搜索结果：Health services & outcomes research methodology

Migrants comprise over 17% of Norway's population and are at increased risk of limited health literacy, a key determinant of health. Health literacy is shaped by language, culture, social norms, discrimination, and health system responsiveness. Inflammatory rheumatic diseases are complex, chronic conditions requiring long-term, specialised care. Patients with these diseases and a migrant background, particularly those with limited proficiency in the dominant language, face additional barriers and poorer outcomes, yet their health literacy experiences remain underexplored. This study explored the experiences of patients with inflammatory rheumatic diseases, a migrant background, and limited language proficiency in accessing, understanding, appraising, and using health information and rheumatology services in Norway. Nineteen semi-structured, in-depth interviews were conducted with patients with a migrant background, and who used interpreters during consultations with health professionals. Participants were recruited from rheumatology departments at two Norwegian hospitals. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Two patient research partners were involved throughout the study. Three main themes were generated. First, barriers to accessing and using health information and services were shaped by the interplay between language proficiency, digital literacy, and social support, which often compensated for system gaps. Health systems implicitly assumed a minimum level of linguistic and digital competence, creating mismatches between system demands and patients' abilities. Second, trust was foundational, shaping engagement and acceptance of treatment. Trust developed over time; length of residency did not necessarily equate to confidence in using services, and trust in health professionals often preceded trust in the wider system. Third, employment was an important factor shaping health literacy and disease management: while colleagues supported service navigation, physically demanding and precariat working conditions constrained access to care and self-management. Managing these conditions among migrants with limited language proficiency is shaped by interrelated individual, relational, and structural factors. Health literacy is co-constructed through social networks, trust, and contexts such as employment, while system assumptions about language and digital competence create fragmented access. Interventions should move beyond communication barriers to foster trust, support shared understanding, and address broader social and structural conditions influencing engagement with health services.

Climate change increasingly threatens public health in West Africa, with pregnant women and young children particularly vulnerable. Despite Nigeria's high exposure to climate risks, epidemiological evidence linking temperature and rainfall to maternal and child health remains limited. This study addresses this gap using nationally representative data. We analysed data from the 2024 Nigeria Demographic and Health Survey, including 27,783 mother-child pairs. Climate exposures, i.e., daytime land surface temperature (&#xb0;C) and annual rainfall (mm), were derived from the 2020 Nigeria Geospatial Covariates dataset and linked to 2024 DHS cluster geolocations. Child health outcomes included stunting, wasting, underweight, and fever. Maternal outcomes included anaemia, postpartum distress, and a composite healthcare access index. Multilevel mixed-effects regression models with survey weights were applied. Higher temperatures were associated with increased odds of stunting (aOR 1.12, 95% CI 1.04-1.22), wasting (aOR 1.15, 95% CI 1.02-1.29), underweight (aOR 1.12, 95% CI 1.04-1.21), and fever (aOR 1.08, 95% CI 1.01-1.16) in children. Among mothers, higher temperatures were linked to greater postpartum distress (&#x3b2;&#x202f;=&#x202f;0.03, p&#x202f;<&#x202f;0.05) and reduced healthcare access (&#x3b2;&#x202f;=&#x202f;-0.07, p&#x202f;<&#x202f;0.01), but not anaemia. A negative interaction between temperature and rainfall suggested attenuation of heat effects on underweight and healthcare access in wetter areas. Poverty and low maternal education amplified risks. Higher temperatures are associated with poorer maternal and child health outcomes in Nigeria, particularly among socioeconomically disadvantaged groups. Integrating climate adaptation into maternal and child health programmes is essential, especially in high-risk regions.

While Canada has established a robust settlement program, significant limitations remain in developing coordinated, integrated, responsive, and sustainable service pathway systems. Contributing challenges include limited awareness and underutilization of pre-arrival and settlement services, as well as a predominant focus on short-term "basic" resettlement needs rather than on long-term mental health and primary service supports. Using a community-based participatory research and mixed-methods research design, we co-designed a concept-to-practice Service Pathways Model comprising four core components: (1) a centralized referral database, (2) a systems navigator role, (3) mobilization of pre-arrival services, and (4) integrated social and health post-arrival services. The proposed model has the potential to: (i) strengthen referral loops, (ii) reduce service fragmentation, (iii) enhance coordination and integration across systems, and (iv) promote positive mental health, resilience, and settlement outcomes among newcomers in the Region of Peel (Canada) and similar contexts experiencing significant newcomer influxes. Further refinement and pilot testing of the model is recommended to assess its implementation feasibility, effectiveness, and underlying theory of change. Such findings will inform how coordinated service pathways can strengthen the responsiveness and sustainability of Canada's settlement system and improve outcomes for immigrant and refugee families.

Population ageing challenges the sustainability of universal health coverage (UHC), underscoring the need to transform primary health care (PHC). PHC adopts a whole-of-society approach to equitably address health needs across the care continuum in people's everyday environments. Public policy is central to this transformation, aligning public health and primary care (PC) through governance, leadership, multisectoral collaboration, information systems, and sustainable financing. However, PHC research has mainly focused on clinical services, with little attention to policy analysis. This study examined the evolution of PHC policies in Singapore over the past four decades using the World Health Organization's Operational Framework for PHC and identified equity-oriented policy strategies relevant to other ageing societies. Significant progress was made in the pillar of integrated health service delivery, whereas the pillars of empowerment of people and communities and multisectoral policy and action remain works in progress. The government plays a central role in policy development, resource stewardship, and budgetary commitments, accelerating reforms over the past decade. The recent policy shift towards place-based care is important for addressing the wider social determinants of health. To advance health equity, two key issues must be addressed: (1) the 'multisectoral policy and action' pillar, by strengthening local governance frameworks to coordinate the increasing involvement of multiple policy actors in PHC implementation and aligning financial models across sectors, and (2) the 'empowered people and communities' pillar, by embedding community participatory and asset-based approaches. As many countries face the dual challenges of an ageing population and rising healthcare costs, there is an urgent need to better integrate health service delivery. This policy analysis highlights the importance of developing strategies that support multisectoral collaboration and empower communities. Focusing on these three pillars is critical for achieving equitable health outcomes.

There is a high prevalence of undiagnosed and untreated hearing loss among older adults. Due to finite resources, task shifting to trained non-specialists is a strategy to improve equity of access to hearing health care. This pilot study aims to implement and evaluate a novel model of hearing care known as the SOUND-BITES program. This will leverage evidence-based mobile health technologies (Arclight otoscopy and Sound Scouts hearing screening app) and partnerships with Meals on Wheels New South Wales and Master of Clinical Audiology students. SOUND-BITES provides a hearing health assessment involving otoscopy using Arclight, hearing screening using the Sound Scouts tablet-based app, and hearing health education to consenting Meals on Wheels clients and their household members. Volunteers from Meals on Wheels and audiology students will be trained to deliver the screening, education and referral components of this program. This pilot study utilises a mixed-methods approach to evaluation. The primary outcomes are program acceptability and feasibility; and secondary outcomes are actions taken by clients to address hearing loss, changes in hearing handicap and cost-benefits six months after program completion. Quantitative data will be collected from a pre- and post-program survey, and qualitative data from an optional post-program interview with clients and volunteers. Findings from the project will be disseminated through peer-reviewed journals and conferences as well as to relevant communities including the Meals on Wheels network.

Early childhood obesity has become a major public health concern globally. The preschool period (ages 4-6 years) represents a critical window for obesity prevention due to its long-term implications on growth trajectories and behaviour formation. However, existing evidence for effective interventions targeting this age group remains limited and inconsistent, particularly in low- and middle-income countries. The Peking University-Smart Monitoring and Responsive Technology for Early Childhood Health is a cluster-randomised controlled trial designed to evaluate the effectiveness and sustainability of a multi-component, digital health-assisted obesity prevention intervention. The trial involves approximately 980 children aged 4-6 years (middle and senior kindergarten classes) from 14 kindergartens, randomly allocated to either the intervention (n=7) or control (n=7) groups. The intervention spans 9 months, followed by a 12-month post-intervention follow-up. Interventions are delivered across kindergartens, families and healthcare systems. A digital Smart Health Platform is integrated into the intervention to provide health education, real-time feedback and interactive support, enabling personalised health management and promoting parental engagement. Data are collected at baseline, 4, 9 and 21 months. The primary outcome is the between-group difference in changes in body mass index Z-score at 9 months. Secondary outcomes include other anthropometric indicators, dietary intake, physical activity levels and other measurements. In addition, a process evaluation will be conducted to assess fidelity and participant engagement, and a health economic evaluation will estimate cost-effectiveness and cost-benefit outcomes. Ethical approval for this study was obtained from the Ethics Committee of the Shandong Maternal and Child Health Hospital (no. 2025-042). Findings from the trial will be disseminated through peer-reviewed publications and conference presentations to inform future childhood obesity prevention policies and practices. NCT07117149.

Community health workers (CHWs) play a critical role in addressing social determinants of health and bridging gaps between communities and healthcare systems, yet limited research has examined how CHWs perceive their roles, integration within healthcare systems, and implementation challenges within specific state-level contexts. We conducted a sequential mixed-methods study consisting of an anonymous statewide online survey of CHWs in Wisconsin followed by two virtual focus group discussions. Survey data were analyzed descriptively. Focus group transcripts were analyzed using team-based inductive thematic analysis. Forty CHWs completed the survey, most of whom were female (98%) and worked in community-based or nonprofit settings. Participants commonly provided advocacy, health education, referrals to services, and navigation of social needs, with focus on chronic disease, mental and behavioral health. Although 84% rated their impact on patient outcomes as high to very high, 74% reported low to neutral levels of professional recognition. Major challenges included lack of funding, limited professional recognition, and inadequate resources. Five qualitative themes emerged: multifaceted CHW roles, bridging healthcare systems and communities, persistent structural barriers, navigating professional identity and recognition, and sustaining commitment amid limited institutional support. Despite high perceived impact, CHWs in Wisconsin experience limited recognition, funding instability, and inconsistent integration into healthcare systems. Addressing these barriers through professional pathways and sustainable financing mechanisms is essential to strengthening CHW workforce integration and long-term system impact.

Routinely-collected data are increasingly used to study outcomes among marginalised communities, including people who use drugs, because they capture groups often under-represented in traditional research. However, little is known about how this population feels about researchers using their data, particularly given the stigma they frequently encounter. This public involvement and engagement study explored the views of people who use(d) drugs on the use of their routinely-collected data in research, with the aim of informing future work in this field. Participants were recruited through a recovery organisation in Southeast Scotland, UK. Two deliberative focus groups were conducted (n=11 and n=12). Each session began with a short introduction to routinely-collected data and its research uses, followed by discussion guided by a topic schedule and a creative participatory activity. Thematic analysis was carried out using NVivo v15. Five overarching themes were identified. Participants expressed very low awareness that their data were being used in research and highlighted the need for clearer and more accessible transparency about data processes. Concerns about consent and personal control were common, with many wanting greater involvement or choice in how their information is used. Participants strongly supported data use when it served a clear and meaningful public benefit and when researchers were held accountable for how findings were used. Discussions also reflected worries about the accuracy, completeness, and fairness of the data held about them, particularly where misunderstandings or assumptions might be recorded. Underpinning all themes was a pervasive sense of fear and mistrust toward services that collect data, which participants felt could limit honest disclosure and ultimately affect data quality. People who use drugs were broadly supportive of their routinely-collected data being used in research with clear social value and transparency. However, pervasive mistrust of data-collecting services may affect data quality and should be carefully considered by researchers.

Leptospirosis is a neglected bacterial zoonotic disease of global health importance, disproportionately affecting marginalised communities in tropical and subtropical settings. Current clinical trial evidence for leptospirosis treatments remains limited by heterogeneous outcome reporting and trial design. This systematic review represents the first comprehensive synthesis of outcomes, outcome measures, and treatments reported across human leptospirosis research to inform the development of a core outcome and outcome measurement set. This systematic review was registered (COMET and PROSPERO: CRD42023397461) and conducted in accordance with a pre-published protocol. Global databases were searched for studies published on human leptospirosis without language or geographical restriction. Screening and full-text review were performed independently by two reviewers. Study characteristics, population, interventions, and reported outcomes, definitions and measurement tools were extracted. Quality and risk of bias assessments were performed. Outcomes were analysed descriptively and grouped thematically into domains. This review included 298 studies from 63 countries. There were 172 unique outcome types extracted and categorized into 23 domains. The clinical/physiological core area was the most frequently reported, with the renal and urinary domain comprising a quarter of all studies. Individual outcomes that predominated included mortality (165/298 studies), discharge from clinical services (79/298), and days of hospitalisation (77/298). Patient focused and harms outcomes were under-reported across studies. Quality assessments highlighted considerable study bias which did not improve with increasing study rigour. There were 92 outcome measures extracted and categorized into 13 thematic areas and of note was the inconsistency in types of measures, absence of patient-reported outcomes, and need for standardised and validated outcome definitions. Data captured on treatments highlighted the variability in clinical management practices worldwide. This review highlights the heterogeneity in outcome reporting, outcome measures, and treatments across human leptospirosis research. Establishing a consensus on core outcomes and core outcome measurements that are clinically relevant, patient-centred, and robust is needed to better support evidence-based guidelines.

Pregnant women living with HIV are at increased risk of depression, anxiety, stigma, gender-based violence, and poor engagement in prevention of mother-to-child transmission services. Psychosocial interventions are increasingly used to complement routine maternal and HIV care, yet evidence remains fragmented across intervention types, settings, and outcomes. This scoping review aimed to map psychosocial interventions designed to improve mental health and well-being among pregnant women living with HIV. This scoping review followed the Arksey and O'Malley framework, refined by Levac et al, and was reported according to the PRISMA-ScR guideline. PubMed, Scopus, and CINAHL were searched for English-language experimental and quasi-experimental studies published from January 2010 to March 2025. Eligible studies focused on non-pharmacological psychosocial interventions for pregnant or perinatal women living with HIV. Data were extracted using a standardized form and synthesized narratively. Fourteen studies met the inclusion criteria. Interventions included problem-solving therapy, cognitive-behavioral approaches, peer-mentor and structured support groups, empowerment-based interventions for gender-based violence, community-based counseling, and integrated maternal mental health-parenting programs. Many interventions used task-shifting, peer or lay providers, culturally adapted content, and delivery through clinics, home visits, groups, telephone support, or hybrid formats. Reported benefits included reduced depressive symptoms, improved coping, self-efficacy, disclosure, social support, ART retention, viral suppression, and selected infant growth outcomes. However, findings varied across studies, and some benefits declined over longer follow-up. Psychosocial interventions show promise for improving mental health, well-being, and HIV care engagement among pregnant women living with HIV. The evidence supports integrating culturally adapted psychosocial support into antenatal and PMTCT services, particularly alongside mental health screening during routine maternal care. Future studies should use stronger designs, longer follow-up, implementation evaluation, and context-sensitive approaches involving partners and families where safe and appropriate.

Climate change is intensifying extreme weather events and altering environmental conditions in ways that increasingly strain health systems. Prehospital emergency medical services (EMS), as the frontline interface between communities and acute care, are uniquely vulnerable to these pressures. Rising call volumes, infrastructure disruption, occupational heat and smoke exposure and service delays have been reported, yet the evidence remains fragmented across disciplines and regions. This scoping review aims to systematically map the global literature on climate-related hazards and their impacts on EMS operations, workforce health, patient outcomes and system adaptation. This scoping review follows Joanna Briggs Institute methodology and will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for Scoping Reviews (PRISMA-ScR). Searches will be conducted in PubMed/MEDLINE, Web of Science, Scopus, CINAHL and Embase together with grey literature sources for English-language studies published from 2000 onwards. Using the Population-Concept-Context framework, studies on climate-related hazards affecting prehospital EMS operations, workforce health, patient outcomes or system adaptation will be included. Non-EMS studies, studies unrelated to climate-related hazards and non-primary reports will be excluded. Two reviewers will independently screen and chart the data. Findings will be summarised descriptively and thematically and presented in an evidence map. As this study uses publicly available data, ethical approval is not required. Findings will be disseminated through peer-reviewed publication, conference presentations and policy-oriented outputs targeting EMS leaders and public health stakeholders.

Smoking rates are up to four times higher among people experiencing homelessness compared to the housed population and how to support them to quit is unclear. To test the effectiveness and cost-effectiveness of providing e-cigarettes to people accessing homeless support services to stop smoking. To explore implementation fidelity, contextual influences and mechanisms of change. A two-arm cluster randomised controlled trial with cost-effectiveness and mixed-methods process evaluation. Setting and participants: Thirty-two homeless centres (clusters) across Great Britain. Participants were aged 18+ years and known by centre staff to smoke. Sixteen staff and 31 participants in electronic cigarette centres completed qualitative interviews. Clusters were randomised (1&#x2005;:&#x2005;1) to electronic cigarettes or usual care prior to staff training. Electronic cigarette participants received a refillable electronic cigarette, 4 weeks' supply of e-liquid and a fact sheet. Usual care participants received very brief advice on smoking, a support leaflet and signposting to Stop Smoking Service. Primary outcome: Carbon-monoxide-verified sustained smoking abstinence from 2 weeks post baseline to 24 weeks. Secondary outcomes: Carbon-monoxide-verified 7-day point prevalence abstinence, <&#x2005;50% smoking reduction, intervention costs, quality-adjusted life-years, implementation fidelity and mechanisms of change. Sixteen centres were randomised to electronic cigarettes (n&#x2005;=&#x2005;239 participants) and 16 to usual care (n&#x2005;=&#x2005;238 participants). In usual care, one participant died, and one withdrew consent. Final sample analysed: n&#x2005;=&#x2005;239 (electronic cigarette); n&#x2005;=&#x2005;236 (usual care). Sustained 24-week carbon-monoxide-verified smoking cessation rates were 5/239 (2.1%) with electronic cigarettes versus 2/236 (0.8%) with usual care (adjusted risk ratio 2.43, 95% confidence interval 0.51 to 11.64); 7-day point prevalence abstinence at 24 weeks was 15/239 (6.3%) with electronic cigarettes versus 5/236 (2.1%) with usual care (adjusted risk ratio 2.95, 95% confidence interval 1.05 to 8.29). Smoking reduction (<&#x2005;50%) at 24 weeks was 83/239 (34.7%) with electronic cigarettes versus 40/236 (17%) with usual care (adjusted risk ratio 2.02, 95% confidence interval 1.44 to 2.84). Four adverse events were reported in the electronic cigarette arm; three electronic cigarette-related and not serious; one serious and not electronic cigarette-related. Mean per participant intervention costs were &#xa3;92 (standard error &#xa3;0) for electronic cigarettes and &#xa3;50 (standard error &#xa3;0) for usual care. Mean total costs were &#xa3;3859 (standard error &#xa3;441) versus &#xa3;2716 (standard error &#xa3;386) in electronic cigarette and usual care groups, respectively. Quality-adjusted life-years were estimated at 0.303 (standard error 0.008) for electronic cigarettes and 0.295 (standard error 0.010) for usual care. From National Health Service and Personal Social Services perspective, the electronic cigarette arm was &#xa3;1267 (95% confidence interval &#xa3;219 to &#xa3;2347) more costly and yielded 0.007 (95% confidence interval -0.016 to 0.033) more quality-adjusted life-years than usual care. The incremental cost-effectiveness ratio was &#xa3;181,000 per quality-adjusted life-year gain. Electronic cigarette intervention was delivered with high fidelity with no variation by centre size or location, although staff capacity and resourcing were barriers to implementation. Quit enablers included high capability to use electronic cigarettes, support from friends/family and increased motivation following smoking reduction. Barriers included lack of satisfaction with electronic cigarettes compared with smoking, a strong smoking culture at centres and staff deprioritising tobacco-related harm. Low quit rates resulted in insufficient power to detect an effect on the primary effectiveness and cost-effectiveness outcomes, leading to uncertainty. Electronic cigarettes showed no effectiveness for 24 weeks' sustained smoking abstinence; 7-day point prevalence abstinence and smoking reduction were possible, and staff can support the intervention. Longer-term and potentially different types of support and systems change are needed to support sustained abstinence. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR132158. Smoking is very common among people experiencing homelessness, but many want to quit. The best way to help them stop smoking is unclear. Electronic cigarettes are a popular quitting aid, but we do not know how well they work for this group. This study tested whether giving electronic cigarette kits to people using homeless centres could help them quit. The study took place in 32 homelessness centres across Great Britain. Staff were trained to support the study and provide stop-smoking help. In 16 centres, people received an electronic cigarette kit and e-liquid (electronic cigarette group). In the other 16, they were given brief advice on quitting and signposted to support (usual care group). We recruited 477 participants and collected information on their smoking and health at the start, then after 1, 3 and 6 months. Long-term (6 months) quit rates were low in both groups but were slightly higher in the electronic cigarette group. Short-term quitting was 6.3% with electronic cigarette versus 2.1% in usual care, and smoking reduction was 34.7% with electronic cigarette versus 17% in usual care. However, because few people quit overall, and considering healthcare and electronic cigarette costs, electronic cigarette was not good value for money. To find out about people&#x2019;s experiences of the study in-depth, we also spoke to 16 staff and 31 participants. Staff said the training helped them to support electronic cigarette use, but there were challenges. Participants said they could use the electronic cigarette but did not always find it satisfying. Some felt more could be done in centres. Motivation and confidence in quitting varied but improved when smoking was reduced. We have shared our findings with homelessness centres and participants. While electronic cigarette did not lead to long-term quitting, it helped people cut down and stop for short periods. More research into different approaches is needed to find better ways to support people experiencing homelessness to quit smoking for good.

Problem-solving is essential for the self-management of type 2 diabetes but remains challenging for underserved individuals. Although mobile health (mHealth) interventions can improve diabetes self-management, few focus on problem-solving. This study evaluates the efficacy of Mobile Diabetes Detective (MoDD), a fully automated web-based intervention with SMS text messaging that provides problem-solving support tailored to self-monitoring data, for improving glycemic control among medically underserved adults with type 2 diabetes. This open-label, 1:1 cluster-randomized controlled trial was conducted in 2013-2018. Participants were adults with type 2 diabetes (glycated hemoglobin [HbA1c] >7.5%) receiving care at 8 Federally Qualified Health Centers serving medically underserved communities in the New York metropolitan area. The centers served as clusters and were randomized using computer-generated allocation. Recruitment and study sessions were conducted either in person or in a hybrid format. The intervention arm used MoDD for 12 months, whereas the control arm received standard diabetes education and routine care. The primary outcome was the change in HbA1c from baseline to 12 months, recorded from medical chart data. We hypothesized greater improvement in the intervention arm than in the control arm. Secondary outcomes included psychosocial measures. Outcomes were compared between groups using intention-to-treat analyses. This report presents the final analysis of the outcomes. This trial randomized 248 participants (intervention arm: n=126; control arm: n=122); 219 were included in the final analysis (intervention arm: n=111; control arm: n=108). Participants were predominantly female (147/219, 67.1%) and ethnically and racially diverse (112/219, 51.1%, Hispanic and 92/219, 42%, African American), with a mean baseline HbA1c of 9.9%. Overall, of the 111 participants, 44 (39.6%) engaged with MoDD at least once weekly in the first 30 days, and 22 (19.8%) engaged at least once weekly in the first 90 days. HbA1c did not differ significantly between groups at baseline (intervention: 9.81%, 95% CI 9.42%-10.20%; control: 9.95%, 95% CI 9.55%-10.34%; difference=0.14%, P=.63) or at 12 months (intervention: 9.36%, 95% CI 8.95%-9.78%; control: 9.58%, 95% CI 9.15%-10.01%; difference=-0.22%, P=.47). Both groups demonstrated reductions in HbA1c from baseline to 3 months. Sustained within-group improvement at 12 months was observed in the intervention group but not in the control group. No intervention-related adverse events were reported. This study evaluated the impact of a mobile intervention for problem-solving in diabetes. MoDD is innovative because it operates autonomously and tailors support to individuals' self-monitoring data. Although there was no significant between-group difference in HbA1c, the intervention group showed sustained within-group improvement at 12 months. These findings highlight the potential long-term benefits of autonomous mHealth interventions for problem-solving. The study observed an increase in diabetes distress, possibly reflecting heightened awareness of uncontrolled blood glucose levels. If implemented in clinical practice, MoDD could complement diabetes education and help improve glycemic control. ClinicalTrials.gov NCT02021591; https://clinicaltrials.gov/ct2/show/NCT02021591.

To explore care recipients (patients' and their caregivers) and care providers (healthcare providers' and law enforcement officers') perspectives on paediatric mental health presentations to emergency departments, to identify challenges to care. Secondary qualitative analysis of free-text responses from a Delphi study conducted within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network in 2022. The original Delphi process aimed to identify research themes and key data points for child and adolescent mental health ED presentations; however, a large number of additional free-text responses were received. The primary aim of this specific study was to identify major categories using the General Inductive Approach (GIA) of these free-text responses to explore the experiences, service delivery and perceived challenges of care recipients and care providers. Patients were recruited from 12 EDs across three Australian states, and pre-hospital services (two police and three ambulance departments) across four Australian states. A total of 184 participants provided responses (36 care recipients and 148 care providers). Three main categories are described: (1) care continuity and communication gaps, (2) challenges in the ED environment and (3) need for improved training and education and behavioural support. Care recipients and care providers identified challenges in service coordination, clinician readiness and the ED environment. Strengthening communication, expanding training, reducing sensory overload and improving privacy in physical EDs and improving links to community care could enhance patient experiences and outcomes.

Antenatal care (ANC) provides an opportunity to prevent or minimise adverse pregnancy outcomes and enhance women's health by providing essential interventions including malaria prevention measures. In Papua New Guinea (PNG), three quarters of women commence ANC after the first trimester of pregnancy and one in five women receive no ANC. The present qualitative study aimed to explore determinants of ANC utilisation in the context of a clinical trial of intermittent preventative treatment of malaria in pregnancy in PNG. A cross-sectional qualitative study was conducted at four health facilities in Madang Province, PNG, between 17 April and 6 September 2023. Data were collected through individual in-depth interviews, focus group discussions (FGDs) and observations of ANC proceedings at clinics. Study participants included 79 pregnant and 5 postpartum women, 15 healthcare providers, and 13 representatives of district, provincial and national health authorities involved with the programming of ANC. In-depth interviews and FGDs were audio-recorded and transcribed. Transcript data were coded using deductive and inductive approaches. Emerging themes from interviews and FGDs were triangulated with data from field notes and observations. We identified four main themes in relation to ANC utilisation: accessibility of ANC; attitudes towards ANC; interpersonal factors; and timing of ANC. Accessibility of ANC services related to costs associated with ANC, healthcare service delivery challenges, proximity to clinics, and rigid clinic schedules. Attitudes toward ANC, including the perceived benefits and disadvantages, knowledge of ANC interventions and access to education, influenced utilisation. In terms of interpersonal factors, positive relationships and communication between women and healthcare providers, and community or family members participation, were enablers of ANC engagement, while negative healthcare provider attitudes and fear of pregnancy disclosure were identified as potential barriers. Timing of ANC contacts were influenced by personal choice, a desire to avoid many clinic visits, community attitudes, prior pregnancy experiences, distance to health facilities, anticipated travel and clinic costs, attitudes of community members around ANC timing and lack of awareness of pregnancy or gestational age. Most women considered ANC important and recognised the need for ANC to ensure safe pregnancy and delivery. Healthcare benefits of ANC were perceived as an important part of ensuring a safe pregnancy and delivery outcome. ANC initiation and utilisation were enhanced through clinic fee remission, ANC content, and community engagement provided in the context of a clinical trial. These findings highlight opportunities for strategic programmatic investments that could lead to improved ANC utilisation in Madang Province.

Video recordings of patient-clinician interactions (PCIs) have become an integral tool in health professions education, with authentic opportunities to enhance clinical communication and decision-making skills. Despite their educational value, ethical and logistical challenges regarding their use remain underexplored. This scoping review aims to map the use of video-recorded PCIs in health education, categorizing types and educational purposes, examining applications across disciplines, and identifying ethical and logistical issues. Comprehensive searches were conducted in MEDLINE, Embase, and ERIC (Education Resources Information Center) databases, supplemented by gray literature, with the last search performed on October 30, 2024. Two independent reviewers screened and extracted data on study design, intervention characteristics, educational objectives, and barriers to implementation. Given the scoping review nature, risk of bias assessment was not conducted. Data synthesis involved descriptive analysis and thematic categorization of findings. A total of 69 studies met inclusion criteria, predominantly from medical (n=28, 41%), dental (n=15, 22%), and nursing (n=8, 12%) education. Publication frequency increased over the past decade. Studies used varied video types, including authentic consultations, simulated encounters, and procedural recordings. Main educational aims focused on clinical skills, communication, professionalism, and reflective practice. Ethical reporting was inconsistent, with variable adherence to informed consent, patient privacy, and confidentiality standards. Common logistical barriers included limitations in technical infrastructure, data management, and curriculum integration. Video-recorded PCIs offer valuable educational resources but face challenges in ethical standardization and logistical feasibility. Future research should prioritize the development of ethical frameworks and standardized protocols, together with the evaluation of long-term educational and psychological outcomes, to support the responsible and scalable integration of PCI recordings into health education curricula.

To compare decompression alone with decompression with fusion in patients with degenerative lumbar spondylolisthesis. PubMed, Google Scholar, Ovid, and Web of Science databases were searched up to March 2025 for randomized controlled trials (RCTs). The primary outcomes were the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. The secondary outcomes included operative time, length of hospital stay, intraoperative blood loss, reoperation, complications, and cost. Pooled analysis was performed using a random-effects model in Review Manager following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The quality of included randomized trials was evaluated using the Cochrane risk-of-bias tool. Of the 4,507 studies, 5 RCTs (n = 898) were included. Both interventions improved ODI and VAS scores, with no significant differences for ODI (mean difference [MD], -3.21; 95% confidence interval [CI], -6.59 to 0.17, p = 0.06) or VAS leg pain (MD, -1.67; 95% CI, -8.85 to 5.51, p = 0.65). Decompression showed greater improvement in VAS back pain (MD, -7.48; 95% CI, -14.23 to -0.73, p = 0.03). Perioperative outcomes favored decompression, with a shorter operative time (95 min), shorter hospital stay (1.7 days), and lower blood loss (322 mL). Complications were more frequent with fusion, whereas reoperation rates did not differ. One study reported lower decompression costs (5,400 versus 12,200 USD). Both interventions significantly improved pain and disability. Decompression alone was associated with a lower perioperative morbidity and some evidence of greater back pain relief, supporting its role as a reasonable initial surgical option, with fusion reserved for patients requiring stabilization.

To evaluate the feasibility, acceptability, and fidelity of a clinician training and subsequent home-based, parent-led powered mobility (PM) intervention for young children with cerebral palsy (CP; Gross Motor Function Classification System Levels IV-V) in early childhood settings. This single-arm, mixed-methods feasibility trial will take place in partnership with two early childhood programs in Oregon. Phase 1 consists of a needs assessment to identify current practices and determinants of PM implementation, and Phase 2 engages with a Community Advisory Board to co-design the clinician training and implementation strategies. In Phase 3, up to 55 clinicians will participate in training focused on integrating PM into routine care, applying caregiver coaching practices, and using implementation strategies. These clinicians will then coach caregivers to deliver a 12-week, home-based PM intervention using the Explorer Mini with up to 12 children aged 12-32&#x2009;months. Outcomes include feasibility (recruitment, retention, acceptability, and appropriateness), implementation fidelity (adherence, dosage, quality, participant responsiveness, and program differentiation), and preliminary caregiver and child outcomes. Quantitative and qualitative data will be analysed descriptively and thematically to inform refinement of future implementation strategies. This study will advance understanding of how PM interventions can be implemented in early childhood systems, through needs assessment, co-design, and feasibility testing. Findings will inform scalable models for clinician training and caregiver coaching, supporting ON Time access to mobility for young children with significant motor impairments. Improving access to powered mobility in early childhood settings requires intentional system-level support to enable integration of evidence-based interventions within routine services.Identifying supports that enable clinicians and caregivers to collaboratively deliver powered mobility within everyday routines is essential for informing feasible and acceptable implementation approaches.Community-engaged partnerships with clinicians and caregivers are critical for designing powered mobility interventions that align with early childhood practice contexts and can be sustained over time.

To assess whether health literacy (HL) changes over time are associated with transition readiness among young people with spinal dysraphism (SD), given that coordinating transition from pediatric to adult care for individuals with SD is vital. We performed a retrospective longitudinal study of prospectively collected patient-reported outcomes from patients &#x2265;12-years-old between 5/2019-2/2024 in a multi-disciplinary spina bifida clinic. Our primary exposure was HL, measured with the BRIEF questionnaire. Our primary outcome was transition readiness, assessed with the Transition Readiness Assessment Questionnaire (TRAQ). Linear mixed effects models with repeated measures were used to assess trends in HL over time and their association with TRAQ score at each timepoint, adjusting for relevant variables and an interaction term between HL and time. Among 248 patients (baseline median age 15.6 years, 60% with myelomeningocele), median follow-up was 2.6 years. Improved HL was positively associated with time (&#x3b2;=0.02 [95%CI 0.01-0.03]) and older baseline age (&#x3b2;=0.12 [95%CI 0.01-0.1]). Older age at baseline and better baseline HL were significantly associated with higher TRAQ score (&#x3b2;=0.1 [95%CI 0.08-0.12] and &#x3b2;=0.06 [95%CI 0.04-0.08], respectively). The interaction term between adequate HL and time was significant, suggesting that those with adequate HL had a faster rate of TRAQ improvement over time compared to patients with inadequate HL (&#x3b2;=0.01 [95%CI 0.004-0.02]). Among young people with SD, improved HL was associated with time, and those who achieve adequate HL may experience faster rates of improvement in transition readiness over time. Further research is required to establish a causal relationship.