Journal of Occupational & Environmental Medicine

Purpose: The GIG-OSH cohort was established to investigate the impact of digital platform work on occupational safety and health (OSH), working and employment conditions, and health in seven countries in Europe. Participants: The cohort comprises 3,945 digital platform workers from seven European countries. The sample includes both web-based workers (e.g., micro-tasking, freelance design) and on-location workers (e.g., delivery, transport). Participants were recruited using non-probabilistic sampling strategies tailored to national contexts, including social media advertising, recruitment through micro-task platforms, and on-site field outreach. Multidimensional data have been collected through online surveys (implemented via REDCap) covering sociodemographic characteristics, working and employment conditions, psychosocial risks, algorithmic management, and physical and mental health indicators. Findings to date: Participants had a mean age of 32.6 years at baseline (SD 10.4), and the majority are male (58.8%), with a higher concentration of migrants in on-location tasks (62.2%) compared to web-based tasks (48.8%). Regarding educational attainment, 55.4% of the total cohort holds a tertiary degree, reaching 64.4% among web-based workers. Platform work intensity varies significantly: on-location workers averaged 85.4 hours of work in the last month, while web-based workers averaged 47.0 hours. Mean income from platform work as a percentage of the national median was 20.6% (SD 22.2). The mean WHO-5 Well-Being Index score was 58.7 (SD 20.3), which is notably lower than the European general population average (69.4), indicating poorer mental health outcomes among cohort members. Future plans: The GIG-OSH cohort represents the first large-scale, longitudinal study examining occupational safety and health among digital platform workers across multiple European countries. Future waves will prioritize developing precise tools to measure hourly earnings and unpaid waiting time. Future research should aim to include underrepresented subgroups, such as medical and domestic care workers, and explore potential linkage with administrative records to evaluate long-term health trajectories and the impact of new EU labour regulations.

IntroductionMusculoskeletal injuries (MSKIs) are ubiquitous in the U.S. military, especially among high-performing service members such as Marines. Given that female service members only started to be assigned to ground combat roles since December 2015, evaluation of sex on MSKI risk in ground combat occupations has not been possible until there was an ample population to study. The purpose of this population-level epidemiological study was to assess (1) if female sex was a salient risk factor for MSKI in Marines serving in different military occupations, including combat arms, and (2) the effects of integration period on MSKI risk among female Marines. Materials and MethodsA population-based epidemiological retrospective cohort study of all U.S. Marines was performed assessing female sex, occupation, and integration period on the prevalence of MSKI from 2011 through 2020. The Military Health System Data Repository was utilized to identify initial healthcare encounters for diagnosed ankle-foot, knee, lumbopelvic-hip, thoracocostal, cervicothoracic, shoulder, elbow, or wrist-hand complex injuries. Prevalence was calculated for female and male Marines in each occupational category (combat, combat support, aviators, aviation support, services) during the pre-integration (2011-2015) and post-integration (2016-2020) periods. ResultsDuring the pre-integration period, 520/1,000 female Marines (n=13,985) and 299/1,000 male Marines (n=142,158) incurred MSKIs. In the post-integration period, the prevalence increased to 565/1,000 female Marines (n=17,608) and 348/1,000 male Marines (n=161,429). In the multivariable evaluation of sex, occupation, integration period, and the interaction of sex and occupation on combined MSKIs, only female sex was a significant factor for injury (prevalence ratio [PR]=1.99), with service in ground combat and aviation occupations identified as protective factors when compared with services occupations (PR=0.69). When these same factors were evaluated for specific MSKI outcomes, female sex remained a robust factor in all lower quarter (PR=1.75-2.63) and upper quarter (PR=1.38-2.36) injuries except for shoulder injuries. Service in ground combat and aviation occupations was protective for all lower quarter injuries (PR=0.46-0.71). In the upper quarter, ground combat was protective for all injuries except for elbow injuries (PR=0.67-0.77). Serving as an aviator was a risk factor for cervicothoracic (PR=1.57) and thoracocostal (PR=1.22) injuries and a protective factor for shoulder (PR = 0.73) and wrist-hand (PR = 0.46) injuries. Adjusted risk for lumbopelvic-hip (PR=1.13), ankle-foot (PR=1.53), cervicothoracic (PR=1.19), thoracocostal (PR=1.14), and elbow (PR=1.48) injuries significantly increased during the post-integration period. There was a significant sex-by-period interaction for shoulder injuries alone, with female sex in the post-integration epoch found to be salient (PR=1.26). ConclusionsFemale sex was a salient factor for MSKI, with service in ground combat and aviation occupations identified as protective factors when compared with services occupations. In the evaluation of specific MSKIs, female sex remained a robust and significant factor in all lower quarter injuries and upper quarter injuries except for shoulder injuries. There was only a significant sex-by-period interaction for shoulder conditions, with an increased risk of these injuries in female Marines in the post-integration period.

ObjectiveThis study aimed to adapt and validate Levensteins Perceived Stress Questionnaire (PSQ) within the Ecuadorian sociocultural context. The PSQ measures perceived stress across two temporal frames: general (past two years) and specific (past month). MethodsThe research followed five sequential phases. Study 1: linguistic and cultural adaptation through standardized translation, back-translation, expert review, and a pilot test with 300 participants. Study 2: item refinement with an additional sample of 300 participants. Study 3: Exploratory Factor Analysis (EFA) with 395 participants. Study 4: Confirmatory Factor Analysis (CFA) with 391 participants, complemented by Structural Equation Modeling (SEM) to evaluate factorial structure, internal consistency, and convergent and discriminant validity through correlational analyses. Study 5: multigroup factorial invariance analysis by biological sex. ResultsThe original questionnaire of 30 items across seven factors was refined for the Ecuadorian context into two versions: a General version with 21 items grouped into three factors, and a Specific version with 23 items distributed across four factors. Both versions demonstrated strong reliability, along with satisfactory convergent and discriminant validity. ConclusionsThe findings endorse the PSQ-593 as a reliable and culturally appropriate instrument for assessing perceived stress among Ecuadorian university faculty. Its validation contributes to a deeper understanding of stress as a psychological risk factor for mental health.

Policing is one of the most rewarding occupations; however, it is stressful and demanding. This study was designed to explore stress, stress management, and coping mechanisms among Nigerian Police Officers working across four geopolitical zones in Nigeria. Using an exploratory design, forty in-depth interviews (IDIs) were conducted with police officers. Data was collected using an interview guide. The interviews were conducted in English and the participants indigenous languages (by preference), audio-recorded, and transcribed verbatim. Data were analyzed using the thematic approach. A range of contextual stressors were identified as barriers to the health and well-being of police officers in Nigeria. The police often lack the tools and equipment needed to perform their official duties effectively. This includes items like uniforms, bulletproof vests, and even operational vehicles. Shortage of manpower, lack of operational tools, poor welfare for police officers, and poor remuneration were also among their concerns. The participants were able to identify signs of stress that are common among police officers, which are majorly weaknesses, lack of sleep, dizziness, headache, anxiety, exhaustion, and anger. The common coping mechanisms include regular exercise, adequate rest, and relaxation through recreational activities, regular medical checkups, and seeking support from colleagues, among others. Nigerian police officers face many challenges that affect their health and daily routines. This analysis identifies potential opportunities to improve officers welfare in these contexts.

BackgroundOutdoor workers are particularly vulnerable to the adverse impacts of heat, but many studies focus on heat exposure in residential settings only. This leads to a limited understanding of the full mortality burden due to occupational heat exposures. Here, we aimed to improve estimates of the total, short-term mortality burden attributable to outdoor occupational heat exposure in the United States (US). MethodsWe developed a panel data set for 3,108 US counties during 2010-2019 by linking all-cause mortality among the working age population, derived from CDC WONDER, with the prevalence of workers exposed to outdoor occupational heat, which integrates data on wet bulb globe temperature, workplace activities, and employment counts. We developed a quasi-Poisson regression model adjusted for ambient temperature, total precipitation, and county and state-year fixed effects to estimate short-term excess deaths attributable to outdoor occupational heat exposure. FindingsNationwide, approximately 3.8% (95% CI: 2.5-5.8%) of all workers were annually exposed to dangerous wet-bulb globe temperatures. This outdoor occupational heat exposure resulted in approximately 9,800 (3,100-17,000) annual excess deaths in the working age population. An estimated 62% of excess deaths occurred in the most socially vulnerable counties despite accounting for 25% of workers. InterpretationThe mortality burden of occupational heat exposure is likely far larger than 39 officially reported annual deaths that the Bureau of Labor Statistics reports for this time period. The workplace should be an explicit focus of heat policies, advocacy, and adaptation measures. FundingUS Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health.

BackgroundWhile veterinary surgeons are known to have particularly high rates of injury compared to other sectors, little is known about rates of injury among veterinary students. This study aims to understand animal-related injury rates, injury context and mechanisms, attitudes to reporting injuries, and behaviour change among UK and Irish veterinary students. MethodsA survey was distributed to students across all veterinary schools operating in the UK and Ireland in 2021. Questions explored participants experience of injury through asking about their most recent and most severe injuries via quantitative and free-text questions. Data were analysed using descriptive statistics, logistic regression, and qualitative content analysis. Results533 responses were included in the analyses. Overall, 47.5% of students reported having been injured by an animal during the veterinary degree, 35.5% of students reported being injured within the last 12 months. Most recent injuries were caused by companion animals (38.0%), livestock (37.6%), and equids (23.5%). For their most severe injuries, 48.7% involved livestock, 28.7% companion animals, and 22.1% equids. The content analysis highlighted that students normalised injuries and infrequently reported injuries to the university. It was very rare for students to take time off from their studies or placements, due to course pressures. ConclusionsThese findings reflect concerningly high levels of injury, which are being under-reported and reflect a culture of injury acceptance and expectation among students. Veterinary schools should consider lessons learnt in other work environments which have been successful in changing safety culture.

Compassion fatigue is a well-documented hazard among healthcare and veterinary professionals, yet the psychological toll on informal caregivers of feral cat colonies, likely numbering several tens of thousands in Portugal, remains largely unexplored. This cross-sectional study examines internal and external factors associated with the secondary traumatic stress component of compassion fatigue among 172 informal caregivers in Portugal. Secondary traumatic stress refers to work-related secondary exposure to individuals who have experienced extremely stressful or traumatic events. Structured telephone interviews assessed sociodemographics, colony management, compassion satisfaction, resilience, spiritual well-being, and perceived social support. Univariate and multivariable linear regression identified predictors of compassion fatigue. Results indicate that 47% of participants experienced moderate compassion fatigue, and 10% reported high levels. Multivariable analysis revealed that caring for large colonies (more than 25 cats) and being unemployed were significantly associated with higher fatigue. Conversely, older age, higher perceived family support, and the resilience dimension of serenity served as protective factors. Interestingly, finding meaning in life was positively correlated with fatigue, suggesting that caregivers who perceive their role as central to their life purpose may become more emotionally invested, increasing vulnerability to distress when unable to help animals. Official colony registration and formal institutional support did not significantly alleviate fatigue. These findings highlight that institutional support alone is insufficient to mitigate fatigue among informal caregivers, who experience significant distress driven by both practical burdens and profound emotional involvement. The most frequently reported concern among caregivers was the inability to cover the costs of feeding and veterinary care for the cats. Interventions must address both external needs (e.g., support to cover veterinary and feeding expenses for the cats) and internal coping mechanisms. Implementing psychosocial support alongside trap-neuter-return programs may also improve caregiver well-being and foster sustainable urban feral cat management. This underscores a One Health perspective, demonstrating that animal health is closely interconnected with human well-being and environmental health.

ABSTRACTO_ST_ABSBackgroundC_ST_ABSHealthcare workers (HCWs) could be subject to stigma, particularly in contexts of fear of contagion related to various communicable diseases. While existing literature has established links between workplace stigma and adverse mental health outcomes, this research has largely focused on stigma derived from personal characteristics (e.g., race, gender). However, studies specifically investigating occupational stigma - the stigma resulting directly from the nature of the healthcare profession itself - remain scarce. ObjectiveWe investigated the association between perceived occupational stigma and post-traumatic stress disorder (PTSD) symptoms one year following the onset of the COVID-19 pandemic. MethodsThis study analyzed data from a cross-sectional online survey conducted in France. PTSD symptoms were measured with the Posttraumatic Stress Disorder Checklist (PCL-5), and perceived stigma was assessed with a single-item question. Associations were analyzed using inverse probability weighting based on propensity scores, which accounted for a broad range of potential confounders, including socioeconomic factors, work characteristics, and comorbidities. ResultsAmong 655 respondents, who were mainly physicians, 44.8% reported experiencing occupational stigma and 8.7% met the threshold for PTSD symptoms. After adjustment, perceived occupational stigma was significantly associated with PTSD symptoms (ORa=2.16; 95% CI [1.09-4.25]). ConclusionOccupational stigma is independently associated with PTSD symptoms among HCWs. These findings underscore the critical need for integrating targeted anti-stigma interventions into mental health strategies for HCWs involving in managing infectious disease or in pandemic context.

BackgroundThe COVID-19 pandemic required South African public sector HIV viral load (VL) laboratories to scale up Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing while maintaining essential HIV services. This placed additional pressure on diagnostic services. This dual mandate introduced significant occupational and environmental challenges (OEC) for staff that remain underexplored. ObjectiveThis study aimed to investigate the OEC and effects that staff experienced during the implementation of COVID-19 testing at public sector VL laboratories in South Africa. MethodsA quantitative, cross-sectional study utilised a census approach among technical and support staff. Data were collected via a structured REDCap questionnaire using 5-point Likert scales. Pre- and post-implementation challenges were assessed across four domains: workload, environmental conditions (space, ventilation, waste), communication, and PPE availability. Statistical analyses included the Wilcoxon Signed-Rank and Spearmans correlation tests. ResultsPerceived occupational challenges increased significantly across all domains post-implementation. Staff workload saw the highest rise (mean score 3.02 to 3.53). Adverse health effects were pervasive; 80.2% of staff reported burnout/fatigue, and 76.5% reported increased anxiety/stress. A strong positive correlation was observed between post-COVID-19 challenges and adverse mental and physical health outcomes (rho = 0.449, p < 0.001). Furthermore, 35.8% of staff considered resigning due to increased job demands. ConclusionIntegrating COVID-19 testing exacerbated systemic weaknesses, causing measurable psychological injury and threatening workforce retention. Findings suggest that the diagnostic workforce requires formal crisis surge staffing models and institutionalised mental health support to safeguard personnel and maintain essential services during future health emergencies.

Rationale & ObjectiveCompetency-based medical education emphasizes observable skills rather than time-based training. Entrustable Professional Activities (EPA) transform competencies into distinct, assessable clinical tasks but have not yet been systematically developed for U.S nephrology fellowships. We aimed to create and achieve consensus on a set of nephrology-specific EPAs and align them with Accreditation Council for Graduate Medical Education (ACGME) competency standards. Study DesignA consensus framework was developed using an online 3-round modified Delphi method. Settings & ParticipantsStudy was conducted within the University of New Mexico nephrology fellowship program. Participants included eight faculty nephrologists and one nephrology fellow. Analytical ApproachAn initial EPA list was generated by the study team using program objectives, literature review, and clinician insight. Participants rated each EPA using a 5-point Likert scale with consensus requiring strict criteria. Final EPAs were independently mapped to ACGME nephrology program requirements to ensure alignment with national competency. ResultsNine study participants (100% response rate) completed all survey rounds. Through iterative consensus, utilizing strict criteria, a final list of 22 distinct EPAs were achieved covering core domains of practice including dialysis management, acute kidney injury, chronic kidney disease, electrolyte abnormalities, hypertension, kidney stones, glomerular disease, pregnancy, transplant care, and education. Mapping demonstrated that the EPAs sufficiently corresponded to the breadth of ACGME-required sub competencies, offering a practical framework for translating broad milestones into observable clinical tasks. LimitationsThe study was conducted at a single fellowship program with a small number of participants which may limit generalizability. Implementation feasibility, resource implications, and potential unintended consequences such as checklist mentality and documentation burden were evaluated during a subsequent phase of the study. ConclusionsWe developed the first consensus-consensus based set of EPAs geared for U.S based nephrology fellowship programs while being systematically aligned with ACGME program requirements. This framework provides a foundation for standardized assessment and curriculum development in nephrology and may inform broader efforts to implement EPA-based evaluation across fellowship programs nationally.

BackgroundLung cancer compensation systems for occupational exposure to asbestos commonly apply Helsinki criteria, which assume 4% excess lung cancer risk per fibre-year of asbestos exposure. The Probability of Causation (PoC) is [&ge;]50% at 25 fibre-years (risk doubling threshold). Large case-control studies have suggested steeper exposure-response relations at lower exposures. We aimed to estimate PoC of asbestos-related lung cancer to evaluate exposure thresholds for compensation of lung cancer cases occupationally exposed to asbestos. MethodsRelative risk of asbestos-related lung cancer was estimated using two approaches: O_LIA meta-regression of 22 occupational studies forming the core evidence on cumulative asbestos exposure and lung cancer since the 1980s (130,341 participants). C_LIO_LIA meta-analysis of the recently conducted SYNERGY pooled case-control study (14 studies, 37,866 participants), adjusted for age, sex, smoking, and study. C_LI The likelihood that lung cancer was caused by asbestos was estimated as the PoC with 95% prediction intervals (95%PI). ResultsOccupational cohort studies produced a shallow exposure-response relation with substantial heterogeneity (I{superscript 2} = 92.7%). SYNERGY showed a steeper relation with 6.8% (95%PI: 0%-17.7%) lung cancer risk increase per fibre-year and lower heterogeneity (I{superscript 2} = 63.4%). PoC [&ge;]50% occurred at 62.93 (point estimate) and 18.2 fibre-years (upper 95%PI) for occupational asbestos studies, compared to 10.5 and 4.3, respectively, in SYNERGY. ConclusionsThe SYNERGY pooled case-control study provided exposure-response estimates that are more representative of current exposure to lower mixed asbestos fibres in the Netherlands, supporting lower exposure thresholds than the existing Helsinki criteria when estimating PoC in compensation contexts.

Structured AbstractO_ST_ABSBackgroundC_ST_ABSHair cortisol analysis allows assessment of long-term cortisol exposure and may provide insight into chronic hypothalamic-pituitary-adrenal activation in medical residents and residency on-call responsibilities. ObjectiveTo determine the hair cortisol concentration(HCC) representing 3 months of medical residency and secondarily, its association with various on-call models (in-hospital, night float, home call and no call). DesignCross-sectional study of 66 medical residents who were recruited to provide hair samples collected after a three-month block in medical residency. SettingAcademic, tertiary health care system. ParticipantsVolunteer sample of first through third year medical and primary care residents. Exposure3 cm of hair was divided into 3 segments of 1 cm each; each segment represented 1 month of cumulative cortisol production. Main Outcome MeasureHCC results were compared to a published, cortisol assay-specific normative population reference interval. HCC results were interpreted according to a priori categorizations of moderate (+1.5SD), considerable (+2SD) or extreme (> +3SD) HCC elevations. Associations with various on-call models were an exploratory secondary outcome. ResultsThe median age was 28 (26-30) years with median sleep duration of 2 hours on in-hospital call. 40% of trainees had at least one HCC segment above the threshold deemed marked elevation. Median HCC was significantly higher for in-hospital and night float vs. no call (285 ng/g and 335 ng/g vs 78 ng/g p<0.05) and approached significance compared to home call (190 ng/g, p= 0.06). Conclusions and RelevanceWe have described chronic exposure to endogenous cortisol in medical residency. Nearly half of trainees experienced at least one month of severe hypothalamic-pituitary-adrenal axis activation in a 3-month timeframe; many had marked chronic cortisol elevations across the entire 3 month observation frame. HCC was higher in months where in-hospital on-call was required. This may have implications for long-term health of trainees and raises questions about the structure of duty hours and sequence of care acuity blocks within residency training programs.

IntroductionChronic kidney disease imposes a high clinical and economic burden on the Brazilian Unified Health System, and kidney transplantation offers the best prognosis. ObjectiveTo describe trends in living kidney (LD) donation in Brazil (2010-2023), analyzing the donor-recipient relationship and the operational stock-to-annual production ratio on the waiting list, and to compare hospital indicators and estimated patient and graft survival between LD and deceased-donor (DD) kidney transplants. MethodsDescriptive ecological time-series study using aggregated, publicly available data. ResultsThe waiting list increased by 15% (from 33,253 to 38,258), and the total number of transplants rose by 29% (from 4,656 to 6,047). Data showed an increase in deceased-donor transplants (from 3,001 to 5,189) and a decrease in LD transplants (from 1,655 to 858), with the LD share declining from 35.55% to 14.19% and the per-million-population rate falling from 8.8 to 4.2. Among LD, there was a relative decrease in related donors (from 82.80% to 71.21%), a relative increase in unrelated spouse donors (from 10.57% to 18.65%), and in other unrelated donors (from 6.63% to 10.14%). Comparatively, LD showed better descriptive performance on survival indicators and lower in-hospital mortality, length of stay, and mean Hospital Admission Authorization value. ConclusionThe findings indicate a need for strategies to sustain DD procurement and LD donation.

BackgroundProlonged wakefulness, restricted sleep, and circadian factors can impact driving performance and road safety. Currently, there are no effective objective roadside tests to detect the state of drivers sleepiness during or prior to driving, or predict future driving impairment risk. This paper reports on an extended wakefulness protocol used to determine if a portable virtual reality device to administer vestibular-ocular motor function (VOM) tests can effectively detect 1) drivers state of sleepiness during or just prior to driving, and 2) predict trait sleepiness and future driving risk. MethodsFifty healthy adults with regular sleep within 9pm to 8am were recruited for an experimental laboratory procedure which involved two phases: an initial overnight sleep study, and a subsequent period of extended wakefulness lasting ~29 hours. During the wakefulness phase, participants undertook neurobehavioural testing, a simulated driving test, and repeat assessments of VOM to establish if ocular markers can predict sleepiness state and sleepiness-related performance impairments (Trial registry ACTRN12621001610820). DiscussionThis protocol outlined a study that aimed to establish the sensitivity of VOM test the effects of extended wakefulness and circadian phase on driver state and trait sleepiness and subsequent sleepiness-related driving impairment. Furthermore, the protocol aims to define the best VOM predictors to identify driver sleepiness state (road side testing and pre-drive assessments) and sleepiness trait (predicting future driving risk) to establish proof of concept for its potential application as a roadside, pre-drive and general sleepiness related fitness to drive test.

PuhrposeTo evaluate the short- and long-term cross-sectional associations between COVID-19 infection and multidimensional sleep health. MethodsData from the COVID-19 Outbreak Public Evaluation (COPE) initiative were used to examine the association between a novel multidimensional sleep health measure (COPE Multidimensional Sleep Health Scale, CMSHS) modeled from the RuSATED instrument and (1) COVID-19 infection and (2) post-acute sequelae of SARS-CoV-2 infection (PASC). ResultsData from 11,326 respondents were used for this study. The cohort was comprised of 51% women, 61% non-Hispanic White, and 17% Hispanic adults. COVID-19 infection was more prevalent among participants who had not received a booster vaccination (55.4% vs. 30.2%, p<0.001); the number of comorbid conditions was higher among those who had been infected (2.2% vs. 1.7%, p<0.001). Participants with COVID-19 infection had significantly lower CMSHS scores indicative of worse sleep health compared with uninfected participants (3.52 {+/-} 1.37 vs. 3.78 {+/-} 1.30; p < 0.001). Participants with PASC had lower CMSHS scores in comparison to those without PASC (2.72 {+/-} 1.30 vs. 3.82 {+/-} 1.28, p<0.001). In adjusted models, a progressive decline in CMSHS scores was observed over 12 months following infection (3.52 {+/-} 0.05 vs. 2.98 {+/-} 0.04; p < 0.001 for <1 month vs. 6-12 months). ConclusionCompared with uninfected individuals, multidimensional sleep health was worse among persons who had a COVID-19 infection. Individuals with PASC had greater and persistent reductions in sleep health for up to 12 months post-infection. Brief summaryO_LISeveral studies have examined the negative effects of COVID-19 on sleep, however the effects of COVID-19 infection on multidimensional sleep health remain poorly understood as do these associations over time. Using a large, population-based cohort, this study evaluates short- and long-term effects of Covid-19 infection on overall sleep health. C_LIO_LIThe study provides evidence that COVID-19 infection is associated with impairments in overall sleep health, with effects persisting up to 12 months post-infection. The findings in this study demonstrate that poor sleep health is an important long-term consequence of COVID-19 infection and emphasizes the need for sleep assessment among patients affected by COVID-19. C_LI

BackgroundApproximately 1 in 5 Canadians experience a mental health illness in any given year. While most individuals can be successfully treated within a primary care setting, a subset of individuals present with a severity and complexity requiring specialist care. Unfortunately, a shortage of psychiatrists (especially in rural regions) can result in wait times of months to years. MethodsWe designed the Alberta Network for Community Health Outreach and Rural Mental Health. ANCHOR-MH is a 12-week program that includes a unique educational intervention, collaborative case conferencing, and a community of practice between family medicine (FM) physicians and psychiatrists. We enrolled two pilot cohorts of n=20 FM physicians each and measured participants confidence and comfort in diagnosing, managing, and treating psychiatric conditions. We also conducted qualitative analyses of their experience. ResultsData from participants that completed both the pre- and post-program survey (n=34) showed increased confidence in screening for, diagnosing, and managing psychiatric issues, as well as increased comfort discussing mental health concerns with patients and families and reduced stigma towards certain psychiatric conditions. Qualitative thematic analysis (n=39) reflected this increased confidence, revealed an increased sense of connectedness to the mental healthcare landscape, and highlighted specific examples of practice changes. Participants broadly agreed that the program improved their ability to provide mental healthcare and would improve psychiatric outcomes within their practice. InterpretationANCHOR-MH improved FM physicians confidence and ability to deliver mental healthcare in their primary care settings. Increasing the reach of this program may improve mental healthcare in underserved communities.

BackgroundWith the rapid ageing of Irans population, accidents among institutionalised older adults represent a major public health concern. This study aimed to determine the prevalence, characteristics, and risk factors of accidents among elderly residents of nursing homes in Shiraz, Iran, during 2024, with particular emphasis on functional limitations. MethodsA cross-sectional census-based study was conducted in all seven nursing homes in Shiraz, involving 550 residents aged [&ge;]60 years. Data were collected through structured interviews, review of medical records, caregiver reports, and an Accident Form. Accidents occurring during the previous year were analyzed using descriptive statistics, and associations between accident occurrence and participant characteristics were examined using chi-square tests. ResultsOverall, 72.0% of residents experienced at least one accident during the study period. Slipping was the leading cause, and bathrooms and toilets were the most frequent locations. Contusion or bruising was the most common outcome. Mobility limitation was the only factor significantly associated with accident occurrence (p < 0.001), whereas age, gender, marital status, and educational level showed no significant associations. ConclusionsAccidents were common among nursing home residents in Shiraz and were strongly associated with mobility limitation. These findings highlight the importance of addressing functional impairments alongside environmental hazards through targeted ergonomic modifications and mobility-support interventions.

BackgroundEnsuring a sufficient and motivated health workforce requires not only retaining existing staff but also understanding the intentions of those entering the labour market. In Lao PDR, limited civil-servant quotas, prolonged volunteer pathways, and expanding private sector opportunities shape the early career choices of health professional students. Yet little is known about how final-year students perceive the public sector or what influences their decision to join or avoid government service. MethodsA cross-sectional survey was conducted among 298 final-year students from four major public health-training institutions. The questionnaire assessed demographic characteristics, motivations for choosing a field of study, post-graduation plans, and perceived drivers and barriers to public-sector employment. Descriptive statistics, chi-square tests, and multivariate logistic regression were used to identify factors independently associated with intention to work in the public sector. ResultsResults: Two thirds of students (66.1%) reported willingness to work in the public sector, though nearly as many simultaneously considered private sector employment (64.8%) and 43.3% expressed interest in working abroad, reflecting a "portfolio approach" to career planning under uncertainty. In multivariate analysis controlling age, field of study, and training institution, several factors independently predicted public sector intention. Each additional year of age increased the odds of public-sector preference by 21% (AOR 1.21, 95% CI 1.07-1.38, p = 0.003). Field of study demonstrated significant variation: pharmacy and dentistry students had 62% lower odds of public-sector intention compared to medical doctors (AOR 0.38, 95% CI 0.15-0.98, p = 0.045), while nursing and midwifery students showed equivalent preference (AOR 0.94, 95% CI 0.46-1.91, p = 0.855). Training institution emerged as a powerful predictor: students from provincial colleges demonstrated nearly three-fold higher odds of public-sector intention compared to those at the University of Health Sciences in Vientiane Capital (AOR 2.80, 95% CI 1.38-5.68, p = 0.004). Gender and marital status, while associated in bivariate analysis, did not remain significant in the adjusted model. ConclusionFinal-year health professional students in Lao PDR demonstrate substantial public-sector commitment, but career intentions are shaped by institutional context and opportunity structures rather than motivation alone. To strengthen workforce recruitment, policymakers should leverage provincial training pipelines, implement field specific retention strategies for high risk disciplines, and ensure equitable career pathways that transform structural barriers into accessible entry mechanisms for all motivated graduates.

BackgroundRising kidney discard rates and uncertainty around accepting higher risk donor kidneys highlight the need for decision support tools that integrate donor and recipient factors and communicate risk in ways that are understandable and usable at the time of offer. Conventional indices (e.g., KDPI/KDRI) provide population level signals but do not deliver individualized, cognitively accessible information aligned with real time clinical workflows. ObjectiveTo describe how key transplant stakeholders (patients, coordinators, and providers) interpret and evaluate a prototype Kidney Risk Calculator app that generates donor-recipient specific survival projections and to identify the content, format and features, and functionality needed for clinically meaningful, patient-centered decision support. DesignQualitative study using focus groups and individual interviews. SettingUniversity of New Mexico Hospital (UNMH) Kidney Transplant Center. ParticipantsFive patients (four transplant candidates and one patient advocate), three transplant coordinators, and five transplant providers (3 attending physicians and 2 advanced practice practitioners). MethodsSemi-structured sessions (45 to 60 minutes) with 13 stakeholders (patients, coordinators, and providers) included a live app demonstration and explored usability, interpretability, contextual information needs, perceived clinical utility, and anticipated barriers/facilitators. Data were collected via one coordinator focus group, one patient focus group, and five provider interviews; sessions were recorded, transcribed, de-identified, and analyzed using inductive reflexive thematic analysis. ResultsStakeholders affirmed the value of personalized projections as an adjunct to clinical judgment, particularly for higher risk offers. Participants prioritized: 1) Content: clear education on hepatitis C virus (HCV) positive donors and Public Health Service (PHS) risk criteria; plain explanations of Calculated Panel Reactive Antibody (CPRA); and framing that makes time on dialysis and tradeoffs salient; 2) Format & Features: plain language narratives, percentages rather than decimals, simple visuals, minimized acronyms, U.S. customary units, and a stepwise (TurboTax-like) input flow preferred by patients; and 3) Functionality: attention to cognitive load and workflow alignment, given phone based time pressure and digital access constraints. Stakeholders emphasized that the value of the tool hinges on clarity, context, and workflow fit, not predictive accuracy alone. LimitationsSingle center, formative prototype study with a modest sample; findings are illustrative and may have limited transferability. Participants reacted to a demonstration rather than using the app during real time offer calls; convenience/email recruitment and Zoom only English sessions may introduce selection bias; team involvement in app development may contribute residual confirmation bias despite mitigation. ConclusionsEarly stakeholder input suggests that a kidney offer decision support tool should integrate individualized predictions with plain language explanations, contextual information that addresses common misconceptions, workflow aligned functionality, and accessible outputs. Tools designed and implemented with these features may support acceptance of medically complex kidneys and may help reduce offer bypass and organ discard. These inferences reflect stakeholder perceptions in a formative qualitative study and warrant prospective evaluation.

BackgroundEvidence suggests maternal exposure to ambient air pollution increases the risk of stillbirth, but few studies conducted in the United States have evaluated temporally varying exposures or susceptibility across gestational windows. Moreover, the generalizability of existing findings is often limited by restricted geographic coverage or reliance on selected study populations. MethodsUsing Georgia vital records from 2005 to 2014, we conducted a matched case-control study including 8,384 stillbirths and 33,459 live birth controls matched on maternal county of residence and conception month. We used stratified Cox proportional hazards models with time-varying covariates to estimate hazard ratios (HRs) for ten air pollutants across five exposure windows (first month, weekly, and first, second, and third trimester). Our primary analysis included all stillbirths combined, with subgroup analyses separating second and third trimester losses. ResultsStillbirths had a median gestational age of 27 weeks (IQR: 6.67) compared with 38 weeks for live births (IQR: 2.13). Particulate matter showed strong associations in the second trimester exposure window for all stillbirths (PM10: HR = 1.07; 95% CI: 1.04, 1.11; PM2.5: HR = 1.05; 95% CI: 1.01, 1.09). This pattern was consistent for NO2 and NH4, which also exhibited positive associations across early and entire pregnancy exposure windows (first month, first trimester, weekly), with the strongest associations for the second trimester exposures. Associations were larger for second trimester stillbirths, whereas estimates for third trimester stillbirths were largely null or negative. ConclusionsIn this population-based study in Georgia, time-varying ambient air pollution exposures during pregnancy were associated with increased risk of stillbirth, particularly for second trimester exposures and for stillbirths occurring earlier in pregnancy. These findings highlight the importance of considering gestational timing when evaluating environmental risk factors for stillbirth. What this study addsThis study is the first to evaluate maternal ambient air pollution exposure and stillbirth using time-varying exposures on vital records in the state of Georgia. By examining ten air pollutants across multiple gestational windows and subset analyses by timing of stillbirth, we identified second trimester susceptibility to NO2, PM10, PM2.5, and NH4. These findings highlight periods of vulnerability to ambient air pollution during pregnancy.