Public Health

Background Early recognition of presentations consistent with the deliberate release of a Category A bioterrorism agent is essential for rapid isolation, public health notification, and containment. The ability of UK clinicians-in-training to recognise these syndromes is unstudied. This pilot assessed final-year UK medical students' ability to recognise these syndromes. Methods A pilot cross-sectional online survey of final-year UK medical students used single-best-answer clinical vignettes depicting syndromes associated with Category A bioterrorism agents (BT vignettes) and clinically overlapping non-bioterrorism syndromes (NBT vignettes). Performance was summarised as the proportion of vignettes correctly identified, with primary analysis comparing within-participant BT and NBT performance. Results Twenty-five participants completed the survey. Participants performed worse on BT vignettes (M = 0.55) than on NBT vignettes (M = 0.81), with a within-participant difference of -0.26 (95% CI [-0.35, -0.18]; t(24) = -6.33, p < 0.001; Cohen's dz = -1.27). Botulism (96.0%) and Ebola virus disease (88.0%) were recognised by most participants, while anthrax (40.0%), pneumonic plague (28.0%), and smallpox (24.0%) were recognised by fewer than half. Conclusion This pilot provides the first UK evidence of a substantial diagnostic deficit in final-year medical students' recognition of Category A bioterrorism agent syndromes.

Background: Travellers visiting friends and relatives (VFRs) experience a disproportionate burden of travel-associated infectious diseases, yet little is known about the complexity of pre-travel consultations required to support their care. We compared enquiries relating to VFR travellers and tourists received by the UK National Travel Health Network and Centre (NaTHNaC) specialist Advice Line to identify differences in traveller characteristics, destinations and clinical complexity. Methods: We conducted a retrospective observational study of enquiries to the NaTHNaC Advice Line between 1 January 2019 and 31 December 2025. Enquiries relating to VFR travellers and tourists were compared using descriptive statistics and appropriate statistical tests. Traveller demographics, travel characteristics, destinations and enquiry management were analysed. Results: Of 16,367 enquiries relating to specific travellers, 3,090 (18.9%) concerned VFR travellers and 7,237 (44.2%) concerned tourists. Compared with tourists, VFR travellers were younger (median age 24 vs 52 years, P<0.001), more likely to undertake long-stay (8.4% vs 1.8%, P<0.001) and last-minute travel (5.0% vs 1.1%, P<0.001), and more frequently travelled to the WHO African Region (56.6% vs 29.2%, P<0.001) and Eastern Mediterranean Region (12.7% vs 2.8%, P<0.001). Pregnancy was substantially more common among VFR travellers (11.6% vs 4.3%, P<0.001). Enquiries concerning VFR travellers were more likely to require a call-back (16.1% vs 13.8%, P=0.012) and escalation to a specialist doctor (13.1% vs 10.5%, P<0.001), indicating greater consultation complexity. General practice generated a higher proportion of VFR-related enquiries than tourist enquiries (69.5% vs 63.9%, P<0.001). Conclusions: VFR travellers generate disproportionately complex pre-travel consultations characterised by higher rates of specialist escalation, distinct travel patterns and travel to destinations associated with the greatest burden of imported infectious diseases. These findings highlight the importance of specialist travel medicine support for healthcare professionals managing VFR travellers and reinforce the need for equitable access to timely, high-quality pre-travel healthcare for this high-risk population.

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

Introduction: Veterinary Professionals are at risk of contracting zoonoses, including potential emerging infections. Personal Protective Equipment (PPE) could reduce infection transmission risk, but use of it in the profession is low. Understanding Veterinary Professionals experiences with PPE could help identify facilitators and barriers, therefore informing a future strategy to improve usage. Methods: Two focus group discussion with veterinary nurses and two with veterinarians took place at a tertiary small animal teaching hospital. With an interpretivist epistemology, transcriptions were inductively coded and analysed using thematic analysis. Results: Veterinary Professionals frequently reported underusing PPE, despite significant zoonotic risk. Friction in interdisciplinary relationships negatively impacted veterinary professionals experiences with PPE: differing views on risk, policy and PPE, contrasting perceptions of each other, and challenges with communication impacted PPE decision-making. Barriers included an absence of initial recognition of risk, a staff culture of prioritising patient health over risk to self, friction in response to others PPE use or lack thereof, an overly complex policy, and a lack of cultural and institutional reaction to occupationally contracted zoonoses. Facilitators included effective inter and intradisciplinary communication and previous personal experience with serious zoonoses. Conclusion: Veterinary Professionals experiences with PPE, are shaped by social and professional factors, such as interdisciplinary friction, perceptions of self and others, of risk and policy. Recommendations are for the findings to be used locally to embed PPE use into everyday practice. At a national level, the United Kingdom Health Security Agency (UKHSA) should use the findings to evaluate current policies regarding PPE and zoonoses in veterinary practice and produce a simplified national guidance, in collaboration with veterinary professionals with lived experience. Further research into General Practice Veterinary Professionals experiences and the interdisciplinary social dynamics is recommended.

Background: Mass gathering events (MGEs) are associated with several public health challenges and may cause a strain on healthcare services. Literature findings on the impact of MGEs on emergency departments (EDs) are heterogeneous. Objectives: To examine shifts in ED attendance characteristics during a major sporting tournament, namely the UEFA European Football Championship 2024 held in Germany. Methods: We conducted a retrospective observational study using ED data from the Emergency Department Data Registry. We compared baseline ED attendance characteristics between the tournament and the reference period, defined as two weeks before and two weeks after the tournament, and between Germany game days and non-Germany game days. Hourly attendance patterns were analysed for all Germany games using a reference range. Results: We included data from 41 EDs, totalling 253,493 attendances during the study period. A 1.57% increase in attendance was observed during the tournament compared to the reference period, with baseline characteristics remaining similar. The median daily attendance within all EDs was slightly lower on Germany game days (4066) compared to non-Germany game days (4128). Modest changes were observed in the hourly attendance on Germany game days, most notable during the last Germany game where a decrease in attendance below the reference range extended over three hours. Conclusions: The observed shifts in ED attendance were minimal, suggesting that no major changes of public health relevance occurred in ED attendance during the tournament. We highlight the utility of using ED data for monitoring and for enhancing the understanding of the public health risks and challenges associated with MGEs.

Background: Patient safety learning systems operate primarily at the national level, yet the potential for international sharing of safety intelligence remains largely unrealised. Other safety-critical industries, including civil aviation, nuclear power, and rail, have developed international incident reporting and learning systems whose design principles may offer transferable insights for healthcare. Objective: To explore the views and experiences of safety-critical industry experts regarding the purpose, key functions and features, transferability, barriers, enablers, and incident priorities of a potential international patient safety learning system. Design: Qualitative phenomenological study using semi-structured key informant interviews analysed with the five-stage framework analysis method. Participants: Eleven international experts purposively sampled from safety-critical industries (healthcare, civil aviation, maritime, and railway) across six countries. Interviews were conducted by telephone or internet-based audio call between May and September 2019. Results: Seven themes were identified: (1) purpose of an international patient safety learning system; (2) key functions; (3) key features; (4) transferability of learning; (5) enablers; (6) barriers; and (7) patient safety incident types appropriate for international sharing. Rare and emerging event detection emerged as the most distinctive value of an international system, a capability that cannot be replicated at national level. Critical functions included robust feedback loops, multidisciplinary analytical capability, and actionable recommendations. Key barriers, including blame culture, inter-organisational mistrust, and cross-border privacy legislation, were each amplified at the international level relative to their national-level equivalents. Conclusions: This study provides the first cross-industry qualitative account of design requirements for an international healthcare patient safety learning system, highlighting transferable lessons from established industries alongside healthcare-specific challenges that require bespoke solutions.

Infectious disease modelling has become an increasingly prominent tool in public health decision-making, with its use accelerating markedly during the COVID-19 pandemic. This growth calls for an understanding of how modelling evidence is received, interpreted, and used or not used by decision-makers. There is a recognised need for evaluations of modelling-to-policy systems to understand how to best integrate modelling evidence into decision-making. So far, no comprehensive evaluation framework exists that maps modelling-to-policy pathways. This study addresses that gap by developing a theory of change for modelling-to-policy systems that could serve as a foundation for future evaluations. A qualitative study design was employed, comprising semi-structured interviews with 35 modellers, knowledge brokers, and decision-makers across five continents and diverse institutional settings, spanning high-income and low- and middle-income countries, as well as national and international modelling-to-policy contexts. Thematic analysis was combined with a backward-mapping-informed approach to develop a multi-level evaluative framework. The protocol for this study has been published on March 20, 2025, at OSF (https://doi.org/10.17605/OSF.IO/J9QXV). Participants diverged in their conceptualisations of successful modelling evidence use, ranging from instrumental use to accurate understanding and consideration of modelling outputs, yet converged on shared risks: decisions informed by inadequately specified models or by evidence that is misinterpreted due to communication failures. The resulting three-level framework identifies factors directly influencing modelling evidence use across three domains (policy relevance, model quality, and communication and interaction), traces these to enabling conditions, and maps them to systemic enablers, including local and embedded modelling capacity, data infrastructure, knowledge brokering capacity, formal knowledge translation structures, established networks, and funding. The proposed framework represents a first theory of change for modelling-to-policy systems. While it requires further testing and application across diverse decision-making contexts, it offers a structured basis for evaluating existing systems and informing the design of new ones.

Digital mental health tools are increasingly promoted as scalable supports for young people, yet implementation remains inconsistent, particularly for marginalised youth. Acceptability and usability are key determinants of successful adoption, but little is known about how these factors shape engagement across diverse youth populations. The aim of the study was to examine the acceptability, usability, and implementation potential of 11 evidence?based digital mental health tools among marginalised young people across the Republic of Ireland (ROI) and Northern Ireland (NI). A mixed?methods design integrated baseline surveys (n = 38), a two?week trial of digital tools delivered through a co?designed Google Site, online workshops/individual interviews (n = 22), and a final usability and engagement survey (n = 24). Usability was assessed using the System Usability Scale (SUS), engagement using the Twente Engagement with E?Health Technologies Scale (TWEETS), and mental wellbeing using the Short Warwick-Edinburgh Mental Well?Being Scale (SWEMWBS). Qualitative data were analysed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Only two tools exceeded the SUS usability benchmark. Engagement was moderate overall, with one tool achieving the highest engagement despite lower usability. SWEMWBS scores indicated moderate baseline mental wellbeing. Thematic analysis identified five acceptability themes: credibility and trust; accessibility and ease of use; positive content supporting emotional regulation; personalisation and self?monitoring; and engagement and habit formation. CFIR analysis highlighted usability, institutional trust, cultural relevance, and emotional needs as core implementation determinants. Digital literacy was high and supported engagement, and usability remained a critical gateway to implementation. Designers and commissioners of digital mental health tools should ensure that supports are simple, trustworthy, culturally relevant, and youth?centred to enable adoption among marginalised young people. Implementation strategies are needed that will co?design with diverse youth communities and prioritise youth work settings as well as governance clarity.

The World Health Organization declared the 2026 outbreak of Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda a Public Health Emergency of International Concern. Public engagement on video-sharing platforms such as YouTube offers insight into public perceptions during such crises, particularly in the affected region, yet these reactions remain largely uncharacterised. We analysed public discourse and sentiment surrounding the outbreak, focusing on thematic trends in YouTube comments, using a qualitative synthesis that combined thematic content analysis with topic modelling. Videos were identified through the YouTube Data application programming interface, which returned 50 videos each for the search terms "Ebola" and "Ebola virus disease." After removing duplicates and excluding videos published before the 17 May 2026 emergency declaration, the 10 most-viewed videos were retained. From 4,457 extracted comments, 4,087 were analysed using Latent Dirichlet Allocation topic modelling, complemented by a lexicon-based sentiment analysis. Five themes emerged: geopolitical and cultural context; public figures, conspiracy theories, and misinformation; disease spread and transmission; public health measures and preparedness; and religious and spiritual interpretation. Discourse was strongly shaped by border concerns, mistrust of institutions, global aid politics, and comparisons with COVID-19, and sentiment was split near-evenly between fear and trust. Effective health communication during this outbreak must therefore address not only the scientific and medical dimensions of the emergency but also its geopolitical, cultural, and religious dimensions, while countering misinformation and building public trust.

Seasonal Influenza and COVID-19 vaccination programmes are critical for reducing morbidity and mortality in older adults, yet uptake remains uneven across populations. We aimed to profile vaccination attitudes and examine predictors of COVID-19/influenza vaccination uptake among a UK participatory surveillance system - FluSurvey. We analysed FluSurvey data from participants aged [&ge;]65 years who were eligible for both vaccines in the 2023-2024 and 2024-2025 Autumn - Winter seasonal campaigns. Descriptive analyses examined self-reported attitudes to influenza vaccination. Logistic regression examined factors (age, sex, socioeconomic status, education, employment, transport, smoking and chronic conditions) associated with influenza and COVID-19 vaccination uptake in each season, adjusting for confounders. Belonging to a risk group and reducing risk of influenza were frequently reported motivations for influenza vaccination, while building natural immunity and concerns around safety and adverse effects were frequently reported barriers. Individuals vaccinated against COVID-19 were more likely to receive an influenza vaccination (aOR2023-2024=13.90 [9.28-21.17]; aOR2024-2025=8.54 [5.82-12.60]), and vice-versa (aOR2023-2024=13.91 [9.30-21.19]; aOR2024-2025=8.52 [5.81-12.58]). Lower educational attainment was associated with lower odds of COVID-19 vaccination (aOR2023-2024=0.59 [0.45-0.78], aOR2024-2025: 0.56 [0.39-0.79]). Other results were weaker or demonstrated variation by season. Our findings highlight recent attitudes and barriers to influenza and COVID-19 vaccination among the FluSurvey cohort, which may inform approaches to improve vaccination coverage in the population.

Improving minority ethnic student retention is a global higher education priority. This mixed-methods study investigated how institutional belonging and socioeconomic status interact to shape dropout intentions among minority university students in the UK (N = 182). Quantitative results revealed that perceived course difficulty and lower subjective socioeconomic status were the strongest predictors of dropout intent. While the interaction between socioeconomic status and difficulty was non-significant, qualitative accounts showed distinct structural vulnerabilities. Financial strain restricted social integration, turning socioeconomic disparities into campus isolation. Conversely, representative curricula, diverse peer networks, and stable cultural in-groups (e.g., religious affiliations, living in the parental home) functioned as essential psychological buffers against academic exhaustion and alienation. Universities must shift from transactional models to sustained structural equity to protect vulnerable student groups.

Objectives To identify research priorities for improving the mental health of neurodivergent higher education (HE) students by exploring the perspectives of individuals with lived experience. Design Qualitative study using an online survey. Data was analysed using a deductive-inductive, hybrid semantic thematic analysis. Setting UK higher education institutions. Participants 104 current and former neurodivergent HE students with diverse neurodivergent profiles and intersecting identities. Main outcome measures Participant recommendations regarding priorities for future research on neurodivergent student mental health. Results Six themes were identified and were grouped into (1) general recommendations for research and (2) recommendations specific to neurodivergence within a HE context. Participants prioritised a shift away from medical model approaches towards research informed by social and strengths-based perspectives. Key priorities included improving understanding of diagnostic barriers and misdiagnosis, reducing stigma, investigating institutional barriers within HE, evaluating the effectiveness of support and accommodations and examining the experiences of underrepresented and intersectional groups. Participants emphasised the need for research on more flexible teaching practices, sensory-friendly learning environments, integrated mental health and educational support and alternatives to diagnosis-dependent access to services. Conclusions Future research should move beyond descriptive accounts towards evaluating interventions and current support provision to understand if they improve the mental health of neurodivergent students. Adopting intersectional approaches, moving beyond binary deficit- or strengths-based frameworks and focusing on inclusive, needs-based support rather than diagnosis-led systems are likely to produce more equitable and effective outcomes for neurodivergent students in higher education.

Nineteen individuals with diverse public health leadership experience across different levels and domains, from countries with varying levels of economic development, and who have direct involvement in crises were interviewed. A concise literature review was conducted, examining the intersection of politics and public health leadership, as well as a brief review of relevant existing leadership courses, training programs, and fellowships. The interviews were transcribed in full, anonymized, coded (total 1104 coded excerpts, 762 discrete excerpts), and used as the basis for analyzing findings. Our research identified four thematic areas at the intersection of public health and political leadership in public health crises: attributes and skills; role of and threshold for political engagement; structural elements underpinning effective public health response; and modalities for building public health leadership. Public health leaders need to learn core skills, especially effective communication, diplomacy, and advocacy, and cultivate key attributes, especially integrity and humility, that support their ability to engage with political decision makers. Political leaders need to contribute productively ways, and at the appropriate time, to ensure societal cohesion and facilitate a well-resourced multisectoral response with public health at its core. Pre-established relationships and coordination mechanisms can play a supporting and productive role when crises strike. Strategies that incorporate experiential learning, peer collaboration, and mentorship are central to building the skills public health leaders need to succeed in crises. Many tangible steps can be taken to foster and support public health leadership including: integrating the political dimensions of public health into public health education; tailoring public health trainings to include practical skills such as stakeholder engagement, effective communication, negotiation, policy advocacy, and community engagement; creating supportive ecosystems through peer, mentor, and fellowship approaches; and advocating for strengthening the structural interface between politics and public health.

Background: Responses to vaccination programmes vary widely, with contrasting perceptions of benefits and harms. This study aimed to provide a contemporary characterization of distinct groups of respondents by moving past traditional "pro" versus "anti" vaccination binaries. The results captured the complex spectrum of vaccine sentiment to directly inform the next strategic phases of a multi-year public health campaign regarding vaccine perceptions and behaviours within the diverse population of London. Methods: Data came from the 2024 Why We Get Vaccinated survey conducted in London, UK using a community-based participatory approach. Participants answered vaccine-related questions based on previous vaccine uptake, future willingness to vaccinate (WTV), perceived effectiveness, and safety concerns. We employed Bayesian Binomial logistic regression to identify sociodemographic predictors of individual responses. Subsequently, a Bayesian Nonparametric Latent Class Analysis (BNP-LCA) using a Dirichlet Process Mixture model was used to identify distinct groups and their sociodemographic compositions. Results: The LCA identified five distinct classes. Class 1, the Consistent Uptakers (37.2%), exhibited high vaccine uptake (89.2%) and near-universal belief in efficacy (98.0%) with minimal safety concerns. Class 2, the Concerned Uptakers (17.5%), maintained high WTV (72.2%) despite significant concerns regarding adverse effects (71.2%). Class 3, the Consistent Refusers (18.4%), demonstrated uniform rejection of vaccines and high levels of safety concern (74.4%). Class 4, the Unconcerned Refusers (20.8%), acknowledged vaccine effectiveness (98.4%) but showed very low uptake (1.7%), possibly due to low perceived personal risk rather than active resistance. Class 5, the Undecided/Uninformed (6.0%), was characterized by pervasive uncertainty and "Don't Know" responses regarding efficacy (80.3%) and vaccination intent. Sociodemographic analysis revealed that residential instability, i.e renting, and caregiving responsibilities were significant barriers to uptake, while older age and retirement were the strongest positive predictors. Conclusions: Vaccine behaviour and attitudes in London are a multidimensional construct. The discovery of "Unconcerned Refusers" and "Concerned Uptakers" highlights that "one-size-fits-all" public health campaigns may not be effective. Tailored public health messaging is required to address the specific uncertainties and socio-economic barriers identified across these distinct profiles. These findings provide a functional framework that will directly guide upcoming resource allocation, messaging adaptations, and policy decisions for the next iterations of the ongoing campaign

Background: Consumer use of AI chatbots for health advice is rising, yet triage safety relative to established services remains unclear. Australia's Healthdirect, a government-backed symptom checker with 2.4 million uses in FY2024-25, remains unevaluated against frontier large language models (LLMs), and whether premium subscriptions improve triage safety remains unexplored. This study compared the triage accuracy and safety of Healthdirect against six LLM configurations across ChatGPT, Claude, and Gemini, assessed whether paid subscriptions improve triage safety, and characterised each system's error patterns. Methods: Forty-five clinical vignettes from the Semigran et al. benchmark spanning emergency, non-emergent, and self-care categories (15 each) were evaluated across seven systems. Healthdirect was tested following a seven-rule interaction protocol. LLMs were evaluated using first-person patient-language prompts under free-tier and paid-tier conditions. Outcomes were triage accuracy, emergency sensitivity, under-triage, and critical misses, analysed using Cochran's Q, Bonferroni-corrected McNemar tests, Cohen's kappa, and Wilson intervals. Findings: Triage accuracy differed significantly (Cochran's Q = 36.79, p < 0.001). Healthdirect achieved 48.9% accuracy (95% CI 35.0% to 63.0%; kappa = 0.233) versus 73.3% to 86.7% for LLMs (kappa = 0.600 to 0.800). Healthdirect operated under conservative interactive defaults while LLMs received complete information in a single prompt, which may have disadvantaged Healthdirect. Emergency sensitivity was 46.7% versus 80.0% to 86.7% for LLMs. Healthdirect produced two critical misses; no LLM produced any across 270 evaluations (95% CI 0% to 1.4%). When LLMs undertriaged, they recommended GP care rather than self-care. No tier differences were significant (all p > 0.05), and most systems over-triaged self-care cases. Interpretation: Frontier LLMs demonstrated higher triage accuracy and safer error profiles than Healthdirect. All LLMs avoided critical misses; Healthdirect did not. Premium subscriptions did not significantly improve triage safety. These findings support clinical governance decisions about whether LLMs warrant formal evaluation alongside government-backed symptom checkers.

Objective: To examine railway suicide trends and change points in Australia and across states/territories. Methods: We identified railway suicides that occurred in Australia between 2001 and 2023, using data from the National Coronial Information System. We performed negative binomial regression analysis to examine railway suicide trends and joinpoint regression analysis to identify potential change points at both national and state/territory levels. Results: Between 2001 and 2023, railway suicide in Australia declined by 54% (Incidence rate ratio [IRR] 0.98, 95% Confidence Interval [CI] 0.97 to 0.99). Substantial declines were observed in Victoria (-62%, IRR 0.97, 95% CI 0.96 to 0.99) and New South Wales (-67%, IRR 0.97, 95% CI 0.96 to 0.99), and, to a lesser extent, in Queensland (-25%, IRR 0.97, 95% CI 0.95 to 0.99). Nationally, one change point was identified. Between 2017 and 2023, the annual percent change was -8.8% (95% CI -24.5 to -3.3). In Victoria, railway suicide rates decreased annually by 13.6% between 2018 and 2023 (95% CI -38.5 to -4.3). In Western Australia, railway suicide rates increased annually by 10.3% between 2002 and 2010 (95% CI 1.5 to 58.8) and decreased annually by 5.4% between 2010 and 2023 (95% CI -19.8 to -1.8). No change point was identified for other states/territories. Conclusion: Australian railway suicides have declined substantially, with this trend largely driven by reductions in Victoria and New South Wales. These findings demonstrate that railway suicide is preventable through multisectoral initiatives and suggest that interventions should be continued to reduce railway suicide.

Introduction: Clinical students are a future health workforce, yet their roles during outbreaks of highly infectious diseases remain uncertain because of safety, training, supervision and welfare concerns. Ugandas 2022 outbreak of Ebola disease caused by Sudan ebolavirus highlighted the need to understand how clinical students perceive outbreak-related care. Aim: This study explored willingness to care for patients with Ebola virus disease among clinical students at a Ugandan medical school and examined how perceived risks, perceived benefits and support needs shaped that willingness. Methods: An exploratory descriptive qualitative study was conducted among clinical students of Makerere University in Kampala, Uganda. Fifteen undergraduate medical and nursing students in the later years of training were purposively selected. Data were collected through in-depth interviews, audio-recorded with consent, transcribed verbatim, de-identified and analysed using latent content analysis. The Health Belief Model sensitised interpretation, and reporting was strengthened using the COREQ guidance. Results: Five interrelated themes emerged, showing that willingness to care was conditional rather than simply present or absent. Students described an initial willingness grounded in professional duty, devotion to patients and the desire to save life. This willingness was restrained by perceived risks of contracting Ebola virus disease, dying, transmitting infection to family members or colleagues, emotional distress, lack of epidemic-readiness in the curriculum, inadequate preparedness and weak welfare support. Perceived benefits, including patient survival, professional learning, outbreak experience and personal fulfilment, strengthened willingness but did not override safety concerns. Students identified reliable personal protective equipment, epidemic-ready curricula, practical infection-prevention and control training, simulation, clear protocols, close supervision, psychosocial support, insurance and fair compensation as cues to action that could convert willingness into safe participation. Conclusions: Clinical students in this Ugandan teaching hospital expressed a strong sense of professional responsibility, but their willingness to participate in Ebola care was conditional upon preparedness, protection, epidemic-ready education and institutional trust. Professional duty and learning opportunities promoted participation, whereas perceived risks and inadequate support limited it. Medical education programmes and outbreak-response systems should develop ethical, supervised, competency-based student roles supported by practical curricula, reliable protective equipment and psychosocial and welfare safeguards.

Background German cockroach (Blattella germanica) infestation is an important urban environmental health menace associated with food contamination, allergic disease, and reduced quality of life. Long-term control depends not only on professional pest management, but also on residents knowledge and preventive behaviors. This study assessed the knowledge, Health belief model (HBM) constructs, self-efficacy, and preventive practices related to German cockroach infestation among urban residents in Tehran, Iran. Methods In this cross-sectional study, 120 adults with professionally confirmed household German cockroach infestation were recruited from licensed pest-control companies in Tehran. Data were collated using a 39-item HBM-based questionnaire assessing knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and preventive practices. Descriptive statistics, Pearson correlation, and multiple linear regression were performed. Results Participants demonstrated modest knowledge regarding German cockroach biology (mean score: 0.538) and moderate preventive practices (3.157). Preventive practices were positively correlated with knowledge (r = 0.256, P = 0.005), perceived benefits (r = 0.292, P = 0.001), and self-efficacy (r = 0.244, P = 0.007). Regression analysis showed that the model explained 17.3% of the variance in preventive practices (R2 = 0.173, P = 0.001). Knowledge ({beta} = 0.191, P = 0.036), perceived benefits ({beta} = 0.231, P = 0.010), and self-efficacy ({beta} = 0.229, P = 0.012) were significant predictors. Conclusions Urban residents with confirmed German cockroach infestation showed limited knowledge and moderate preventive behaviors. Knowledge, perceived benefits, and self-efficacy were independently associated with preventive practices and demonstrated modest predictive value. Interventions targeting these behavioral factors, alongside environmental and structural improvements, may enhance sustainable household cockroach control.

Background Despite existing road safety regulations, commercial motorcycle riders commonly referred to as "Boda Bodas" in Uganda continue to experience high rates of injuries due to road traffic accidents resulting from unsafe riding behaviours, contributing significantly to morbidity and mortality among both riders and passengers. Safe riding behaviours are less well documented, as well as factors associated with the observance of those behaviours. This study aimed to determine factors associated with safe riding behaviors for both boda-boda riders and their passengers in Kampala Central Division. Methods A cross-sectional survey study design was conducted using a convergent parallel mixed-methods design guided by the PRECEDE model. Quantitative data were collected from 424 riders through structured questionnaires administered by trained research assistants. Binary Logistic regression was used to determine the independent predictors of safe road riding behaviors, and Adjusted Odds ratios (AORs) have been reported. Data were analyzed using descriptive and inferential statistics, with a p-value <0.05 considered statistically significant. Qualitative data were collected simultaneously with quantitative data through in-depth semi-structured interviews with 10 passengers to capture perceptions of rider behaviors and safety practices. Thematic analysis was applied, and results were triangulated to highlight convergences and divergences between quantitative and qualitative findings, providing a comprehensive understanding of safety determinants for both riders and passengers. Results Of the 424 riders (mean rider age was 29.56 {+/-} 5.71), overall, 276 (65.1%) of riders exhibited unsafe riding behaviors. In the bivariate analysis with Logistic regression, predisposing factors (education, marital status, religion, and willingness to obey traffic regulations), and reinforcing factors (family encouragement) were significantly associated with safe riding behaviors. However, in the adjusted model, secondary (AOR=0.50; 95% CI:0.30-0.85) and post-secondary education (AOR=0.57; 95% CI:0.33-0.98), being married (AOR=0.56; 95% CI:0.34-0.91), Christian religion (AOR=2.98; 95% CI:1.63-5.47), willingness to obey traffic regulations (AOR=0.41; 95% CI:0.24-0.70), union advocacy (AOR=1.76; 95% CI:1.03-3.01), and well-maintained roads (AOR=1.65; 95% CI:1.07-2.55) were significant predictors of safe riding behaviors. Qualitative interviews further highlighted barriers to safety, including a lack of helmets, over-speeding, disregard for traffic regulations, and poor road infrastructure. Conclusions Rider and passenger safety is still low, interdependent, and influenced by multiple factors. Integrated interventions focusing on education, stronger families, religious affiliations, union safety advocacy, and stricter enforcement of traffic regulations are vital for enhancing safety for both riders and passengers.

Background/Objectives We evaluated the impact of the COVID-19 adolescent vaccination in England at two different epidemic points: the autumn (August-November) 2021, in the presence of a large Omicron epidemic wave, and the autumn (August-November) 2022, when the subsequent Omicron epidemic was at an endemic stage. Methods Using the Covasim SARS-CoV-2 model for England, under varying vaccine uptake and onset time, we evaluated the impact of a)vaccinating 18+ only versus additional 12+ vaccination from the autumn 2021; and b)the current immunisation strategy at the time versus additional 12+ vaccination from September 2022, projecting the number of new daily SARS-CoV-2 infections, hospitalisations and deaths. Results In presence of the BA.1 Omicron wave in late 2021, the expanded adolescent vaccination averted ~3,000,000 cases across all-ages, ~1,010,000 SARS-CoV-2 infections in the period 2-6 months from vaccine onset in the vaccinated cohort. During the Omicron waves in 2022, additional adolescents vaccination did not significantly reduce the COVID-19 burden in the entire population, nor within the vaccinated cohort. Conclusions Our findings highlight that adolescent vaccination impact depends on the timing/speed of implementation, other present intervention strategies, and the status of the epidemic at the time and it should not be considered as a stand-alone immunisation strategy.