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 HPV-vaccination prevents HPV-related cancers, but uptake remains suboptimal. In the Netherlands, a catch-up campaign invited 18-27-year-olds for an additional cost-free opportunity to initiate or complete their HPV-vaccination in 2023-2024, which led to 24% of this invited population getting vaccinated. As young adults increasingly seek health information online, understanding online questions, concerns and misinformation in response to the campaign may help improve future vaccination efforts. Supplemental to overall evaluation of the vaccination campaign, we piloted online social listening processes to generate an insight report for Public Health Service (PHS) Amsterdam. Objective This study piloted online social listening processes at the PHS Amsterdam to identify actionable insights into questions, concerns and misinformation surrounding the HPV-vaccination catch-up campaign among young adults. Methods Upon inventory of potential platforms and data sources, a retrospective online social listening analysis was conducted across the platforms Instagram, Facebook, and X, collecting data from PHS, the National Public Health Institute for Public Health and the Environment (RIVM), the Dutch public broadcasting foundation (NOS), and LINDA.meiden sources from January 1, 2023, to June 1, 2024. Publicly available posts, comments, and engagement concerning HPV-vaccination were manually collected, and inductively coded. Themes were assessed for risk, based on expected potential harm and observed reach, and used to develop recommendations. Results A total of 821 posts and 5157 comments were collected and analysed. Ten recurring themes were identified across varying levels of risk. Two themes were classified as high risk: an information gap regarding the effectiveness of HPV-vaccination and concerns about the transparency on HPV-vaccine side effects. Three themes were classified as medium risk: questioning HPV-vaccine effectiveness under certain circumstances, reduced general vaccine trust following COVID-19, and accessibility issues related to vaccination locations and service times. Two themes were classified as neutral risk: questions regarding eligibility criteria for the campaign and calls for broader HIPV-prevention measures. Finally, three low risk themes concerned questions regarding HPV-vaccine brand specifics, campaign choices, and questions about scheduling or rescheduling HPV-appointments. Comments also referred to subsequent information sources, including reliable sources (public health institutes), false narratives and misinformation. Recommendations focused on addressing questions and information gaps (i.e. improving HPV risk perception and providing more detailed HPV-vaccine information), improving communication about HPV-vaccination, and reducing practical barriers to vaccination. Conclusions Manual social listening across selected online sources provided actionable insights into the public discourse during the HPV-vaccination catch-up campaign. Results mostly reflected questions, concerns and information gaps. Although some themes were critical of HPV-vaccination, false narratives and misinformation did not dominate the discourse. Recommendations aim to reduce practical barriers and address information needs. This pilot showed that online social listening can be effectively implemented even with limited resources.

Background Sepsis is a life-threatening medical condition caused by the bodys extreme response to an infection. It can have lasting physical, cognitive, psychological and social consequences that extend beyond the acute illness. However, limited research has explored how people with a history of sepsis and their families experience these longer-term consequences and engage with healthcare services in Ireland. Methods A qualitative study was conducted using semi-structured interviews with 21 participants, including 14 people who had personally experienced sepsis and seven family members of people affected by sepsis. Participants were recruited through professional networks and a sepsis charity organisation in Ireland. Interviews were conducted by telephone or Zoom between May and June 2026, audio-recorded and transcribed verbatim. Data were analysed using Braun and Clarke's reflexive thematic analysis. Results Five themes were identified: (1) recovery - a prolonged journey of physical & cognitive rebuilding; (2) navigating a recovery journey: lack co-ordination and integration; (3) continuity of support was uneven and often depended on individual healthcare professionals; (4) recovery reshaped family roles, work and everyday life; and (5) participants suggested a more coordinated approach to recovery. Participants described persistent physical, cognitive and psychological difficulties, alongside substantial effects on family responsibilities, employment and everyday activities. While some participants experienced valuable support from individual healthcare professionals, many described fragmented services, limited information about recovery and uncertainty about where to seek ongoing support. Conclusion Individuals with a history of sepsis and their families described substantial and ongoing consequences and variable experiences of longer-term care. The findings highlight the need to better recognise and respond to longer-term health needs following sepsis and to develop coordinated, accessible approaches to ongoing support in Ireland.

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: 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.

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.

Background: Optimising sampling frames for genomic surveillance of E. coli and Klebsiella may support interventions to mitigate bloodstream infections (BSIs), but approaches to estimating sample size and how these relate to bacterial population diversity at multiple genetic levels (strain/plasmid/antimicrobial resistance genes [ARGs]) are lacking. Methods: Using systematically collected, regionally-stratified, whole genome sequencing data from a 6-month genomic survey of English E. coli/Klebsiella BSI isolates (n=1,939; NEKSUS), we used Bayesian approaches to estimate the sample sizes required to capture genetic diversity at strain- (MLST, fastBAPS clusters), plasmid- and ARG-levels, using two diversity measures: 'coverage' (i.e. proportion of the bacterial population/plasmids/ARGs represented by features observed in the sample), and the number/proportion of unique features observed at varying surveillance sample sizes. Our method is available as a user-friendly R Shiny application, EpiSENTRY (https://01a0c3dd-90d2-e597-58a5-51391a468387.share.connect.posit.cloud/). Findings: Randomly sampling 1,400 E. coli/Klebsiella BSI isolates each achieved [&ge;]80% coverage of bacterial lineages and ARGs (i.e. capture features constituting [&ge;]80% of the population) at 95% certainty, but captured lower proportions of unique features (28% MLSTs, 59% fastBAPS clusters, 19% plasmid subcommunities, and 57% ARGs for E. coli; 49%, 87%, 50% and 83% for Klebsiella, respectively). Sample sizes required for 80% coverage of E. coli plasmid populations were higher than MLSTs (1,928 [95% CrI: 1,837-2,025] vs 1,351 [1,230-1,472]), while for Klebsiella, estimates were lower for plasmids (1,115 [1,052-1,181] vs 1,422 [1,331-1,515] for MLSTs). Lower sample sizes adequately captured 80% coverage of fastBAPS clusters and ARGs (649 [575-727] and 27 [23-30], respectively, for E. coli; 113 [84-145] and 83 [72-96] for Klebsiella), due to feature-specific frequency distributions. Klebsiella BSIs were more diverse than E. coli, with sampling 10.9% vs 3.2% of total annual BSIs in England needed to reach 80% MLST coverage. Plasmid populations and Klebsiella MLSTs were region-specific, emphasising the need for regionally-representative sampling. Interpretation: Bayesian analysis facilitates estimates of context-specific genomic surveillance sample sizes. Cost-effective targets for coverage require further optimisation.

Background: The decline of mental health among adolescents in the UK over the past two decades has occurred amidst many societal and technological changes making it difficult to identify drivers of these trends. We aimed to identify which aspect of life showed the most rapid deterioration in satisfaction in the UK since 2009 and which aspects have become increasingly correlated with mental health. Methods: Between 2009 and 2024, 15,829 adolescents aged 10-15 rated their satisfaction with life as well as five aspects of life (family, friends, school, schoolwork, appearance), via the UK Household Longitudinal Study. Population-weighted regressions were used to estimate annual summary statistics on these items (means, proportions) and the relative associations between satisfaction items and socioemotional difficulties, as measured by the Strengths and Difficulties Questionnaire (SDQ). Meta-regressions estimated linear changes over time, with interactions testing for heterogeneity across sexes, age-groups, and household income. Results: Mean satisfaction with life dropped over the 16 years of study (B=-0.028, 95% CI=-0.034, -0.022), as did satisfaction with all five aspects of life. Satisfaction with school declined most rapidly (B=-0.027, 95% CI=-0.034,-0.020), becoming accelerated in the most recent 5-year window (2020-24; B=-0.139, 95% CI=-0.178,-0.099). The proportion of dissatisfied individuals rose most rapidly for schoolwork, particularly for females. Satisfaction with appearance became increasingly associated with general life satisfaction (B=0.009, 95% CI=0.005, 0.013, p<.001) and socioemotional difficulties (B=-0.051, 95% CI=-0.073,-0.029, p<.001) over time. Conclusions: Our findings add to international evidence for academic pressure and school environments as plausible drivers of recent declines in life satisfaction, particularly among female adolescents. Future studies should aim to identify the specific aspects of school life that are influencing adolescent mental health and the impact of existing educational policies on student wellbeing should be evaluated.

Introduction: Vaping public education campaigns are a central prevention strategy for young adults (YAs), but message effectiveness varies widely and formative testing typically evaluates one message attribute at a time. This study examined how four perceptual dimensions, including cognitive engagement, social relevance, emotional arousal, and emotional valence, relate to perceived message effectiveness (PME), and whether multiple combinations of these dimensions correspond to similarly high PME. Methods: In a cross-sectional online message-testing study conducted from March to April 2025, 540 U.S. YAs who vape each evaluated 15 messages randomly sampled from a corpus of 229 text-image vaping public education messages, yielding 8,100 message evaluations. Cross-classified multilevel models estimated associations between each perceptual dimension and PME. An Explainable Boosting Machine probed nonlinear associations, and k-means clustering of high-predicted-PME perceptual configurations identified distinct profiles. Analyses were conducted in 2026. Results: Cognitive engagement (b = 0.20, 95% CI [0.18, 0.22]) and social relevance (b = 0.15, 95% CI [0.13, 0.17]) showed the strongest associations with PME, followed by emotional arousal (b = 0.06, 95% CI [0.04, 0.08]); emotional valence showed no linear association (b = 0.00, 95% CI [-0.02, 0.02]). The Explainable Boosting Machine revealed a U-shaped valence pattern, with higher predicted PME at both the negative and positive ends of the scale. Clustering yielded five distinct perceptual profiles with similarly high predicted PME (4.10-4.25). Conclusions: Multiple perceptual configurations correspond to similarly high PME, supporting a configurational approach to formative message testing rather than a single optimal message formula.

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.

Introduction Cancer incidence is rising rapidly in low- and middle-income countries (LMICs), where diagnostic pathology capacity is constrained. AI applied to routine histopathology could strengthen diagnostic capacity and offer leapfrogging potential by embedding AI into diagnostic systems as they are built up. However, without empirically identifying implementation determinants in LMIC cancer-diagnostic settings, AI solutions risk being poorly aligned with local constraints, limiting impact or exacerbating existing disparities. Methods We conducted an exploratory mixed-methods pilot study across three phases: 1) a structured survey characterising the diagnostic and technical landscape and AI priorities; 2) focus group discussions (FGDs) to inductively identify implementation determinants and 3) a second survey quantifying FGD-derived themes. Twelve physicians were purposively recruited (10 from LMIC, 2 from high-income countries for reference) and findings integrated through narrative triangulation. Results There was substantial heterogeneity in diagnostic and AI infrastructure that did not track consistently with country income classification. H&E staining was universally available, immunohistochemistry capacity was rudimentary at 7 of 10 sites and molecular testing absent or minimal at 6 of 10 sites. Whole-slide-imaging scanners were available at 8 of 10 sites, while graphical processing units, required for efficient AI inference, were available at only 4 of 10 sites. The participants would prioritise use of AI for cancer screening, cancer diagnosis, and biomarker prediction from H&E slides. Six implementation determinants were identified: AI literacy, governance frameworks, funding, evidence generation, clinical deployment, and collaboration. Financial constraints emerged as the dominant barrier across all determinants, and collaboration as an important enabling mechanism. Conclusion AI implementation readiness in LMIC cancer-diagnostic settings is highly heterogeneous and cannot be inferred from income classification, underscoring the need for institution-level assessment. Realising the leapfrogging potential of AI in this context requires coordinated progress across all determinants, with sustainable financing, and collaboration enabling the remaining determinants.

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.

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: Overuse of antibiotics accelerates antimicrobial resistance (AMR), threatening public health. Poland faces challenges with high antibiotic use; therefore, understanding people's antibiotic-related behaviours and beliefs would help identify targets for interventions. This study aims to identify sociodemographic and psychosocial correlates of antibiotic use among a representative sample of adults in Poland. Methods: The study employed an exploratory survey design. Adults in Poland (N=1,000) were randomly sampled, ensuring the representativeness of the Polish general population. Data were collected using a pretested questionnaire, administered through computer-assisted telephone interviews. Quantitative data were analysed descriptively and using a logistic regression. Free-text data were analysed using content analysis. Results: 31.6% of respondents used oral antibiotics in the preceding year, most commonly for respiratory tract infections (RTIs). Higher age, higher household income level, and education level were identified as predictors of increased antibiotic use, with increasing age being the most prominent factor. The belief that antibiotics accelerate recovery from RTIs and expectations for antibiotic prescriptions were found to be associated with greater antibiotic use. Encouragingly, 92.9% of respondents reported trusting their doctors, 51.5% that doctors explained why antibiotics were unnecessary for particular infections, and 57.1% were willing to engage in such discussions. While 76.5% of respondents reported awareness of antibiotic resistance, descriptions of the concept were often flawed. Conclusions: Key areas of focus for future interventions include addressing attitudes and behaviours of middle-aged (35-65) and older (66+ years old) adults, managing patient expectations regarding recovery and prescriptions, and correcting fundamental misconceptions about AMR.

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.

Background: The first thousand days are a sensitive window for child health and social health inequalities. When routine care falls short, parents of young children turn to online sources and, recently, to generative artificial intelligence (AI). Evidence on their concerns, child-health literacy, and AI use is scarce. Objective: To describe health informational needs and concerns, child-health literacy, and use of AI for child-health questions, including differences by parental role and parity, among parents of young children. Methods: In this cross-sectional study, two anonymous self-administered online questionnaires were disseminated through a digital health application between May 12 and June 11, 2026, to French-speaking parents of at least one child aged 0 to 47 months in France. Questionnaire 1 covered unmet information needs, concerns across 16 topics, perceived intra-couple concordance, and confidence in routine care. Questionnaire 2 covered a four-item child-health literacy quiz and AI use (frequency, topics, 12-month trend, barriers, trust conditions, perceived effect on consultations, and disclosure). Results: In total, 12,634 parents responded (Questionnaire 1, n=5,410; Questionnaire 2, n=7,224), mostly mothers (94.6% and 92.9%). Most (61.8%) had searched for information without finding a clear, reliable answer, selecting a median of 4 (Interquartile range [IQR] 3-7) over 16 topics. Leading concerns were sleep (51.3%), nutrition (48.1%), and education (i.e., upbringing and behavior) (47.8%). Mothers were nearly twice as likely as fathers to select accident prevention (26.5% vs 16.3%) and parental mental health (38.7% vs 28.6%); first-time parents selected most topics more often than experienced parents, most markedly dental hygiene (43.8% vs 27.6%). The median child-health literacy score was 3 (IQR 3-4) on a 0-to-4 quiz, with 19.9% of parents scoring 2 or below; tooth-brushing age was the weakest item (68.4% correct). Mothers outscored fathers on every item. More than half of parents (54.2%) had used AI for a child-health question, 11.2% weekly; among those reporting a trend, 68.3% had increased AI use for child-health questions over the year and 6.2% decreased it. The main barriers to AI use were a preference for professionals (55.9%) and reliability concerns (48.7%); trust depended most on medical oversight of the tool (76.6%). AI use appeared additive, with 66.8% reporting no change in healthcare visit frequency. One third (35.5%) had told an AI something shared with neither a professional nor their network, rising to 64.1% among regular users. Conclusions: Parental informational needs were widespread and frequently unmet. AI has become a common and fast-rising source for child-health questions, at times a confidential one, used alongside rather than instead of professionals. Child-health literacy was generally high but uneven, with oral health the clearest gap. Strengths include the sample size and early-generative-AI timing; limitations include the cross-sectional design, self-report, digital-recruitment selection bias, and the small proportion of fathers.

Background: Previous studies indicated that regional fluctuations in COVID-19 impact were associated with socioeconomic, demographic and environmental factors early in the pandemic. It is unclear whether factors associated with regional COVID-19 mortality and SARS-CoV-2 infections changed over the course of the pandemic. Methods: We evaluated the association of ecological factors with municipality-specific COVID-19 mortality in the national population of Austria between January 2020 and June 2023. Analyses were conducted separately per calendar year and pooled across years via random-effects meta-analysis. Outcomes were analysed using univariable and multivariable zero-inflated negative binomial (ZINB) regression, including annually averaged environmental exposome exposure (including air pollution and UV radiation), socioeconomic, demographic and infection dissemination predictors with significance threshold set to p<0.005. Secondary analysis modelled SARS-CoV-2 infections using of negative-binomial model (NB). Two additional approaches for smaller predictor set selection were applied as sensitivity analyses. Results: Within the entire observation period 18,430 COVID-19 deaths were reported. In univariable analyses (pooled RR (99.5% CI)), COVID-19 mortality was significantly associated with the proportion of commuters (0.79 (0.73-0.86)), residents aged 75-84 (1.18 (1.01-1.37)) and [&ge;]85 years (1.29 (1.04-1.60)), residents with at most compulsory education (1.15 (1.02-1.29)), employed residents aged 15-64 (0.89 (0.85-0.93)), and homeowners (0.91 (0.83-0.99)), as well as with precipitation (0.94 (0.89-0.99)) and the average time with a mean temperature of 5-15 C (0.95 (0.90-0.99)). In multivariable analyses the share of population aged 85 or older (1.30 (1.09-1.54)) and home ownership (0.92 (0.87-0.98)) were independently significant. Mortality predictor estimates were relatively stable across pandemic years. Across 5,963,882 documented SARS-CoV-2 infections share of employed in 15- to 64-year-olds (1.01 (1.01-1.02)), part-time employment rate (1.01 (1.00-1.02)) and district level nursing care allowance recipiency (0.97 (0.95-0.98)) were associated with detected infections. Overnight stays, population 85 or older, income, compulsory education or less and air pollution all had multiple significant estimates with opposite directionality, leading to non-significant overall associations. Sensitivity analyses outcomes mirrored main analyses outcomes. Conclusions: Throughout the pandemic in Austria, demographic and socioeconomic factors were associated with COVID-19 mortality and infections, but many associations, especially for infections, were unstable over time. These findings underscore the importance of structural vulnerabilities in epidemic impact.