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Tobacco use is a significant global public health issue, increasingly affecting low- and middle-income countries. In culturally sensitive contexts like Lebanon, self-reported smoking may be unreliable, particularly among socially restricted groups such as women and youth. This study aims to evaluate the discrepancy between perceived and actual dependence on cigarettes and waterpipes in the Lebanese population and its association with social desirability, while also examining gender differences and patterns among self-identified non-smokers and younger individuals. A cross-sectional study was conducted between February and March 2025, enrolling a total of 377 participants. Data were collected through an online self-administered survey distributed via Google® Forms, using previously validated scales for smoking dependence and social desirability assessment. The present study showed a substantial gap between self-perception and actual nicotine dependence among Lebanese youth and young adults: despite scoring high on the Lebanese Cigarette Dependence and Waterpipe Dependence scales, 10.6% of cigarette smokers and 28.6% of waterpipe smokers did not perceive themselves as dependent. Underestimation of tobacco dependence was more prominent among waterpipe smokers; according to the model, it was overall associated with higher waterpipe dependence (ORa = 1.24; 95% Confidence Interval (CI) 1.14-1.34) and cigarette dependence (ORa = 1.12, 95% CI 1.08-1.18), more smokers at home (ORa = 1.53; 95% CI 1.24-1.90), depression (ORa = 6.44; 95% CI 1.38-30.08), and social desirability components, mainly the reversed independent thinking (ORa = 1.09; 95% CI 1.00-1.18). Underestimation of cigarette and waterpipe dependence was linked to lower virtuous perfectionism in both sexes. Additionally, males living outside Beirut were more likely to underestimate waterpipe dependence, while in females, underestimation was also associated with depression. These findings should be interpreted within Lebanon's unique cultural and religious context. Given the important role of social and psychological factors in tobacco dependence underestimation, future interventions should go beyond physical health messaging. Targeted campaigns should encourage self-awareness, challenge conformity, and embrace acknowledging addiction and seeking help. Not applicable.

Child survival is a critical indicator for a nation's health and its progress is important in attaining the Sustainable Development Goals. Understanding the regional and country-specific dynamic and interplay of various determinants of under-five child mortality is vital for the African continent, which remains one of the most vulnerable regions for child mortality globally. This study investigates the association of economic, health-related, social and demographic, environmental, and infrastructure-related factors with under-five child mortality. It integrates generalisable regional associations using a standard fixed-effects panel model and examines illustrative country-specific associations of the selected determinants through multiple linear regression, based on a balanced panel dataset of 45 countries over a 22-year period. Fixed-effect analysis reveals that the diphtheria-tetanus-pertussis (DTP) immunisation and total fertility rate (TFR) are robust regional determinants of under-five mortality across specifications. While health expenditure, sanitation services, and malaria incidence show significant associations in the baseline model, these findings are sensitive to the inclusion of year fixed effects, suggesting they are influenced by broader temporal trends or common regional shocks rather than serving as stable independent factors within the study period. Regional analysis, which controls for unobserved country-specific heterogeneity over an extended period and is complemented by country-specific analysis, facilitates the formulation of policy implications at both national and international levels. Recommended policy measures include increasing immunisation coverage, implementing malaria control programmes, strengthening community health infrastructure, enhancing girls' education, promoting widespread access to modern family planning, and improving sanitation services. These strategies are expected to contribute to the progress toward Sustainable Development Goal 3.2 in the African region.

Hypertension (HTN) and type-2 diabetes mellitus (T2DM) present a substantial economic burden of disease in China. The National Essential Public Health Service Package (NEPHSP) is a Chinese government initiative to provide a suite of basic public health services to all residents for free, with the aim to shift the focus of the healthcare system towards prevention and community-based primary health care. However, evidence is scarce regarding its economic impact. A retrospective, province-wide study was designed to extract 5,456,854 electronic medical records from 339 institutions in Henan province from January 1, 2022 to December 31, 2024, using stratified cluster sampling. Patients with HTN or T2DM managed under the NEPHSP were identified by linking medical records to the NEPHSP management registry. Based on the International Health Partnership + (IHP +) common monitoring and evaluation (M&E) framework, we assessed medical costs as the primary outcome. Propensity score matching was used to create comparable cohorts of NEPHSP-managed and non-managed patients. The difference in mean annual total medical costs per capita was analysed using a two-sample Z-test. NEPHSP-managed patients had lower mean annual total medical costs across all years for both HTN and T2DM, with the largest cost difference observed in 2023 (up to CNY 713.57). When stratified by types of medical costs, we found NEPHSP-managed patients had lower average costs for general medical services, diagnostics, treatment, and western medicine compared to non-managed patients. The cost savings associated with NEPHSP-managed were most pronounced in males, older patients (≥ 65 years), and those with three or more comorbidities. Community-based public health management of HTN and T2DM through China's NEPHSP is associated with substantial medical cost savings, particularly for high-risk demographic groups. Our findings provide real-world evidence supporting national policies that prioritise prevention and community health services. Continued investment in NEPHSP is a highly effective strategy for mitigating the economic burden of chronic disease in China and similar settings.

Community-based medical education and research services (COBMERS) place medical students in primary health care facilities to strengthen their skills in community health service delivery, teamwork, leadership and professional ethics within limited-resource settings. Beyond training, COBMERS enables universities to generate evidence on local disease epidemiology, transmission dynamics, and control practices, resulting in a tangible, contextualized impact on the communities. There is however limited data on disease profile in Teso subregion, with limited epidemiological research in the area. This prospective study aims to profile the disease burden in the Teso subregion through COBMERS, thereby informing community-level interventions and health policy. The study will employ convergent parallel mixed-methods design, integrating quantitative and qualitative approaches. Quantitative components will include cross-sectional surveys to determine prevalence of non-communicable diseases (NCDs), neglected tropical diseases (NTDs), and infectious diseases, complemented by prospective cohort studies to assess temporal trends. Qualitative data will be gathered through focus group discussions and key informant interviews to explore community perceptions, health system capacity, and effectiveness of preventive measures. A community-based participatory research (CBPR) approach will guide all phases, ensuring that research is co-designed with community members, health practitioners, and local authorities. Medical students, under the supervision of faculty and site mentors, will serve as primary data collectors, integrating research with their COBMERS training. The study is expected to provide evidence on the prevalence, trends, and risk factors of major diseases in the Teso subregion, alongside community perspectives on health priorities and barriers to care. Findings will stir up debates to inform tailored interventions, strengthen primary health care, and guide policy formulation. Additionally, embedding research within COBMERS is expected to build local research capacity among site mentors and students, fostering sustainability and continued community-university collaboration. This protocol therefore provides an integrated framework that combines epidemiological surveillance, community engagement, and capacity building. By leveraging COBMERS and CBPR, the study seeks to provide actionable evidence to reduce the burden of NCDs, infectious diseases, and NTDs while promoting health system resilience in Eastern Uganda.

Collaboration between local health authorities and community actors is widely recognised as central to effective emergency preparedness and response, particularly in low- and middle-income countries (LMICs), where health systems face persistent resource and governance constraints. However, empirical evidence on how such collaboration is conceptualised, operationalised, and evaluated remains fragmented. This scoping review mapped and synthesised available evidence on collaboration between local health authorities and community leaders (including community-facing actors) during health emergencies, using the COVID-19 pandemic as an illustrative context to inform further research. A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with the PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar for studies published between January 2020 and October 2025. Eligible studies were primary empirical research conducted in LMICs that examined collaboration between local health authorities and community-facing actors involved in emergency responses. Data were extracted using a structured charting tool and synthesised using descriptive and narrative approaches. Three qualitative studies from Bangladesh and the Philippines met the inclusion criteria. Collaboration involved partnerships between local health authorities and non-governmental organisations, universities, and community-based actors, often formalised through coordination mechanisms. Reported strategies included joint planning, co-implementation of services, resource and workforce sharing, capacity building, and community outreach. These approaches were associated with enhanced surge capacity, continuity of essential services, strengthened system resilience, and improved access and community engagement. However, community leadership roles were rarely explicitly defined, with leadership functions often embedded within community-facing or intermediary actors. The evidence base on collaboration during health emergencies in LMICs remains limited and conceptually underdeveloped. Available studies suggest that collaboration between local health authorities and community-facing actors may support coordinated and resilient responses. However, important gaps persist in how community leadership is conceptualised, operationalised, and evaluated. Future research should more explicitly define and examine community leadership roles, alongside strengthening institutionalised and sustainable collaborative mechanisms for emergency preparedness and response. Not applicable. This scoping review does not involve a healthcare intervention or human participant enrolment. The review protocol has been published previously and is publicly accessible.

Organisational Health Literacy (OHL) refers to the capacity of healthcare organisations to enable people to find, understand, appraise, and use health information and services equitably. Although interest in OHL has grown across Europe, the degree to which healthcare organisations adopt and assess OHL remains uneven. This study explored stakeholders' perspectives on factors that facilitate or hinder the uptake of OHL strategies and assessments within healthcare organisations in Europe. Semi‑structured interviews and surveys were conducted with stakeholders from six European countries within the JA PreventNCD initiative. Data were analysed using qualitative content analysis to identify macro‑ and micro‑themes related to OHL adoption and assessment. A SWOT analysis was conducted to provide a framework for discussing the factors that facilitate and hinder the adoption of OHL in healthcare organisations. Across countries, stakeholders highlighted several overarching themes: the importance of leadership commitment, staff training, and integrating OHL into organisational processes; the need to involve patients and communities; and key strategies to support OHL assessments-communicating their added value, securing managerial or authority‑level incentives, and using practical tools. A lack of awareness of OHL, scarce resources and management support, and overly complex tools, actors and steps to secure commitment were also identified as issues to address. Stakeholders across diverse health systems emphasised that strengthening OHL requires coordinated organisational action rather than isolated activities. Prioritising leadership engagement, embedding OHL into quality improvement structures, and supporting staff through training and accessible tools are crucial to creating sustainable OHL‑responsive environments. These findings provide actionable insights for designing and implementing OHL strategies and assessments in European healthcare organisations considering facilitating and hindering factors for their adoption.

Australia's increasingly diverse population includes a nearly one third from Culturally and Linguistically Diverse (CALD) backgrounds, who often face significant challenges in accessing and utilizing healthcare services, particularly for non-communicable diseases (NCDs). These challenges stem from various factors including understanding and communication barriers in English, cultural differences, limited health literacy and healthcare system related limitations. This project aims to co-develop and test a culturally responsive community-based, multi-packaged model of care to enhance access to and utilization of health services for common NCDs (screening of hypertension and diabetes mellitus, and initiation of treatment for those diagnosed) among CALD communities in Australia. This project will follow a four-phased approach, based on the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Other complementary frameworks including the consolidated framework for implementation research will also be utilized depending on contextual requirements. In Phase I, formative research will be conducted through a scoping review, quantitative survey, and qualitative interviews with service users and healthcare providers to identify successful care models, service preferences, and key facilitators and/or barriers to service access and utilization. Phase II of the project will focus on co-developing a culturally responsive care model informed by the findings of the first phase, which will then be reviewed and standardized with input from stakeholders, including healthcare providers and CALD community members. The Phase III activities will involve capacity building and collecting baseline data and implementing the care model. Finally, in Phase IV, implementation outcomes will be assessed by collecting follow‑up data using the same tools from Phase III, but not necessarily from the same individuals. The quantitative follow up window for outcome assessment is 6 to 12 months after site activation, with any longer activity focused on qualitative work, sustainment assessments, and dissemination. Overall, this project may play a pivotal role in enhancing the accessibility, quality, and cultural responsiveness of healthcare for CALD communities and reducing health disparities. We believe the lessons learned and the model developed through this process will be useful not only in Australia but also in other countries with similar multicultural communities.

The COVID-19 pandemic underscored the importance of integrating human behaviour in infectious disease modelling approaches, yet an in-depth assessment of how behavioural components are incorporated remains limited. We conducted a scoping review of COVID-19 models applied to Belgian data to examine how behavioural dynamics, both voluntary and policy-driven, were represented within model structures. Our aim was to identify current practices, highlight methodological gaps, and provide recommendations for the development of behaviourally integrated epidemiological models. Using Scopus and PubMed, we identified 98 studies published between March 2020 and October 2024, describing 105 models in total. Models were classified by model class (mathematical, statistical, or ensemble), objectives, approaches used to incorporate behavioural factors, and types of behaviour data employed. Behavioural integration was confined to specific modelling contexts, with only half of the 105 models incorporating behavioural components. Mechanistic models, particularly compartmental models, were the most likely to include behavioural features, especially in studies assessing non-pharmaceutical interventions or conducting long-term forecasts and scenario analyses. Behavioural change was most commonly represented through modifications to transmission parameters or contact matrices. These adjustments were frequently informed by social contact surveys or mobility data derived from various sources. In contrast to previous reviews that focused exclusively on behavioural models, this study evaluates the full landscape of Belgian COVID-19 models, offering a comprehensive perspective on how behavioural representation varies across modelling approaches. Our findings recommend that effective behavioural integration relies on timely, routine, and disaggregated surveillance and behaviour data, alongside the use of flexible mechanistic models.

Fertility rates in Somalia are among the highest globally, posing significant challenges to maternal and child health and sustainable development. However, there is limited evidence regarding the specific drivers of high fertility. This study aimed to identify the factors associated with the number of children ever born among Somali women of reproductive age to inform reproductive health policies and programs. A cross-sectional analysis of a nationally representative household survey was performed. We analyzed the weighted data of 27,352 women aged 15-49 years who participated in the 2020 Somali Health and Demographic Survey. The number of children born was defined as the total number of live births and was modeled as a count outcome. Owing to overdispersion, survey-adjusted negative binomial regression was used to estimate unadjusted and adjusted incidence rate ratios with 95% confidence intervals for demographic, socioeconomic, reproductive, and geographic factors. The mean number of children born was 6.22. Higher education level showed the strongest inverse association (higher vs. none: incidence rate ratio = 0.154; 95% confidence interval: 0.049-0.487). A later age at first birth (> 20 vs. ≤20 years) and literacy were associated with fewer children ever born (incidence rate ratio = 0.913; 95% confidence interval: 0.902-0.923, and incidence rate ratio = 0.965; 95% confidence interval: 0.939-0.991, respectively). Compared with rural residents, urban women had more children ever born (incidence rate ratio = 1.019; 95% confidence interval: 1.003-1.035), whereas nomadic women had fewer (incidence rate ratio = 0.979; 95% confidence interval: 0.965-0.993). Women in the middle wealth quintile had more children ever born than the poorest women (incidence rate ratio = 1.033; 95% confidence interval: 1.021-1.046). Compared with current modern method users, non-users intending future use and non-users with no intention to use had more children ever born. Fertility rates in Somalia remain high and are shaped by structural and behavioral factors. Expanding girls' education, delaying childbearing, improving literacy, and ensuring equitable access to contraception may help reduce fertility and improve population health.

Phthalates, parabens, benzophenone-3, bisphenols and triclosan are among the contaminants suspected of being involved in several hormone-related pathologies. In developing countries, weak regulations and lack of a precise monitoring plan lead to exposures that could be much worse than in developed countries. The objectives of this study were to evaluate the level of exposure of the adult population of Kinshasa in the Democratic Republic of the Congo to these compounds and to assess the health risk induced by these pollutants. Concentrations of four parabens, nine phthalate metabolites, two non-phthalate plasticizers, benzophenone-3, three bisphenols and triclosan were assessed in the urine of 145 volunteers recruited between November 2022 and January 2023 in Kinshasa. Measurements were performed using a liquid or a gas chromatography coupled to a mass spectrometer. Methylparaben (MeP: 62.6 μg/L), mono-n-butyl phthalate (MnBP: 78.1 μg/L) and bisphenol A (BPA: 1.54 μg/L) were detected in over 95% of urine samples, with exposure levels exceeding those observed in Western populations. For BPA and MnBP, 100% and 15% of the study samples, respectively, exceeded human biomonitoring guidance values (HBM-GV) proposed by the European Human Biomonitoring Initiative (HBM4EU) consortium, meaning that their exposure levels are associated with health concerns. The exposure of the population of Kinshasa to these pollutants merits consideration, as it constitutes a serious public health concern. To enhance protection, regulatory measures must be implemented and large-scale studies and awareness campaigns must be conducted.

Gallbladder cancer (GBC) is highly fatal and, unlike most cancers, is more common in women than in men. Most GBC cases have gallstones, but most people with gallstones do not develop GBC. Thus, a critical question is what drives the risk of GBC in the presence of gallstones. We designed a case-control study to complement the Chile Biliary Longitudinal Study (Chile BiLS) cohort, enriching the number of GBC cases and enhancing our ability to evaluate risk factors for GBC. Starting in July 2022, we began to recruit non-cohort prevalent (diagnosed between January 1, 2016, and July 18, 2022) and incident (diagnosed on or after July 19, 2022) GBC cases, as well as patients with high-grade dysplasia (HGD), in a high-risk area of Chile. Individuals with GBC or HGD are considered cases (HGD +). We are matching gallstone cholecystectomy patients to cases at an approximate 1:1 ratio. We also include unmatched controls (adjudicated) who were initially suspected of having cancer but had benign findings on gallbladder pathology. If a case or control is deceased, we conduct proxy interviews to maximize the potential for detailed epidemiological data collection. Through August 31, 2025, we recruited 196 prevalent and 117 incident HGD + cases. Of these cases, 189 (96%) prevalent and 108 (92%) incident cases were diagnosed with GBC. All prevalent and 98.3% of incident cases have matched controls. Participation rates are 70.8% for HGD + cases and 67.8% for matched controls. The Chile BiLS case-control study is conducted in an area with high risk of GBC and a high proportion of people with Mapuche Amerindian ancestry. This study will provide important insights into the factors associated with GBC among people with gallstones. Here, we provide a thorough description of the design of the study, field procedures, and biological resources, as well as research opportunities, which will enable a more complete picture of the etiology of GBC by combining epidemiological, molecular, digital imaging, and clinical data. This study represents a powerful resource for the identification of new targets for cancer prevention and treatment, which are particularly needed in populations at high risk of GBC.

Maternal disorders remain a critical public health challenge in sub-Saharan Africa, accounting for disproportionate maternal mortality despite global progress. This study examined regional inequalities and temporal trends in maternal disorders across sub-Saharan Africa from 1990 to 2023 using the Global Burden of Disease 2023 data. Age-standardized disability-adjusted life years and death rates per 100,000 population were extracted for 11 maternal disorder causes across 46 sub-Saharan African countries classified into four subregions (Western, Eastern, Central, and Southern Africa). Cause of Death Ensemble modeling and DisMod-MR 2.1 were used to generate mortality and morbidity estimates. Temporal trends were assessed using percentage change calculations, and geographic distributions were mapped using choropleth visualizations. Subregional inequalities were quantified by comparative analyses of absolute and relative disparities. In 2023, maternal disorders accounted for 1,601.9 disability-adjusted life years and 25.8 deaths per 100,000 population region-wide, with substantial subregional variation. Central Africa exhibited the highest burden (2,592.6 disability-adjusted life years; 42.7 deaths per 100,000), followed by Western Africa (1,889.6; 30.9), Eastern Africa (1,204.4; 18.7), and Southern Africa (586.3; 9.4). Maternal hemorrhage, sepsis, and hypertensive disorders were the leading causes. From 1990 to 2023, the overall burden declined by 60%, driven primarily by Eastern Africa's 76.6% reduction in disability-adjusted life years. Central and Western Africa achieved moderate declines (42.8% and 50.2%, respectively), whereas Southern Africa experienced increases in specific causes, including hypertensive disorders (33.5%) and HIV-aggravated maternal deaths (241.5%). Despite remarkable progress, profound regional inequalities persist in the burden of maternal disorders across sub-Saharan Africa. Achieving Sustainable Development Goal 3.1 requires strengthened health systems, universal access to quality obstetric care, expanded reproductive health services, and targeted interventions that address subregion-specific maternal health challenges.

Nepal has made significant strides in reproductive rights, legalizing safe abortion services (SAS) in 2002, and recognizing them as fundamental rights in its 2015 constitution. Despite this, over half of abortions remain unsafe, with persistent disparities in access to and utilization of safe abortion services. This study examines the trajectory of Nepal's abortion policy evolution and reform process, and implementation status, and ongoing challenges and opportunities using the heuristic policy cycle framework to inform evidence-based strategies for equitable reproductive rights. A policy process and content analysis was conducted using a mixed-methods approach. To identify relevant policy documents and literature, we used search terms related to three concepts: abortion, law, and location (Nepal). We identified 25 peer-reviewed studies and 32 grey literature policy documents published in English or Nepali up to 30 June 2025, identified via PubMed, Embase, Medline Ovid, Google Scholar, and government sources. Quantitative data were extracted from government annual reports and national census data. Data analysis involved thematic coding of qualitative data across five policy stages (agenda setting, formulation, adoption, implementation, and evaluation) and descriptive analysis of quantitative service utilization and the sex ratio at birth (SRB) data. Agenda setting of the legalization of abortion in Nepal was driven by high maternal mortality ratio and advocacy aligning with global commitments. The 2002 legal reform legalized abortion up to 12 weeks on demand, with provision requiring spousal consent, and banned on sex-selective abortion. Implementation efforts focused on capacity building, service expansion-expanding SAS to 1,685 sites-and equitable distribution of services, delivering 1.6 million SAS over two decades. The proportion of medical abortion has increased from 50% to 73% of cases. However, 53% of pregnancies are unintended, with abortion often used as contraception. More than 50% of service providers are outside the formal system. There is inequitable access to SAS, and the SRB is skewed towards male, indicating ongoing sex-selective abortion. Nepal's abortion policy journey represents remarkable progress in legal reforms and service expansion; however several contextual and systemic barriers such as low awareness, rural inequity, unregulated providers, sex selective abortion, and the repeated use of abortion as family planning undermine equitable access and reproductive rights. Key reforms include expanding second-trimester services, strengthening regulations, combating sex-selective abortion practices, enhancing access to family planning services, and implementing abortion related awareness campaigns to address gender discrimination, service information gaps, and unintended consequences of unsafe practices.

Female genital mutilation is a major public health and human rights concern, with the highest burden reported in countries of the Horn of Africa. Despite long-standing legal bans and prevention efforts, the practice remains nearly universal in Somaliland, driven by deeply rooted social and cultural norms. Evidence on the prevalence, types, and population-level determinants of female genital mutilation in Somaliland remains limited. This study assessed the prevalence, types, and associated factors of female genital mutilation among women of reproductive age in Somaliland. This population-based study analyzed data from 5,143 women aged 15-49 years who participated in the 2020 Somaliland Demographic and Health Survey. A two-stage cluster sampling design was used, involving the selection of enumeration areas followed by households. Descriptive analyses were conducted to estimate prevalence and types of female genital mutilation. Binary logistic regression was used to identify factors associated with the pharaonic type of female genital mutilation in comparison with other types. The overall prevalence of female genital mutilation was 99.49% (95% confidence interval: 99.30-99.70). The most common form was type three (pharaonic), affecting 66.97% of women, followed by type one (sunni) at 22.01% and type two (intermediate) at 9.50%. Women from nomadic communities, those with no formal education, those in lower wealth households, women who had never used the internet, and those circumcised by traditional practitioners had significantly higher odds of experiencing the pharaonic form of female genital mutilation. Female genital mutilation remains nearly universal among women of reproductive age in Somaliland, with severe forms predominating. Social disadvantage, limited access to education and information, and reliance on traditional circumcisers are key population-level drivers of harmful practices. Interventions that expand educational and digital access and engage traditional practitioners may be critical to reducing the persistence and severity of female genital mutilation in Somaliland.

The ageing and shortage of healthcare workers represents a major problem in many countries worldwide, including Czechia. This study focuses specifically on nurses in the Czech healthcare system. The aims of the article are to describe the age and geographical structures of nurses and analyse their entry into and exit from the healthcare system, as well as to provide projections aimed at highlighting the potential risks of a shortage of nurses. This retrospective observational study utilised data from the largest Czech health insurance company (the General Health Insurance Company of the Czech Republic (GHIC)), which has concluded contracts with almost all healthcare providers in Czechia, for the period from 31 December 2012 to 30 September 2023. Demographic methods were used to evaluate the age structures and entry and exit patterns, which was followed by the compilation of a "what-if" projection model of nursing capacities up to 2035. The analysis revealed a clear ageing trend across all the country's healthcare segments, as reflected in the increasing proportion of nurses in older age groups and the declining representation of younger age groups. If current entry and exit trends continue, projections for 2035 predict declines in both the full-time equivalent capacity (FTE) and physical capacity (headcounts) of up to 8% compared to the year 2022. The study points to the need for targeted planning, improved entry conditions for nursing graduates and support for personnel retention, especially in regions and care sectors most at risks of shortages. It further highlights the importance of implementing policies that ensure the long-term sustainability of the nursing workforce in an ageing healthcare system.

Cancer primary prevention (CPP), particularly through evidence-based recommendations like the 4th European Code Against Cancer (ECAC4), represents a cost-effective strategy to reduce cancer burden. Dissemination and implementation (D&I) of CPP strategies remain fragmented and inconsistent, and instruments to assess dissemination of CPP are lacking. This study aimed to develop and validate an instrument to assess the public (i) perceptions of CPP message characteristics, and (ii) public perceptions of ECAC4. The validation of the ´Information on Cancer Primary Prevention` instrument was developed through a multi-stage process grounded in two D&I frameworks: McGuire's Communication-Persuasion Matrix and Rogers' Diffusion of Innovations. After literature review, items were generated for the two questions assessing message characteristics (channel preferences and source trustworthiness) and 25 items to assess ECAC4 five perceived attributes: advantage, compatibility, complexity, trialability, and observability. Validation involved cognitive interviews for message characteristics, expert validation through a two-round Delphi panel for ECAC4 attributes, and pre-testing with 240 adults recruited through an online panel. Exploratory factor analysis (EFA) was conducted to assess structural validity, and Cronbach's alpha was used to evaluate internal consistency. Refinements in terminology, response scales, and item wording were implemented after cognitive interviews for the two questions of message characteristics (channel preference and source trustworthiness). EFA revealed three factors for channel preferences (Traditional broadcast media, Digital media/online interactive platforms, and Print media and interpersonal; α = 0.703-0.775) and two factors for source trustworthiness (Official sources and Unofficial sources; α = 0.792-0.859). The five ECAC4 attributes were evaluated in a Delphi panel with two rounds - due to participant attrition the panel was discontinued before full consensus could be reached for all items; five items were adapted based on expert qualitative feedback and included in the pre-test. All five ECAC4 attributes subscales demonstrated unidimensionality with strong factor loadings (> 0.50) and good to excellent reliability (α = 0.714-0.831). This instrument exhibits initial evidence of content and exhibits satisfactory psychometric properties, offering preliminary evidence of structural validity, and internal consistency. By operationalizing key constructs from established dissemination and implementation frameworks, it addresses critical gaps in cancer prevention communication research.

Extensive population testing played a crucial role in mitigating the COVID-19 pandemic. However, scaling up testing capacity requires a considerable workforce and infrastructure. Furthermore, sampling and testing delays can hinder timely interventions. We therefore sought to improve pre-test triage through an ensemble model based on self-reported information. We trained an XGBoost classifier to predict individual risk of COVID-19 infection for higher education students in Leuven (Belgium) from real-world social and health data related to 38,180 test results. The model could recommend isolation, testing, or release of individuals at high, moderate, or low risk of infection, respectively, based on two parametrizable probability thresholds. We then studied the epidemiological impact of the ensemble triage tool in silico, by simulating its implementation in our context to control an epidemic over time. The predictive model achieved a ROC AUC of [Formula: see text], but its performance varied across rolling retraining windows. The epidemiological simulations highlight the potential of the ensemble-enhanced triage system to control a surge of infections in the student population of Leuven. Given a rapid implementation at the onset of an infection surge, it could reduce the effective reproduction number below 1.0 while reducing the testing requirements by [Formula: see text]. The predictions of the ensemble model were strongly influenced by the number of contacts which individuals reported, the reason for testing, and the onset of symptoms. Our study suggests that pre-test triage guided by ensemble models could play an important role in allocating testing resources efficiently. Given timely implementation and isolation compliance within the population, it could also help rapidly control a surge of infections. Future research could validate this approach for other pathogens, in other settings, and with deep learning models.

Since South Korea entered a super-aged society in 2024, the demand for formal care services has increased rapidly. Formal care workers employed in hospitals and long-term care facilities, including long-term care aides and paid caregivers, play a central role in providing health-related care and assistance with daily living for older adults. Despite their essential contribution, empirical evidence on their working conditions and health remains limited and no dedicated cohort-based study focusing on this workforce currently exists. This study aimed to develop an integrated, cohort-based survey instrument to systematically assess the working conditions, care environments, and health of institution-based formal care workers in South Korea. The survey instrument was developed through a multi-phase scale development process, which included: (1) a review of existing national and international labor and care-work surveys; (2) in-depth interviews with institution-based care workers employed in hospitals and long-term care facilities, followed by qualitative content analysis using Attribute Analysis of the Dynamic Mapping Method; (3) item generation, consolidation, and inter-researcher validation; (4) expert consultation to assess content validity; and (5) pilot testing with formal care workers. Qualitative findings and expert feedback were iteratively integrated to refine domains and survey items. The final conceptual framework comprised three major domains (i.e., sociodemographic characteristics, care work environment, and health), encompassing 11 subdomains and 79 variables. The finalized instrument consisted of 79 items encompassing multiple dimensions of institutional care work, including employment status, care-related workload, occupational health and safety, organizational and social support, and physical and mental health. Key components related to working conditions (including working hours and income), organizational support, and workplace safety were prioritized through expert review and importance assessment. This study presented the first cohort-oriented survey instrument specifically designed for institution-based formal care workers in South Korea. By focusing on care labor within hospitals and long-term care facilities, the instrument provided a robust foundation for longitudinal monitoring, policy evaluation, and research on workforce sustainability in aging societies.

The 2024 conflict in Lebanon triggered widespread internal displacement and placed significant strain on the national health system. This study analyzes the emergency healthcare response of the Health Society during Lebanon's 2024 conflict using a health systems resilience framework and SWOT analysis to inform evidence-based interventions for conflict-affected populations and guide future policy and research. From September to December 2024, a large Lebanese NGO ("Health Society") scaled up its response by operating 91 facilities, including 48 newly established emergency sites and 43 existing centers. In parallel, 36 mobile medical teams comprising 984 healthcare professionals (254 physicians) were deployed to maintain service continuity. Service utilization data were aggregated and analyzed descriptively. A total of 588,000 beneficiaries received essential services. Beirut recorded the highest service volume, including 145,523 medication dispensations and 71,276 consultations. Mount Lebanon also showed substantial utilization, while Baalbeck-Hermel accounted for the highest number of psychological consultations (1,130) and surgical procedures (2,076). Environmental risk assessments conducted in 158 displacement centers identified hazards in 30.4% of sites, most commonly unsafe indoor coal use (17.1%). Preventive efforts included vaccination campaigns in 33 displacement schools, reaching 520 children. The findings highlight the value of combining fixed facilities, mobile outreach, mental health integration, and community-based risk assessments to sustain healthcare access during conflict. While challenges related to geographic inequities, surge staffing, and financial sustainability persist, the response demonstrates how emergency interventions can strengthen health system resilience in crisis settings.