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Provision of adolescent-friendly Health services (AFHS) at lower primary health care centres (PHCs) is a core strategy for improving access and health outcomes of adolescents. In this study we assessed the health facility-based prevalence of repeat adolescent pregnancies and the capacity of PHCs (Health centres (HC) level III and IV) to provide AFHS in Uganda. We conducted a cross-sectional study between April and May 2023 involving 43 healthcare facilities (33 HC III and 10 HC IV) across 4 districts in Southwestern Uganda. Using pretested structured questionnaires, we interviewed the health facility in-charges or their delegates. We extracted the 6-month information from registers on: number of repeat adolescent pregnancies, post-abortion, and post-natal adolescents attending each facility. With a checklist, we assessed the availability of family planning materials/services and other medical equipment. Descriptive statistics were generated. Adolescent contributed 4.9%, 16.3% and 14.8% of all repeat pregnancy, post-abortion and post-natal consultations documented at all PHCs. We noted a low perinatal care staffing with the majority of HC IIIs lacking adolescent peer educators (n = 34; 79%), and counsellors (n = 26; 60.5%). The need for training in the provision of adolescent-friendly services, post-natal or post-abortion care in adolescents (> 90%) was high. PHCs were inadequately supplied with equipment for post-abortion care and IUD insertion. Female and male sterilization and emergency contraception were less offered. Health workers were willing to give family planning to previously pregnant adolescents (90.7%), without parental consent (65.2%), but did not support contraceptive administration to adolescents who had formerly been pregnant in fear of promoting sexual promiscuity (41.9%). A quarter of the PHCs had a dedicated clinic for adolescents and had a day in the week for adolescent services. This study reveals major gaps in adolescent perinatal care in Southwestern Uganda, including limited peer educators, inadequate post-abortion care, and poor healthcare worker training. Strengthening services requires interactive, peer-based training and addressing staffing shortages through peer educators and community health workers. Equipping Health Centre IIIs to deliver comprehensive, adolescent-friendly care is essential to improving access and closing these critical service gaps.

In the context of the changing need for health care and prevention due to climate, digital and demographic change, occupational health services are of enormous relevance, as many people can be reached. Of particular interest are the occupational health services in micro-, small- and medium-sized enterprises (MSMEs), as smaller companies are experiencing an unequal distribution of resources. To optimise the implementation in MSMEs, the aim of this scoping review is to present an overview of the MSMEs' needs regarding occupational health services. The literature search was conducted through Embase, Pub Med, Scopus, and Web of Science. Additionally, a manual search was performed through the references of included sources. A protocol was registered with Open Science Framework. The screening was conducted by two reviewers. Eligible were peer-reviewed articles in English and German, published between 2000 and 2024 on the perspective of MSMEs regarding occupational health services. The articles were narratively synthetised. A critical appraisal was carried out. A total of 1,252 sources were found during the search on August 26, 2024. Fifteen were included from the database search and two from the manual search. The studies used qualitative (n = 11), quantitative (n = 3) or mixed-methods (n = 3) approaches. The narrative synthesis identified five categories of felt and expressed needs with fourteen subcategories. MSMEs had a need for collaborative culture including communication, participation, trusting relationships and external support. The need for knowledge and competencies contained information, training and accessibility. Organizational structures subsumed the need for time, financial, technical resources as well as management commitment and simple solutions. Tailored legislation and less bureaucracy were categorised as needs for political and regulatory context. In the included studies, a selection of specific interventions such as flu vaccination, ergonomic solutions and psychosocial risk assessment were discussed. To optimise the implementation of occupational health services, this overview shows that political stakeholders and occupational health professionals should improve the organizational structures, political and regulatory context, collaborative culture with and the knowledge and competencies of MSMEs. Further research is recommended with the explicit aim of identifying the needs of MSMEs in each sector on occupational health services, psychosocial risk and assessments.

Child and adolescent mental disorders are creating significant demands on Norway's general and specialized health services. Addressing these demands requires innovative approaches to increase workforce numbers and effectiveness. The Individualized Digital Decision Assist System (IDDEAS) is a Clinical Decision Support System (CDSS) for child and adolescent mental health services in Norway. IDDEAS 1.0 is a guidelines-based prototype with attention-deficit/hyperactivity disorder (ADHD) as the first model clinical paradigm. IDDEAS 1.0 is the focus of a formative usability study to examine clinicians' information processing needs and their perceptions of the acceptability, functionality and ease of interactions with user interface (UI) and user-experience (UX). In collaboration with the Norwegian Association for Child and Adolescent Mental Health (N-BUP) a provisional list of practitioners in child and adolescent mental health services (CAMHS) was compiled for recruitment of potential participants. Child and adolescent psychologists and psychiatrists (n = 68) completed IDDEAS formative usability testing. Study participants also completed a think-aloud protocol in which they verbalized their thoughts about the experience in real time while assessing hypothetical patient case vignettes. By observing these representative, potential IDDEAS users, developers gain insight from their interactions with the prototype. A self-developed display and functional ease-of-use questionnaire, as well as the IDDEAS modified system usability scale and user engagement scales, were completed. All qualitative data were analyzed using both protocol analysis and content analysis. Examination of the formative usability identified a participant appreciation of the side-by-side guideline/patient view, simplistic UI presentation, and alignment with their diagnostic routines. 89% of usability comments informed next-step improvements pinpointing forced linear navigation, ADHD focused prototype, and ambiguous prompts. This resulted in proposed enhancements centered on dynamic criteria selection, optional guideline choice, individualized content, and seamless electronic health records integration. The scenario-based exploration of the IDDEAS 1.0 prototype allowed CAMHS clinicians to offer honest reflections about receiving decision-support, and what they might potentially need for such support to enhance their clinical decision-making and information processing at the point of care. Functional adjustments in IDDEAS were recommended, with a focus on workflow cohesion and individualized adaptability for optimal ease of use and personalized patient care.

Refugee populations face tremendous psychological, financial, and physical health challenges due to traumatic experiences and the stresses of resettlement. Access to oral healthcare represents a significant challenge due to language barriers, cost, and lack of familiarity with the healthcare system. Robust costing analyses are necessary to inform oral health programs tailored to newly landed refugees. The purpose of this study was to estimate the costs associated with delivering the Government Assisted Populations (GAP) oral health program for refugees settling in Nova Scotia, Canada. Using a bottom-up micro-costing method, we calculated the yearly direct and indirect costs associated with the delivery of oral health services via the GAP program between 2016 and 2024 from a healthcare system and societal perspectives. Direct costs consisted of the treatments rendered, and the salaries of a program coordinator and two language interpreters. Indirect costs were measured as opportunity costs. The valuation of costs was done according to published professional documents (i.e., Nova Scotia Dental Association suggested fee guide) and the current market values for goods and services. All costs were adjusted to the 2025 Canadian Dollars (CAD). Data from nine years of the GAP program data (2016-2024) were analyzed. The number of beneficiaries of the program/year rose from 67 patients in 2016 to 187 in 2024. The average annual treatment costs ranged from CAD 191 (SD 73) in 2016 to CAD 1,188 (SD 1,297) in 2024. The average annual productivity losses incurred by patients also rose from CAD 51 (SD 21) in 2016 to CAD 164 (SD 156) in 2024. Except for the first year, during which only hygiene services were administered, unmet needs were highest for restorative (19%-69%), preventive (13%-48%), and oral surgical (1%-10%). Total direct costs of the program ranged from CAD 53,589 in 2016 to CAD 267,622 in 2024. Over the same period, total indirect costs ranged from CAD 3,411 to CAD 30,561. The GAP oral health program addressed substantial oral healthcare needs among refugees, with costs increasing alongside service demand. These findings provide evidence to inform resource allocation and support equitable, culturally appropriate oral healthcare programs for newly resettled refugee populations.

Older adults bear a disproportionate cancer burden but remain underrepresented in digital health intervention trials compared to younger counterparts. Since the COVID-19 pandemic, engagement with telemedicine and patient portals through the electronic health record (EHR) has grown for all age groups, suggesting readiness to adopt digital health tools. This qualitative study primarily sought to understand how adults eligible for lung cancer screening (LCS) engage with technology and digital health in their daily lives. The secondary objective was to assess acceptability and compatibility of a video-based LCS health communication as a digital health tool. Semi-structured interviews were conducted with 15 participants aged 51-80 through videoconferencing or telephone. Transcripts were analyzed using a rapid team-based analysis approach. The Consolidated Framework for Implementation Research (CFIR) was used as a guiding framework from throughout the study, with constructs of interest informing interview guide questions in data collection, and CFIR-mapping to generate a code list in the analysis. Our findings generated four CFIR-informed themes, with 8 subthemes: (1) Internal facilitators: comfort with technology, self-efficacy in troubleshooting; (2) External facilitators: leveraging internet for health information, use of wearable devices, patient portal functionalities; (3) Internal barriers: emotional response, social isolation; (4) External barriers: scamming and data privacy. When shown the LCS video-based health communication, participants described general approval of the content and delivery but expressed concerns about safety related to accessing the video due to its delivery via weblink. Broadly, we found that older adults had high levels of technology use and leveraged various digital tools (such as wearable devices, mobile applications, and EHR patient portals) to manage their health care needs. Our findings underscore that older adults are active users of digital tools, yet persistent concerns about privacy, social isolation, and emotional burden must be addressed for digital health interventions to be acceptable and sustainable in this population. NCT05747443 | www. gov | Registration Date 2023-02-28.

Armed conflict disrupts health systems and daily self-care practices, yet quantitative evidence on its impact on oral health is scarce. This study compared self-reported oral health status, hygiene behaviours, and access to dental care among residents of the Gaza Strip before and during the 2023-2024 war. A comparative cross-sectional survey was conducted among 599 Gaza residents using a structured, self-developed 34-items online questionnaire. Participants reported oral health conditions and behaviours for two periods: before October 2023 and during the war. Paired categorical data were analysed using Bowker's test of symmetry for multi-category variables, and McNemar's test for binary variables, and subgroup associations were examined using chi-square tests. Significant deterioration was observed across all 12 assessed domains (p&#x2009;<&#x2009;0.001 for 11 variables; p&#x2009;=&#x2009;0.013 for the remaining variable). The proportion reporting severe oral pain increased from 6.5% pre-war to 73.8% during the war, while those reporting no pain decreased from 25.5% to 2.0%. Favourable self-rated dental status (excellent/good) declined from 85.3% to 9.7%, and the proportion reporting healthy gums decreased from 88.1% to 12.4%. Twice-daily tooth brushing fell from 77.5% to 9.5%, and complete cessation of brushing increased from 0.8% to 38.4%. Unmet dental care needs rose from 11.7% to 92.7%, with insecurity and lack of dental services as the main barriers. Stress-related oral habits increased markedly, and 86.0% of participants reported dependence on canned foods. Overall, 95.5% perceived their oral health to have worsened since the onset of the war. The Gaza war was associated with profound deterioration in self-reported oral health status, hygiene practices, and access to dental care. These findings highlight oral health as a neglected dimension of humanitarian crises and underscore the need to integrate essential dental services into emergency health responses and post-conflict reconstruction.

Early initiation of therapy can be crucial for the course of mental health problems. Among other new care elements, the structural reform of the outpatient psychotherapy system in Germany introduced psychotherapeutic consultations to enable early low-threshold access to psychotherapists. This study aims to compare access to outpatient psychotherapeutic care for patients diagnosed with a first-time diagnosis of depression before and after the reform, and to analyse the utilisation of other relevant health services. A retrospective cohort-based analysis was conducted using anonymised administrative claims data to examine the initial contact to the outpatient psychotherapeutic system for children and adolescents (under 18 years old) and adults (over 21 years old) with a first-time diagnosis of depression. Patients with at least one documented ICD-10 depression diagnosis in either the first quarter of 2016 (pre-reform) or the first quarter of 2018 (post-reform), and at least one further diagnosis within 12 months, were included in the analysis. The initial contact to outpatient psychotherapeutic care, as well as the utilisation of other relevant health care services (i.e. inpatient stay, antidepressant prescriptions, low-intensity interventions) was analysed for patients with and without initial contact. Descriptive and logistic regression analyses were performed. A total of 11,038 children and adolescents and 284,773 adults were included in the analysis. The proportion of children and adolescents and adults who had initial contact with outpatient psychotherapeutic care increased by 14 and 5 percentage points respectively between the pre- and post-reform period [both: p&#x2009;<&#x2009;0,001]. The main effect parameters for initial contact were age, sex and the severity of depression diagnosis. The analysis revealed that, in terms of health care utilisation, patients who had an initial contact had significantly more relevant health care services such as antidepressant prescriptions or low-intensity interventions after initial contact in the post-reform period than in the pre-reform period. Those who had no initial contact used other relevant health care services less frequently in the post-reform period. This analysis indicates that the outpatient psychotherapy system became more accessible for people with a first-time diagnosis of depression in terms of initial contact to psychotherapists following the reform and sheds light on the complexities of care provision for those with depression.

Retaining home care workers who are experiencing increasing job demands alongside deteriorating occupational health has become a growing concern. Previous research has found occupational self-efficacy, that is belief in one's own capabilities to successfully fulfil work-related responsibilities, associated with work wellbeing and meaningfulness. The aim of this study was to explore how home care workers who experience threatened occupational health perceive the importance of occupational self-efficacy for their occupational health and their sense of meaningfulness at work. Eight home care workers with threatened work ability, defined as having accumulated 30&#x2009;days or more of sick leave in the past year, were interviewed. The semi-structured interviews were analysed using Braun and Clarke's reflexive thematic analysis. Based on the analysis, an overarching theme-"Occupational self-efficacy, health and meaningfulness at work walking hand in hand"-was generated, together with two main themes. The main themes were "Holding on to myself through the balancing act of health, worth and work", and "Protecting the value of meaningfulness in the face of organisational challenges". The findings highlight a reciprocal relationship between occupational self-efficacy, health and meaningfulness at work, however, influenced by work environment. Supporting the inner health and sense of worth of home care workers experiencing ill health enhances sustainable occupational self-efficacy. A balanced sense of meaningfulness at work further contributes to this process. Although occupational self-efficacy is a personal resource, it is strongly influenced by the psychosocial and organisational work environment, underscoring the importance of developing a healthy work environment.

Food and Nutrition Surveillance is a key strategy of Brazil's National Food and Nutrition Policy and plays a central role in the organization of nutritional actions in primary health care. Despite its strategic importance, food and nutrition surveillance implementation faces persistent challenges related to training gaps, funding discontinuities, and limited institutional support. This study assessed the organizational readiness of primary health care professionals for food and nutrition surveillance implementation via the Organizational Readiness for Implementing Change (ORIC) instrument. This cross-sectional study was conducted in Mato Grosso do Sul, Brazil, during a state-level permanent education event in 2023. Eighty-five primary health care professionals from 49 municipalities responded to the Brazilian version of the ORIC instrument, adapted for the food and nutrition surveillance context. ORIC measures two core constructs: change commitment and change efficacy. The statistical data were analyzed and compared with the readiness levels by professional category (frontline representation) and health macroregion. The mean ORIC score indicated neutral to moderate readiness across participants (commitment: 3.65; efficacy: 3.71 on a 5-point Likert scale). Nurses and physical education professionals exhibited the highest levels of readiness, surpassing the threshold of 4.0 in both domains. In contrast, nutritionists-despite being the professional group most directly associated with the food and nutrition surveillance-scored lower. Geographic disparities were also evident: professionals from the Eastern Border and Southern Cone regions reported greater readiness than those from the Central and Pantanal macroregions did. The findings reveal important gaps in organizational readiness for food and nutrition surveillance implementation in primary health care, particularly among nutritionists and in certain territories, suggesting limited engagement or perceived capacity to implement the policy. These results emphasize the need for regionally tailored strategies, stronger integration with permanent education initiatives, and institutional support mechanisms. The ORIC instrument proved to be a useful tool for assessing team-level readiness and guiding implementation efforts. Applying implementation science frameworks may help foster greater alignment between health professionals' practices and policy goals, ensuring more equitable and sustainable integration of food and nutrition surveillance in primary health care.

Despite the importance of promoting healthy lifestyles in primary healthcare (PHC) to prevent non-communicable diseases, implementing and sustaining evidence-based health-promotion lifestyle practices remains challenging. This study aimed to evaluate the sustainability of uptake of a health-promoting practice using a 12-month multifaceted implementation intervention in a Swedish PHC setting. A non-randomized parallel group design was used to compare five PHC intervention centers and five matched control centers with respect to health-promotion activities registered in medical records at: 6 months pre-implementation, during a 12-month implementation phase, and a follow-up at 18 months (sustainability). The intervention centers received a multifaceted implementation intervention based on a leadership change model using internal and external facilitators. Uptake was analysed using negative binomial mixed-effects models with a log link, modelling monthly uptake rates with an offset for the number of visits. Time since intervention initiation and time since the post-implementation phase were modelled using restricted cubic splines, allowing intervention effects to vary over time. Models were adjusted for seasonality, secular trends, patient sex, and site pair, with site included as a random effect. Intervention effects were estimated as ratios of rate ratios with simultaneous 95% confidence intervals. The intervention centers successfully adopted and sustained the clinical intervention. At the 18-month follow-up, intervention centers sent out 7.2 times as many lifestyle screening forms compared with the control centers. The mean crude uptake difference was 43.6 and the relative rate was estimated at 2.23, indicating that patients at the intervention centers were more often asked about their lifestyle and more often received advice or consultative conversations about lifestyle changes. This multifaceted implementation intervention, focusing on leading change and facilitation in a routine clinical setting, increased the uptake of a health-promoting practice at the PHC intervention centers that was sustained over time. Health-promoting activities reached a larger proportion of patients in the intervention centers, indicating that the clinical intervention may work under routine conditions. These results are promising but need to be verified in larger randomized studies. In addition, differences between the intervention centers emphasize the need to explore the mechanisms of impact. This study was registered at ClinicalTrials.gov on 4 March 2021 (ref: NCT04799860).

Decentralisation in healthcare governance is widely promoted to enhance managerial autonomy, responsiveness, and performance. However, empirical evidence suggests that managers operating in decentralised systems continue to rely on centrally coordinated organisational structures. This interdependence remains insufficiently conceptualised in existing research. A scoping review was conducted to synthesise empirical studies examining how central coordination in organisational systems shapes managers' effective decision space in decentralised healthcare organisations. Searches were performed in PubMed and CINAHL, complemented by snowballing. The review followed PRISMA-ScR guidelines. Data were analysed using a conceptual synthesis approach informed by paradox theory and the decision space framework. Four interrelated themes were identified: (1) delegated authority and experienced autonomy, (2) the role of organisational capacity in enabling decision space, (3) persistent central coordination within decentralised systems, and (4) autonomy dependent on coordination. The findings show that while decentralisation expands formal decision-making authority, the effective exercise of this authority depends on centrally coordinated enabling systems, including digital infrastructure, administrative support, and financial management. This interdependence reflects a consistent pattern across contexts. The study proposes the concept of a centralisation paradox, demonstrating that managerial autonomy in decentralised healthcare governance is contingent upon central coordination. By extending the decision space model, the study proposes a dual-domain conceptualisation distinguishing between professional decision-making and enabling systems. This reframing advances theoretical understanding of decentralised governance and offers practical insights for designing healthcare organisations that balance local autonomy with system-wide coordination.

People with mobility impairments such as stroke survivors or people with spinal cord injury (SCI) receive ambulatory healthcare from several healthcare providers. The coordination of these providers is challenging because there are usually no team meetings or shared treatment protocols. To gain insights into the coordinative processes of ambulatory care, the information transfer between providers was explored. A cross-sectional network study was conducted in an urban community in the south-west of Germany. First, an exploratory internet search for local providers was conducted. Then, providers were asked to distribute a survey to their patients (stroke, SCI) to identify the provider network. This was followed by a survey of the providers named by the surveyed patients. Network analysis was applied to explore connections and network characteristics (density, centrality). Based on the patient survey (n&#x2009;=&#x2009;22), a total of 58 healthcare providers in the community were identified, 20 of whom took part in the provider survey. In the network identified, physiotherapists, general practitioners, occupational therapists, orthopaedic technicians, neurologists, speech therapists and neuropsychologists were connected by 251 ties. The network had a density of 0.152 and a centrality of 0.442. Inter-organizational information sharing was only mentioned for 12 connections between healthcare providers. Care coordination in the community was rated as medium. Network analysis provided insight into a local network of healthcare providers. The network is dominated by a few providers and all providers have a low degree of connectivity. This study found that sharing of patient's information between providers is rarely implemented.

Strong opioids are central to effective symptom control in palliative care. In cases of complex symptom burden, primary care teams frequently rely on palliative care consultation services (PCCSs) for expert guidance. This survey explored the recommendations issued by hospital-based PCCS teams regarding the use of strong opioids in patients with advanced disease (e.g. clinical indications, opioid agent). A closed online survey was conducted via the SoSci Survey platform. All PCCS teams registered with the German Association for Palliative Medicine were invited to participate in November 2024, with a reminder sent three weeks later. Thirty-nine PCCS teams participated (21 university hospitals, 18 general hospitals). All respondents agreed on the indication for strong opioids in cancer-related pain and dyspnea. Differences emerged regarding the use of opioids in patients with non-malignant conditions: although most PCCS considered opioids appropriate for dyspnea associated with pulmonary (n&#x2009;=&#x2009;37) or cardiac disease (n&#x2009;=&#x2009;33), non-cancer pain was less consistently endorsed (n&#x2009;=&#x2009;20). Hydromorphone and morphine were the most commonly used opioids (>&#x2009;30 services reporting frequent use), whereas the use of fentanyl, oxycodone, and buprenorphine varied widely across services. There is consensus regarding the use of opioids in patients with cancer-related pain and dyspnea. The differing approaches to their use for symptoms caused by non-malignant conditions suggest varying clinical interpretations and underscore the need for further research and clearer guidelines.

The COVID-19 pandemic has affected health services around the world. As a result, the control of endemic infectious diseases has been significantly hampered. This study aimed to quantify the impact of the COVID-19 pandemic on quality indicators of leprosy services in Brazil in 2020 and 2021. This is an ecological study with 3 indicators: 1- Proportion of new leprosy cases with degree of physical disability assessed at diagnosis; 2- Proportion of contacts of new cases examined; 3- Proportion of leprosy cured among new cases. The period from 2015 to 2019 was considered pre-pandemic for the purpose of calculating the minimum expected for the pandemic years (2020 and 2021). To determine the impact, the percentage of variation was used, taking into account the values of the indicators expected for 2020 and 2021, using the average of the last five years, and the values observed in the same years. The impact was quantified as a percentage. Brazil's performance in the three indicators analyzed was considered regular (between &#x2265;&#x2009;75% and 89.9%), both in the pre-pandemic period and in the first two years. In the assessment of the degree of physical disability, the number of countries with a proportion greater than 90% decreased from 11 (expected value) to 7 (in 2020) and 9 (in 2021). In the evaluation of contacts, four states were expected to achieve the target (>&#x2009;90%), but only three achieved the indicator in 2020 and one in 2021 (Tocantins). As for the cure rate, four states were expected to achieve values above 90%, but only three did so in 2020 and two in 2021. The study showed a negative impact on the quality indicators of leprosy services in Brazil, which was more pronounced in 2021 (for contact examination and cure indicators) than in 2020, making it even more difficult to control the disease in the country.

Oral lesions are frequent complications of Human Immunodeficiency Virus (HIV) infection, particularly among individuals with advanced immunosuppression. These lesions reduce quality of life and increase vulnerability to secondary infections. This study assessed knowledge, risk factors, and healthcare-seeking behavior related to oral lesions among HIV enrollees in Osun State, Nigeria. A descriptive cross-sectional study was conducted among 180 HIV-positive adults with clinically confirmed oral lesions attending selected Antiretroviral Therapy (ART) clinics in Osun State, Nigeria. Participants were recruited from three selected ART clinics using complete enumeration. Data were collected using a structured interviewer-administered questionnaire and analysed using SPSS version 20. Descriptive statistics and appropriate bivariate tests were used, with statistical significance set at p&#x2009;<&#x2009;0.05. Participants were mostly male (51.7%) and Yoruba (74.4%). Only 56.1% had good knowledge of oral lesions. Common risk factors included poor oral hygiene (56.1%), alcohol use (31.7%), and ART non-adherence. Healthcare-seeking within two weeks of symptoms was low (26.7%). Religion, education, and occupation were significantly associated with care-seeking. Poor oral hygiene and low CD4 counts were significant predictors of oral lesions. Knowledge and prompt care-seeking for oral lesions remain inadequate among HIV enrollees. Integrating oral health education, routine screening, and dental care into HIV treatment services is essential to improve outcomes in this population.

Multidisciplinary collaboration between traumatologists and geriatricians has gained international recognition for improving outcomes for older patients after fragility fractures through various models of care delivery. To inform decisions about harmonizing existing models, a deeper understanding of their delivery and impact on patient-relevant and health-economic outcomes is needed. We analyzed health insurance claims data from patients aged&#x2009;&#x2265;&#x2009;80 years hospitalized with hip fractures between 2014 and 2019 at 121 certified German orthogeriatric centers. We defined hospital-level orthogeriatric care models by the geriatricians' integration into the surgical wards (geriatric consult service (GCS) vs. integrated care model (ICM)), their weekly patient visit frequency in hospitals with GCS (>&#x2009;2 (high) vs. 2 (low)), and the network structure between hospitals (single-site institution vs. multisite network cooperation). Outcomes included survival time, direct inpatient medical costs, length of stay (LOS), delivery of early complex geriatric rehabilitation (EGR), and transfer patterns. The four care models observed in [Formula: see text] hospitals were low-frequency GCS (26 hospitals, 1479 patients), high-frequency GCS (46 hospitals, 3451 patients), hospital networks (42 hospitals, 1832 patients), and ICM (7 hospitals, 457 patients). Covariate-adjusted death hazards revealed the lowest 30-day hazard in ICM hospitals and the lowest 30-to-180-day hazard in hospital networks. Statistically significant differences were found when comparing these hazards with those in low-frequency GCS hospitals, showing respective reductions of 28% and 20%. Although the care models involved different individual treatment paths, such as varying timings and rates of EGR or transfers to external wards or subacute facilities, their overall costs remained similar. Our findings indicate that health outcomes in orthogeriatric care models depend not only on the availability of geriatricians but also on the extent of their involvement in patient management, whereas mean costs were similar across all models.

The capability of healthcare organizations to provide high-quality care is in part determined by their workers' ability to adapt to a complex and uncertain environment. Since healthcare operations are often highly standardized and bureaucratized, adapting and responding to internal and external changes is no small feat. This study investigates these tensions as determinants of individual agility. Using survey data collected from 2,173 Canadian nurses along with structural equation modelling, the study assesses a hypothetical model to understand how process standardization and administrative burden influence individual agility and, in turn, the quality of care provided to patients. The results show that the quality of care provided by nurses to their patients is increased by their internal and external individual agility. These, in turn, are positively influenced by process standardization but inhibited by administrative burden. This study extends current literature on the microfoundations of agility in healthcare by providing theoretical and practical contributions on the impact of enabling and coercive bureaucracy.

Africa is entering a new era of cancer research, driven by renewed commitments to genomic innovation, data equity, and strengthened cancer registry systems. The "Harnessing Functional Genomics in Cancer Research: Opportunities for Diagnosis and Treatment" conference, held in Windhoek, Namibia, from 23 to 26 September 2025, convened leading experts to evaluate current progress and identify priorities for advancing cancer genomics and precision oncology across the continent. This conference synthesis report and narrative review drew on four days of expert-led presentations, interactive panel discussions, and structured delegate engagement sessions. Conference proceedings were documented through session minutes, presenter slide decks, recorded discussions, and post-conference feedback. Perspectives from more than 160 participants representing 21 countries were synthesized into priority thematic areas through an iterative drafting and multi-author review process. Conference findings were integrated with supporting peer-reviewed and grey literature to identify opportunities, challenges, and strategic priorities for advancing precision oncology in Africa. Discussions highlighted Africa's unparalleled human genomic diversity and its continued underrepresentation in global genomic datasets, emphasizing the need for African-led genomic discovery and precision oncology strategies. Key priorities included strengthening cancer registries and surveillance systems, expanding genomic infrastructure and workforce capacity, establishing ethical and sovereign data-governance frameworks, and improving the translation of genomic discoveries into clinical practice. Next-generation sequencing, multi-omics approaches, artificial intelligence, and collaborative research networks were identified as important enablers of equitable and sustainable precision oncology implementation across Africa. Africa's genetic diversity represents a critical resource for advancing precision oncology. Conference insights, supported by the literature, underscore the need for coordinated investments in genomic infrastructure, cancer surveillance systems, workforce development, ethical data governance, and translational implementation. Advancing these priorities will strengthen genomics-informed cancer prevention, diagnosis, and treatment while positioning Africa as an increasingly important contributor to global oncology innovation.

The Safe Medication Dashboard (known as SMASH), an intervention to reduce hazardous prescribing in general practice through a pharmacist-led intervention and web-based dashboard, was piloted in 2017. A rollout of SMASH by the regional health innovation network was funded in 2019. A longitudinal qualitative evaluation of the regional implementation effort was conducted over three years, including in-depth semi-structured interviews with relevant stakeholders (n&#x2009;=&#x2009;18), non-participant observations (n&#x2009;=&#x2009;42), and documentary analysis. Assumptions about the replicability and complexity of the intervention led to an implementation strategy and pace that were misaligned. The implementation of SMASH suffered from delays, diversions, and disruptions due to unanticipated infrastructure needs, regulatory changes in data sharing, and the health systems' response to the COVID-19 pandemic. The findings will be discussed alongside relevant implementation frameworks to highlight how interdependencies between wider policies, organisations, and technologies can significantly shape the trajectories and pace of implementation efforts.