Risk Management and Healthcare Policy

Perioperative safety checklists standardize critical actions, but reliable completion depends on the surrounding work system and team behavior. We conducted a prospective observational analytic study from April to May 2026 in the central surgical unit of a high-volume public teaching referral hospital in Indonesia to examine whether patient safety culture and teamwork were associated with directly observed perioperative safety compliance and whether teamwork mediated the culture-compliance relationship. Patient safety culture was measured with the Hospital Survey on Patient Safety Culture 2.0, teamwork with a 35-item TeamSTEPPS Teamwork Perceptions Questionnaire research adaptation, and compliance by direct role-based observation using a 45-item checklist derived from the AORN Comprehensive Surgical Checklist. Eighty of 92 recruited professionals contributed 240 person-operation observations across 50 operations. Overall compliance was 74.75%, with sign-out lowest at 70.68%. Patient safety culture was associated with teamwork ({beta} = 0.590; 95% CI 0.510-0.770) and directly with compliance ({beta} = 0.407; 95% CI 0.187-0.712). The teamwork-compliance coefficient was positive ({beta} = 0.285; p = 0.046), but the prespecified percentile 95% CI included zero (-0.045 to 0.517). The indirect effect through teamwork was not supported ({beta} = 0.168; p = 0.079). These findings support a system-level interpretation of perioperative safety and identify learning-oriented responses to error, situation monitoring, and sign-out fidelity as measurable targets for future improvement efforts.

Background: Academic achievement is crucial for university students, but various factors affect their performance. This study explores the impact of anxiety, sleep quality, social media use, and socioeconomic status on academic performance (CGPA) among public university students in Bangladesh. Data and Methods: Data were collected from 225 students using a structured questionnaire that assessed anxiety (GAD-7), sleep quality (PSQI), social media use (SMUQ), and socioeconomic status (income, parental education). Structural Equation Modeling (SEM) was used to analyze the relationships between these variables. Outcomes: The results showed that socioeconomic status had a strong positive effect on academic performance ({beta} = 0.745, p < 0.001), while anxiety negatively impacted academic outcomes ({beta} = -0.675, p < 0.001). Sleep quality was positively related to academic performance ({beta} = 0.113, p < 0.05), but with a weaker effect. Social media usage is found to have a negative significant effect on academic performance ({beta} = -0.137, p < 0.001). Conclusion: These findings highlight the importance of controlling social media usage and anxiety to enhance academic performance among adult students. Sleep quality and socioeconomic background of the students are also found to be meaningfully associated with their educational progress.

High-alert medications are a leading cause of preventable patient harm worldwide, but there was no any high alert medicine list or error prevention strategy for Sri Lankan hospitals. This study addresses that gap by using interviewer administered questionnaire [n=315], five stakeholder consultative meetings [n=62] including multidisciplinary clinicians to reach consensus, followed by interviewer administered questionnaire [n=45], semi-structured three focus group discussions [n=45] to explore implementation barriers. Our findings identified [n=100] medicines as high-alert for acute care settings, and [n=40] medicines for community settings. I believe this article will be of interest and benefit to the readers of your journal. I declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere.No conflicts of interest exist. Ethical approval was obtained from the Ethics Review Committee of Faculty of Medicine, University of Colombo (Reference number: 18-008) and approval were renewed annually as required and Ethical Review Committees of National Hospital of Sri Lanka (Reference number: AAj/ETH/COM/2017) and Colombo South Teaching Hospital (Reference number: PL/MO/2018-2019).All approval covered the full data collection period. Permission to photograph hospital pharmacies were obtained from chief pharmacist of participating hospital and no patient-identifiable information is shown.Written informed consent was obtained from all participants. The high alert medicine lists for acute and community settings are provided as S1 and S2 appendices.As corresponding author, I confirm that the manuscript has been read and approved for submission by all the named authors.

Objectives: To evaluate the sustainability of Lean Healthcare practices after the implementation phase of a national quality improvement programme and to identify organisational factors associated with maintaining results over time. Design: Multicentre cross-sectional study with a mixed-methods approach. Setting: Twelve public and philanthropic hospitals in Brazil participating in Phase 2 of the Lean in Emergency Departments Project. Participants: Key respondents in managerial or leadership roles from participating hospitals (response rate: 75.0%). Outcome measures: Sustainability of Lean practices and organisational readiness, assessed through a structured survey and triangulated with operational indicators collected across successive implementation cycles at hospital level. Results: During one year of structured follow-up, 66.7% of respondents reported maintenance of Lean practices; this decreased to 33.3% after the end of structured follow-up. Although 66.7% considered professionals capable of maintaining results, only 58.3% positively evaluated institutional structure, indicating a discrepancy between individual capacity and organisational readiness. Operational indicators showed heterogeneous behaviour across hospitals, with no consistent pattern of sustained improvement. Qualitative analysis identified professional and managerial turnover, formal governance structures, and continuous monitoring as key factors associated with sustainability. Conclusions: The sustainability of Lean Healthcare practices is more strongly associated with institutional capacity to embed and sustain changes over time than with isolated individual training. Quality improvement programmes should incorporate structured strategies for the post-implementation phase. Keywords: Lean Healthcare; Sustainability; Quality improvement; Hospital flow; Health systems; Organisational factors

The forced displacement of medical students due to armed conflict presents a profound disruption to the global medical education continuum. Existing research predominantly evaluates individual psychological trauma, leaving a critical gap in measuring the structural and institutional friction displaced learners face when transitioning into host medical schools. This study details the development, structural refinement, and psychometric validation of the Displaced Medical Student Scale (DMSS), a novel 38-item instrument theoretically grounded in Pierre Bourdieus Theory of Practice. Utilising an exploratory sequential mixed-methods design adhering to COSMIN guidelines, initial qualitative items generated from a transnational cohort underwent content validation by an expert panel (Scale-Level Content Validity Index Average = 0.96) and pilot face validation (N = 29) to eliminate linguistic barriers. Subsequent psychometric testing with 156 displaced Gazan medical students confirmed a robust six-factor latent structure: Mechanisms of Conflict, Hysteresis and Dislocation, Agential Coping, The Agents Toolkit, The Institutional Field, and Transition Outcomes. Confirmatory factor analysis using diagonally weighted least squares demonstrated excellent model fit (, Comparative Fit Index = 0.925, Tucker-Lewis Index = 0.918, Root Mean Square Error of Approximation = 0.058, Standardised Root Mean Square Residual = 0.064) and exceptional internal consistency (Cronbachs , McDonalds ). Structural equation modelling proved that institutional symbolic violence negatively impacts transposed clinical capital () and that structural hysteresis mathematically mediates the path between symbolic violence and professional attrition fatigue (). Furthermore, agential coping significantly moderates identity crisis outcomes (). The DMSS provides medical faculties with an evidence-based metric to transition from deficit frameworks to targeted structural interventions that preserve displaced clinical capital.

Health facilities (HFs) routinely administer medicines and are expected to ensure patient safety by detecting, reporting, investigating, and analysing adverse events following exposure to drugs (AEFED). This study aimed to assess the implementation of pharmacovigilance activities in referral and regional health facilities in Cameroon and to identify pharmacovigilance training needs among healthcare personnel (HP). This was a cross-sectional descriptive study targeting referral and regional health facilities and healthcare personnel involved in patient care and pharmacovigilance activities in Cameroon. Health facilities were selected using stratified purposive sampling, while healthcare personnel were selected through exhaustive sampling. Data were collected using semi-structured electronic questionnaires administered face-to-face by trained enumerators. The questionnaires assessed the organization, resources, and implementation of pharmacovigilance activities at health facilities, as well as healthcare personnel knowledge of pharmacovigilance concepts, previous training, and perceived training needs. Of the 14 eligible health facilities, 10 (71.4%) consented to participate in the study. Of the 10 health facilities, 4 (40.0%) had an established pharmacovigilance unit, while 3 (30.0%) reported conducting neither detection nor notification activities. Among the 261 healthcare personnel approached, 214 (81.9%) participated. Only 41.6% had needed knowledge to detect an adverse event, while 72.9% were aware of adverse event notification procedures. Previous exposure to pharmacovigilance training was reported by 37.9% of healthcare personnel, and all participants expressed a need for additional training, particularly on national pharmacovigilance regulations (69.2%), organization of the pharmacovigilance system (67.3%), and adverse event detection (67.3%). The main reported challenges by healthcare personnel in the implementation of pharmacovigilance activities included insufficient budget allocation, limited access to pharmacovigilance training, lack of pharmacovigilance guidelines and insufficient qualified human resources. Pharmacovigilance implementation in referral and regional health facilities in Cameroon remains limited, with gaps in organizational structures, resources, healthcare personnel knowledge, and training. Strengthening pharmacovigilance systems through improved facility capacity, availability of essential tools, and targeted healthcare personnel training is needed to enhance drug safety surveillance.

Background HIV testing is a key entry point for prevention and treatment in Nigeria, yet age-related disparities persist. Adolescent girls and young women (AGYW) are disproportionately affected by HIV but often demonstrate lower uptake of testing services. This study examined differences in HIV self-testing awareness, use, and antenatal HIV testing between AGYW and older women, the distribution of HIV testing service uptake, and identified multilevel factors associated with HIV self-test awareness and testing among AGYW. Methods This study analyzed cross-sectional data from the 2023-2024 Nigeria Demographic and Health Survey (NDHS), including women aged 15-49 years. Descriptive statistics were used to assess differences in HIV self-testing awareness, use, antenatal HIV testing, and place of HIV testing between Adolescent Girls and Young Women (AGYW) (15-24 years) and older women (25-49 years). Among AGYW, bivariate and multivariate logistic regression were conducted to identify socioecological factors associated with HIV self-testing, awareness and use. Results A total of 14,708 AGYW and 24,342 older women were included in the analysis. The median age of AGYW was 19 years (IQR: 17-22), compared to 35 years (IQR: 25-41) among older women. Older women reported significantly higher awareness of HIV self-testing (13.1%) compared to AGYW (8.8%). Use of the HIV self-testing kit was low overall but higher among older women (2.3%) than among AGYW (1.1%). Older women reported greater uptake of antenatal HIV testing (57.9%) than AGYW (48.4%). Education, wealth, and internet use were positively associated with awareness, while AGYW aged 15-19 had significantly lower odds of awareness than AGYW women aged 20- 24. Regional disparities were also observed in the awareness and use of HIV self-test kits. Conclusions Findings support that targeted, AGYW-centred strategies are needed to improve equitable access to HIV testing and achieve national and global HIV prevention goals.

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.

Objective: To assess the efficacy of an executive peer coaching program, Charting Champions Program (CCP), in helping physicians manage their administrative workload, thereby improving time management, workflow and well-being. Findings: In this longitudinal survey study, physicians self-reported significant improvements in completing charting and administrative paperwork during their clinical day. Physicians reported significant improvements in mental, cognitive and emotional states after the program. Meaning: The Charting Champions Program is an effective intervention that supports physicians in problem-solving the administrative burden of their clinical day, improving workflow efficiency, completing administrative requirements during clinical hours, and enhancing work-life balance and personal satisfaction. Background: Physicians are subject to high levels of mental, physical, and emotional stress, partly due to increasing administrative burdens. Online coaching is a proven intervention to help physicians improve workflow efficiency, reduce administrative burden and improve job satisfaction. Design: This voluntary longitudinal survey took place between 2020 and 2023. Physicians were asked to complete a survey at program entry and again 30-90 days after program completion. The survey consisted of 14 Likert scale questions, and a final sample of 280 physicians completed both surveys. Intervention: CCP contains modules that teach workflow improvements for clinical days, including timely charting, administrative task workflow, managing patient consultations and reducing interruptions. Interventions include self-paced modules, live coaching, recordings and an online peer community. Results: Post-CCP physicians reported a significant decrease in hours spent charting (P<0.0001) and completing clinical paperwork outside of clinical hours (P<0.006). Physicians also reported a decrease in work-related dread (P<0.001), feelings of burnout (P<0.001), and thoughts of quitting due to administrative burdens (P<0.001). Physicians felt more focused at work (P<0.001), felt more in control of the clinical day (P<0.001), and rated their mental energy at work higher (P<0.001). The program did not affect the number of patients seen in a full clinical day (P > 0.918). Conclusion and Relevance: The CCP reduces the time physicians spend on tasks outside of clinical hours, increasing free time without decreasing the number of patients seen per day.

Background: While critical care pharmacists (CCPs) are broadly associated with improvements in outcomes for critically ill patients, operationalizing staffing in the intensive care unit (ICU) requires further study. The purpose of this evaluation was to determine the relationship of a CCP on interprofessional rounds for weekday admissions of ICU patients on patient-centered outcomes. Methods: This post-hoc analysis of the Optimizing Pharmacist-Team Integration for ICU Patient Management (OPTIM) study included adults admitted to an ICU on a weekday in the multicenter observational study. The primary outcome was in-hospital mortality. The primary exposure was level of comprehensive medication management (CMM) during the first 24 hours of ICU stay. A secondary exposure was pharmacist-to-patient ratio. Multivariable generalized estimating equations (GEE) were used to estimate associations between mortality and patient, ICU, and institution variables. Fine-Gray sub-distribution hazards regression estimated hazard of discharge alive (HDA) from the ICU and hospital and hazard of extubation alive. Results: 21,835 patients met inclusion criteria, and 76.1% of patients had CMM delivered on interprofessional rounds. Patients who had no CMM on the first ICU day had an increased risk of mortality of 23% (Odds Ratio (OR) 1.23, 95% Confidence Interval (CI) 1.04-1.46, p=0.02) compared to those who received CMM on interprofessional rounds. Patients with no CMM also had decreased HDA from the ICU and hospital and decreased hazard of extubation alive. No difference was seen in any outcomes when comparing other levels of CMM (CMM delivered outside of interprofessional rounds or abbreviated CMM) compared to CMM delivered on rounds. Conclusions: Absence of pharmacist CMM on the first day of ICU stay for patients with weekday admission was associated with an increased risk of in-hospital mortality, but no difference was seen in other levels of CMM: this signal supports further investigation in prospective analysis.

Abstract Objective. To identify and rank the leadership traits most valued by medical staff in public hospitals, and to compare them with an established generic instrument and a generative artificial intelligence source. Design. Sequential exploratory qualitative-quantitative (QUAL QUAN) mixed-methods study: focus groups followed by an online ranking survey, with cross-comparison against the Northouse Leadership Traits Questionnaire (LTQ) and a ChatGPT derived list (LAIT). Setting. Major public hospital affiliated with Monash University, Melbourne, Australia, in 2023. Participants. Twenty-four senior medical staff (16 men, 8 women; 18 clinicians, 6 administrators) recruited through opportunistic sampling. Main outcome measures. Weighted ranking of the ten most desired leadership traits (Leadership Enabling Traits Survey, LETS); internal consistency (Cronbach s alpha); agreement between LETS and LTQ self-scores; and strong overlap with the AI-derived list. Results. The first most-weighted LETS traits were integrity (1.526), communication (1.435), compelling vision (1.404), emotional intelligence (1.040) and empathy (0.969), the same five identified by the AI source. Integrity was weighted 3.6 times more heavily than rebelliousness (0.424). Both LETS and LTQ achieved Cronbach s alpha > 0.7. Unweighted total self-scores did not differ between LETS (77.4 +/- 7.6) and LTQ (78.4 +/-6.9); weighted emotional intelligence related and other-trait sub-scores diverged significantly (p<0.001). Survey power was 45% at alpha=0.05.

ABSTRACT Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality globally. Accurate and objective blood loss measurement is essential for timely detection and management of PPH. However, visual estimation remains the predominant method of blood loss estimation in low- and middle-income country settings, despite it underestimating blood loss by 33-50%. In this context, a calibrated obstetric blood collection drape offers a practical, low-cost alternative. However, Evidence on acceptability, appropriateness and feasibility remains limited. Objective: To explore the facilitators and barriers to the acceptability, appropriateness and feasibility of the routine implementation of a calibrated obstetric blood collection drape for postpartum haemorrhage (PPH) detection in two tertiary-care hospitals in Delhi, India. Methods: This qualitative study used semi-structured interviews to explore healthcare providers' experiences and perceptions regarding the acceptability, appropriateness and feasibility of using the drape in routine labour room practice. Qualitative data were analysed using thematic analysis. Results: Eighteen healthcare providers participated in qualitative interviews. The calibrated drape was perceived as more reliable than visual estimation and easy to use, supporting confidence, quicker responses and clinical decision-making. It was also considered useful for early PPH detection and timely management. Key challenges included staff shortages and concerns about drape slipperiness and fastening mechanisms. Conclusions: Findings suggest that the calibrated obstetric blood collection drape is perceived as acceptable, appropriate and feasible for routine use in high-volume tertiary-care hospitals in India. Wider implementation will require reliable supply chains, design refinements, and sustained training programmes, including for support staff.

Abstract: (i) Background and objectives: Millions of women across the world experience menstruation, yet for those in the low-income, informal urban workforces, it can be accompanied by an unpleasant experience due to poor sanitation, financial constraints and lack of awareness. In the Indian urban context, despite a decade of implementing policy initiatives, including the Rashtriya Kishor Swasthya Karyakram and the Menstrual Hygiene Scheme by the Government of India, urban women of reproductive age in the low-income group informal workforce have seen limited benefits. We sought to understand the gaps preventing healthy menstrual health management (MHM) among these women in Mumbai's suburbs and aimed to learn, directly from them, what interventions might help in their MHM. (ii) Methods: 100 randomly selected women of reproductive age, belonging to the low-income group urban work force, in Mumbai Suburbs were surveyed. A structured 18-item questionnaire was used to conduct a one-on-one interview, surveying about demographics, menstrual hygiene product use, hygiene practices, sanitation access, diet, and challenges faced. (iii) Results: More than half the participants of the study (53%) earned under INR10,000 a month and 87% were aged above 18 years. A striking 79% of the participants had experienced at least one clinically significant menstrual morbidity; sanitation barriers affected 67% while 15% were forced to change pads in unsafe, open spaces; and adequate nutrition during periods was reported by only 24%. 57% of the participants reported that a combination of awareness, better toilets and subsidised pads will help them manage their menstrual hygiene better. (iv) Interpretation and conclusions: For low-income women in the informal urban workforce, menstrual health challenges arise from gaps in knowledge, inadequate sanitation infrastructure and unaffordability of menstrual hygiene products. This highlights the need for coordinated action- spreading awareness, building accessible sanitation facilities, and strengthening primary healthcare to screen and treat menstrual morbidities- along with distribution of subsidised menstrual hygiene products for these underserved population.

Background: Under the DRG/DIP payment reform, the cost structure and its driving factors for laparoscopic cholecystectomy (LC) in resource-limited plateau regions remain unclear. Methods: Based on a single-center cohort of 605 plateau LC patients from May 2020 to October 2025, natural log transformation was applied to total hospitalization costs. Pearson/Spearman correlation, multivariate linear regression (traditional clinical model vs system-driven model with year dummies), and quantile regression were used. Results: Mean hospitalization cost 8097.49+/-936.85 CNY, CV=11.6%, Gini=0.062, demonstrating high homogenization. Traditional six-variable clinical model yielded R^2=0.008 (F=0.78, P=0.587), no significant predictors. The system-driven model achieved R^2=0.143 (F=3.42, P=0.001), with year dummies as dominant predictors. The study proposes the SAO (System-Allocation-Outcome) paradigm to replace the traditional SPO framework.

Background: Whether corrective actions documented in medical safety incident reports rely on individual vigilance ("Safety-I") or on structural, system-level intervention ("Safety-II") has not been quantitatively evaluated on a national scale in Japan. We developed an automated classification pipeline to assign corrective-action free-text to a 7-level maturity scale (L0-L6) and computed two summary indices: the Safety Measure Quality Profile (SMQP), the full L0-L6 distribution, and the System-based Safety Measure Rate (SSMR), the proportion of non-L0 records classified L3-L6. Methods: We analyzed all 11,507 corrective-action free-text entries from the 2010 release of Japan's national medical accident and near-miss reporting database (Japan Council for Quality Health Care, JCQHC), comprising 8,804 near-miss (Hiyari-Hatto) and 2,703 accident (Jiko) reports. Records were classified using a five-stage hybrid pipeline: an expert-developed rule dictionary, TF-IDF + k-nearest-neighbor matching, cosine-similarity matching, a two-tier large-language-model (LLM) classifier, and a conservative priority-cascade fallback. SSMR was compared between near-miss and accident reports using a chi-square test, Wilson 95% confidence intervals, Cramer's V, and the risk difference (RD), against pre-specified minimal clinically important difference (MCID) criteria of RD >= 2 percentage points and Cramer's V >= 0.10. Results: Every record received a definitive L0-L6 label (0% unresolved). Overall, 16.6% of records were unclassifiable (L0); among the 9,599 classifiable (non-L0) records, individual-vigilance actions (L1) predominated (54.6% of all records), and only 11.82% (95% CI, 11.19-12.49%) met the SSMR criterion (L3-L6). SSMR was higher for accident reports than for near-miss reports (18.12% [95% CI, 16.69-19.64%] vs. 9.[95% CI,46% [95% CI, 8.80-10.17%]; RD = 8.66 percentage points; Cramer's V = 0.120; chi-square(1) = 136.97001), exceeding both pre-specified MCID thresholds. Conclusions: In this interim single-year analysis, the large majority of documented corrective actions in Japanese medical safety reports remained individual-vigilance-based rather than system-based, with accident reports showing a substantively, rather than merely statistically, higher proportion of system-based actions than near-miss reports. These findings support the feasibility of large-scale automated assessment of corrective-action quality and provide the rationale for the planned 16-year longitudinal analysis.

Background: Snakebite envenoming remains a major but neglected public health problem in sub-Saharan Africa, where access to antivenom is often limited and unevenly distributed. In Zambia, evidence on facility-level determinants of antivenom use is scarce. This study examined factors associated with antivenom administration among snakebite patients in selected health facilities. Methods: A retrospective cross-sectional study was conducted among 128 snakebite patients presenting to five health facilities in Zambia. Associations between antivenom administration and health facility, admission year, age group, and gender were assessed using Fisher's exact test, with statistical significance set at p < 0.05. Results: Overall, 16/128 patients (12.5%) received antivenom. Antivenom administration varied significantly by health facility (p < 0.0001). All patients at Kabwe General Hospital received antivenom (9/9, 100%), compared to 50% (2/4) at Commando Urban Health Centre and 22.7% (5/22) at Chipata Central Hospital. No patients received antivenom at Mpongwe Mission Hospital (0/70) or St. Dominic's Mission Hospital (0/23), where antivenom was not available. Admission year (2023 vs 2024; p = 0.78), age group (p = 0.53), and gender (p = 0.80) were not significantly associated with antivenom use. Conclusion: Antivenom administration in this setting is determined primarily by health facility-level availability rather than patient demographic or temporal factors. The very low overall treatment rate highlights critical inequities in access to life-saving therapy. Strengthening antivenom procurement, equitable distribution, and referral systems is urgently needed to reduce preventable morbidity and mortality from snakebite envenoming.

Background Although often perceived as a technical tool, a data bank is fundamental for district performance management, facilitating integrated coordination, data consolidation, and routine information use for decision-making. However, implementation unfolds within hierarchical bureaucratic systems shaping authority distribution, workload allocation, coordination, and resource use. This study examines the political economy of institutionalizing a district-level health data bank in West Sumbawa District, Indonesia. Method A longitudinal qualitative case study was conducted in West Sumbawa District, West Nusa Tenggara Province, Indonesia, from November 2025 to March 2026 across three evaluation phases (baseline, midline, endline), involving 25 District Health Office (DHO) officers appointed to the Health Data Bank team, representing five organizational units, including the Secretariat, General and Human Resources Unit, and Public Health Division. Data were collected through participatory workshops, focus group discussions, in-depth interviews, observation, and document review, including official decrees, SOPs, meeting minutes, and implementation records, and analysed using Bossert's Decision Space Framework combined with a problem-driven political economy analysis examining how power relations, institutional norms, workload, resource support, and perceived incentives influenced whether technical reforms became operationalized in routine practice. Results The Health Data Bank progressed from strong institutional acceptance to structural formalization. Decision-making authority remained centralized within the Secretariat, enabling coordination but limiting distributed ownership. Resource constraints increased workload, concentrated in the Secretariat and division coordinators responsible for data consolidation and validation, without dedicated financing or staffing, despite improved analytical capacity. Accountability mechanisms were established through governance instruments, though enforcement and feedback loops remained underdeveloped. Data submission, validation, and use were not yet fully institutionalized, resulting in a gap between structural readiness and functional use. Conclusion Data institutionalization involves both technical and organizational processes, requiring collaborative negotiation of authority, workload, and resources. Continued attention to these factors will help structural formalization translate into sustainable operational outcomes.

Objectives This study aimed to assess sleep patterns and life satisfaction among employees of a private company in Dubai, United Arab Emirates, and to examine the relationships among sleep quality, life satisfaction, and selected demographic variables. A quantitative descriptive cross-sectional survey design was adopted. Methods A convenience sample of 110 male employees participated in the study. Data were collected using the Sleep Disorder Assessment Scale (16 items; Cronbachs = 0.89) and the Life Satisfaction Scale (5 items). Statistical analysis was performed using SPSS version 29, including descriptive statistics, chi-square tests, and Pearson correlation analysis. Results Most participants (66.4%) were aged 20-30 years, and 82.7% experienced moderate sleep-related problems. Mobile phone use before bedtime was common, with 60.9% reporting occasional use and 35.5% reporting regular use. Overall, 41.8% reported neutral life satisfaction, while 25.5% and 24.6% were slightly and extremely satisfied, respectively. A significant negative correlation was found between poor sleep patterns and life satisfaction (r = -0.389, p < 0.001). Mobile phone use before bedtime and shift work were significantly associated with sleep patterns (p = 0.048). Conclusion Poor sleep quality, particularly among shift workers and frequent bedtime mobile phone users, is associated with lower life satisfaction. Workplace interventions promoting sleep hygiene may enhance employee well-being.

Introduction: Antenatal depression is a major public health concern linked to adverse maternal and neonatal outcomes, including preterm birth, impaired fetal growth, low birth weight, infant malnutrition, and increased episodes of childhood illness. This study assessed the magnitude and factors associated with antenatal depression among pregnant women attending public health centers in Shire town, Tigray, Ethiopia. Methods: This facility-based cross-sectional study allocated the sample proportionally across health centers based on November-December 2025 antenatal care caseloads. After selecting the first participant by lottery, every third eligible attendee was enrolled through systematic sampling. Variables with p[&le;]0.25 in bivariable analysis were entered into a multivariable logistic regression model to identify factors associated with antenatal depression among pregnant women in post-war Shire Town, Tigray, Ethiopia. Results: All 463 participants were included (response rate: 100%). The magnitude of antenatal depression was 34.3% (95% CI: 30-38.7%). Increased odds of depression were observed among age group 25-34 years (AOR = 3.43; 95% CI: 1.7-7.2), those with unplanned pregnancies (AOR=2.2; 95% CI: 1.25-3.87), exposure to conflict-related traumatic events (AOR=2.6; 95% CI: 1.41-4.81), Internally displaced people (AOR=2.02; 95% CI: 1.05-3.92), experience of intimate partner violence (AOR=2.22; 95% CI: 1.31-3.8), poor partner relationship (AOR=2.17; 95% CI: 1.2-3.96), and low perceived neighborhood safety (AOR=2.7; 95% CI: 1.5-5.08). Protective factors included middle income (AOR=0.54;(95% CI:0.31-0.93), higher income (AOR=0.15; 95% CI: 0.065-0.33), and very good pre-war economic status (AOR=0.4; 95% CI: 0.16-0.94). Conclusion: Antenatal depression was common among pregnant women in this post-war population, with internally displaced women experiencing higher odds. Integrating mental health and psychosocial support into antenatal care, alongside interventions addressing conflict-related trauma, intimate partner violence, socioeconomic vulnerability, and community safety, is warranted.

Objective: In 2021, a large-scale survey highlighted that in a subset of biomedical journals, a few authors -often serving on the editorial board- published disproportionately and experienced shorter acceptance times. Our study aims to specifically quantify editors research articles within the journals in which they operate. Methods: We selected journals indexed in Open Editors, a dataset that collects publicly available information on journal editorial boards through web scraping. Journals not indexed in PubMed, mega-journals, and those with very low publication volume were excluded. For the remaining journals, we linked the 2022 editorial boards from Open Editors to authors of research articles (i.e., original articles, case reports, and reviews) published between 2020 and 2023. For each journal, we then computed indicators describing publication patterns: the percentage of research articles (i) by the most prolific editor, (ii) with at least one editor, and (iii) by the most prolific author, as well as publication lags for each article. Results: Across the 1,623 journals studied, the median and 95th percentile of research articles are 1.78% and 6.7% for those co-authored with the most prolific editor, 12.1% and 41.1% for those with at least one editor, and 2.5% and 7.9% for those with the most prolific author. An editor was among the most prolific author(s) in 45.0% of the journals. For authors, the median and 5th percentile publications lags are 99 and 35 days; for editors, it is 95 and 33 days; and for editors-in-chief, it amounts to only 84 and 12 days. An in-depth examination of journals where the most prolific editor co-authored more than 6.7% (95th percentile) found a median impact factor of 3, and a median h-index of 42 for their most prolific editor(s). Conclusion: In 5% of cases, an editor contributes to approximately >7% of the articles published in their own journal. In nearly half of the journals, the most prolific author is an editor. These results need to be complemented by a qualitative approach to examine whether research articles authored by editors appropriately address potential conflicts of interest, as required by COPE recommendations, and to better understand the motivations underlying this practice.