Communities, as funders and users of the health system, have a vital role in ensuring the provision of integrated people-centered primary health care (PHC). However, there is a lack of information on community voices about the competence of health professionals in Ethiopia. Therefore, this study aimed to explore the community voices on the competence of health professionals for the provision of quality PHC services. A qualitative case study involving 10 key informant interviews and 6 FGDs was conducted from June 1 to July 30, 2023, in the Amhara Region among community representatives. The sample size was determined based on data saturation, and purposive heterogeneous sampling was employed. The high-quality health system framework and the Standards for Reporting Qualitative Research (SRQR) were used for analysis and report writing, respectively. The key informants and discussants shared views regarding the competence of health professionals working in PHC facilities. These were categorized into three main themes and six subthemes. The main themes were quality impacts, process of care, and foundations. The subthemes were confidence in health professionals' competence, health outcomes of the care provided by health professionals, economic benefits of the care, users' experiences, competent care and system, and governance. The community had lost trust/confidence in the health professionals working at the PHC settings due to their negative experiences with them and forgone health care services. The community recommended that primary health care should have highly competent health professionals who receive adequate support, payment, working conditions, training, regulation, and who prioritize the people's needs and expectations in their practices. This implies that the region has not yet achieved effective implementation of UHC principles through PHC. Thus, the regional and sub-regional governments and health professionals should work to rebuild the confidence (trust) of the community by paying attention to their concerns and pain points.
With the acceleration of global aging, the potential of digital technologies for self-care management among older adults has surged. Older adults often face numerous difficulties and challenges when seeking health information, including issues related to technology adaptability and the complexity of the social learning environment. In addressing these challenges, Bandura's Social Learning Theory framework offers a robust theoretical foundation for resolving these dilemmas. This research employs focus groups and semi-structured interviews with 20 older adults and 6 community workers on four occasions. Qualitative data were analyzed using Braun and Clarke's six-phase reflexive thematic analysis to identify key themes. Older adults learn to utilize technology for health management through peer imitation and community workers. Community workers' lack of systematic training results in a limited range of technologies. The complexity of technology and the absence of family support were found to weaken older adults' self-efficacy, while community workers struggled to provide in-depth guidance due to resource constraints. While encouraging short-term participation, over-reliance on incentives can lead to instrumental motivation. Both older adults and workers called for an age-friendly design, highlighting inadequate community equipment and weak promotional activities as critical issues that need to be addressed. The needs of older adults and community workers in utilizing technology for health exhibit a multi-layered interaction. Older adults require simplified technologies and social support, and community workers demand technical training and policy backing. The study's findings support a reframing of immediate recommendations towards age-friendly design, structured training for community workers, and policy support for resources. Developing artificial intelligence-assisted tools is a potential long-term direction inferred from the broader need for scalable and personalized support, thereby narrowing the technology gaps for older adults.
Surgical gastrostomy tubes (G-tubes) are common pediatric surgery procedures; however, they require caregiver perioperative education for appropriate management. One factor that has not been well explored is the impact of caregiver health literacy on the effectiveness of G-tube education. This study aimed to understand caregiver health literacy levels and associated clinical outcomes to inform design of future education interventions. A prospective cohort analysis was performed for caregivers of children who underwent initial G-tube placement from 11/2024-7/2025. Data collection included demographic information, assessment of sociodemographic factors, assessment of health literacy using the validated Parental Health Literacy Activities Test (PHLAT-8) score, and presence of complications and health resource utilization 30 days after surgery. Descriptive statistics were reported. PHLAT-8 scores were compared by education and annual household income level. Poisson and logistic regression models were used to predict clinical outcomes. Of the 86 eligible caregivers approached, 49 consented to participate in the study. The median PHLAT-8 score was 6 (IQR 6-8). Higher scores were associated with higher attained education levels and higher annual household income (p < 0.05 for both). There was no association between PHLAT-8 scores and health utilization or complications 30 days after surgery. All caregivers in our study demonstrated adequate health literacy. In contrast to prior data, this series did not find any differences in health care utilization or complication rates based on parental health literacy, indicating our population may have appropriate literacy levels to understand the management of pediatric G-tubes. III.
Self-management behaviors (SMB) are fundamental to outcomes in lumbar disc herniation (LDH), yet those remain frequently suboptimal. Electronic health literacy (eHL) may support SMB, but the mechanisms are unclear. Guided by the Information-Motivation-Behavioral Skills model, we investigated whether patient activation (PA) mediates the association between eHL and SMB among LDH patients, and whether pain intensity moderates this pathway. In this cross-sectional study, 402 patients with LDH were recruited from a tertiary grade-A hospital in Shanghai, China. This study was conducted from November 2023 to April 2025. Data were collected using a general information questionnaire, the eHealth Literacy Scale, the Patient Activation Measure, the Self-Management Scale for Chronic Patients, and the Numerical Pain Rating Scale. Statistical analyses were performed using independent samples t-tests, one-way analysis of variance, Pearson correlation analysis, multiple linear regression, and the PROCESS macro for SPSS. The average SMB score among LDH patients was 24.58 ± 9.67, with significantly higher scores observed in those under 40 years old, employed, holding a bachelor's degree or higher, urban residents living alone, individuals with lower monthly income, and those with fewer hospitalizations. It showed that eHL was positive correlations with PA and SMB, while pain intensity was negatively correlated with three all. PA partially mediated the relationship between eHL and exercise (indirect effect: β = 0.132, 95% CI [0.035, 0.228]) and doctor-patient communication (β = 0.053, [0.014, 0.093]) dimensions of SMB, but not cognitive symptom management. Critically, Pain intensity negatively moderated the indirect effect of eHL through PA: the mediated pathway was decreased by over 60% at high pain levels compared to low pain. This study provides evidence that PA mediates the association between eHL and SMB in LDH. More importantly, his mediation pathway is progressively attenuated by increasing pain intensity, indicating that pain functions as a barrier to the translation of digital health skills into motivation and behavior. These findings support the development of pain-responsive self-management interventions that dynamically adjust support based on real-time pain levels. Not applicable.
Hidradenitis suppurativa (HS), an inflammatory skin disorder characterized by painful nodules and abscesses, has varying prevalence among different races/ethnicities. This study explored the social drivers of health, burden, and impact of HS among different racial and ethnic groups. An online, cross-sectional survey was conducted among adult patients with HS (September 2023-December 2023) in the USA. Patients were recruited through HS Connect (patient advocacy group) and AmeriSpeak (US national sample panel). Descriptive data were collected using patient-reported outcome measures and de novo questions about patients' disease knowledge and perception, healthcare access and utilization, impact on quality of life (QoL), and social impact. All analyses were descriptive and stratified by racial/ethnic groups. The study included 583 patients (mean age, 34.8 years; 95.5% female) representing a range of racial backgrounds: Black or African American (n = 273; 46.8%), white (n = 236; 40.5%), Two or More Races (n = 47; 8.1%), American Indian or Alaska Native (n = 18; 3.1%), Asian (n = 7; 1.2%), and Native Hawaiian and Other Pacific Islander (n = 2; 0.3%). Ethnic representation also varied (Hispanic/Latino = n = 76; 13.0%). Patients of all races and ethnicities reported considerable QoL impact (Dermatology Life Quality Index, EQ-5D-5L), with results for smaller subgroups (n < 10) included for descriptive completeness only and not intended for comparison with other groups. During flaring, most patients used over-the-counter products/medications (54.2%) or nonmedical intervention/home remedy (56.9%) Up to 36.5% of patients reported challenges in procuring food, utilities, medicine/healthcare, phone, clothing, or childcare when needed in the past year. Among those who paid out-of-pocket for their HS treatment, 55.6% reported that it stopped them from visiting a healthcare provider for treatment. The findings indicate a high burden and impact of HS across all races and ethnicities. Patients reported social drivers of health and challenges with healthcare utilization, indicating the need for integrating social workers and care management teams in dermatology practice, which could facilitate improved care of patients with HS. Hidradenitis suppurativa is a painful skin condition that causes lumps and abscesses. It affects people of all races and ethnicities but is more common in Black or African American individuals. This study surveyed 583 adults in the USA to understand how hidradenitis suppurativa affects people from different racial and ethnic backgrounds. Our focus was on how the disease impacts their daily lives, their ability to access healthcare, how often they visit doctors, their quality of life, and their mental and emotional well-being. Most people said that hidradenitis suppurativa lowers their quality of life and makes daily activities harder. During flaring, many used home remedies instead of seeing a doctor. People suffering from hidradenitis suppurativa also reported trouble getting basic needs such as food, medicine, and transportation. These challenges occurred among patients from different racial and ethnic groups; results for very small subgroups (Asian, Native Hawaiian/Other Pacific Islander) are reported descriptively only and should not be interpreted as representative of these groups or compared with other groups. The research underscores the importance of improving awareness and tailoring care for people with hidradenitis suppurativa, particularly those facing barriers to healthcare.
Graduate health informatics programs in the United States differ widely in cost, curriculum, and program design. However, it is unclear how these differences influence affordability, accreditation signaling, and preparation for a data-driven workforce. This study aimed to evaluate the value (tuition and affordability), structure (delivery format, credit load, culminating experience, and accreditation), and curriculum (technology content emphasis) of US graduate health informatics programs. It examined how accreditation and modality relate to program design, and whether tuition-normalized curriculum breadth differed by accreditation status. A cross-sectional study of 107 US graduate health informatics programs was conducted using publicly available data collected between January and May 2025. Tuition was standardized to cost per credit. Curricular content was coded for technology density and mapped to the Commission on Accreditation for Health Informatics and Information Management Education domains. Comparative statistics, regression models, and exploratory cluster analyses were used to assess relationships between tuition, credit requirements, accreditation, delivery format, and curriculum characteristics. Programs varied by delivery format, with 37 of 107 (34.6%) online, 32 of 107 (29.9%) hybrid, 23 of 107 (21.5%) in person, and 15 of 107 (14.0%) flexible. Credit requirements most commonly fell between 31 and 39 credits. Culminating experiences included capstone (54/107, 50.5%), internships (21/107, 19.6%), and thesis (7/107, 6.5%). Required credit hours showed modest variation by delivery format but not by accreditation status. Accreditation was not associated with differences in the tuition-normalized curriculum breadth structural proxy in this program-level analysis. Programs requiring internships had significantly higher mean credit loads than programs without internships (39.0 vs 31.3 credits; P=.005). Cluster analysis revealed 4 descriptive program configurations differentiated by cost, modality, credit requirements, and culminating experiences. In this program-level descriptive analysis, accreditation status was not associated with differences in tuition-normalized curriculum breadth structural proxy. Instead, delivery format and internship requirements were descriptively associated with variation in credit load and cost. Improving transparency in tuition models and aligning program structure with curricular scope may support efforts to enhance equity and value in graduate health informatics education.
Maternal health literacy (MHL) represents a potentially modifiable public health determinant concentrated among socioeconomically disadvantaged populations. While 15-45% of pregnant women demonstrate inadequate health literacy, its impact across the full spectrum of infant and early childhood outcomes remains inadequately characterized, limiting understanding of its broader public health significance. To systematically synthesize evidence on associations between MHL and infant/child health outcomes from birth through age three, and to examine whether MHL functions as a systemic determinant across outcome domains. Following PRISMA guidelines, we searched MEDLINE, Embase, and Web of Science from inception through March 2025. Studies examining associations between validated MHL measures and any child health outcomes up to age three were included. Methodological quality was assessed using JBI checklists, and the certainty of evidence using the GRADE framework. Narrative synthesis was conducted. Eight studies (n = 13,407 participants) from seven countries met inclusion criteria. Higher MHL was consistently associated with favorable birth weight. A pattern consistent with a behavioral pathway hypothesis emerged: outcomes requiring maternal behavioral competencies (e.g., symptom recognition, care-seeking) showed stronger and more consistent associations (e.g., reduced neonatal jaundice readmission, diaper dermatitis) than medically-determined conditions. Limited evidence also suggested MHL effects beyond the perinatal period, with inadequate MHL associated with increased risks of nutritional deficiencies and developmental delays (over four-fold increased risk in vulnerable populations). JBI assessment indicated generally adequate quality, while GRADE rated the certainty of evidence as Low to Very Low due to cross-sectional designs and imprecision. MHL shows promising systematic associations with infant outcomes across multiple domains spanning the early life course, operating primarily through behavioral pathways requiring maternal agency. This pattern supports conceptualizing MHL as a potential foundational public health determinant and equity-relevant intervention target. However, low certainty of evidence underscores the need for standardized measurement, longitudinal studies, and intervention trials to establish causality.
The pressure on publicly financed healthcare systems may necessitate decisions to not (or no longer) reimburse health technologies. Such decisions remain politically sensitive and often evoke public opposition, pressuring decision-makers to revoke or revise them. However, the elements that constitute public opposition remain unclear. This study addresses this gap by systematically reviewing the scientific literature. We searched Embase, Google Scholar, Google, and Startpage, and supplemented these with a hand search in 2021, updated in 2022 and 2024. Based on 81 articles, we developed a thematic framework of 21 categories grouped under the Five Ws-'Who, What, When, Where, and Why'-of public opposition to negative reimbursement decisions. Citizens, patients (and representatives), physicians, pharmaceutical companies, and politicians emerged as key actors. Opposition typically targets the outcomes and justifications of decisions, driven by high expectations, claims about effectiveness, or perceptions that decision-makers prioritize cost containment. Distrust in decision-makers and evidence-based decision-making may leave some actors-particularly citizens and patients-vulnerable to commercial driven information and misinformation. Other actors-including pharmaceutical companies, patient representatives, and politicians-may strategically use the media to shape opinion and amplify opposition. Public opposition is multifaceted. Understanding its dynamics may help align decision-making with public values and support efforts to address misconceptions and counter misinformation, thereby enhancing the acceptability of such decisions in healthcare.
Health researchers often struggle with challenges such as translating complex texts, interpreting nuanced information, conducting detailed statistical analyses, and more. Artificial Intelligence (AI) models, by providing easy access to information, offer a promising solution to these challenges. This study aims to examine university students' perspectives on the impact of AI models in overcoming these challenges. This survey study was conducted in 2023 by using a researcher-developed questionnaire. A total of 445 students from the Kerman University of Medical Sciences participated and completed the questionnaire. Descriptive statistics and linear regression were used to analyze the relationship between independent variables and the impact of AI models on health research. Open-ended responses were coded and stored in MAXQDA. Sixty percent of students reported moderate or greater familiarity with AI models, while only 52% had moderate or greater usage of these tools. Over 70% considered the associated risks high. Participants rated AI models most favorably for "Translation of an article" (Mean = 3.33, SD = 1.07), "Article rephrasing" (Mean = 3.33, SD = 1.07), and "Reference search" (Mean = 3.27, SD = 1.14), with the lowest ratings for "Article submissions" (Mean = 3.10, SD = 1.01), "Data analysis" (Mean = 3.23, SD = 1.01), and "Proposal submissions" (Mean = 3.23, SD = 0.91), respectively. The most important applications of AI models were noted in "Translation of research" (Mean = 3.44), "Grammer checking" (Mean = 3.46, SD = 1.12), and "Text editing" (Mean = 3.35, SD = 1.14), while the least were in "Correspondence with journal editors" (Mean = 2.99, SD = 1.20), "Adherence to journal guidelines" (Mean = 3.07, SD = 1.17), and "Response to the reviewers' comments" (Mean = 3.12, SD = 1.13). "Providing false information" (n = 34), "Failure to apply legal and ethical standards in research" (n = 10), and a "Loss of ability and creativity among researchers" (n = 9) were the most significant risks of using AI models in health research. AI models show promise for improving research efficiency and quality, but further efforts are necessary to mitigate perceived risks and encourage broader adoption.
College students are the main force of the country's future. The physical health of college students is directly related to the country's future development and progress. Overweight and obesity not only affect the appearance of college students, but also increase the risk of illness, and affect their study, life and career development. Therefore, this study aims to evaluate the current status of weight loss behavior and its influencing factors in college students, in order to provide baseline data for the development of targeted weight loss measures, and provide a basis for improving the physical and mental health of college students and long-term weight management goals. Using the convenience sampling method, 302 Chinese full-time college students from a traditional medicine university in Shandong Province were selected as the survey subjects from July to August 2025. Questionnaire surveys were conducted using the General Information Questionnaire, the Dutch Eating Behavior Questionnaire, the Chinese version of the Self-Efficacy for Exercise Scale, and the Health Status Survey Scale. SPSS 26.0 software was used to process and analyze the data. Descriptive statistics were used to analyze the general information. Logistic regression was used to analyze the influencing factors of weight loss among college students and conducted a correlation analysis. 45.0% of college students had weight loss behavior, among whom 63 were male and 73 were female. Dutch Eating Behavior, Self-Efficacy for Exercise were positively correlated with weight loss behavior of college students. Logistic regression analysis showed that there were statistically significant differences between body mass index, weight loss intention, Dutch Eating Behavior, Self-Efficacy for Exercise and weight loss behavior of college students, p < 0.05. Body mass index, weight loss intention, Dutch Eating Behavior, and Self-Efficacy for Exercise were the influencing factors of weight loss behavior among college students. Relevant departments of the school should do good job in health education for students, guide them to establish good lifestyle, improve their dietary management skills and confidence in exercise, strengthen their motivation for weight loss, enhance self-health management, and maintain healthy weight.
Reusable surgical instruments require repeated sterilization between procedures, yet many instruments prepared for surgery are never used. The national scale of the reusable surgical instrument fleet and its associated reprocessing burden remain poorly quantified. Aggregated operational data from 251 U.S. healthcare facilities encompassing 2,618 operating rooms were analyzed to quantify instrument inventories, sterilization volume, and instrument loss. National estimates were derived by scaling operating room-level metrics to reported U.S. operating room capacity. Published sterilization cost estimates and instrument utilization rates were applied to estimate national sterilization expenditures and idle reprocessing costs. Replacement costs for missing instruments were modeled using log normal price distributions and Monte Carlo simulation. The dataset included 336,784 trays and 6.7 million instruments, with 236 million instruments reprocessed annually. National extrapolation suggests a reusable instrument fleet of approximately 112 million instruments and nearly 4 billion annual reprocessing events. Estimated annual sterilization costs ranged from $1.3 to $11.8 billion. This study provides an initial estimate of the national cost of surgical instrument reprocessing in the U.S. Further work is required to determine a national estimate of the percentage of instruments that go unused. Nevertheless, the scale of expenditures on this process indicates there will be significant opportunities to improve perioperative efficiency and reduce waste through better inventory management yielding substantial cost savings and decreasing the environmental footprint of surgical care.
Dental emergencies are common during childhood and typically occur due to trauma or infection. The current evidence on managing dental injuries is from a dental perspective, with limited information on treating pediatric dental injuries in medical settings. Proper treatment of infection, correct storage, prompt repositioning, and replantation are essential for successful outcomes, as supported by the latest evidence-based guidelines. Pediatric patients have a better prognosis when proper treatment is provided without delay. Understanding potential issues enables providers to assess the severity of the condition, offer initial guidance and management, and recommend appropriate follow-up dental care. This continuing education activity aims to educate providers on how to care for children with low-acuity dental injuries and infections using an evidence-based approach.
While mobile health (mHealth) technologies can support individuals' physical activity management, they often present accessibility barriers for blind and low-vision (BLV) users. To address this gap, we developed the Personalised and Conversational Health Agent (PCHA) app for BLV users. We conducted a 7-day usability study with six BLV adults. Data were collected on physical activity indicators (daily step counts and walking distance), System Usability Scale (SUS) scores, and qualitative feedback from semi-structured exit interviews. The PCHA app achieved a mean SUS score of 77.1, with ratings ranging from "Okay" to "Excellent." Participants valued the app's streamlined interface and reminder system but expressed mixed preferences for voice versus text-based data input. The AI-based chat feature demonstrated limited engagement, with participants reporting generic responses that reduced its perceived utility. The physical activity data revealed highly variable patterns, influenced by personal and contextual factors, and technical issues such as incomplete data synchronisation. Voice interfaces offer important accessibility benefits but should complement screen reader-based interactions. Further improvements should include multi-modal interaction options, improved technical reliability, and adaptive personalisation features that account for individual circumstances and preferences. These findings provide design insights for advancing inclusive mHealth interventions to better support physical activity management among BLV individuals. This study can guide practitioners on how accessible mobile health apps can be effectively utilised in physical activity rehabilitation for blind and low-vision (BLV) individuals.By proposing assistive technology that enables BLV individuals to independently manage their physical activity using primarily voice-guided mobile applications, this work demonstrates how such technology can be incorporated into rehabilitation settings to promote independent engagement in physical activity.Findings from this development and evaluation study can serve as foundational data for future research aiming to identify efficient strategies for physical activity management among BLV individuals in rehabilitation contexts.
People with severe mental illness (SMI) experience disparities in cancer care, including delayed diagnosis, poorer symptom management, and reduced quality of life. This study aimed to explore the lived experiences of individuals with SMI who have also been diagnosed with cancer. A qualitative, grounded theory study was conducted with 11 adults in England with lived experience of both SMI and cancer. Participants were recruited via NHS and voluntary organisations. Semi-structured interviews, conducted via telephone or video call, were transcribed verbatim. Coding progressed through initial, focused, and theoretical coding alongside constant comparative methods and memoing. Stigma emerged as a main theme, derived through participant explanations of limited information sharing, restricted involvement in decision-making, and the misattribution of physical symptoms to mental illness. These perceived forms of stigma contributed to delays in cancer diagnosis, reduced opportunities for informed decision-making, and feelings of disempowerment. Collectively, they reinforced existing health inequities and negatively affected participants' mental and physical wellbeing throughout their cancer care and beyond. Structural and public stigma intersect, resulting in health-related stigma, creating barriers across cancer care pathways for people with SMI. Stigma may compromise quality care and contribute to poorer clinical and experiential outcomes in people with cancer and SMI. Interventions are needed to reduce stigmatising behaviours and beliefs in healthcare settings, to distribute power within clinical settings, and promote shared, person-centred decision-making to ensure comprehensive information provision and recognition of patient expertise. Collectively, these actions may improve early diagnosis, cancer symptom management, recovery, and overall quality of life for cancer survivors with SMI.
Social support is important in the management of breast cancer. We developed a series of structured variables or modules from electronic health record (EHR) data to form the basis for the development of EHRsupport, an EHR-based measure of social support. We built a natural language processing (NLP) algorithm from clinical notes in 7,989 women diagnosed from January 2006 to September 2021 with invasive breast cancer. Our team reviewed charts, developed a lexicon, manually crafted rules, applied the NLP algorithm to 565,258 EHR notes and 68,760 patient messages -1 to +3 months around diagnosis, combined terms into separate modules, and tuned (N = 40), updated, and tested (N = 100) these versus chart review. We further developed modules from structured data sources. We identified and developed 11 modules from unstructured data: spouse/partner status, parenthood status, (clinical) visit support, living situation (alone or with others), friend or other support, positive social support, negative (lack of) social support, deceased person, transportation issues, relationship conflict or stress, and social isolation. Module data availability ranged from 1.4% for social isolation to 92.0% for spouse/partner. Modules were accurate (0.81-0.95). The most highly available groups had moderate to excellent F1 scores (0.75-1.00), precision or positive predictive value (0.61-1.00), and recall or sensitivity (0.75-1.00). Recall and precision were more variable among rarer modules. Five percent of patients lacked an in-state emergency contact and 3% of patients had diagnostic codes for low support at any time point. The EHRsupport algorithm accurately identified social support data, supporting the development of a clinical tool that can be used to identify patients with low social support.
Hypertension increases the risk of cardiovascular diseases and is prevalent worldwide, especially in low- to middle-income countries. Globally, it is poorly controlled, especially in Sub-Saharan Africa, and patients experience several challenges in adhering to recommended interventions. The study aimed at exploring and describing the support needs expressed by patients with hypertension in an urban primary care setting in Ghana to inform the development of a psychoeducational programme to support the management of hypertension. A qualitative descriptive design was employed in this study. Face-to-face interviews were conducted using a semi-structured interview guide. Thirty-five participants were purposively sampled. Each interview lasted for 30-60 min until data saturation was achieved. Inductive content analysis was used to analyse the data. Ethics committee approval was secured for this study. Four main themes and ten sub-themes emerged from the study. The main themes: (i) health information needs from healthcare providers, (ii) lifestyle modifications, (iii) Patient self-care, and (iv) psychosocial support. Sub-themes include blood pressure monitoring and interpretation, the mechanism of medications, side effects of medications, complications of hypertension, dietary modifications, stress management, the importance of exercise, medication adherence, attending regular checkups, and emotional and psychological support. The findings identify patient-expressed needs that can guide the design of future psychoeducational interventions for hypertension management.
Diabetic retinopathy is one of the most common microvascular complications of diabetes, with over 100 million people affected worldwide. The development of mobile health applications can play an effective role in managing and monitoring diabetic retinopathy. Still, the development of these applications first requires the identification of the minimum dataset. Therefore, the purpose of this study is to identify and determine the minimum dataset as the first step in designing a self-care mobile application for patients with diabetic retinopathy. This Descriptive-Validation Study was conducted in 2025 in two phases: design and validation of the MDS. In the first phase, a comprehensive review of the research literature was conducted and electronic databases such as PubMed, Web of Science, Scopus, and Google Scholar were searched until October 2024. Then, data elements were extracted and identified. In the second phase, these elements were validated by 20 experts from the fields of endocrinology, ophthalmology, and health information management using the Delphi technique. Then, in order to include patients' opinions, a researcher-made questionnaire was administered to 20 patients with diabetic retinopathy. Fifty-five MDS elements were validated in three domains: administrative, clinical, and functional data, using two rounds of the Delphi technique. Data elements with over 75% expert approval were included in the final dataset: 13 administrative, 19 clinical, and 19 functional elements. The Ministry of Health and Medical Education, app designers, and developers can utilize the findings of this study to develop a high-quality application that addresses the educational and informational needs of patients with diabetic retinopathy.
Malaria constitutes a major public health burden in Sudan, accounting for most outpatient visits and hospital admissions across approximately 80% of the states. The armed conflict beginning in April 2023 severely disrupted an already fragile health system, affecting the surveillance system infrastructure. No prior studies have assessed the impact of conflict on routine malaria surveillance data reported through District Health Information Software 2 (DHIS2). This study evaluated the effects of conflict on completeness and reporting of malaria impact indicators data across Sudanese states. A mixed-methods design combined quantitative analysis of quarterly DHIS2 data (January 2020-March 2025) from 17 states with qualitative exploration of surveillance system functionality. Quantitative analysis included descriptive analyses and interrupted time series analysis (ITSA) of three malaria impact indicators: quarterly reported malaria cases (presumed and confirmed) per 100,000 state population, test positivity rate (RDT + microscopy), and quarterly inpatient malaria deaths per 100,000 state population. Data completeness was quantified as the proportion of missing quarterly reports per state. Descriptive analysis graphs illustrate pre- and post-conflict trends and missing data patterns. ITSA was conducted for 11 states with complete post-conflict time series; six states with incomplete data were excluded. Three key informant interviews with national- and state-level malaria programme managers, selected from severe and less severe conflict-affected states, provided contextual insights. Qualitative data were analyzed using a deductive framework approach. Missing DHIS2 reporting increased substantially after April 2023. Inter-state variation was observed: western and southern states (except North Kordofan) experienced persistent data gaps, whereas northern and eastern states maintained relatively continuous reporting despite declining trends. Qualitative findings indicated stronger surveillance functionality in less-affected states by conflict. ITSA showed a statistically significant decline in quarterly reported malaria case rates per 100,000 state population at conflict quarter (p = 0.02), with no significant post-conflict trend change. Key informants identified health facility destruction, workforce shortages, unpaid salaries, and communication breakdowns as major barriers. The conflict coincided with widening disparities in malaria surveillance across states, reflecting underlying inequalities in health system capacity. Strengthening states' surveillance systems is critical in conflict-affected settings. Future research should examine locality-level impacts to better capture subnational variation.
Athlete burnout significantly affects both athlete well-being and performance, potentially influenced by dietary patterns, sleep quality, screen time, and stress-coping strategies. However, the mechanistic interplay among these factors remains unclear. This study utilized a cross-sectional design to examine the relationships between daily health behaviors (including diet, sleep, and screen time), stress coping strategies, perceived psychological strain and athlete burnout among Chinese competitive swimmers. A comprehensive questionnaire was developed, encompassing demographic information, eating behavior (BEDA), sleeping behavior (ASSQ), screen time, stress coping strategies (CSCA), perceived psychological strain (APSQ), and athlete burnout (ABQ). This questionnaire was administered online and distributed to participating athletes through a snowball sampling method during the 2024 Shanghai Youth Swimming Competition to enhance the sample size. Data from 1,071 swimmers (477 females, 44.5%) revealed through Lasso regression analysis that perceived psychological strain emerged as the strongest predictor of athlete burnout (β = 5.07), followed by age (β = 2.19) and athlete level (β = 3.76). Sleep disturbances (ASSQ) demonstrated a weaker yet significant contribution to ABQ (β = 0.92). A temporal inflection point in age-related burnout trajectories was identified at 19 years. This study identified psychological strain (APSQ) as the strongest predictor of burnout (ABQ) among Chinese swimmers (β = 5.07), underscoring the critical need for strain-specific management in prevention strategies. The significant effects of advancing age (β = 2.19) and increased training load (β = 3.76) further revealed the developmental nature of burnout across career stages, necessitating age-targeted interventions. Although sleep disorders (ASSQ) had a weaker influence (β = 0.92), their significant role supports the integration of sleep quality enhancement into a holistic strain-sleep intervention framework. These findings provide a novel pathway for athlete mental health management through prioritized strain regulation, hierarchical age-specific interventions, and synergistic sleep-stress protocols.
Sepsis, the body's life-threatening response to infection, is associated with significant morbidity and mortality. In 2017, the World Health Assembly passed a resolution urging member states to recognize sepsis as a public health priority. Our objective was to identify and describe sepsis policies, guidelines, and health professional training standards in Canada. We conducted a scoping review and an environmental scan, including systematic searches of published and grey literature. Policies, guidelines, or training standards related to identifying, managing, or reporting sepsis, published since 2010 and available in English/French, were included. We extracted data on the organization(s) involved in the development, information on the source, including the target patient population, measures of inclusive engagement, and whether the source considered at-risk, equity-denied, and/or Indigenous communities. We identified 32 sources of evidence, including sepsis policies or guidelines for 38% (5/13) of provinces and territories, the inclusion of sepsis as a training competency in 16% (11/67) of the Royal College of Canada medical specialties/subspecialties competency standards, and two Canadian Hospital Accreditation Standards. Only 6% (2/32) of the sources considered the role of social determinants of health, and 13% (4/32) engaged individuals with lived sepsis experience or members of the public. We identified existing sepsis policies, guidelines, and standards that reveal significant gaps across provinces and territories, particularly the lack of attention to social determinants of health and the exclusion of individuals with lived experience. Coordinated national policy efforts are urgently needed to reduce the burden of sepsis in Canada.