa model for predicting depression was built on tweets from both user groups, with an 80/20 training-testing split. GPT-4o models were subsequently employed to analyze depressive users posts to understand potential causes for depression. The RoBERTa model achieved strong performance in predicting depression among Twitter users from their tweets, with an accuracy of 0.822, an F1 score of 0.855, and an AUC of 0.809. Common reasons for depression identified by GPT-4o models included societal pressure, low self-esteem, cultural influences, and identity-related challenges. These findings highlight the potential of deep learning models in early screening of depression using social media data. Insights into potential reasons for depression may inform targeted prevention strategies, public health interventions, and improved mental health support for at-risk populations.

The -Bonacci weighted sequence space {ell}(,) is introduced for [&ge;] 2, 1 [&le;] < {infty}, and > 0). It is proved to be a Banach space which is isometrically isomorphic to {ell}, with an unconditional Schauder basis. The space is also reflexive and uniformly convex. Its strict inclusion chain, continuous dual, and asymptotic truncation estimate of order - / are also established. Based on this framework, Scaled &#119898-BonacciNet is proposed as a lightweight CNN that rescales Fibonacci-Net channels using the dominant &#119898-Bonacci root and employs depth wise separable convolutions. Tribonacci-Net achieved 96.09% accuracy and a 0.9581 macro F1-score on the 15-class Brain MRI dataset using 0.85 million parameters and 0.366 GFLOPs. Pentanacci-Net attained 95.87% accuracy on the 44-class dataset while reducing parameters and FLOPs by 47.10% and 44.48%, respectively. On the CKD ultrasound dataset, Hexanacci-Net achieved 83.75% accuracy and a 0.7941 macro F1-score, with corresponding reductions of 50.37% and 45.10%. These findings support dominant-root scaling as a structured approach to lightweight CNN design.

Globally, Hepatitis C Virus (HCV) infection is a leading cause of chronic liver disease and remains a significant public health threat in Ghana. However, there is a paucity of data on the prevalence and awareness of HCV among market sellers and informal workers in Ghana. This study sought to determine the prevalence and awareness of HCV among this population. This was a cross-sectional study conducted among 397 sellers and workers at Kejetia market from December 2024 to January 2025. HCV was diagnosed using the One Test Hepatitis C Virus Test Strip (Qingdao Hightop) for the qualitative detection of HCV antibodies. Data were analysed using SPSS version 26 and GraphPad Prism version 8.0. A p < 0.05 was considered statistically significant for awareness of HCV. The prevalence of HCV in this study was 4 (1.0%). Awareness of HCV was low at 112 (28.2%). Residence (p=0.021) and age group (p=0.040) were significantly associated with HCV awareness. Age 41-50 years was almost three times more likely to be aware of Hepatitis C infection compared to [&le;] 30 years. Although the prevalence of HCV was low, awareness of the infection was also limited; this highlights the need for public health authorities to implement targeted HCV education programs in major markets to effectively reach informal sector workers who are often overlooked by conventional campaigns.

Background: Antimicrobial resistance (AMR) is a growing global health threat, and India's high antibiotic consumption makes public knowledge, attitudes, and practices (KAP) a critical determinant of stewardship outcomes. Existing Indian KAP evidence is drawn from small, localised cohorts, leaving a gap in nationwide, digitally-sourced data. This study aimed to describe antibiotic-related knowledge, attitudes and self-reported practices among users of a digital healthcare platform in India, examine demographic and regional variation, and identify potential areas for future stewardship interventions. Methods: A cross-sectional survey was conducted among adult users of the Tata 1mg platform (December 2025-February 2026), with participants invited via an in-app banner. Knowledge and attitude were each scored on a 0-4 scale (4 items); practice was scored as a percentage of applicable items answered favourably, with scoring adjusted for branching logic based on antibiotic-access route. Of 10,726 respondents who started the survey, 4,883 completed it (45.5%). City of residence was mapped to one of six regions (India's five statutory Zonal Council zones plus a North-Eastern region) for 4,187 respondents. Associations with demographic characteristics were assessed using multivariable linear regression, and regional differences were assessed using one-way ANOVA. A parallel survey of 256 physicians was conducted to enable patient-provider comparison. Results: Mean scores were: knowledge 2.28 (SD 1.19), attitude 0.91 (SD 1.14), practice 44.9% (SD 33.4); attitude, not knowledge, was the weakest domain. Older age was associated with higher scores across all domains (practice: B=12.52, p<0.001 for age [&ge;]65 vs. 18-34); city tier was independently associated with lower knowledge and attitude (Tier 3 vs. Tier 1: p=0.010 and p<0.001, respectively). Regional differences were non-significant for knowledge and practice but significant for attitude (F=2.56, p=0.026, ^2=0.003), driven by lower scores in the North-Eastern region. In the parallel physician survey, 55.5% of respondents estimated that more than half of their patients self-medicated before consultation. Conclusion: In this platform-based sample, attitudes were the weakest domain, not knowledge, and 42.0% said their last antibiotic did not come on a doctor's recommendation. The findings may inform digital stewardship touchpoints, such as point-of-purchase guidance and prescription verification, in line with India's National Action Plan on Antimicrobial Resistance 2.0. As a cross-sectional survey of platform users, it cannot establish the relative contributions of knowledge, beliefs and access pathways to antibiotic use.

A. Rationale: Medication-related incidents are an important patient-safety concern, particularly in critical-care and inpatient settings where polypharmacy, clinical complexity, frequent therapeutic modifications, and transitions of care increase the risk of medication errors. Systematic analysis of reported incidents can help identify predominant error patterns, potential contributing factors, and priority areas for quality improvement. The present study was undertaken to characterize medication-related incidents and identify areas requiring targeted patient-safety interventions. B. Research Question What are the predominant patterns and distribution of medication-related incidents across critical-care and inpatient units, what patient-care, process, communication, documentation, and system-level factors potentially contribute to their occurrence, and how can these findings be systematically translated into prioritized, evidence-based quality-improvement interventions to strengthen medication safety and reduce preventable medication-related harm? C. Study Design and Methods A retrospective descriptive observational study was conducted to assess the pattern of medication-related errors identified through medication audits conducted in inpatient and critical-care settings. A total of 74 medication audit records were retrospectively reviewed. Each record was evaluated for the presence and type of medication-related error, including transcription, administration, documentation, and dispensing errors. The identified medication errors were categorized based on the nature of the error documented in the audit records. As individual records could contain more than one type of medication-related error, the error categories were considered non-mutually exclusive. Consequently, the total number of error occurrences could exceed the number of records reviewed. Descriptive statistical analysis was performed using frequency distributions and percentages to determine the relative occurrence of each medication-error category. Pareto analysis was subsequently performed to identify the predominant error categories and establish priorities for quality-improvement interventions. The Pareto analysis demonstrated that transcription and administration errors constituted the major contributors to the observed medication-related errors. The identified error patterns were further evaluated using a process-based patient-safety approach to determine potential failure points within the medication-use process. Poka-Yoke (error-proofing) principles were applied to identify opportunities for preventing or detecting errors at the point of occurrence. Based on the findings, potential interventions included standardization of medication-ordering and transcription processes, mandatory verification of medication details, strengthening of independent verification for high-alert medications, and incorporation of technology-enabled safeguards such as electronic medication administration records and barcode-based medication administration. The findings were used to identify priority areas for targeted quality-improvement interventions aimed at reducing medication-related errors and strengthening the safety and reliability of the medication-use process. D. Results: A total of 91 medication-related error occurrences were identified across the 74 audit records reviewed. Transcription errors constituted the predominant error category (46; 50.5%), followed by administration-related errors (41; 45.1%). Documentation-related and dispensing-related errors accounted for 3 (3.3%) and 1 (1.1%) occurrences, respectively. Pareto analysis demonstrated that transcription and administration-related errors collectively accounted for 87 of the 91 identified occurrences (95.6%), indicating a substantial concentration of medication-related errors within these two categories. The cumulative frequency increased from 50.5% for transcription errors to 95.6% following inclusion of administration-related errors, while the remaining categories contributed only 4.4% of the total error occurrences. Accordingly, transcription and administration-related errors were identified as the principal priority areas for subsequent root cause analysis and quality-improvement interventions. Interpretation: The findings demonstrate that transcription errors (50.5%) and administration-related errors (45.1%) were the predominant medication-related errors, collectively accounting for 87 of the 91 identified error occurrences (95.6%). Documentation-related errors constituted 3.3%, while dispensing-related errors accounted for 1.1% of the observed occurrences. Pareto analysis revealed a marked concentration of medication-related errors within the transcription and administration domains, indicating that these two categories represented the principal areas requiring focused quality-improvement interventions. Subsequent Root Cause Analysis (RCA) and Poka-Yoke-based error-proofing approaches were therefore directed toward identifying and mitigating process vulnerabilities within these high-frequency error domains. Keywords: Medication-related incidents, Medication errors, Patient safety, Critical care, Inpatient care, Medication transcription errors, Medication omission, Medication administration, Root Cause Analysis, Pareto analysis, Poka-Yoke, Error-proofing, Quality improvement, Medication safety, PDSA.

Background: Patient satisfaction is a key measure of healthcare quality among people experiencing homelessness. Student-run free clinics (SRFCs) provide care to underserved populations, but the role of student involvement in patient satisfaction remains unclear. Methods: We conducted a cross-sectional study of patients receiving care at an SRFC. From February 2024 to February 2025, patients completed post-visit surveys assessing satisfaction that were evaluated using regression analyses. Results: Eighty-eight patients completed surveys, reporting high overall satisfaction (mean 9.26/10). In separate linear regression models adjusted for age, gender, and race, greater perceived benefit of student involvement was associated with higher satisfaction ({beta} = .298, p = .037), whereas perceiving the visit as too long was associated with lower satisfaction ({beta} = -.285, p = .019). Conclusion: Greater perceived benefit of student involvement was associated with higher patient satisfaction, whereas longer perceived visit duration was associated with lower satisfaction. These findings highlight the importance of balancing educational opportunities with efficient workflows in SRFCs.

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

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

Background: The mothers of children with autism spectrum disorder (ASD) are more stressed than those of neurotypical or any other children with special needs. There remains a notable lack of contextually grounded evidence on the experiences of mothers raising children with autism in resource-constrained settings of a lower middle-income country (LMIC). Methodology: A qualitative phenomenological study was carried out at a government-run autism rehabilitation center over a period of six months. The main purpose of the study was to explore the lived experiences of the mothers of autistic children in a setting like Karachi, Pakistan. Twenty-five mothers of 3-18 years old children enrolled in the selected facility participated in two focus group discussions (FGD) and seven In-depth interviews (IDIs) until data saturation was achieved. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines and Guba s constructs of trustworthiness were followed. Results: Several themes were derived, corresponding to the different layers of the Ecological Systems Theory. Themes included maternal emotional journey, interpersonal relationships, societal perceptions, access to support services and adaptation over time. Conclusion: Mothers of children with Autism in Pakistan face significant challenges at the personal, family, societal, and support systems levels. Removing misconceptions and improving access and quality of services to children with Autism and their families is essential for easing their burden.

Background: Chronic pharmaceutical stock outs hinder Universal Health Coverage in Ethiopia. To address this, the Ministry of Health introduced the electronic Logistics Management Information System for inventory visibility and Auditable Pharmaceutical Transactions and Services for financial management. However, no national study has tested their combined impact. This study evaluated the individual and synergistic effects of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services on essential commodity availability across Ethiopian public healthcare facilities. Methods; We conducted a secondary analysis of the 2024/2025 Ethiopian Service Provision Assessment dataset utilizing 1245 public facilities nested within 125 clusters. The primary outcome was optimal essential commodity availability (zero stock outs and 100% tracer commodity presence). A two-level mixed-effects logistic regression model with an interaction term evaluated synergy, reporting Adjusted Odds Ratios with 95% Confidence Intervals. Results; Overall optimal availability was 54.2% (95% CI; 51.4%-57.0%). Implementation rates were 41.2% for eLMIS, 38.2% for APTS and 26.5% for dual implementation. Facilities using eLMIS alone (AOR = 2.15; 95% CI: 1.52-3.04) and APTS alone (AOR = 1.82; 95% CI; 1.28-2.58) showed higher security. Dual implementation showed a profound synergistic effect (AOR = 4.32; 95% CI; 3.25-5.74, p < 0.001). Positive predictors included functional cold chains (AOR = 2.08), qualified staffing (AOR = 1.68), hub proximity (AOR = 1.58) and urban settings (AOR = 1.95). The model explained 66.2% of regional variance. Conclusion; Dual implementation of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services creates a powerful synergistic impact on pharmaceutical availability. Synchronized national scale-up and cold chain investments are urgently needed to achieve supply chain resilience and Universal Health Coverage in Ethiopia.

IntroductionCurrent evidence suggests that patient health passports may improve care for patients with chronic illnesses. This systematic review aimed to evaluate the impact of patient health passports on health outcomes in adults with diabetes. MethodsA systematic review was conducted in February 2025 following PRISMA 2020 guidelines, using Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Web of Science, and Scopus. The review included studies of adult diabetic patients using paper or digital patient health passport as part of their care in comparison with the standard of care. Data were analysed using meta-analysis and a thematic analysis where appropriate; otherwise, the data are presented narratively. Quality appraisal was undertaken using the Cochrane Collaboration tool for assessing risk of bias and Evidence-based librarianship checklist. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. ResultsEleven studies (n=14,350) were included. Seven studies were randomised controlled trials, two were retrospective in nature, one was a qualitative and one was a pre-post study. Overall, the studies are limited in design, resulting in high or unclear risk of bias across multiple domains. Results of the meta-analysis of five studies showed a statistically significant mean difference reduction in HbA1c and total cholesterol in favour of the intervention group; however, the certainty of the evidence is low or very low. The narrative analysis of the data revealed little to no improvement in body mass index, blood pressure, blood glucose, and cholesterol levels. Patients opinions and perceptions revealed some benefits in usability, perceived value, and in enhancing collaboration. ConclusionThis review provides evidence suggesting that patient health passports may improve patient care and can inform the design of future high-quality studies. However, the low certainty of the evidence highlights the need for high-quality studies with larger sample sizes. Key PointsO_LIPatient health passports show promise in enhancing diabetes management, however current evidence is limited by high risk of bias; future high-quality studies are required to confirm efficacy. C_LIO_LINurses are pivotal in this process as they play a central role in diabetes education, self-management support and continuity of care. C_LIO_LIPatient health passports could be considered as a structured tool to facilitate ongoing monitoring, reinforce adherence, enhance communication between patient and nurses/multidisciplinary team. C_LI

ABSTRACT Background: Poliomyelitis remains a major public health concern where population immunity is incomplete and circulating vaccine-derived poliovirus (cVDPV) persists. Although Nigeria interrupted wild poliovirus (WPV) transmission in 2020, cVDPV cases continue to pose challenges, particularly in parts of northern Nigeria. Modern control strategies require a synergy of routine immunization, supplementary campaigns, disease surveillance, and community trust. Methods: This multicentre descriptive cross-sectional study evaluated community knowledge and attitudes towards polio immunization across 37 Local Government Areas (LGAs) in 20 states and the Federal Capital Territory (FCT). A multistage sampling strategy was utilized to select 1,850 adult respondents (50 per LGA) spanning rural, semi-urban, and urban settlements. Results: Overall, 40.4% (n = 747) of respondents demonstrated good knowledge, while 58.4% (n = 1,080) displayed positive attitudes towards polio immunization. A striking disparity was observed across residence classifications: respondents in urban/semi-urban LGAs exhibited significantly higher levels of good knowledge (51.7%, 569/1,100) compared to those in rural LGAs (23.7%, 178/750; {chi} = 144.00, df = 1, p < 0.001). Main sources of information were Questionnaire responses (53.6%) and community and Traditional leaders(17.2%). Conclusion & Recommendations: Substantial knowledge deficits persist in rural northern Nigerian communities despite generally favorable attitudes. Interventions must prioritize localized risk communication, involvement of traditional/religious leaders, strengthening routine primary healthcare integration, and targeting zero-dose children in hard-to-reach areas. Keywords: Poliomyelitis, Oral Polio Vaccine, Vaccine Hesitancy, Northern Nigeria, Community Health, Routine Immunization.