The benefits of computational forecasting in the later phase of the COVID-19 pandemic when vaccines and clinical pharmaceutical interventions were available have seldom been assessed. We aimed to evaluate computational forecasting research applied to Swedish populations in the vaccination phase of the pandemic. A systematic search was performed on March 8, 2024 in the electronic databases PubMed, Scopus, Cochrane library, Embase, Love platform and Epistemikos. An updated version of the Risk of bias Opinion Tool (ROBOT) was used to assess the quality of evidence reported in the papers identified in the search. The articles fulfilling the quality criteria were assessed for suitability for meta-analysis. Data were extracted from the selected articles for synthesis of characteristics, and a thematic analysis was used for a qualitative synthesis of the contents. Of 2034 unique publications identified in the database search, 6 articles satisfied the selection and quality criteria. Variability in the reporting of forecasting performance results was found to make a quantitative meta-analysis of forecast performance infeasible. The data synthesis showed that statistical modeling using Bayesian calibration was the most common methodological approach. No external model validation was reported, but 5/6 articles included internal model corroboration data. The primary theme resulting from the qualitative synthesis of article content was design or refinement of computational models with demonstration of model use in health service practice as a secondary theme. None of the articles referred to health service policymaking as the primary research context. Computational forecasting research using Swedish population data from the vaccination phase of the COVID-19 pandemic was deployed in a model design context. While methodological knowledge was developed, most of the research was not initiated to solve the public health and healthcare problems at hand. Our results indicate that the alignment between computational forecasting research and policymaking needs in the vaccination phase of pandemics can be enhanced.
In Sub-Saharan Africa, maternal health remains a significant public health challenge, and women with disabilities (WWD) experience profound inequities in access to essential healthcare services. In Mozambique, although national strategies promote disability inclusion, systemic and structural barriers continue to undermine equitable access to maternal health services. This study explores the intersection of maternal health and disability inclusion in Mozambique, identifying barriers faced by women with disabilities and opportunities to improve service accessibility and quality. A mixed-methods design was employed, integrating a desk review with stakeholder consultations and an interactive workshop. The desk review examined national policies and relevant literature on maternal health and disability inclusion in Mozambique. Stakeholder consultations were conducted via surveys across multiple regions, engaging WWD, healthcare providers, policymakers, and disability advocates. Key findings were validated and refined through participatory workshops involving diverse stakeholders. Quantitative data were analysed descriptively, while qualitative responses were thematically analysed. The study found that women with disabilities in Mozambique face multifaceted barriers to maternal health, including inaccessible infrastructure, lack of adapted medical equipment, financial constraints, inadequate provider training, communication gaps and stigmatizing attitudes. Among 81 surveyed participants, over 80% reported physical and communication barriers as major obstacles, while 62% reported attitudinal barriers. Although some participants noted the existence of policies such as the National Action Plan for Disability and the Strategy for People with Disabilities in Public Services, their implementation was widely perceived as ineffective or insufficient in improving maternal health service accessibility for women with disabilities. Disability inclusion within Mozambique's maternal health system remains limited, with policy commitments insufficiently translated into practice. Achieving equitable and inclusive maternal healthcare for women with disabilities in Mozambique requires sustained investment in accessible infrastructure, provider training, community engagement, and effective accountability mechanisms. Addressing these systemic barriers is critical to improving maternal health outcomes and advancing health equity for all women in Mozambique.
Accessibility to healthcare is a fundamental human right aimed at facilitating better health outcomes for people with disabilities. However, the persistent gap between policy intents and actual implementation results in poorer health outcomes for people with disabilities, which is against universal health coverage. This study explored policymakers' perspectives on barriers to accessibility to healthcare services for people with disabilities. Through purposive sampling, qualitative, descriptive, exploratory research was conducted among five policymakers in a rural constituency. Each participant signed an informed consent form. The face-to-face interview lasted 50-60 min and used validated semi-structured questions, audio recordings, and memos to capture data. Manual coding, employing an inductive approach and categorisation, was conducted, resulting in the formulation of themes. Two main themes emerged: Systemic and structural challenges to inclusive healthcare, and training and attitudinal barriers to inclusive healthcare, highlighting transport and infrastructure barriers, as well as insufficient budget because of ineffective health policy implementation. A lack of training and discrimination were key issues reported. This study highlighted key obstacles related to weak policy enforcement, inadequate infrastructure, stigma, and funding issues, which impede accessibility to health services for people with disabilities in Namibia. Understanding how policies are translated into practice is crucial for closing implementation gaps and enhancing healthcare access for people with disabilities.
Expectations of integrating health and social care providers have driven the development of digital solutions aimed at overcoming interoperability challenges and ensuring access to information needed for integrated care across fragmented services. However, challenges persist in aligning diverse coding practices, heterogeneous data-sharing mechanisms, and stakeholder needs. We examine how expectations of interoperability and integrated care have shaped the growth of regional information infrastructures in Scotland, using the Key Information Summary (KIS), a summary record that shares key patient information from general practitioner records with out-of-hour services, ambulance services, hospitals, social workers, and caregivers across multiple care settings, as a case study. This qualitative study examined the development, implementation, and adoption of KIS in Lothian, Scotland, across health and care settings, where it has been in use for 13 years. Multisited ethnography was used to understand how technology design, implementation, and adoption were shaped by social, organizational, cultural, and political factors. Data were collected through interviews with users, vendors, and implementers; observations of technology use and multidisciplinary team meetings; and documentary analysis of policies, user guides, and internal reports. A hybrid analytical approach was applied: the Technology, People, Organization, and Macroenvironment framework guided initial coding, while the sociology of expectations and information infrastructure theory were used inductively to trace evolving visions of integration, and the long-term development of regional information infrastructure. Data included 54 qualitative interviews, 20 hours of observation, and 59 documents collected between April 2024 and March 2025. Findings illustrate how information infrastructures for integrating health and care providers evolved through successive concerted efforts, conceptualized as waves. Three waves were identified, each characterized by attempts to interlink disparate information systems used by various health and care providers. The first wave focused on linking health care providers by developing networks and architectures required for sharing clinical information, which later supported the development and sharing of KIS. Subsequent waves sought to interlink information systems used by health care providers with those used by local authorities and social care providers. In the absence of shared data standards across these sectors, interoperability was achieved by extending the existing health care-centric infrastructure to different social care settings through workarounds such as providing proxy access to hospital systems and secure emailing networks. This work illustrates how regional information infrastructures for integrated care evolve through orchestrated waves of change. Some expectations for change required coordinated, system-level action, such as setting up standards, networks, and architecture, while others were realized through local adaptations. Integrating health and care providers through digitalization is a long-term process requiring sustained coordination, with progress often occurring through incremental, local extensions. Policies must support adaptive, long-term coordination, balancing system-level initiatives with local adaptations to achieve meaningful integration.
Financing emergency healthcare remains a major challenge for households worldwide considering the issue of uncertain income levels and increasing healthcare costs. Financial limitations may result in delayed use of healthcare services. Saudi Vision 2030 emphasizes the need for enhancing financial inclusion alongside healthcare delivery. However, little research done on financial inclusion impacts on household access to emergency healthcare financing. This study uses a panel dataset comprising 13 regions within Saudi Arabia spanning from 2015 to 2023 (117 observations). We use the fixed effects approach, system GMM model, and the panel ARDL model. Indicators of financial inclusion comprise formal finance, digital financial services, and savings indicators while controls are income stability and healthcare infrastructure. Financial inclusion increases household access to emergency healthcare financing both in short run and long run. Digital finance and savings are strong predictors of emergency healthcare finance capacity (FI=0.287, p<0.001). Income stability and healthcare infrastructure reinforce the effect of financial inclusion. The error correction measure indicates that convergence to equilibrium happens rapidly (-0.412, p<0.001). Improvement of financial inclusion via adoption of digital financial services and savings can enable households to deal with health emergencies effectively. Access to finance in combination with income stability and health infrastructure development is essential in ensuring that health financing is sustainable in Saudi Arabia. The above findings have significant policy recommendations concerning financial-sector reform and health system resilience in line with Vision 2030. G21; I13; I18; O16; O53.
The longitudinal relationship between school absence and mental health has important policy implications; if school absence predicts later mental health problems, it could be used to identify young people at increased risk and enable further assessment, prevention, and early intervention. We analysed an existing data linkage between the National Pupil Database and healthcare records representing a sample of 47,926 young people aged 11-15 in the UK. We used logistic regression to examine the longitudinal association between persistent school absence (defined by the Government Department for Education in England as missing more than 10% of available school sessions) and later contact with secondary care mental health services. We also compared the sensitivity and positive predictive value of the >10% absence threshold to alternative thresholds for predicting adverse mental health outcomes. At the currently applied threshold of >10%, persistent school absence was associated with 2.77 (95% CI 2.33-3.30, girls) and 1.58 (95% CI 1.29-1.95, boys) times the odds of accepted referral to secondary care mental health services in the following year, after adjustment for sociodemographic and educational factors. The absolute risk difference for girls was 4.7% (95% CI 3.9-5.4) and for boys, 2.8% (95% CI 2.1-3.4). Compared to other thresholds, the >10% absence threshold provided a good balance between sensitivity (40.5%), positive predictive value (5.5%), and identifying a manageable proportion of young people as high risk (18%). The longitudinal relationship between school absence and later secondary care mental health service contact suggests that school absence may be a useful marker for educators to identify children in need of support. The >10% absence threshold used in education policy in England may also serve as a useful marker of later mental health risk in other national policy contexts.
Early childhood caries (ECC) remains one of the most prevalent chronic diseases affecting children worldwide and represents a major public health challenge in many African settings. Understanding its determinants is essential for developing oral health promotion strategies and preventive policies aimed at improving child oral health and reducing inequalities. This umbrella review followed PRISMA guidelines and was registered in PROSPERO (CRD420261379153). Systematic reviews and meta-analyses published between January 2000 and May 2026 were identified through searches of MEDLINE, Scopus, Web of Science, and Embase. Methodological quality was assessed using AMSTAR 2, risk of bias using ROBIS, overlap using a citation matrix and corrected covered area (CCA), and certainty of evidence using a narrative GRADE approach. Findings were synthesized narratively. Seven systematic reviews and meta-analyses were included. Methodological quality ranged from high to critically low, while ROBIS identified predominantly low overall risk of bias, although two reviews were judged to be at high risk of bias. The corrected covered area (CCA) was 4.7%, indicating a low degree of overlap among reviews. ECC prevalence ranged from 17% to 57%, with higher estimates reported in North and Southern Africa. The most consistently reported determinants were dietary, oral hygiene-related, sociodemographic, and breastfeeding and bottle-feeding-related factors, whereas maternal/caregiver-related, biological, health-related, and contextual determinants were supported by a smaller body of evidence. Certainty of evidence was moderate for ECC prevalence and the most consistently reported determinants, but low for maternal/caregiver-related, health-related, biological, and contextual determinants. These findings support evidence-informed oral health promotion and prevention strategies across African settings. ECC remains a substantial oral health burden in Africa and is influenced by interacting behavioral, sociodemographic, caregiver-related, biological, health-related, and healthcare access determinants. Comprehensive oral health promotion strategies should strengthen caregiver education, support healthy dietary and oral hygiene behaviors, improve access to preventive services, and integrate oral health into maternal and child health programs. Such approaches may help reduce ECC burden and oral health inequalities among vulnerable populations. PROSPERO, identifier CRD420261379153, http://www.crd.york.ac.uk/PROSPERO/view/CRD420261379153.
Iran has an extensive governmental network of primary health care facilities and hospitals. In 2019, the integration of asthma-related services into this network was designed and pilot-tested. Primary health care providers (PHCPs) and family physicians (FPs) are the main members of the care provision team and are responsible for case identification and management. The pilot was conducted from November 2019 through April 2020 in seven areas-Kerman, Maragheh, Ahvaz, Kashan, Urmia, Karun, and Qazvin-covering both urban and rural locations and a population of approximately one million people. Our objective was to report indicators related to the integration of asthma identification, referral, and management within the existing primary health care system. In total, 350,894 individuals were screened for asthma by PHCPs. The observed proportion of positive (probable) cases among those screened was 2.48%. Key process indicators included screening uptake (34%), attendance of referred cases at physician visits (83%), and follow-up adherence (49% of confirmed cases). We conclude that improving screening uptake and the accuracy of asthma case detection by PHCPs are the most effective strategies for enhancing care provision efficiency. The findings of the pilot project have significant implications for understanding efficient integration of asthma-related services. The results indicate that integrating asthma care into primary health services is feasible and can improve early detection and care coordination, informing policy decisions for broader implementation and resource planning.
BackgroundIt is unclear what the consequences would be if nurses were unwilling to provide care services that require sacrifice during times of crisis. However, identifying nurses' experiences of care involving sacrifice in these situations is crucial for improving nurses' well-being and, consequently, the quality of patient care.AimTo describe the altruistic experiences of nurses affected by the earthquake centered in Kahramanmaraş, recorded as the disaster of the century in Turkey.DesignQualitative research design, phenomenological type.MethodsThe research was conducted between November 2023 and October 2024 with 17 nurses who worked in the 6 February 2023 earthquake, following institutional permission and ethics committee approval. Data were collected using face-to-face semi-structured interview method. Phenomenological analysis was used to analyze data. Ethical considerationsApproval was obtained from the institutional (E-12472141-604.01-235032340) and ethics review boards (E-13562490-050.01.04-436203), and informed consent was obtained from the participants.ResultsThe majority of participants were female and had a bachelor's degree. The average years of experience in profession was 7.82 and 94.12% worked in a hospital that was damaged by earthquake. Four main themes were identified, comprising 20 sub-themes reflecting altruistic experiences of nurses providing care to earthquake victims: (i) The lifesaving mission; (ii) The light of altruistic care; (iii) The weight of altruistic care; and (iv) Balancing acts: the challenge of professional and personal life.ConclusionStudy results highlight the experiences of nurses providing altruistic care after earthquake, revealing natural burdens and benefits that come with their professional commitment.Implications in practiceDeveloping nurses' disaster preparedness, resilience, and psychosocial support is essential for strengthening nursing services in future crises. Comprehensive policies and disaster nursing programs are needed to ensure safe work environments and sustainable healthcare systems. Understanding these phenomena requires a comprehensive examination of the psychological and practical consequences of such commitment, which necessitates further research.
Adolescence is a critical developmental stage characterized by significant physical, emotional, and cognitive changes, including sexual maturation. However, this population group faces challenges such as early sexual initiation, limited contraceptive access, high sexually transmitted infection risks, including HIV (with 43% of new HIV infections in Tanzania occurring among youth, with higher rates found among young women), and unintended pregnancies, negative outcomes of limited access to sexual and reproductive health (SRH) information and services. Social, cultural, and policy constraints restrict access to SRH services, highlighting the need to understand adolescents' preferences to improve accessibility and health outcomes. The study aimed to explore the preferences for accessing sexual and reproductive health information and services among adolescent girls and young women (AGYW) in higher learning institutions in Tanzania. This qualitative descriptive study was conducted at two universities in Dodoma, Tanzania. Purposive sampling recruited 13 sexually active students aged 19-24. Data were collected through in-depth interviews conducted in Swahili, audio-recorded, and transcribed verbatim. Data saturation was reached at the 13th interview. Young women reported different preferences for accessing sexual and reproductive health (SRH) information and services. They accessed SRH information through community, media, and healthcare-based sources. Family members,(particularly sisters)and friends, were key information sources, though parental reluctance limited access. Social media and search engines provided privacy but raised concerns about misinformation. Healthcare facilities were perceived as reliable yet unwelcoming, leading many participants to prefer over-the-counter services. Participants advocated for reliable online platforms to enhance the accessibility and accuracy of SRH information. This study highlights AGYW's preferences for accessing SRH information, emphasizing digital platforms and peer education. Strengthening these approaches while improving the youth-friendliness of healthcare settings is essential for improving SRH outcomes among this population.
Brazil is home to 50 million children and adolescents, whose mental health needs require context-sensitive research. Although scientific output is growing in the country, publications remain scattered and often inaccessible. This systematic review compiles prevalence estimates, assessment instruments and interventions for child and adolescent mental health-related outcomes in Brazil (PROSPERO: CRD42023491393). We searched international (PubMed, Web of Science, PsycINFO, Google Scholar) and regional (Scielo, Lilacs, Brazilian Digital Library of Theses and Dissertations) databases up to July 2024. We consulted reference lists and experts. Extraction followed Consensus-based Standards for the selection of health Measurement Instruments and Cochrane manuals. We included 734 studies on 2576 prevalence estimates, 908 studies on 912 instruments and 192 studies on 173 intervention trials. The prevalence of any mental disorder ranged from 10.8% (12-year-olds; Pelotas, RS) to 19.9% (ages 7-14; Porto Alegre, RS and São Paulo, SP) although a nationally representative study is lacking. There is an alarming rise in self-harm notifications, reaching 133 in 2019 (per 100 000 aged 10-19). Indigenous youth face suicide rates of 11 (ages 10-14), far exceeding national numbers (0.652). Nationwide surveys reveal severe violence exposure (eg, 21% of adolescents suffer physical violence at home in the previous year), disproportionately impacting Black youth and increasing risk for mental disorders. There are reliable instruments for assessing psychopathology, yet most lack cross-cultural validation. Interventions remain underimplemented. The largest trials adapted substance-use prevention programmes from high-income countries, proving ineffective in Brazil. Public investment is the primary driver of research, which is centralised in wealthier states and misrepresents social minorities. This review provides timely access to appraised evidence-based resources, facilitating uptake into practice. Brazil's historical sociocultural challenges impact youth mental health, with public health priorities including systemic violence, racism and indigenous suicide.
Psilocybin is a federally illegal psychedelic substance that carries positive (e.g., treatment for mood disorders) and negative (e.g., emotional distress) consequences. In 2020, Oregon legalized psilocybin for adult use (21+) at the state level, restricted to designated service centers. In Fall 2024 and Spring 2026, we summarized and compared Oregon's legal/regulatory psilocybin context and highlighted public health considerations. We found there are no limits on the number of licenses that can be issued, and there are mandated trainings to obtain facilitator licensure (e.g., 120/128 hours of instruction in 2024/2026, requiring a test score of 75% [unlimited number of testing attempts]). Regulations specify manufacturing rules, including allowable ingredients and testing for contaminants and concentration. One serving includes 25mg of psilocybin analyte; two servings per person are allowed. Labeling guidelines are provided (e.g., safety warnings and no youth-oriented wording). We identified the presence of psilocybin-related websites that were not age-gated. We found pricing information related to administration ($15-$3,500/person) and facilitator training ($3,000-$14,175). Given the inability to limit the number of psilocybin licensees, the number of service centers is likely to increase. Since Oregon psilocybin services do not license training programs, and given the unlimited number of testing attempts allowed, there may be issues ensuring individuals have adequately acquired the necessary knowledge. Longitudinal research is needed to assess the health impact of these programs and the long-term impacts of psilocybin use.
National policies have been introduced to promote the delivery of Culturally Safe dental care for Aboriginal and Torres Strait Islander Australians. However, the understanding of what constitutes Culturally Safe dental care and how it can be effectively implemented into clinical practice, remains limited. This study aimed to gain a deeper understanding of Culturally Safe oral health care through collaboration with Aboriginal people residing in regional Victoria. A Community-Based Participatory Research (CBPR) approach was utilised between the study team and a Victorian Aboriginal Community Controlled Health Service to design the study and develop yarning prompts. Following engagement, 40 individuals from the Victorian Aboriginal community participated in yarning groups that were audio recorded. Discussions were guided by a researcher who, through clinical work, had community familiarity. Following transcription and de-identification, the data were thematically analysed utilising a constructivist grounded theory approach. The data analysis revealed 13 themes that were categorised according to Ramsden's foundational work with Cultural Safety domains: Holistic care (physical, mental, social, spiritual), power (clinical interactions, agency, overseas-trained practitioners, vulnerable space and sense of belonging), access to services (cost and time) and trust (trust building and historical distrust). These themes discuss significant barriers to achieving Culturally Safe oral health care for Aboriginal Australians in regional Victoria. These are influenced by structural issues like limited oral health funding, deficit narratives and a limited Aboriginal dental workforce. Culturally Safe oral health care is a dynamic, relational practice that is embedded in Aboriginal worldviews. Achieving it requires structural reform, trust-based relationships and communication that empowers to ensure oral health is addressed holistically. These findings will help inform future policy, education and service delivery initiatives grounded in Aboriginal knowledge systems.
Sustainable Development Goal 3 (SDG 3) emphasizes universal access to high-quality healthcare services as a cornerstone of global health improvement. Although access to care has expanded in many low- and middle-income countries, including Ghana, healthcare service quality (HSQ) and patient satisfaction (PS) remain uneven, particularly within tertiary hospitals. This study assessed PS and determinants of HSQ in Ghanaian tertiary hospitals using the RATER model. A multi-center cross-sectional survey was conducted among patients attending five tertiary hospitals in Ghana that were operational prior to the inception of SDG 3. PS was measured using the Client Satisfaction Questionnaire (CSQ-8), while HSQ was assessed using the RATER dimensions of SERVQUAL. Of the 354 participants targeted, 297 were enrolled with a response rate of 83.9%. Data were collected electronically using REDCap. Group differences, associations, and predictors of PS were examined using appropriate non-parametric tests and multivariable regression models. All analyses were performed using SPSS and R software. The mean age of participants was 38.96 ± 15.19 years (range: 18-75), and 65.7% were female. Overall PS was high with a mean score of 3.56 ± 0.41. All RATER gap dimensions were strongly intercorrelated (ρ= 0.62-0.80) and demonstrated moderate-to-strong positive associations with PS (ρ=0.50-0.59). Demographic characteristics were not significantly associated with satisfaction. However, monthly income predicted satisfaction, with low-income participants reporting higher satisfaction than those with no income. Institutional differences in unadjusted satisfaction were observed, with the highest satisfaction among patients attending Tamale and Komfo Anokye Teaching Hospitals, although these differences attenuated after multivariable adjustment. Among HSQ dimensions, reliability showed the strongest association with PS. Patient satisfaction in Ghana's tertiary hospitals is driven more by structural and socioeconomic conditions, institutional performance and perceived service reliability than by demographic characteristics. Strengthening reliability in service delivery and reducing inter-hospital disparities are critical for advancing patient-centered care and achieving SDG 3.
Housing is a key social determinant of health, yet little is known about how homelessness shapes migrants' health in Nordic welfare states where legal status, labour market attachment and welfare entitlements are unevenly distributed. This article examines how homelessness affects the physical and mental health of migrants, and how structural barriers limit their capacity to navigate access to health care. Exploratory mixed-methods study combining registry data on shelter use in Oslo (2019-2023) and interviews with ten frontline health and social care staff at a long-term, NGO-run shelter. Analyses were informed by precarious citizenship and structural vulnerability. Homeless migrants represented a heterogeneous group in terms of citizenship status and health problems. Migrants' region of origin influenced their resident status, the uncertainty of their situation, and the duration of their stay. Homelessness interacted with migrants' pre-existing vulnerabilities, such as precarious legal and economic status, language barriers, limited access to public services, and untreated chronic disease, to accelerate health decline. Precarious citizenship can be enacted through gendered arenas of exploitation, with consequences for safety, access to care and possibilities for recovery. Homelessness among migrants reflects structural vulnerability and contributes to cumulative disadvantage. Homelessness is not simply a backdrop to migrant ill-health; it is an active health risk that exacerbates disease, disrupts treatment, and limits recovery. Shelters and low-threshold services play a crucial bridging role by enabling access to treatment and rehabilitation. Addressing migrant health inequities requires rights-based approaches and integrated policies linking housing stability and health care access.
Many people presenting to emergency departments after self-harm do not receive adequate care, even in well-resourced health systems. To identify patterns of health care service use across two periods: (a) during and (b) up to 1 year after an index emergency department self-harm presentation. A retrospective population-based cohort study including 4668 individuals aged ≥9 years who presented to the Royal Melbourne Hospital emergency department for self-harm between January 2012 and December 2019. Linked administrative data captured >1.3 million records across primary care, pharmacy, specialist mental and physical health services and emergency departments. Sequential pattern mining identified longitudinal service-use clusters. Multinomial regression explored associations with demographic, clinical, psychosocial and presentation characteristics. Cox proportional hazards models assessed associations between clusters and all-cause and suicide mortality. Emergency department self-harm presentations triggered short-term increases in multi-sector contacts. However, most (68.7%) reverted to the same service-use cluster observed prior to their index presentation. Suicide risk was highest within 1 year, particularly among those in the specialist mental health services cluster (4.5% of the cohort). A small subgroup engage intensively with specialist mental health services yet remain at high suicide risk, while one in ten remain disengaged altogether, suggesting that an acute presentation of self-harm often fails to alter patients' care trajectories long-term. Policy alignment with national recommendations for integrated, community-based care could improve sustained, evidence-based support beyond acute crises.
Parenting children with autism spectrum disorder (ASD) significantly affects mothers' quality of life (QoL) throughout their lifespan. However, research specifically examining the QoL of mothers in the West Bank (WB) who have children with ASD is limited. This study aimed to assess the QoL of mothers raising children with ASD in the WB, and examine the factors associated with their QoL. This cross-sectional study included 119 mothers of children aged 4-12 diagnosed with ASD. Participants were purposively recruited through rehabilitation centers. Data collection took place from May to August 2024 using WHOQOL-BREF tool, a validated self-administered questionnaire designed to assess overall QoL and its four dimensions: physical, psychological, social, and environmental. Statistical analysis was used to analyze the data and identify factors associated with QoL. The findings indicated moderate overall QoL (M = 2.85), with the environmental domain scoring the lowest (mean = 2.64), followed by psychological (mean = 2.77) and social domains (mean = 2.99), while the physical dimension scored highest (mean = 3.01). Factors signifi-cantly associated with QoL included mother's age, educational level, family income, and sleep duration. This study provides valuable in-sights into the QoL of mothers raising children with ASD in the WB. The findings highlight the critical need comprehensive policy interventions, including mental health support, socioeconomic assistance, and tailored services to improve the mother's QoL. Policymakers and healthcare providers should prioritize these strategies. Further research should focus on policies that improve the environmental conditions and psychological well-being of these mothers in Palestine.
We sought to understand how hospitalized older adults describe their goals for hospital care. Eliciting patient healthcare goals is the first domain of the Center for Medicare and Medicaid Services' Age Friendly Hospital measure. Heart failure, a leading cause of hospitalization and readmission in older adults, is an ideal condition for exploring how hospitalized patients articulate goals. We conducted qualitative interviews with 24 patients admitted for heart failure, using the Patient Priorities Care (PPC) framework to identify their goals for hospitalization and health outcome goals. PPC is a communication intervention that identifies patients' values and health outcome goals to guide shared decision-making. Patients' goals for hospitalization were clear and uniform: to feel better and go home. Values and health outcome goals centered on independence, social connection, and maintaining routines, which patients experienced as disconnected from recurrent hospitalizations that provided only short-term symptom relief. Patients articulated goals of hospitalization related to short-term symptom relief, but felt that over the longer term, hospital care was disconnected from their broader health priorities. When eliciting goals for hospitalization, clinicians should connect immediate treatment goals with patients' broader values and realistic health outcome goals through explicit discussion of prognosis and tradeoffs.
Blast overpressure (BOP) exposure is an important, evolving, and highly visible topic with growing operational, clinical, and policy relevance for the U.S. Armed Forces. Special Operations Forces (SOF) personnel are particularly vulnerable to repeated sub-concussive events from BOP because of their operational role and tempo, but conventional forces and other high-risk occupational groups may also experience meaningful cumulative exposures. Recent Congressional actions, including provisions in the National Defense Authorization Acts establishing blast safety oversight and standardized monitoring, underscore the urgency of improving BOP risk management, surveillance, and research. Although BOP-related brain injury may represent a distinct health condition, the lack of a pathognomonic diagnostic criterion often results in it being considered analogous to, or on the continuum of, mild traumatic brain injury (concussion). Diagnosing BOP-related injury and its sequelae remains a challenge, and consensus on an acceptable threshold for occupational BOP exposure has not yet been determined. Overlap in symptom presentation between BOP-related effects and concussion further complicates identification, clinical management, and longitudinal monitoring, particularly in the absence of validated diagnostic tools or BOP-specific clinical guidelines. Rehabilitation following concussion has increasingly focused on identifying clinical subtypes (vestibular, ocular-motor, cognitive, anxiety/mood, post-traumatic headache) and modifiers (sleep, cervical spine) to inform symptom-targeted treatments, guide specialty referral, and improve outcomes. This subtype-based approach has enhanced clinical decision-making in concussion care and provides a pragmatic framework for addressing heterogeneous symptom presentations. We propose extending this established concussion clinical subtype framework to guide future longitudinal research and management of BOP-related effects, leveraging symptom-based classification alongside exposure documentation and objective assessments. The purpose of this commentary is to outline a conceptual framework for the longitudinal study of BOP exposure and its potential effects, integrating baseline assessment, exposure monitoring, serial clinical evaluation, and emerging biomarkers to include advanced neuroimaging approaches. Adoption of a standardized, subtype-informed longitudinal approach has the potential to improve understanding of BOP-related effects, support return-to-duty and risk management decisions, and inform the development of evidence-based policies aimed at protecting brain health, optimizing performance, and enhancing readiness in military personnel.
Guidelines recommend implementing medication reconciliation (MR) at every healthcare transition. However, limited research has been conducted in outpatient clinics to explore whether MR affects the physicians' decisions. This study aims to evaluate the clinical impact of MR in these settings, specifically investigating whether MR leads to adjustments in treatment policies. The study also aims to assess the severity of potential harm avoided by these adjustments. A cross-sectional study was performed between 1 June 2019 to 18 April 2022 at Maastricht University Medical Center+, The Netherlands, involving 20 different outpatient clinics. All patients who had an appointment at one of the involved clinics were assessed for eligibility (n = 3,031). Pharmacy technicians obtained the best possible medication history (BPMH) through MR. The BPMH was shared with the physician after the patient's visit. The physician could adjust his initial treatment policy based on the new information provided with the BPMH. The physician scored the severity of these policy adjustments, using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index. The primary outcome was the proportion of patients with a policy adjustment. Secondary outcomes included the proportion of patients with potential severe harm and the physician's perceived value of the BMPH for possible future treatment. Descriptive data analysis was used. In total, 2,289 patients were included (mean age: 59, 47.6% male). MR in outpatient clinics resulted in treatment policy adjustments by physicians in 3.8% of patients, with physicians deeming 0.5% of all MRs necessary to prevent severe harm. Physicians considered the BPMH valuable for future treatment in 13.8% of patients. Routine medication reconciliation for all patients at every outpatient visit is not justified by this study. Future research should focus on identifying high-risk patient who would benefit most from MR in outpatient clinics.