Agriculture dominates United Kingdom ammonia emissions, from livestock manure exposed to the atmosphere via livestock housing, storage, land and grazing. Ammonia significantly contributes to the formation of PM2.5 (particles with diameter of 2.5 μm or less) concentrations in Europe which are associated with adverse human health outcomes. Ammonia emissions contribute to nitrogen deposition, whereby reactive compounds of nitrogen are deposited into the biosphere, potentially resulting in biodiversity loss. Recent research has not found sufficient evidence for effectiveness of interventions to reduce ammonia emissions and little evidence on the cost-effectiveness of interventions. The current study aimed to address this knowledge gap. The study aimed to assess effectiveness and cost-effectiveness of two agricultural interventions to mitigate ammonia emissions - improved housing for farmed animals and improved manure application. Emission measurements were made at five farms (dairy, pig, poultry). Information on uptake of mitigation measures, barriers and enablers for implementation were determined through an online survey and focus groups with farmers, supplemented by stakeholder interviews. Chemical transport and dispersion modelling estimated population exposures to air pollution at local and national levels under three scenarios (low, medium, high intervention uptake). A health impact assessment estimated health effects associated with the scenarios, and data on self-reported health issues were collected via an online survey of rural residents. Economic evaluation methods estimated cost-benefits of the scenarios and impact on ecosystems. Farmers favour mitigation measures which are cheaper, and build on existing practices, such as amending diet or extending the grazing season. However, these are less effective in decreasing ammonia emissions. Scenarios based on realistic current, and future, uptake levels of measures showed little impact on air quality, partly due to the ammonia-rich United Kingdom atmosphere minimising conversion of ammonia emissions to particulate matter. Consequently, minimal impact of mitigation measures was evident on health outcomes and costs. There was no evidence that self-reported health symptoms from rural residents were related to living near a farm, type of farm or seasonality of farm activities, consistent with results of local dispersion modelling which estimated that most emissions from animal housing dispersed within 1 km. Impacts of COVID-19 and the United Kingdom's withdrawal from the European Union on the agricultural industry affected the recruitment and availability of farms and farmers, resulting in fewer field measurements than planned. A lower response to the farmers' survey was mitigated by the quality of data provided by participants and the successful series of focus groups. The study highlights the need for enhanced communication with the farming community to encourage implementation of more effective mitigation measures, such as air scrubbers, or those relating to slurry storage, currently perceived to be too expensive and complex. Greater clarity on benefits is essential so that farmers understand not only what they need to do but also how and why. Further investigation of the health impacts of ammonia emission should focus on those exposed on the farm, or resident nearby animal houses. Further modelling development of key atmospheric processes is also indicated to minimise uncertainties associated with the regional modelling. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129449. Air pollution damages lung and heart health, contributing to premature death and hospital admissions. These health effects are associated with exposure to very small particles, including from reactions of ammonia emitted from farming, the main United Kingdom producer of ammonia, principally from animal manure in livestock housing, fertilisation of fields and animal grazing. Recently, other United Kingdom sources of particles have decreased, but ammonia levels have not. This study aimed to assess the effectiveness of improved cattle housing and manure storage and application, at reducing emissions of gases and particles. We measured ammonia emissions from five farms and used surveys, focus groups and interviews with farmers and stakeholders to understand views on ammonia reduction measures. Computer models were used to estimate the impact of emissions reduction on exposure and related health issues of people near farms and the wider United Kingdom population. We calculated savings in National Health Service costs. We also surveyed people living near farms about their health. The study found that the measures that farmers were currently prepared to consider implementing reduced ammonia emissions by up to 13%, but the overall reduction in air pollution particles was limited (around 1%). Improvements in health and cost-savings were also small, and surveys of rural residents did not show health problems were related to farming. The study also showed that emissions from farms almost entirely dispersed into the background air within 1 km. Farmers were interested in reducing their environmental impact and favoured cheaper interventions building on existing practices, which also tended to be less effective in reducing ammonia emissions. Barriers to using these interventions were costs and lack of knowledge. To reduce ammonia emissions, future policies should address the barriers and clearly communicate benefits to the environment and to farmers. It would be useful to study more effective farming interventions to reduce air pollution.
There is currently wide variation in prehospital major trauma triage across the National Health Service, with regional ambulance services using different triage tools, varying in format, structure and variables. To develop a national triage tool that is acceptable, usable, accurate, and optimises under- and over-triage. A three-phase research programme, comprising Phase 1: development of a new triage tool by expert consensus informed by existing evidence, a systematic review of elderly triage, document analysis of current tools, decision-analytic modelling, expert consensus definition of a major trauma reference standard, and a qualitative examination of current triage; Phase 2: case-cohort study validating triage tools identified and developed in Phase 1, with identification of an optimally performing candidate triage tool; Phase 3: evaluation of the candidate triage tool following implementation, including cohort study investigating accuracy of triage decisions, cost-effectiveness analysis, and examination of user experiences. English regional trauma networks served by the South-Western, West Midlands, Yorkshire and London Ambulance Services. Phase 2 case-cohort study and Phase 3 cohort studies performed between 1 November 2019 and 28 February 2020, and 1 November 2021 and 15 May 2022, respectively. Injured patients presenting to ambulance services in participating regional trauma networks. In Phase 1, document analysis identified 19 United Kingdom triage tools and 34 published international tools. The systematic review demonstrated limited diagnostic accuracy of triage tools in the elderly, with divergent real-life triage decisions. The reference standard included the need for critical trauma-related interventions, significant individual anatomical injuries, burden of multiple minor injuries and specific patient attributes. Decision-analytic modelling indicated that high-specificity triage tools were favoured. Triage tool simplicity and the option for clinical judgement were valued by stakeholders, but real-world triage was a multifaceted, nonlinear, dynamic and multiagency process. Following review of Phase 1 evidence, a three-step Major Trauma Triage Study candidate triage tool targeting relatively higher specificity was developed through expert consensus. The Phase 2 case-cohort sample included 2757 patients, with a weighted prevalence of major trauma of 3.1% (95% confidence interval 2.3% to 4.0%). The Major Trauma Triage Study tool performed optimally compared to under- and over-triage targets (sensitivity 37.3%, specificity 95.1%). In Phase 3, the newly implemented Major Trauma Triage Study triage tool was received favourably by stakeholders. Prehospital triage decisions using the new tool demonstrated a sensitivity of 55.3% (95% confidence interval 51.8% to 58.7%) and specificity of 94.3% (95% confidence interval 94.1% to 94.6%, n = 38,010, 2.2% prevalence of major trauma). Minimal differences were apparent between the costs (£149) and benefits (0.006 quality-adjusted life-years) of triage decisions, regardless of the triage tool used, reflecting similar real-life triage accuracy. However, the new Major Trauma Triage Study tool appeared cost-effective when theoretical triage tool performance was examined, demonstrating an incremental cost effectiveness ratio of £21,163. The Major Trauma Triage Study triage tool performed optimally, targeted an appropriate under-/over-triage trade-off, and was perceived to perform well by stakeholders. National implementation could ensure evidence-based, standardised and cost-effective triage. Significant variation in National Health Service ambulance service and trauma network configurations could limit the generalisability of results. Paediatric triage, pre-alerting and the benefit of remote clinical support could benefit from future research. This trial is registered as Current Controlled Trials ISRCTN17968752. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/16/04) and is published in full in Health Technology Assessment; Vol. 30, No. 34. See the NIHR Funding and Awards website for further award information. Treatment in specialist hospitals, called major trauma centres, can improve survival after serious injury. Ambulance crews use a triage tool, a checklist of patient and injury features, to help them recognise whether a patient is seriously injured and indicate that early care in a major trauma centre care would be beneficial. The presence of serious injury is not always obvious. Taking patients with minor injuries to the major trauma centre (‘over-triage’) wastes time, money and resources. In contrast, failing to recognise serious injury (‘under-triage’) could result in less effective treatment and a worse outcome. Each NHS ambulance service currently uses a different triage tool, and this project aimed to develop a new national tool to get the right patient to the right place at the right time. The project had three phases. In Phase 1, background work was completed to help design the new triage tool. This work was carefully considered by a panel of experts who then designed a new triage tool (the ‘Major Trauma Triage Study tool’). In Phase 2, the accuracy of the Major Trauma Triage Study tool was compared with other current triage tools in 2607 patients from four ambulance services. The Major Trauma Triage Study tool was shown to perform best, achieving the best balance of under- and over-triage. In Phase 3, the Major Trauma Triage Study tool was introduced into practice in two ambulance services and information was collected on 38,010 patients. When ambulance crews using the tool thought early major trauma centre care was not needed, 99% of patients had injuries that could be safely managed initially in non-specialist hospitals. However, ambulance crews highlighted that they did not always use the tool, and often preferred using their own judgement. Wider implementation of the Major Trauma Triage Study tool might therefore have a limited impact on outcomes but could potentially improve the consistency of triage decisions.
In 2019, the NHS App was launched as a 'digital front door' to England's National Health Service, aiming to improve access to primary care, enhance patient experience, save time in general practitioner practices and promote self-care. This project aimed to identify and understand the use and acceptability of the NHS App, to measure the extent to which it improved patient experience and influences health service access, and to understand patterns of early take-up and participation. Qualitative work explored experiences and views on the acceptability of the app through 60 hours of observation in general practices, document analysis (approximately 100 documents), and 62 interviews and four focus groups with patients, carers, members of the public and staff across five general practices, as well as commissioners and policy-makers. Our theoretical approach used the Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework. Quantitative work examined the impact of the NHS App on the usage of primary and secondary care, using routinely collected data. Firstly, using monthly NHS App user data at general practice level in England, descriptive statistics and time series analysis explored monthly NHS App use from January 2019 to May 2021. Secondly, data on the sociodemographic characteristics of the general practitioner-registered population and their healthcare needs at the general practitioner level were used as covariates to explore inequalities in app usage. Finally, NHS App usage data were also compared with measures of patient experience of care and care access extracted from the General Practitioner Patient Survey database. The qualitative analysis guided by the Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework illustrated the multiple layers of complexity when introducing a constantly shifting technology into a challenging environment such as English general practice, during and after a period of considerable societal turbulence caused by the COVID-19 pandemic. Quantitative work showed there was strong adoption of the NHS App even before the onset of the pandemic, although the introduction of the COVID-19 Pass feature was linked to a fourfold increase in downloads. Analyses by sociodemographic data found higher usage in less-deprived and less ethnically diverse practices, with a generally younger population. There were 25% lower registrations in the most deprived practices (p < 0.001), and 44% more registrations in the largest-sized practices (p < 0.001). Registration rates were 36% higher in practices, with the highest proportion of registered White patients (p < 0.001), 23% higher in practices with the largest proportion of 15- to 34-year-olds (p < 0.001) and 2% lower in practices with highest proportion of people with long-term care needs (p < 0.001). Analyses by patient subgroup and by patient experience of care showed mixed findings. There was no opportunity to evaluate the app or the app functionality in an experimental design. The technology itself, and the context, was changing during the study, which added challenges and complexity. The quantitative analyses used aggregated data rather than individual-level linked data. The NHS App was introduced into a complex and changing landscape. It has achieved strong uptake, with the COVID-19 Pass feature increasing adoption substantially. Overall uptake and use have followed an inverse deprivation gradient, influenced in particular by age, ethnicity and healthcare needs. Different functions of the NHS App have been used to different extents, and with different patterns over time. Further evaluation as the healthcare landscape and the functions of the NHS App evolve is warranted, including longitudinal studies using person-level data and further work on inequalities in access and use. This study is registered as ISRCTN72729780. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref.: NIHR128285) and is published in full in Health and Social Care Delivery Research; Vol. 14, No. 15. See the NIHR Funding and Awards website for further award information. In 2019, the National Health Service in England introduced a new smartphone app for patients, called the ‘NHS App’. This aims to become the ‘digital front door’ to the National Health Service. Over the last 5 years, an increasing number of functions have been added to the app. For example, people are able to use it to see their medical records, book appointments, order repeat prescriptions and undertake other tasks related to their health and care. In this research study, we looked at how many people use the NHS App, what functions they use, what people think about the NHS App and whether it changes how people use the National Health Service. To do this, we used interviews and discussions with people who use (or do not use) the app, and with doctors and other staff who work in the National Health Service. We also looked at the statistics showing how often the NHS App is used. We found that the NHS App has been widely adopted by many millions of users. In the early days, this high uptake was helped by events related to the COVID pandemic, and especially the introduction of the COVID Pass. Usage has continued to grow since then. The use of the app appears to be more common in areas which are less poor, and where general practices have younger patients, and where the populations they serve are less ethnically diverse. Different features of the NHS App are used by different groups of patients to a greater or less extent. Patients who are most looked after in primary care may find the app more useful than those who are being looked after by hospital specialists. Healthcare staff and the organisations they work for have had to adapt their own work in order to introduce the NHS App into their practice.
Telehealth was essential for maintaining care continuity during the COVID-19 pandemic, leading to its rapid adoption across the United States. Telehealth has been heralded as a strategy for improving health care access and reducing health disparities, especially for community-dwelling older adults who face significant barriers to in-person care. However, data on telehealth use among socially and financially vulnerable older adults are limited, and little is known about characteristics associated with telehealth use in this population. Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework, this study examined factors associated with postpandemic telehealth use among older adults living at home and receiving publicly funded home- and community-based services (HCBS), considering HCBS receipt as an indicator of social and financial vulnerability. This cross-sectional study included older adults aged 65 years or older living at home with available telehealth use data who participated in the 2021-2022 survey wave of the National Core Indicators-Aging and Disabilities Adult Consumer Survey. We used complete-case multivariable logistic regression, adjusting for sociodemographic and health-related factors with state-level random intercepts, to examine associations between telehealth use and covariates of interest (age, sex, race/ethnicity, zip code, rural-urban commuting area code, internet access, self-perceived overall health, medical transportation access, living alone, number of known non-Alzheimer disease and related dementias [ADRD] diagnoses, known ADRD diagnosis, and HCBS program/payer type). Based on the regression results, we estimated bivariate associations between internet access and key sociodemographic variables (age, sex, race/ethnicity, and zip code rural-urban commuting area) using the Pearson chi-square test. Findings were organized and interpreted through the SEIPS 3.0 framework. Of the 3680 participants, 1467 (40%) were telehealth users and 2213 (60%) were nonusers. Significantly lower odds of telehealth were observed for older adults in older age groups, males, Black individuals, those living in nonmetropolitan areas, and recipients of Older Americans Act services (odds ratios [OR] between 0.66 and 0.80). Individuals with more than one known non-ADRD diagnosis (OR 1.49, 95% CI 1.02-2.17) and those with an ADRD diagnosis (OR 1.33, 95% CI 1.07-1.66) had higher odds of telehealth use. Internet access was strongly associated with telehealth use (OR 2.51, 95% CI 2.15-2.92). Follow-up bivariate analyses between internet access and sociodemographic characteristics revealed that those of younger age, females, and White individuals had higher levels of internet access. Differences in telehealth use among older HCBS recipients are associated with multiple individual, technological, and organizational factors. Interpreted through the SEIPS 3.0 framework, these findings underscore the importance of viewing telehealth use as the outcome of multiple features of the health care system. Future research should clarify the mechanisms driving variation in telehealth use to identify and address barriers to telehealth adoption among vulnerable older adults.
To explore the perceptions of Indigenous South Australian adults regarding their oral and general health, social and emotional well-being and dental care experiences. Qualitative study; interviews with Indigenous South Australian adults involved in a non-randomised implementation and service-delivery project evaluating provision of culturally safe, comprehensive dental care. Study governance was provided by an Indigenous Oral Health Unit Reference Group with Indigenous leadership to centre cultural authority and cultural safety across all study dimensions. Semi-structured interviews were conducted with 136 Indigenous South Australian participants at a location of their choosing (e.g., their home, a community centre, a research facility), which were held at baseline (1 July 2022-15 December 2023) and 12-month follow-up (1 March 2024-31 March 2025). The overarching study consisted of a pre-post assessment of oral health embedded in routine dental care with oral epidemiological examinations and assessment of systemic health biomarkers (blood glucose, inflammation, cholesterol, kidney function). This was followed by semi-structured interviews at 12-month follow-up. Qualitative outcomes-participant experiences, understandings and recommendations around supporting oral health, social and emotional well-being and culturally safe dental care for Indigenous South Australians. Reflexive thematic analysis was used to analyse interview data, from which five themes were developed. Participants described the importance of oral health for overall health, aesthetic and functional impacts and judgement and discrimination related to poor oral health, all of which were linked to social and emotional well-being. Culturally safe care that includes oral health assessments alongside assessments of biomarkers for systemic health were suggested to promote self-confidence, reduce feelings of shame and empower communities. This study highlights the need to incorporate holistic approaches in promoting Indigenous oral and systemic health and in supporting social and emotional well-being. Australian New Zealand Clinical Trials Registry (ACTRN12626000046303; retrospectively registered). The known: Indigenous Australians experience greater barriers in accessing oral healthcare that is culturally safe, addresses systemic health disparities and considers oral health in relation to social and emotional well‐being. The new: Indigenous participants shared concerns around perceived poor oral health, including aesthetic and functional issues and experiences of discrimination or shame, impacting their social and emotional well‐being. The implications: In supporting Indigenous oral health and well‐being and closing the gap in health inequities, these findings emphasise the need for culturally safe dental care, outreach and mobile dental care, integration of oral health within primary health services and interdisciplinary collaboration.
Ensuring affordable and quality primary health care for urban populations remains a persistent challenge in resource-constrained countries such as Bangladesh. The country's fragmented and pluralistic urban health system exacerbates these challenges, making it particularly difficult to deliver primary health care to urban residents. In Bangladesh, the Aalo Clinic has been piloted to provide essential health services to low-income urban residents, including slum dwellers. This study aimed to assess how this model affects health care-seeking behavior from medically trained providers (MTPs) for managing chronic diseases. We conducted implementation research from October 2021 to August 2023 using a cross-sectional study design. To assess the effectiveness of the Aalo Clinic model, the baseline survey was conducted from January to February 2022, and the end-line surveys were carried out from April to June 2023 in the Korail, Mirpur, Shyampur, Dhalpur, and Tongi-Ershadnagar slums, which are adjacent to the clinics. In the baseline survey, we randomly selected 2000 households (with 9196 members), while 2033 households (with 8223 members) were interviewed in the end-line survey. We considered 8919 individuals in the baseline and 7994 individuals in the end-line, all aged 1 year or older. We used descriptive analysis and chi-squared tests to assess changes in health care usage from MTPs and applied logistic regression models to assess the model's influence on health care usage from MTPs while controlling for other factors. Among slum dwellers, awareness of Aalo Clinic increased by approximately 62 percentage points, from 11.46% (n=227) at baseline to 73.36% (n=1473) at end-line. The usage of health care for the management of chronic diseases from Aalo Clinics' MTPs was significantly higher at the end-line period (n=63, 11.13%) compared to the baseline period (n=6, 0.59%). Regression analysis indicated that slum dwellers were approximately 23 times more likely (95% CI 8.77-61.80) to use health care from Aalo Clinic for chronic diseases in the end-line period compared to the baseline. However, there was no substantial change in health care usage from non-MTPs, which remained stable at around 38% (baseline: n=388; end-line: n=218) in both periods, and local drug stores continue to be the primary source for managing chronic diseases. Usage of Aalo Clinic MTPs for chronic disease care increased substantially compared to other MTPs among slum dwellers. However, reliance on non-MTPs, particularly local drug stores, remained stable. Ensuring the availability of essential medicines may further reduce dependence on non-MTPs among low-income urban slum residents. Future longitudinal studies are needed to evaluate the long-term impact on chronic disease management in Bangladesh.
The amygdala is involved in the emotional expression, memory processing and managing stimulatory input. Although amygdala atrophy is early evidenced in Alzheimer's Disease (AD), the molecular mechanisms disrupted in initial neuropathological stages are still unknown. In the present study, we investigated the proteomic impairment of the amygdaloid region from AD-Braak stage I-II and III-IV subjects to better understand the neuropathological processes occurred early in this area and to identify potential targets that may face AD from the beginning of the disease. Label-free quantitative proteomics was applied using an Orbitrap Exploris 480 mass-spectrometer in 24 postmortem amygdala specimens derived from non-demented (n = 3F/5M), AD-Braak stage I-II (n = 4F/4M) and AD-Braak stage III-IV (n = 4F/4M). Data analysis was performed using MaxQuant and Perseus software (two-way Student T-test; p < 0.05). Metascape and Ingenuity Pathway Analysis softwares were considered for biological interpretation. Connectivity map platform was used for drug repurposing analyses. Transcriptomic/proteomic data of other brain regions were obtained from AlzData, Neuropro, and Agora repositories. Amygdaloid proteome of AD-Braak stage I-II and III-IV subjects compared to controls revealed a progressive proteomic impairment with a minimal overlap across Braak stages. Some of the amygdaloid DEPs were known interactors of human Aβ plaques, APP, or Tau proteins or were previously identified at transcriptional or translational level in other brain regions affected by AD. Interestingly, amygdaloid proteome was more severely affected in women than in men with a particular protein expression profile associated to each AD stage. Comparing our sex-dependent differential proteome datasets with transcriptomic data of different brain regions, we identified potential sex-specific proteins related to cognitive decline and neurodegeneration. Finally, data-driven drug repositioning using amygdaloid omics profiles unveiled that most of the small molecule candidates were neuropathological stage and/or sex-specific. Early and sex-specific amygdaloid proteome dysregulation in AD highlights the consideration of a deliberate stratification by sex in future research and clinical trials to develop effective therapeutic strategies in AD for both sexes. The amygdala is a brain region involved in the expression of emotions, memory processing and managing incoming stimulus. Atrophy of this area is evidenced at the first stages of Alzheimer's Disease (AD), pointing out a potential involvement of amygdala in the pathology of this disease. However, the molecular changes occurred early in this area are not fully understood. To this end, we interrogated the proteome of amygdala postmortem samples came from subjects of early AD stages. By applying data and functional analyses, we observed a stage-dependent and progressive proteomic impairment in this area. We detected proteins differentially expressed that were already known to interact with well-stablished neuropathological proteins or were altered in other brain areas. Importantly, data stratification by sex revealed that protein expression changes of amygdala were more abundant in women than men across AD progression. After comparing our results with published data in different brain regions affected by AD, we identified sex-specific proteins that could be used as biomarkers of cognitive decline and neurodegeneration. Finally, a drug repositioning-based approach proposed candidates with the potential to reverse amygdaloid malignant AD signature more effectively in one sex than in other or just in one sex. These observations highlight the consideration to include sex differences in future research to develop more precise and effective treatments in AD.
This study examined the direct and indirect associations among health literacy (HL), its determinants, and health-related quality of life (HRQoL) in individuals with physical disabilities based on the Integrated Model of Health Literacy (IMHL). This cross-sectional study analyzed data from 441 adults with physical disabilities obtained from the 2021 Korea Health Panel Survey. Based on the IMHL, path analysis was conducted to examine the direct and indirect associations of situational determinants (usual source of care, need for care) and societal and environmental determinants (employment status, unmet healthcare needs) on HL and HRQoL. Among the participants, 44.0% were classified as having inadequate HL and 22.3% as problematic. Need for care was negatively associated with both HL (β = - 0.12, p = .002) and HRQoL (β = - 0.33, p < .001). Unmet healthcare needs also had a significant negative direct association with HRQoL (β = - 0.17, p < .001). Employment status (β = 0.15, p < .001) and HL (β = 0.13, p = .005) were positively associated with HRQoL. HL partially mediated the relationship between need for care and HRQoL (β = - 0.02, p = .044). These findings highlight the role of HL in relation to HRQoL among individuals with physical disabilities. Improving HRQoL in this population may require approaches that go beyond individual-level HL promotion and also address support for care-dependent individuals and structural factors, including healthcare accessibility and employment opportunities. Individuals with physical disabilities often experience worse health and lower quality of life than the general population. This study examined whether health literacy affects health-related quality of life among individuals with physical disabilities in South Korea. It also explored how determinants of health literacy are linked to health literacy and health-related quality of life. The main finding is that health literacy plays an important role in health-related quality of life. The results showed that many participants had low health literacy. Those who needed more care or could not receive the healthcare they needed reported lower health-related quality of life. In contrast, individuals who had jobs and better health literacy reported better health-related quality of life. Health literacy helped explain why the need for care was linked to health-related quality of life. These findings suggest that helping individuals with physical disabilities better understand health information, making healthcare easier to access, and supporting employment opportunities may improve their health-related quality of life and reduce health inequalities.
Health care is undergoing rapid change due to digitalization, artificial intelligence, data-driven decision-making, and shifting patient needs. These developments raise complex ethical, social, and organizational questions that cannot always be addressed by conventional research methods alone. There is a growing need for tools that help stakeholders imagine alternative futures to surface underlying values. Futures studies and speculative fiction respond to this need by presenting "what if" scenarios that make uncertain futures concrete and discussable, enabling dialogue among diverse stakeholders such as health care professionals, researchers, policy makers, and decision makers. This paper examines how speculative fiction can be used as a structured yet imaginative tool in health care research. It positions speculative fiction as a tool within futures studies and participatory research approaches, outlining its conceptual grounding and clarifying its role that stimulates interpretation and reflection within methods such as focus groups, workshops, and surveys. In this way, speculative fiction complements established approaches such as human-centered design, contextual inquiry, and value specification by addressing what does not yet exist and making abstract future issues tangible. The paper presents a case study, The Digital Data Divide, in which speculative fiction was used to explore the use of personal data in health care. Two contrasting short films were developed to stimulate dialogue and invite participants to reflect on associated values. Insights from this case are structured into a 6-step practical reporting guide: determining whether speculative fiction fits the research aim, choosing an appropriate form of speculative fiction, creating or selecting speculative scenarios, engaging participants, analyzing responses, and sharing and disseminating results. Across these steps, the paper discusses methodological and ethical considerations, including alignment between scenarios and study aims, balancing utopian and dystopian elements, questions of plausibility and interpretability, and the need for researcher reflexivity. Overall, this paper contributes to the growing discussion on future-oriented tools in health care research by showing how speculative fiction can help address complex and uncertain challenges in ways that are accessible to a wide range of stakeholders and that support dialogue across perspectives, provided that its use is ethically transparent, methodologically explicit, and carefully reported. The paper concludes with a call to other researchers to also experiment with speculative fiction and to share their experiences with the health care research community to learn and advance its use.
Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.
In 2017, Lifeline Nehemiah Projects in Sierra Leone launched 2YoungLives, a mentoring initiative for vulnerable pregnant adolescents, including those living with disabilities. Drawing from the social model of disability, we aimed to investigate the exacerbated disabling barriers which prevent these girls and their babies from accessing available healthcare and develop comprehensive solutions to improve their access. Qualitative methods were used in this study. Participants were invited to participate in face-to-face interviews in one district in Sierra Leone. Six pregnant or postnatal adolescents living with disability, alongside four caregivers and five stakeholders from various organisations participated in semi-structured interviews employing thematic analysis. We identified four key themes: (1) discrimination and financial barriers within the healthcare system, despite laws ensuring free healthcare for persons living with disabilities, (2) societal stigma manifested through abandonment by families and inadequate support, (3) lack of understanding of disability issues, particularly of those with intellectual impairments, leading to stigmatisation and exclusion, and (4) infrastructural limitations which hinder accessibility to essential services, with many facilities remaining non-compliant with disability regulations. Adolescent girls living with disability during pregnancy and after birth in Sierra Leone face barriers to accessing healthcare, including caregiver ignorance, lack of autonomy, disabling services, social stigma and ineffective policy implementation, despite existing supportive laws. These findings keep those women who are arguably the most vulnerable, adolescent and living with a disability, from accessing perinatal healthcare, exacerbating their risk and that of their babies. Solutions include the need to enforce disability-inclusive policies and infrastructure adaptations, awareness and training for healthcare providers and community advocacy to break down social stigma.
Culturally and linguistically diverse (CALD) communities have unique strengths, needs, and health seeking behaviours reflecting their cultural background. Therefore, top-down population-level health promotion initiatives with externally imposed performance indicators are frequently ineffective in CALD contexts. Accordingly, the Healthy New Communities (HNC) program implements an equity-based bottom-up commissioning model aimed at addressing socio-cultural factors impacting health seeking behaviours with people from refugee and migrant backgrounds. In the first phase of a comprehensive evaluation of the HNC program commissioning model, stakeholders involved in the implementation of commissioned activities and programs shared their experiences with this innovative funding model pioneered by the Queensland Health Metro South Hospital and Health Services, Health Equity and Access Team. Their perspectives were gathered in focus groups and interviews and analysed using an inductive approach to thematic analysis. The findings demonstrate the effectiveness of the HNC program commissioning model in engaging CALD communities in health promotion initiatives. Flexibility, responsiveness, trust, relationships, shared commitments, and cultural representation facilitated community members' participation in the commissioned activities. The impacts of the HNC program commissioning approach extend beyond the adoption of healthy lifestyles and include positive social, emotional, cultural, and physical impacts across a range of life domains and the creation of employment, training, and career pathways. The HNC program demonstrates how socio-cultural determinants of health can be influenced by commissioning models that prioritise community engagement, relationships, co-design, and the culturally shaped health-seeking behaviours of CALD individuals, families, and communities in the funding, design, and implementation of health promotion initiatives. SO WHAT?: Phase one results are promising and lay the foundation for an in-depth investigation of the potential of equity-based commissioning models for improving health and wellbeing outcomes for CALD communities across Queensland and beyond.
Community resources may benefit children's long-term health, but the lasting impact of public spending in childhood is unclear. Identifying policies to address residential wealth and opportunity disparities could promote long-term health equity. To assess whether childhood exposure to public spending on community resources (public primary and secondary education, libraries, parks and recreation, and community development and housing) is associated with subsequent adult health. This retrospective cohort study used linked national datasets from 1977 through 2019. US cities with at least 150 000 residents in 1980 were included. Childhood public finance data covered 1977 through 2017, and adult health was measured in 2019. Included adults were in the 2019 Panel Study of Income Dynamics, were born between 1960 and 2000, and lived in a medium to large city before 18 years of age. Analyses were performed from August 2024 to March 2026. Total per capita operational spending on community resources, summed across city, county, and school district levels for the year and city when the respondent was 9 years of age. The main outcome was overall adult health rated as fair or poor. Secondary outcomes included cardiovascular disease (CVD), anxiety, and depression diagnoses. Data were analyzed using weighted linear probability models adjusted for demographics. Estimated margins compared the 25th and 75th percentiles of spending. Among 2214 adults (mean [SD] age in 2019, 38.9 [10.2] years; 1223 [52%] female), 389 (17%) reported fair or poor health, 458 (22%) reported CVD, and 184 (10%) reported anxiety or depression. A 1% increase in childhood community resource spending was associated with a 0.20 (95% CI, 0.04-0.35) percentage point decrease in adult fair or poor health and a 0.25 (95% CI, 0.07-0.44) percentage point decrease in adult CVD. To contextualize the magnitude, shifting from the 25th to 75th spending percentile decreased the estimated probability of reporting adult fair or poor health from 19.38% to 12.87%, a reduction of 6.51 (95% CI, 1.38-11.64) percentage points. A 1% increase in education (0.15 [95% CI, 0.02-0.29] percentage points) or library (0.05 [95% CI, 0.01-0.10] percentage points) spending was correlated with better overall health. Education (0.23 [95% CI, 0.07-0.39] percentage points) and community development and housing (0.04 [95% CI, 0.01-0.08] percentage points) spending were associated with lower CVD. No association was found for overall community resource spending or its individual four component sectors and anxiety or depression. In this cohort study of US urban adults, greater childhood exposure to community resource spending was associated with improved overall and cardiovascular health in adulthood. Variation in public spending levels may partially explain geographic differences in US health outcomes.
Global mpox outbreaks have exposed healthcare inequities in testing accessibility. Socioeconomic disparities and medical discrimination and distrust influence testing service utilization among vulnerable populations. We examined how medical discrimination and distrust affect testing intention across socioeconomic strata among men who have sex with men (MSM) in China. We conducted a nationwide cross-sectional study across six regions of China (November 2023 to March 2024). MSM aged ≥ 18 years who reported male sexual partners within previous six months were recruited through local Centers for Disease Control and Prevention and community-based organizations. Participants completed anonymous questionnaires measuring medical discrimination and distrust (DS), structural determinants, behavioral factors, psychosocial factors, and mpox testing intention. Path analysis was used to examine the effects of medical discrimination and distrust on testing intention, stratified by socioeconomic status (SES). 50.7% of 2403 participants reported high testing intention. Path analysis revealed that medical discrimination and distrust were associated with testing intention through distinct mechanisms across SES groups. For high-SES participants, positive indirect associations were found between medical discrimination and distrust and testing intention (β = 0.061, P < 0.001) mediated by voluntary HIV counseling and testing services, social support and depression. For low-SES participants, medical discrimination and distrust demonstrated a negative direct effect (β = -0.218, P < 0.001) and indirect effects through social support, depression, and mpox prevention-related self-efficacy (β = -0.028, P < 0.001). Social support emerged as a crucial mediator among low-SES groups, while depression served as the crucial mediator among high-SES groups. Healthcare inequities manifest through socioeconomically patterned pathways affecting mpox testing intention. Our findings suggest differentiated intervention strategies: integrating services with existing healthcare infrastructure for high-SES populations while strengthening community-based support for low-SES groups. These insights inform efforts to address healthcare disparities in infectious disease responses, particularly in resource-limited settings.
Several medications are available for rapid tranquilisation in psychomotor agitation, but choosing among them varies across local practices and this variation is compounded by inconsistent guidelines. We performed a systematic review with individual participant data network meta-analysis to inform evidence-based recommendations. In this systematic review and individual participant data meta-analysis, we searched multiple databases from database inception to Nov 14, 2025, for randomised trials comparing intramuscular or intravenous treatments for rapid tranquilisation (primary outcome defined as sedation within 15-30 min) in patients with psychomotor agitation in general or psychiatric emergency settings. Anonymised individual participant data were collected and harmonised into a common dataset. Risk of bias was assessed using the RoB 2 tool. We performed Bayesian one-stage random-effects individual participant data network meta-regressions, accounting for between-study heterogeneity, drug classes, prognostic factors, and subgroup effects based on agitation severity. We combined individual participant data and aggregate data to evaluate side-effects. Confidence in the evidence was assessed using the Confidence In Network Meta Analysis (CINeMA) framework. People with lived experience were involved in the design and interpretation of the findings. The protocol was registered with PROSPERO (CRD42023402365). We included 18 trials across eight regions (3411 participants; 1988 [58·3%] men, 1423 [41·7%] women; mean age 36·0 [SD 11·7] years), of which 13 trials (2705 participants) provided individual participant data for antipsychotics, benzodiazepines, and their combination. In moderate agitation, odds of achieving sedation relative to haloperidol monotherapy were higher with antipsychotic-benzodiazepine combinations (odds ratio [OR] 12·93, 95% credible interval [95% CrI] 3·00-50·91; relative risk [RR] 1·58), benzodiazepines (5·52, 1·37-21·02; 1·49), and other antipsychotics (4·54, 1·35-14·45; 1·45). In severe agitation, antipsychotic-benzodiazepine combinations were more effective than haloperidol (4·86, 1·28-17·54; 1·73), whereas results were uncertain for benzodiazepines (2·09, 0·58-6·99; 1·38) and other antipsychotics (1·70, 0·62-4·59; 1·28). Confidence in these estimates was very low, mainly due to imprecision and heterogeneity. Haloperidol monotherapy was associated with higher risk of extrapyramidal side-effects and benzodiazepines, alone or in combination, with hypotension. Antipsychotic-benzodiazepine combinations might be among the most effective options for rapid tranquilisation in patients with psychomotor agitation but carry a risk of hypotension, whereas haloperidol monotherapy appeared among the least effective and is associated with extrapyramidal side-effects. These findings should be contextualised to the specific setting and patient characteristics, including the underlying agitation aetiology. Large trials are needed to provide more precise recommendations. German Ministry of Research, Technology and Space and Swiss National Science Foundation.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Despite the growth of breastfeeding and lactation medicine as a specialty, the care of breastfeeding families is compromised because few standards and recommendations exist for its practice and integration into health systems. We conducted a qualitative study involving three focus groups (N = 13) with breastfeeding and lactation medicine physician leaders who currently work within large health systems across the United States. Our study aimed to gather the perspectives of physician leaders regarding breastfeeding care in health systems, to summarize current practices and recommendations for optimal care, and to explore barriers and facilitators to the implementation of these recommendations. A deductive content analysis approach guided by the Exploration, Preparation, Implementation, and Sustainment Framework was used to analyze the transcripts. Resulting themes revealed the important role that health systems play in modeling breastfeeding supportive practices and the strong influences of leadership and staff personal breastfeeding experiences on health system policies. Recommendations included the creation of breastfeeding and lactation medicine divisions, adequate staff education, staffing and coordination of lactation care across the system and community, support for lactating employees, and public awareness of resources and programs. Barriers to implementation included siloing of lactation services by department, lack of breastfeeding-supportive workplaces, deficient clinical billing for lactation services, and low prioritization by training programs. Facilitators included multidisciplinary collaborations, employee supportive lactation policies, appropriate dyadic lactation billing, and electronic health record workflows. Our focus groups revealed many barriers to the delivery of optimal breastfeeding care within health systems, but strategies were identified for systemic changes. Next steps include identification of breastfeeding and lactation medicine divisions and health systems already implementing the best practices described here. Further research should engage additional stakeholders to better understand administrative and financial points of view regarding barriers and facilitators of breastfeeding support.
 The attitude that one holds towards healthcare services is an important factor associated with health-seeking behaviour. People with bad experiences of previously used healthcare services are less likely to engage with healthcare services; the healthcare worker-patient relationship is an important factor influencing attitudes towards healthcare services. This study aimed to determine the attitude of men towards public health services and utilisation practices.  A self-administered questionnaire was administered using a quantitative cross-sectional design on 400 men conveniently selected from randomly selected communities within the selected districts. Data from 387 questionnaires successfully returned were analysed using the Statistical Package for Social Sciences version (SPSS) 29.0. for Windows.  Out of 387 men, 310 (81%) reported that during consultation, healthcare professionals do not respect patients, and the majority (88%; 339) reported that the waiting period in public healthcare facilities is very long. Most men (84%, 322) felt more at ease going to a private health facility than a public one. About 54% (204) of the men visited public health facilities to seek health services. There was a statistically significant relationship between men's level of education and utilisation of healthcare services (p = 0.005).  These men held negative attitude towards public health facilities and reported a lack of respect for patients by health workers. Revitalisation of work ethics and professional conduct among public healthcare workers is needed to remind workers about their code of conduct and improve the provision of public health services in a manner that users feel comfortable visiting health facilities to seek the services.Contribution: The study brings meaningful insights of men's attitudes towards public health services and may help to better understand why few men engage in health services.
The COVID-19 pandemic was associated with increased mental health-related hospitalizations and emergency department (ED) visits in children and youth. However, population-based studies examining geographic variation in, and neighbourhood correlates of, acute mental health service use in this population during the pandemic are lacking. We conducted a population-based study examining geographic variation in and neighbourhood correlates of mental health-related hospitalizations and ED visits among Ontario children and youth. We used hot spot analyses to visualize geographic variation in service use before (March 2017 to February 2020) and during (March 2020 to July 2021) the pandemic. We used spatial regression models to estimate unstandardized and standardized coefficients of the association between neighbourhood characteristics and acute mental health service use. Mental health-related hospitalization and ED visit rates were highest in rural and northern Ontario. The variables most strongly associated with hospitalization rates within the same neighbourhood were neighbourhood income and family size. A one standard deviation (SD) increase in income was associated with a 0.50 (95% CI: -0.56 to -0.43) SD decrease in hospitalization rates, while a one SD increase in family size was associated with a 0.35 (95% CI: 0.29-0.42) SD increase in hospitalization rates. Additionally, increases of one SD in neighbourhood income, the proportion of the population speaking neither English nor French, and remoteness were associated with respective increases in the SD of hospitalization rates of in adjacent areas. Neighbourhood income and remoteness were strongly associated with ED visit rates, with each standard deviation increase in income associated with a 0.52 (95% CI: -0.57 to -0.47) standard deviation decrease in ED visits while each standard deviation increase in remoteness was associated with a 0.29 (95% CI: 0.21-0.37) standard deviation increase in ED visit rates. Geographic location and neighbourhood socioeconomic and demographic factors influenced acute mental health service use among children and youth during the pandemic. These findings highlight the need for targeted social interventions that address neighbourhood disparities and bolster mental health services in vulnerable regions, particularly in preparation for future large-scale disruptions.
The abrupt withdrawal of humanitarian aid in early 2025 has destabilized health systems across sub-Saharan Africa, yet little is known about the frontline realities of these cuts in refugee-hosting settings. To explore health care practitioners' perspectives and experiences of how reductions in global health funding have affected services and refugee health and to identify practitioner recommendations for sustaining care. This qualitative study used semistructured, in-depth interviews conducted in July 2025 at 6 health facilities within Nakivale Refugee Settlement, Uganda. Participants were health care practitioners representing diverse cadres and facility sizes. Reduction of humanitarian aid. The primary outcomes were health care practitioners' perspectives on the impacts of funding reductions, including changes in service delivery, supply availability, staff conditions, and anticipated future health trends, as well as their recommendations to mitigate harms. Rapid qualitative techniques and thematic analysis were used to analyze responses to obtain actionable implications systematically and efficiently. The 26 participants (mean [SD] age, 30.92 [3.52] years; 16 men [61.5%]) had a mean (SD) duration in practice of 6.80 (2.65) years, with a mean (SD) of 3.09 (1.92) years in Nakivale. Interviews yielded 4 overarching themes and 18 subthemes: (1) reductions in health care services (HIV and tuberculosis services, nutritional support, maternal health, immunization adherence, inpatient and outpatient care, and perceptions of service availability), (2) supply shortages (medical supplies, transportation fuel, and household support), (3) deteriorating staff conditions (staff reduction, workload and burnout, and resilience), and (4) future predictions and recommendations (disease patterns, migration patterns, bridging the funding gap, and general settlement conditions). This qualitative study examined the cascading outcomes of humanitarian aid withdrawal on refugee health care through the voices of frontline practitioners. Their testimonies underscored urgent priorities for restoring and retargeting aid-investing in high-impact levers, strengthening local leadership, and advancing policy reforms-to safeguard refugee health and system resilience, while reminding us of the shared human stakes of humanitarian policy and the global responsibility to act.