Public Health in Practice

iii.Background and ObjectivesThe "Pan-European Transfusion Research InfrAstructure" (PETRA) project was established to advance the use of donor, blood product, and patient datasets in Europe, aiming to benefit both patient and donor health. Here, the initial PETRA objective was to describe the landscape of existing donor and blood establishment (BE) databases. Materials and MethodsAn online survey was circulated to the European Blood Alliances BE members. The survey collected information on the feasibility of accessing donor data, and challenges and possibilities for linking these datasets with information on the associated blood products and transfusion recipients, and donors own health records. ResultsSeventeen BEs across 16 countries completed the survey. The majority could, in principle, link their donor data to product data (13 BEs (76%)) and recipient data (10 BEs (59%)), for research purposes. However, capabilities were limited and in only 29% of the BEs was the donor to recipients linkage an automated process. BEs reported significant challenges to achieve full vein-to-vein linkage, including legal constraints and lack of consent (11 BEs) and resources (10-14 BEs). IT and data issues as well as lack of knowledge and training were cited as obstacles by a minority of BEs. ConclusionWhilst the survey results suggest considerable interest in developing linkages between blood donors, their products, and recipients, many challenges remain due to a variety of obstacles. First steps in working towards a PETRA may be assistance to navigate legal frameworks as well as investing in resources and quality and harmonisation of data collections. iv. HighlightsO_LI17 blood establishments (BEs) in 16 countries responded to a survey on obstacles and opportunities for achieving vein-to-vein datasets. C_LIO_LIIn 59% of the BEs donor-to-recipient links can be established for research improving transfusion outcomes, but only in 29% this is an automated process. C_LIO_LIIn order to work towards a "Pan-European Transfusion Research InfrAstructure" (PETRA), legal frameworks, adequate donor consent and (financial and human) resources are the most common obstacles that require addressing. C_LI

BackgroundSexual violence (SV) is a major public health problem with far-reaching consequences; however, adolescent survivors rarely seek help. This underestimates the prevalence of SV and undermines prevention and response efforts. This study was conducted to determine the prevalence and reporting of sexual violence among adolescents in Ibadan, Nigeria. MethodsBetween September and October 2021, a cross-sectional study was conducted among 360 in-school adolescents in Ibadan South-West local government area, Nigeria. Adolescents were selected using multi-stage sampling. Information on experience and reporting of sexual violence was obtained with the aid of an interviewer-administered questionnaire. Data were analysed using descriptive and inferential statistics at p[≤]0.05 level. ResultsRespondents mean age was 14.6{+/-}1.7 years, and 50% were female. Thirty-five per cent reported at least one incident within the past 12 months. Forms of sexual violence experienced included unwanted sexual touch (25.6%), forced sex (19.2%), attempted rape (15.2%), and suggestive comments (9.6%). Seventy per cent of adolescents who experienced sexual violence did not report to anyone; reasons included fear of getting in trouble (46.6%), thinking it was not a problem (31.8%), feeling it was their fault (30.7%), and embarrassment for self/family (27.3%). Adolescents who were closer to their mothers and younger adolescents were more likely to report their experience of sexual violence (p=0.006 and p=0.038, respectively). ConclusionSexual violence is common among in-school adolescents in Ibadan, yet reporting remains low. This study highlights the need to strengthen prevention and address barriers to reporting among adolescent survivors. Key MessageO_ST_ABSWhat is already known on this topicC_ST_ABSSexual violence has physical, psychological, and social consequences on the health and well-being of adolescent survivors, and low levels of reporting and help-seeking contribute to these consequences. What this study addsThis study provides evidence on the prevalence and reporting patterns of sexual violence among adolescents in Ibadan, Nigeria. It highlights key barriers and facilitators of reporting. How this study might affect research, practice, or policyThis study provides information about factors at individual, relationship, societal and policy levels that are associated with reporting and help-seeking among adolescent survivors of sexual violence in Ibadan, Nigeria. This highlights the importance of training stakeholders, such as parents, teachers, health workers, other caregivers and the adolescents themselves, on responding to sexual violence experience and reporting. It underscores the need for improved adolescent-friendly services, policy implementation and collaboration across families, schools, communities and states to address sexual violence.

Introduction: Solitary plasmacytomas (SP) are rare neoplasm of localised proliferation of clonal plasma cells. It can be classified based on site of involvement and bone marrow involvement. It is an indolent disease in the majority of patients. Primary modality of treatment is radiotherapy and surgical excision. Materials and methods: This was a retrospective audit of SP who were treated and followed up at a tertiary care center in eastern India from January 2012 to December 2025. Patients who has solitary plasma cytoma with more than 10% plasma cells, POEMS syndrome, have been excluded from analysis. Results: We identified 46 patients of SP. The median age of the studied population was 53 years (23-75 years). Males were more commonly affected than females (M:F=2.2:1). Most common chief complaints were bony pain (67.4%). SBP was seen in 39 (84.8%) cases whereas SEP was seen in 7 (15.2%) cases. Vertebra was the most common site of involvement (61.4%). Median M band concentration 0.24 g/dL (0.1 to 1.95 gm/dL). IgG was the most common isotype accounting for 60.6% cases. Six cases (13%) had minimal bone marrow involvement. The majority of the patients received local radiotherapy (89.1%). With a median follow up of 5.4 years (95% CI: 1.8 - 9.0), median OS was not reached, median PFS was 9.22 years (95% CI: 5.8-12.6), median time to next treatment (TTNT) was 9.86 years (95% CI: 6.8 - 12.9). Conclusion: Solitary plasmacytoma commonly affects young males. Bones are more commonly affected than extramedullary sites. SP has a lower rate of progression and excellent prognosis when treated with local radiotherapy.

IntroductionAnaemia is one of the most prevalent global public health challenges, particularly among women of reproductive age and children. According to the World Health Organization, anaemia is defined as a hemoglobin concentration below 13.0 g/dL in adult men, 12.0 g/dL in non-pregnant women, and 11.0 g/dL in pregnant women. Hemoglobin measurement therefore plays a critical role in diagnosis, classification, and monitoring of anaemia at both clinical and public health levels. Hemoglobin estimation allows early identification and intervention in at-risk populations. MethodologyA cross-sectional study was conducted at Aniniwaa Medical Centre, Kumasi, involving 100 participants who visited the laboratory for a complete blood count. Venous blood samples were collected aseptically into EDTA tubes and analysed first with the fully automated analyser, followed by the two Hb meters. Data were analysed using Chi-square tests, Bland-Altman plots, and descriptive statistics. ResultsResults showed that the prevalence of anaemia varied across methods: 28% by the analyser, 60% by Urit, and 64% by Mission. Both meters demonstrated 100% sensitivity but lower specificities (55.6% for Urit and 50.0% for Mission). Bland-Altman analysis indicated negative biases (Urit = -1.665 g/dL; Mission = -1.55 g/dL), suggesting both underestimated hemoglobin values compared to the reference. ConclusionThe study revealed that while Hb meters offer convenience and portability for field screening, the fully automated analyser remains more accurate and reliable for diagnosing anaemia in clinical settings.

ObjectivesThis study aimed to determine the prevalence of occupational fatigue and identify its primary risk factors among long-distance truck drivers operating along the key Kenya-Uganda transport corridor, a vital artery for regional commerce where comprehensive data has been limited. MethodsA cross-sectional analytical study was conducted with 207 exclusively male long-distance truck drivers at the Busia and Malaba border points. Participants completed structured questionnaires capturing demographics, work patterns, sleep habits, and stimulant use. Fatigue was assessed using the Chalder Fatigue Scale. Data were analyzed in RStudio, using LASSO regression with 10-fold cross-validation for predictor selection to address multicollinearity. Selected variables were used in a multivariable logistic model to calculate adjusted odds ratios (aORs). Bootstrap validation assessed the models performance. ResultsThe overall prevalence of occupational fatigue was 51.7%. Key risk factors identified included high pressure to meet deadlines, the use of stimulants (e.g., caffeine, khat) to maintain alertness, and excessively long average shift lengths. The multivariable model demonstrated excellent and stable performance, with a mean Area Under the ROC Curve (AUC) of 0.987 across 1,000 bootstrap samples. ConclusionsOccupational fatigue is highly prevalent among long-distance truck drivers in this region, driven largely by organizational factors. The findings highlight an urgent need for multimodal interventions, including enforceable regulations on driving hours, targeted driver education, and improved scheduling practices by transport companies to safeguard driver well-being and public road safety. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSTruck-driver fatigue is a global problem, but evidence from East African corridors has been minimal. What this study addsFatigue prevalence on the Kenya-Uganda corridor is high (51.7%). LASSO analysis highlights key predictors: deadline pressure, stimulant use, long shifts, and poor rest. How this study might affect research, practice or policyFindings support driving-hour regulations, improved scheduling by transport companies, and targeted public health messaging on stimulant risks.

Background: Firearms are frequently transferred through inheritance and other non-purchase pathways, leaving many individuals in possession of unwanted guns and limited options for safe disposal. This study examined the characteristics and motivations of individuals relinquishing firearms at community gun buyback and destruction events in Michigan to inform understanding of firearm divestment and disposal pathways. Methods: We conducted an explanatory sequential mixed-methods study of six faith-based gun buyback and destruction events held in southeastern Michigan between June and October 2024. Quantitative surveys (n = 109) captured participant demographics and firearm characteristics. Follow-up qualitative interviews (n = 7) explored participants' experiences and motivations using inductive-deductive thematic analysis. Results: Across six events, 151 individuals relinquished 318 firearms, most of which were handguns. Nearly one-third of participants disposed of firearms on behalf of others, and two-thirds of personally owned guns had been obtained through non-purchase transfers, most commonly inheritance. Participants frequently expressed anxiety about storing unwanted firearms and relief after safe disposal. The most common motivations were concern about misuse (59%) and fear of theft (54%). Interviews identified five intersecting themes: inheritance and unwanted firearms, safety and family protection, evolving views on ownership, barriers to legal disposal, and emotional relief and closure after relinquishment. Conclusions: Many individuals become firearm owners through inheritance or other non-purchase transfers rather than intentional acquisition. Their experiences reveal that unwanted firearms can generate sustained unease and moral responsibility, motivating voluntary divestment when safe, non-punitive options are available. Results: Across six events, 151 individuals relinquished 318 firearms, most of which were handguns. Nearly one-third of participants disposed of firearms on behalf of others, and two-thirds of personally owned guns had been obtained through non-purchase transfers, most commonly inheritance. Participants frequently expressed anxiety about storing unwanted firearms and relief after safe disposal. The most common motivations were concern about misuse (59%) and fear of theft (54%). Interviews identified five intersecting themes: inheritance and unwanted firearms, safety and family protection, evolving views on ownership, barriers to legal disposal, and emotional relief and closure after relinquishment. Conclusions: Many individuals become firearm owners through inheritance or other non-purchase transfers rather than intentional acquisition. Their experiences reveal that unwanted firearms can generate sustained unease and moral responsibility, motivating voluntary divestment when safe, non-punitive options are available.

BackgroundHelmet use is a proven safety measure that reduces the risk of head injury among cyclists and e-scooter riders. Despite legal requirements for pedal bikes and e-bikes in Australia, compliance varies, particularly among users of electric vehicles. The growing popularity of e-bikes and e-scooters in urban areas presents new public health challenges, yet observational data on helmet use, behavioural determinants, and the effectiveness of safety interventions remain limited. AimPhase 3 of the Helmet Use in Canberra study aims to characterise head injury presentations associated with cycling and e-scooter use and examine their association with helmet use and injury severity. MethodsDe-identified emergency department records from The Canberra Hospital will be retro-spectively analysed for presentations involving cycling or e-scooter-related head injuries during the study period. Extracted variables will include age, sex, vehicle type, documented helmet use, injury diagnosis, severity indicators, and date/time of presentation. Descriptive statistics will summarise injury patterns, while regression analyses will evaluate associations between helmet use and injury severity, controlling for demographic and contextual factors. Sensitivity analyses will address missing helmet data and subgroup differences by vehicle type, age, and gender. Expected ResultsIt is hypothesised that lower helmet use will correlate with higher rates and greater severity of head injury presentations. Findings will provide a population-level perspective on helmet effectiveness, inform local injury prevention strategies, and guide public safety interventions. Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) [ACTRN12626000245392]

BackgroundOut-of-hospital cardiac arrest (OHCA) survival depends on timely bystander cardiopulmonary resuscitation (CPR) and quick defibrillation via automated external defibrillator (AED). However, access to CPR education and willingness to intervene are not equitably distributed. Within the Muslim community, intersecting religious identity, language, immigration-related concerns, and other social determinants of health may affect CPR/AED education, bystander response, and ultimately OHCA outcomes, underscoring the need for culturally responsive, faith-based training models. MethodsA survey based cross sectional study was conducted to evaluate the perceived barriers to emergency response and lay rescuer cardiopulmonary resuscitation (CPR). Individuals aged 13 years and older were recruited between January and June 2025 through convenience sampling at free, non-certification public CPR/AED classes, where participants self-reported demographic characteristics and barriers to calling 9-1-1 or initiating CPR. Analyses compared Muslim and non-Muslim participants using Fisher exact tests and multivariable logistic regression models adjusted for demographic and socioeconomic factors, with results reported as odds ratios (OR) and 95% confidence intervals (CI). ResultsOf the 651 surveys collected, 33% of participants identified as Muslim, and 46% reported no prior CPR/AED training, with a higher proportion among Muslim respondents (57% vs 41%). Religion was significantly associated with some perceived barriers, with Muslim participants more likely to report law enforcement as a barrier to calling 9-1-1 (OR: 0.53 for non-Muslims vs Muslims, p=0.04) and less likely to report "no problem" starting CPR (OR: 0.91, p=0.04). Race and gender also influenced barriers, with non-white and female participants more likely to report immigration status, language, cost, and concern for violence as barriers to initiating CPR or calling 9-1-1. ConclusionMuslim participants were more confident in performing CPR, but reported less confidence in calling 9-1-1, revealing gaps in emergency response readiness. This emphasizes the importance of culturally adapted CPR/AED training that addresses specific barriers within faith-based communities and to strengthen all links of the chain of survival.

ObjectiveInvestigate a strategy of mass asymptomatic testing and isolation ("pulse testing") aimed at early containment of outbreaks in prisons in comparison to or combination with a symptom-based isolation strategy. MethodsSimulations using an individual-based time-since-infection model were run under different pathogen and intervention strategy scenarios. Measured outcomes were the proportion of outbreaks contained and number of individuals isolated. ResultsFor R0 = 2, 25% probability of being asymptomatic (pa = 0.25), a COVID-19-like infection dynamics and perfect adherence, one pulse test contained approximately 20% of outbreaks, and three tests up to 50%. With no asymptomatic cases, three tests performed similarly to isolating cases one day after symptoms ({approx} 55% outbreaks contained), but symptom-based isolation degraded significantly faster than pulse testing with increasing pa. With perfect adherence, combining both interventions contained between {approx} 25% (R0 = 3, pa = 0.5) and > 90% (R0 = 1.5, pa = 0) of outbreaks. Across all scenarios, pulse testing isolated substantially fewer individuals than symptom-based isolation, e.g. {approx} 5% versus {approx} 30% for R0 = 2 and pa = 0.25. ConclusionIf implemented promptly upon outbreak declaration and with high adherence, pulse testing may stop outbreaks early, substantially reducing the number of isolations and mitigating the impact on prison regime and resident/staff wellbeing. However, for large R0 or delayed implementation, effectiveness drops rapidly.

BackgroundWorking while sick (presenteeism) with an infectious disease contributes to the spread of infections and is detrimental to productivity. Respiratory illnesses are a common cause of sickness in the working population and understanding the prevalence of presenteeism linked to respiratory illness is therefore important. MethodsWinter Covid Infection Study (WCIS) panel members in work aged 18-64 were surveyed in February - March 2024 and asked about presenteeism in the previous 28 days. Multilevel regression and poststratification was used to estimate the prevalence and length of presenteeism and its effect on productivity in the English workforce, as approximated using the WCIS survey sample calibrated to census proportions. Differences by demographic groups and work sector were also analysed. ResultsAround one in six working adults in England worked while sick with a respiratory infection during the study period, and one in ten attended a non-home workplace. Overall, around one day per adult was spent working while sick with a respiratory infection, approximately half of which was non-home working. Respondents felt they were able to work at around three-quarters of their usual capacity while sick. Presenteeism was more common among respondents who were younger, White, worked in a hybrid pattern, lived in larger households, had Long COVID-19, or worked in teaching and education. ConclusionWorking while sick with a respiratory infection is relatively common, including among those who primarily work away from the home. Key messagesAround one in six working-age adults in employment worked while sick with a respiratory infection during the study period (Feb-Mar 2024). - The likelihood of working while sick with a respiratory infection varied by demographic group and work sector. - On average, survey respondents said they could work at around three quarters their normal effectiveness while sick with a respiratory infection.

BackgroundThe COVID-19 pandemic significantly changed the daily routines of frontline health workers (FLHW), particularly those directly caring for COVID-19 patients. This study explores the lived experiences and coping strategies of FLHW at a Zonal Hospital in Kilimanjaro, Tanzania MethodThe study used a qualitative exploratory descriptive design, to retrospectively capture psychological impacts, challenges, coping strategies, and professional dilemmas faced by FLHW. Participants were purposively sampled from KCMC Hospital departments directly involved in COVID-19 patient care. FindingsThe FLHW experienced considerable fear, stress, and stigma. The fear of infection and high mortality rates among patients and colleagues heightened their anxiety. Stress was exacerbated by long working hours, uncomfortable personal protective equipment (PPE), poor remuneration, and the emotional toll of witnessing numerous deaths. FLHW also experienced being stigmatized and discriminated against, both within their workplaces, within the family and in the broader community. Some FLHW considered quitting their jobs due to the overwhelming workload, fear of being infected, and emotional strain. Additionally, absenteeism and avoidance of COVID-19 duties were common, driven by fear and inadequate hospital capacity. Coping strategies among FLHW to manage their stress and maintain resilience included acceptance, faith, family support, rest, and, the use of recreational substances. ConclusionThe FLHW experienced considerable fear, stress, and stigma. The study highlights the need for better psychological support, improved communication, adequate training, and resources to support FLHW before, during, and post-pandemic. Enhanced resilience and confidence, along with a greater appreciation for protective measures and compassion for patients, were some of the key lessons learned from their experiences during the pandemic informing more effective preparedness care in future pandemics.

World Health Organization recommendations to reduce road deaths were examined to assess the potential reductions that could be realized in countries that have not adopted them. Data from 72 countries on recommended speeding laws, alcohol laws, and vehicle safety standards were analyzed, controlling statistically for differences in average temperatures and population density per square kilometer. Using regression coefficients, estimates of the reductions that would be realized if each countermeasure were adopted in countries not currently employing it were calculated. The coefficient on alcohol laws was not significant, but deaths in these countries would likely decline by about 23 percent if speeding laws were improved. The road death would have been about 55 percent lower if vehicle safety standards for imported vehicles had been adopted. New and used vehicles that did not adhere to the standards were sold in low-income countries. Better data identifying clusters of specific collision types (pedestrians in the dark, animals, fixed objects) could lead to the adoption of countermeasures known to be effective.

BackgroundHi-fun among gay, bisexual and other men who have sex with men (GBMSM) is increasing across Southeast Asia. Yet research remains focused on epidemiological trends and health risks, with limited qualitative work capturing lived experiences, motivations and support needs. These gaps are pronounced in Thailand, where social, legal and cultural structures emphasise control and enforced abstinence over harm reduction and holistic support. MethodsThis qualitative study drew on five FGDs and six IDIs with 30 Thai and non-Thai GBMSM in Bangkok, Khon Kaen and Pattaya. Data explored contexts, experiences, strengths, challenges and support needs related to hi-fun. Thematic analysis was conducted, and findings were reviewed with a community advisory board and partner NGOs. ResultsParticipants described hi-fun as a distinct world enabling self-expression, pleasure, intimacy and a sense of being valued and accepted beyond what everyday life affords. This world was shaped through equipment preparation, participant screening and unwritten rules promoting trust and safety. Hi-fun offered emotional and social benefits, including connection and belonging. However, participants also reported risks, including mental health challenges, dependence, sexual performance difficulties, violence, non-consensual recording, financial strain and legal consequences. Hi-fun became problematic when individuals lost control, encountered police or mandatory rehabilitation, experienced health decline or struggled with daily functioning. Participants emphasised needs for sterile equipment, post-use care, accurate information, stigma-free environments and legal reforms aligned with lived realities. ConclusionSupporting GBMSM engaged in hi-fun in Thailand requires moving beyond abstinence-focused approaches toward flexible harm reduction and structural reforms that uphold dignity, safety and equity.

ObjectiveThis study aimed to identify characteristics that define population need groups with similar mental health service needs within prisons and describe the mix of services required to meet those needs. MethodsMixed methods were used, including three iterative, semi-structured focus groups, followed by an online survey, seeking information on the characteristics that define service needs, how these can identify groups of people who require mental health care in prisons and the services required by each group. Participation was sought from prison health services, prison mental health services, non-government service partners and people with a lived experience. Focus group transcripts and free text survey responses were thematically analysed. Descriptive statistics were generated for online survey responses to Likert Scales to determine the levels of agreement with survey content. ResultsThe characteristics and service needs of four distinct population groups who require mental health care in prisons were defined: indicated prevention, mild, moderate, severe and complex. These groups were delineated using characteristics including presence of a diagnosed mental illness, level of functional impairment, presence of added complexity and service response required. The required service mix varied across need groups, however service types common across all groups included assessments, psychological therapies, peer support, lifestyle interventions and carer support. ConclusionsThe identified need groups and service descriptions will contribute to the evidence required for needs-based planning of mental health care in Australian prisons. This information can be used for planning a responsive, equitable, and needs-based mental health service system within custodial environments.

BackgroundCommunity safety is a key determinant of mental well-being, yet racially and ethnically minoritised communities in the UK often face higher exposure to violence alongside barriers to formal protection and support. In these contexts, informal support networks may play a critical role in shaping how safety is experienced and how distress is managed. Although such networks are widely recognised as protective for mental well-being, there is limited qualitative research examining how they operate in relation to community safety in settings shaped by structural inequality. This study explores how informal support networks influence experiences of community safety and mental well-being among racially and ethnically minoritised groups in South East London. MethodsThis qualitative study draws on semi-structured interviews (n = 31) with racially and ethnically minoritised participants aged 16+ living or working in Lambeth and Southwark [South East London]. Using a co-produced qualitative design, community consultations informed the development of interview topics. Interviews explored informal support networks, experiences of community safety and their intersections with mental well-being. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis. ResultsFour themes were identified: (1) experiences of community safety and their mental health impacts; (2) gendered experiences of safety and responsibility; (3) formal support and its barriers; and (4) community and peer-led initiatives as a response to institutional distrust. ConclusionInformal support networks are central to everyday safety and emotional well-being, yet they cannot substitute for adequately resourced, culturally informed public provisions. Strengthening public infrastructure must involve meaningful collaboration with trusted community networks and address the intersectional needs of racially and ethnically minoritised groups.

BackgroundAvian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. For outbreak management testing is essential. Current knowledge on testing behaviour is mostly derived from other infectious diseases such as COVID-19. It is necessary to identify determinants of testing behaviour for AI in an early phase. Therefore, this interview study aims to identify a wide range of behavioural determinants of testing during a hypothetical human-to-human transmissible AI outbreak. MethodsSemi-structured in-depth interviews, based on the Theoretical Domains Framework, were carried out between May 2024 and February 2025. Participants were included through purposive and convenience sampling. During the interviews an animation was shown illustrating a hypothetical AI outbreak. Verbatim transcripts were thematically analysed. ResultsWe included seventeen participants (median age 44, range 20-81; 71% women) with diverse backgrounds in terms of age, gender, educational level and country of birth. We found that having the freedom to decide to test would make testing more acceptable, whereas a decreased sense of autonomy would discourage testing. Most themes included individual rather than population-level benefits as drivers of testing behaviour. These included protecting loved ones, ones own health and gaining psychological reassurance. External conditions like being unable to go to work or an event would generally encourage testing behaviour. Lower trust in governmental authorities could hamper testing behaviour. Previous experiences from the COVID-19 pandemic shaped participants answers about AI testing behaviour. ConclusionKey considerations include balancing peoples need for autonomy with the external measures imposed by employers or the government, rebuilding trust in institutions and acknowledging how prior experiences with testing may shape testing behaviour in future AI outbreaks. Further research is needed to determine how these findings can be translated into effective communication and how trust in authorities can be build.

BackgroundHelmet use is a proven safety measure that reduces the risk of head injury among cyclists and e-scooter riders. Despite legal requirements for pedal bikes and e-bikes in Australia, compliance varies, particularly among users of electric vehicles. The growing popularity of e-bikes and e-scooters in urban areas presents new public health challenges, yet observational data on helmet use, behavioural determinants, and the effectiveness of safety interventions remain limited. AimPhase 4 of the Helmet Use in Canberra study aims to identify demographic and behavioural predictors of unsafe riding and to explore perceived barriers and facilitators to helmet use, including compliance with existing regulations. MethodsA cross-sectional survey will be administered to Canberra residents aged 18 years or older, both online and in-person. The survey will assess attitudes toward helmet use, perceptions of head injury risk, and the deterrent effect of fines. Data will capture demographic characteristics, vehicle type, riding behaviours under varying conditions, and opinions regarding mandatory helmet laws and signage interventions. Survey responses will be de-identified, securely stored, and analysed using descriptive statistics and ordinal logistic regression to evaluate factors influencing compliance. Survey findings will be triangulated with observational and hospital data from earlier study phases. Expected ResultsThe survey is anticipated to provide insights into public attitudes toward helmet use, the perceived effectiveness of fines as behavioural deterrents, and the acceptability of policy interventions. These findings will inform evidence-based strategies to improve helmet compliance and reduce head injuries among urban riders. Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) [ACTRN12626000245392].

ObjectivesTo quantify patterns of preventable death in Australian coronial findings, measure government compliance with coroner recommendations across jurisdictions, and identify case characteristics associated with recommendation issuance and acceptance. DesignCross-sectional computational text analysis of publicly available coronial findings using unsupervised topic modelling and rule-based classification. SettingAustralian coronial system, all eight state and territory jurisdictions, findings published on the Australasian Legal Information Institute (AustLII) database, 2000-2024. Participants9833 coronial findings and 2040 linked government responses. Main outcome measuresDeath-type topic prevalence, recommendation rate by jurisdiction, government response acceptance rate. ResultsTwenty-six death-type topics were identified, with medical/surgical deaths (12.5%), men-tal health (10.4%), and deaths in custody (8.6%) most prevalent. Overall, 45.6% of published find-ings contained formal recommendations (95% CI, 44.6-46.5%). Of 2040 government responses, 43.0% were unclassifiable (predominantly Victorian administrative cover letters). Among classifi-able responses, 53.2% were accepted (implemented, already implemented, or partially accepted), ranging from 26.0% (Western Australia) to 88.0% (Queensland). Multivariable logistic regression showed that jurisdiction was the strongest measured predictor of acceptance (pseudo R2 0.13 vs 0.14 with all covariates), though most variance remained unexplained. Among published findings, In-digenous Australians were represented in 10.1% (2.7 times the 3.8% population share).12 Findings involving medication errors had the highest recommendation rate (55.1%) but among the lowest acceptance rates (26.4%). ConclusionsAmong publicly available coronial findings, fewer than half contain formal recom-mendations. Government acceptance is low and structurally determined by jurisdiction rather than case characteristics, suggesting that legislative reform is needed to improve the systems preventive effectiveness.

Hemoglobinopathies are inherited disorders of hemoglobin, most notably sickle cell anemia and thalassemia. These conditions result from mutations in the globin genes, leading either to structural abnormalities in the globin chains or to reduced synthesis of normal globin chains. Hemoglobinopathies is a worldwide health problem according to the World Health Organization; it affects mostly the indigenous Tharu groups in Nepal. Both the global and local rates of illness and death associated with these diseases are on the rise. The objective of this study was to assess the presence of hemoglobinopathies and common mutations of the beta-globin gene within the Tharu population in western Nepal. A cross-sectional study of 1,400 Tharu individuals was conducted among individuals obtained through hospitals within the Banke district, Bardiya district, and Kailali district in western Nepal. A thorough hematological analysis was done with the use of a Sysmex XN-350 analyzer. Hemoglobin variants were detected via high-performance liquid chromatography (HPLC). The molecular characterization of the seven most common mutations of {beta}-thalassemia was performed on a subset of 20 confirmed cases by using a real-time PCR kit.The total number of cases diagnosed with hemoglobinopathies was 14.43% (n=202 out of 1,400). Sickle cell trait (HbAS) was reported as the most prevalent type of Hemoglobinopathies (8.50% of population), followed by {beta}-thalassemia trait (4.00%). In addition to these disorders were sickle cell disease (HbSS), HbE trait, and compound heterozygous states. Hematological parameters differed significantly across types of hemoglobinopathies, and the patterns of microcytic, hypochromic, and hemolytic anemia were also distinct. Commonly documented symptoms included fatigue and joint pain (42.5% and 23.1%, respectively). Molecular characterization of {beta}-thalassemia cases demonstrated that most individuals were compound heterozygotes with IVS1-6 (T>C) as the most prevalent variant. The research identified that the Tharu population in western Nepal has a significant burden of hemoglobinopathies (especially sickle cell trait and {beta}-thalassemia), highlighting the requirement for appropriate screening programs, genetic counseling and public health strategies to help manage and prevent these conditions within this particular region.

Structured AbstractO_ST_ABSObjectiveC_ST_ABSThis mixed-methods study investigated the lived-experience perspectives of receiving a novel, brief digital mental health intervention after psychological trauma. The online gamified imagery-competing task intervention (ICTI) involves one researcher-guided session followed by self-use. Tested in two randomised controlled trials (GAINS-01; GAINS-02), ICTI led to fewer intrusive memories at week-4, with the reduction sustained over 24 weeks, alongside reductions in post-traumatic stress. Here, we contrasted user experiences of ICTI with an Active Control (AC; music-listening task), and explored longer-term impact in qualitative interviews to contextualise GAINS-02 findings. Methods and AnalysisThe GAINS-02 trial randomised healthcare staff experiencing intrusive memories after work-related trauma to ICTI (N=40), AC (N=39), or treatment-as-usual (TAU; N=20). Expectancy was assessed before the researcher-guided session (Day 0), acceptability at week-4, and usage tracked for 24-weeks. Semi-structured interviews (N=27) were conducted in ICTI and AC arms only (15 at week-4; 12 during 12-24-weeks). Interviews were analysed using reflexive thematic analysis. ResultsPrior to use, many trial participants did not think the intervention would work, favouring AC over ICTI. However, after completing the tasks, participants found ICTI more acceptable and relevant to intrusive memories than AC. After the one guided session, median ICTI usage the next four weeks was 4.00 times with little additional use (once more) over the next 20 weeks because of lack of need. Potential implementation facilitators included ease of use, and advantages over existing interventions due to not needing to talk about the trauma, brevity, and lesser resource commitment. Perceived barriers included a lack of staff and manager education about the nature and consequences of intrusive memories, with a need for workplace buy-in and demonstration of organisational benefits. ConclusionHealthcare staff experiencing workplace-related trauma found ICTI to be acceptable and effective for reducing intrusive memories with low effort and emotional burden, even among participants who initially expressed scepticism. Participants highlighted implementation considerations including offering ICTI both within and outside the workplace, and providing a self-guided version of ICTI with optional support. Future work should assess cost-effectiveness, impacts on presenteeism and retention, and real-world implementation including the feasibility and effectiveness of a self-guided ICTI. Summary BoxO_ST_ABSWhat is already known on this topicC_ST_ABSIn a previous randomised controlled trial (GAINS-01) with Intensive Care Unit (ICU) staff exposed to work-related trauma, a brief online gamified imagery-competing task intervention (ICTI) reduced intrusive memories compared to usual care at four-weeks. What this study addsThe GAINS-02 randomised controlled trial replicated GAINS-01 and extended results by comparing ICTI to an active control (AC; music listening) task, enrolling hospital staff from outside ICU, and a follow-up period of 24-weeks. Qualitative interviews found that, despite initial scepticism from healthcare staff prior to using the intervention, ICTI was more acceptable than an AC due to specific effects on swiftly reducing intrusive memories and requiring minimal support or usage after an initial researcher-guided session. After one guided session, ICTI was used 4 more times in the first four weeks, with little additional usage (once) thereafter because of lack of need (i.e., no longer experiencing intrusive memories). How this study might affect research, practice or policyICTI is an efficacious scalable intervention to relieve staff of intrusive memories with effects sustained for at least 6-months. It was found to be more acceptable to participants than alternatives, requiring less time commitment than standard psychological treatments.