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Challenging behaviour (CB) occurs frequently in nursing home residents with dementia. Up to now, little attention has been given to how to document CB in nurses' daily progress reports in a standardised way. The aim of the study was to gain deeper insight into the factors influencing nursing staff members in their reporting CB. We conducted fourteen semi-structured interviews in Dutch nursing homes with nursing staff members (EQF level 2-6) working in (highly specialised) geriatric units. Participant used a standardised method for reporting in the Electronic Patient Record. Thematic data analysis was conducted, based on the framework by Braun and Clarke. Quality criteria for conducting and reporting qualitative research were applied. Four themes influencing nurses reporting emerged from the data:1 Sense of Ownership, with varying perceptions of responsibilities, and resistance towards CB;2 Involvement of psychologists, with concerns about quality of plan of approach and, uncertainties in reading progress reports;3 Complexity of defining CB, including differences in interpretation and the normalisation of CB; and4 Complexity of reporting CB, affected by reporting skills, present-day challenges, and digital access to reports by relatives. This study highlights that reporting CB in dementia is complex, and its complexity appears underestimated. The results display several issues including the integration of CB as part of the nursing process, the ambiguous nature of the CB concept, the occurrence of ethical dilemmas, the perceived ownership of CB, and the need for interprofessional collaboration. Recommendations for each issue have been derived from this.

Deep learning models for medical image analysis require substantial computational resources, domain expertise, and curated datasets, making them valuable intellectual property. Protecting the ownership of such models is critical, yet existing watermarking techniques often compromise diagnostic accuracy or introduce visible artifacts that are unacceptable in clinical settings. In this paper, we propose a stealthy watermarking framework specifically designed for medical AI models. Our approach utilizes a spatial patch trigger mechanism that mimics natural imaging phenomena commonly observed in dermoscopic images, combined with a two-stage training strategy that decouples feature learning from watermark embedding. The first stage trains the model on clean data to establish robust feature representations, while the second stage jointly optimizes for the primary classification task and watermark embedding with partial network freezing and weight regularization. We evaluate the proposed method on the ISIC 2018 Skin Lesion Analysis dataset using a ResNet-50 backbone. Across five random seeds, the proposed margin-masked two-stage method attains a watermark success rate of 94.08% while maintaining a classification fidelity of 76.16%, reducing the accuracy gap to the clean baseline from about 22 to about 12 percentage points relative to an unmasked single-stage embedding and lowering the run-to-run variance. The trigger remains within the perceptually indistinguishable range, with an SSIM of 0.984 and an LPIPS of 0.060. We additionally evaluate robustness to model-modification attacks, the false positive rate of ownership verification, and generalization across four network architectures. The framework offers a practical mechanism for protecting the intellectual property of medical AI models at a quantified and honestly reported cost in classification accuracy.

Research projects are a mandatory requirement for advanced training in Aotearoa New Zealand, yet trainees and supervisors report challenges in the research process. While barriers and enablers of research have been described internationally, the experience within physician training in New Zealand has not been formally explored. We aimed to identify barriers and enablers of research conducted by nephrology trainees in New Zealand from the perspective of supervising nephrologists and to inform evidence-based recommendations for addressing challenges. We carried out semi-structured interviews with nephrologists who had supervised at least one advanced training research project in New Zealand until theoretical sufficiency occurred. Reflexive thematic analysis was conducted on transcribed interviews. Eighteen nephrologists from eight training centres were interviewed. Five themes were identified: (1) perceived value motivates supervisors; (2) research constrained by feasibility, including competing clinical demands with insufficient research time, limited access to specialised research support and bureaucratic delays; (3) trainee engagement and ownership facilitated success; (4) overcoming trainee inexperience with supervisor guidance; and (5) the importance of research infrastructure. Perceived value, trainee ownership, adequate supervision and supportive infrastructure were critical to successful research projects.

Background and Aim: While the proliferation of digital health technologies and wearable devices provides nursing professionals with constant access to biometric data, the pathological reliance on these metrics represents an emerging, yet empirically unexamined, digital anxiety framework. This study aims to theoretically define and systematically analyze this theorized phenomenon-termed "Technohypochondria"-within the context of nursing management and clinical practice. Methods: Utilizing Walker and Avant's eight-stage concept analysis method, a systematic literature search was conducted across PubMed, CINAHL, Scopus, and Web of Science databases. Following strict inclusion and exclusion criteria, a total of 1240 data sources spanning nursing, management, psychology, and informatics literature were analyzed. Results: Three defining attributes of Technohypochondria emerged inductively from the literature: (1) Biometric data obsession, (2) Digital misinterpretation and catastrophizing, and (3) Need for algorithmic feedback. Unlike the general informational search patterns of cyberchondria, these attributes specifically capture a continuous, device-driven feedback loop. Ownership of wearable technology and inadequate digital health literacy were identified as primary antecedents. The analysis revealed significant managerial consequences, including loss of clinical focus, increased risk of medical errors, and weakened professional autonomy. Conclusions: Technohypochondria operationalizes a specific anxiety framework driven by constant biometric monitoring, conceptually diverging from cyberchondria's focus on online health-information seeking. For nursing managers, addressing the psychological relationship between staff and technology is a strategic necessity for patient safety and workforce productivity. A primary limitation of this study is its theoretical nature; however, this study provides the essential conceptual foundation awaiting future empirical validation and scale development.

Virtual reality (VR) provides a controllable medium to couple perception and motor behavior in rehabilitation. This study investigated whether experiencing a foot-elongated avatar (FEA) via virtual self-touch (VST), which combines VR visual information and synchronized vibrotactile stimulation, is associated with body schema-related change and whether such change is reflected in motor behavior during obstacle crossing, indexed by maximum foot clearance (MFC). Twenty-two healthy young adults experienced two avatars in counterbalanced order: a life-size avatar (LA) and an FEA with a rightfoot length that was 1.5 times that of the LA. The primary outcome measure was MFC while stepping over 10-cm and 30-cm virtual obstacles; the secondary outcome measures were perceptual drift in the perceived toe-tip position and questionnaire scores for the sense of ownership and sense of agency. The VST task produced significantly greater perceptual drift with the FEA than with the LA (p < 0.05, r = 0.813). For the 30-cm obstacle, the MFC value was significantly greater with the FEA than with the LA (p < 0.05, r = 0.415). In contrast, the questionnaire scores did not exhibit statistically significant group-level differences between the avatars. These findings suggest that body schema-related change after experiencing a FEA via VST was mainly limited to the perceptual aspect and was not clearly observed in the subjective aspect. Furthermore, the finding suggests that an aspect-specific body schema-related change may be associated with measurable gait adjustment during a more demanding obstacle-crossing task, although VST contribution cannot be isolated in the present design.

Whole blood (WB) is an easy-to-use resuscitation fluid. As more low-titer group O WB has become available at our hospital, it is being used in an increasingly diverse range of situations, both pre-hospital and in-hospital. We conducted a retrospective analysis of all WB units issued by our transfusion service during calendar year 2024. Data were obtained from the transfusion service database and linked to patient medical records to characterize indications, location of transfusion, and patient outcomes. Results are descriptive. A total of 1915 WB units were issued. 1879 units (98.1%) were transfused to 524 patients, of which 237 units (12.6%) were prehospital. Of these, 1817 units (96.7%) were transfused to patients ultimately treated at HMC. Trauma accounted for the majority of in-hospital utilization (87.6%), with motor vehicle collisions (MVCs) and penetrating trauma the most common indications. Non-trauma indications accounted for 12.4% of transfused units and included gastrointestinal bleeding, vascular surgery, cardiac emergencies, necrotizing soft tissue infections, and other shock states. Among 477 admitted patients who received WB, in-hospital mortality was 29.6%. Operational strategies, including extended cooler validation and retention of inventory ownership until use, supported high utilization with minimal waste. Whole blood utilization was primarily driven by traumatic hemorrhage but extended across diverse acute care settings. Utilization patterns were shaped by supply limitations and operational considerations rather than clinical demand alone, underscoring the importance of incorporating logistics and utilization data into future whole blood research and implementation efforts.

Stimulant-associated harms are increasing in the U.S. Contingency management (CM) is the most effective available stimulant use disorder (StUD) treatment; guidelines recommend CM in conjunction with other psychosocial treatments. Unfortunately, there are barriers to CM provision, and it is unclear to what extent recommended StUD treatment is available in substance use treatment facilities. We examined provision of recommended StUD treatment reported by U.S. treatment facilities and associated facility characteristics. We used 2024 National Substance Use and Mental Health Services Survey (N-SUMHSS) data. Outcomes included facility report of frequent use of CM/motivational incentives (CM/MI) for non-opioid substances, and CM/MI plus other recommended treatments (cognitive behavioral therapy [CBT], community reinforcement approach [CRA], or Matrix Model [MM]). We estimated associations between facility characteristics and outcomes using multivariable logistic regression models. Less than half of facilities reported frequent use of recommended StUD treatment (42% CM/MI, 41% CM/MI+CBT, 8% CM/MI+CRA, 25% CM/MI+MM). In general, reported provision of CM/MI alone or in combination with other treatment was positively associated with state licensure/certification, accepting state-financed insurance, offering opioid agonist treatment, and higher state percent rural population (except CM/MI+CRA), and negatively associated with primarily providing substance use services (vs. mental health and substance use services), private non-profit ownership (vs. private for-profit), accepting Medicare or Medicaid, cash/self-pay only, and higher state-level stimulant-involved overdose mortality rate. Increasing the availability of recommended StUD treatments, especially CM, is crucial in U.S. substance use facilities. These exploratory findings can inform future research to help policymakers and administrators improve access.

Primary care is widely recognized as a cornerstone of universal health coverage, providing high-quality care in community-based settings. Structured managerial approaches such as Lean & Safety Management (L&SM) can support quality improvement in healthcare by reducing waste and risk and enhancing patient safety and satisfaction. However, evidence on the sustainable implementation of L&SM-defined as the ability to complete implementation and maintain improvements over time-remains limited in primary care. This study aims to identify key challenges affecting the sustainability of L&SM implementation in community healthcare centers. An unsuccessful L&SM implementation was analyzed through an in-depth case study of an Integrated Family Medicine Centre in Italy. The project, based on the DMAIC framework, was discontinued after the Define phase. A structured three-step methodology was adopted: 1) selection of a failed implementation case using predefined suitability criteria; 2) identification of implementation barriers through a systematic assessment of Critical Success Factors for sustainable Lean and Safety implementation adapted from the literature; and 3) validation of findings and exploration of corrective actions through a stakeholders focus group. The analysis identified multiple barriers that contributed to implementation failure. These barriers were synthesized into three interrelated themes: organizational readiness, stakeholder ownership and engagement, and governance fragmentation. Together, these factors limited coordination, reduced commitment to improvement activities, and hindered the sustainability of the implementation process. Sustainable L&SM implementation in primary care requires organizational readiness, committed leadership, stakeholder engagement, adequate training, and robust data infrastructure. Addressing these factors may improve the successful adoption and long-term sustainability of quality improvement initiatives in community-based settings.

Despite developmental heterogeneity, children under five are often analyzed as a single group, obscuring age-related differences in Plasmodium infection. Using the 2018 Nigeria Demographic and Health Survey data, we analyzed 2,914 younger children (6-23.9 months) and 5,553 older children (24-59 months) to identify age-common and age-specific factors. We applied a Cluster-aware Multistage Selection (CMS) framework integrating penalized regression, interaction testing, and bidirectional selection while accounting for sampling weights, clustering, and stratification. Plasmodium prevalence was 37.3% in younger children and 49.4% in older children. Each 10-percentage-point increase in community-level livestock and agricultural land ownership was associated with 2.5% (PR&#x2009;=&#x2009;1.025; 95% CI: 1.011-1.039) and 4.6% (PR&#x2009;=&#x2009;1.046; 95% CI: 1.029-1.062) higher prevalence, respectively. Socioeconomic disadvantage was associated with higher prevalence. Children in the lowest wealth quintile had 80.7% higher prevalence than those in the richest quintile (PR&#x2009;=&#x2009;1.807; 95% CI: 1.467-2.224), and children whose mothers had no formal education had 55.8% higher prevalence than those with higher education (PR&#x2009;=&#x2009;1.558; 95% CI: 1.225-1.980). Severe maternal anemia was associated with 22.5% higher prevalence (PR&#x2009;=&#x2009;1.225; 95% CI: 1.012-1.483). Stunting and household insecticide-treated net (ITN) ownership were associated with 8.0% (PR&#x2009;=&#x2009;1.080; 95% CI: 1.024-1.139) and 10.4% (PR&#x2009;=&#x2009;1.104; 95% CI: 1.017-1.198) higher prevalence, respectively. Conversely, sleeping under an ITN (PR&#x2009;=&#x2009;0.916; 95% CI: 0.858-0.977), breastfeeding (PR&#x2009;=&#x2009;0.845; 95% CI: 0.764-0.934), maternal internet use (PR&#x2009;=&#x2009;0.638; 95% CI: 0.475-0.857), and overweight-for-height (PR&#x2009;=&#x2009;0.761; 95% CI: 0.631-0.917) were associated with lower prevalence. Age-specific associations were observed only in younger children, including paternal lack of education (PR&#x2009;=&#x2009;1.301; 95% CI: 1.025-1.652) and rural residence (PR&#x2009;=&#x2009;1.462; 95% CI: 1.266-1.688). These findings support age-tailored Plasmodium prevention and highlight the utility of CMS for complex population data.

This study examines whether climate smart agriculture (CSA) practices reduce technical inefficiency among smallholder vegetable farmers in Northwest Ethiopia. Using cross sectional data from 550 households producing onion, potato, and tomato, the study applies a stochastic frontier analysis to estimate technical inefficiency and derives inefficiency scores for second stage analysis. To identify the determinants of inefficiency, three econometric models, beta regression, Fractional Logit, and Two-limit Tobit, are employed and compared. Model selection based on the loglikelihood, Akaike Information Criterion, and Bayesian Information Criterion confirmed the superiority of the beta regression model. The results reveal that average technical inefficiency levels are 0.170 for onion, 0.195 for potato, and 0.244 for tomato, indicating substantial scope for improving productivity through better resource utilization. The findings consistently show that the adoption of CSA practice combinations significantly reduces technical inefficiency across all vegetable crops. In particular, the integrated adoption of soil and water management practices reduces the largest inefficiency part, followed by climate related and soil based practices. These results highlight the importance of complementarily among agricultural technologies to reduce inefficiency. Socioeconomic and institutional factors, such as education, livestock ownership, credit access, and market proximity, significantly influence inefficiency levels. This study contributes to the literature by explicitly integrating CSA practices into the inefficiency framework and showing that the bundled adoption of climate smart practices enhances production efficiency. These findings provide important policy insights for promoting integrated and context specific CSA interventions to improve smallholder productivity and resilience.

The United Nations International Multiple Micronutrient Antenatal Preparation of a multiple micronutrient supplement (UNIMMAP MMS or MMS) is replacing iron and folic acid supplementation (IFAS) in antenatal care (ANC) in low- and middle-income countries (LMICs). An investigation into determining how to secure a sustainable supply of MMS began in response to the Indonesian Ministry of Health (MOH)'s decision to introduce MMS into its national health services. We aimed to identify and test sustainable strategies for securing MMS supplies. A three-phase implementation science framework was applied to (1) foster an enabling environment for securing MMS supplies, (2) undertake implementation research (IR) to compare sourcing strategy options, and (3) plan and execute actions to scale MMS supply availability and distribution. The MOH assumed ownership of the initiative and guided policy, procurement, and program decisions. (1) Landscaping resulted in recommendations that triggered supply-related policies, an accommodating regulatory framework, integration of MMS into key government support systems (i.e., budget, finance, procurement, and distribution), and identification of supply strategy options. (2) IR resulted in the selection of a local manufacturing and sourcing strategy for acquiring a sustainable supply of high-quality MMS product while retaining an option to import a limited supply of MMS during scaling. (3) A multi-year plan was developed to scale MMSs within ANC services. Applying implementation science provided an evidence-based framework with which to identify, establish, and test a sustainable strategy for securing MMS supplies and yielded insights useful for other countries introducing MMS into their national health systems.

Intestinal parasitic infection is a significant issue of public health, especially in low-resource preschool-aged children. The local prevalence and risk factors are crucial to know to implement specific interventions. A community-based cross-sectional study was conducted among 409 preschool children in West Badawacho Woreda, Hadiya, Central Ethiopia. Socio-demographic, environmental, water, sanitation, and behavioral data were collected using structured questionnaires. Stool samples were examined for intestinal parasites using standard laboratory techniques. Bivariate and multivariate logistic regression analyses were performed to identify risk factors associated with infection. The total prevalence of intestinal parasitic infections was 70% (287/409). The most prevalent parasites identified were Ascaris lumbricoides (14.5%), Entamoeba histolytica/dispar (11.98%), Giardia lamblia (11.25%), and hookworm (9.7%). Single infections accounted for 66.5% of cases, while double and multiple infections represented 2.2% and 1.47%, respectively. Multivariate analysis showed that lack of personal hygiene (AOR&#x2009;=&#x2009;12.9; 95% CI: 7.7-23.8), open defecation practices (AOR&#x2009;=&#x2009;11.4; 95% CI: 3.55-26.56), domestic animal ownership (AOR&#x2009;=&#x2009;11.13; 95% CI: 4.1-22.3), and use of unprotected drinking water sources (AOR&#x2009;=&#x2009;6.09; 95% CI: 1.73-21.5) were significant predictors of infection. Conversely, maternal education at high school level and above was significantly protective (AOR&#x2009;=&#x2009;0.36; 95% CI: 0.23-0.55). A high prevalence of intestinal parasitic infections (IPIs) was reported in West Badawacho Woreda in preschool children, indicating a significant public health problem in the region. Poor hygiene and unsafe water sources, open defecation, and zoonotic exposure were among the factors that were identified as key factors in infection, while greater maternal education was protective. This burden can be mitigated by increasing the capacity and outreach of community health education, upgrading sanitation facilities, increasing the availability of potable water and raising awareness about personal hygiene. Importantly, this study has important community-level information regarding IPIs in preschool children in West Badawacho Woreda for future interventions and planning policies.

Student Promotions Committees (SPCs) are tasked with making life-altering decisions regarding student advancement, remediation, and dismissal. Most research focuses on the legal requirements of due process, yet the nuanced role of the student's case presentation has received minimal scholarly attention. This study investigates the criteria SPC committees utilize when evaluating student presentations and how these factors influence committee decisions. This qualitative study employed elements of constructivist grounded theory to frame data collection and analysis. We conducted 15 semi-structured interviews with current and former SPC members at a U.S. military medical school. Using constant comparative methods, 'insight' was identified as a salient in faculty decisions. To interpret these findings, we utilized a conceptual framework from rehabilitation science, which describes the mechanisms by which courts evaluate an individual's potential for reform. Insight emerged as a critical component of the SPC's deliberation process, serving as both an essential prerequisite for professional growth and a significant indicator of future risk when found lacking. Students demonstrated insight by assuming full ownership of their academic or professional issues, utilizing institutional resources, and actively collaborating with the committee. Conversely, a lack of insight was signaled by doing nothing, externalizing blame, or repeating problematic actions despite prior interventions. The prominence of insight suggests that medical education has unintentionally adopted a burden of proof like the legal system, requiring students to demonstrate rehabilitation to maintain their professional standing. By articulating these implicit expectations, this study provides transparency, potentially fostering a more equitable and effective remediation process.

Soil is an important reservoir for antimicrobial resistance (AMR) and increasingly recognized as a pathogen transmission pathway, especially for young children. However, drivers of domestic AMR soil contamination in low-income countries remain unidentified. We conducted a cross-sectional study with 237 peri-urban households in southern Malawi to identify household and environmental factors associated with cefotaxime-resistant E. coli in yard soil. Enumerators employed structured surveys and sampled 900 cm2 of yard soil per household. We enumerated cefotaxime-resistant E. coli in soil using IDEXX Quanti-Tray/2000 with Colilert-18 and cefotaxime supplement, and assessed associations with household sanitation, animal ownership and management, child health and antibiotic use, and weather. Among children <5 years, 25-90% played, ate, slept, or crawled on the ground outside. Of 233 soil samples, 69% harbored cefotaxime-resistant E. coli at a mean of 0.90 log10 most probable number (MPN) per dry gram. Compared to households without animals, household soil had approximately 0.50-log lower mean cefotaxime-resistant E. coli concentration if animals were enclosed at night and 0.40-log higher concentration if they were not (p-values<0.05). Mean cefotaxime-resistant E. coli concentrations were approximately 0.90-log lower if soil was dry at the time of collection, 0.70-log lower if the household was in the top wealth quintile (p-values<0.005), and 0.30-log lower if any child in the household used antibiotics in the last four weeks (p-value&#x2009;=&#x2009;0.05). There were no associations with daytime animal confinement, household sanitation, temperature, and ambient humidity. Findings suggest that animal husbandry and soil moisture had stronger associations with cefotaxime-resistant E. coli in soil compared to sanitation or antibiotic use, underscoring the importance of a One Health approach to AMR that incorporates domestic animals and environmental factors. Given children's frequent soil contact, our findings also highlight potential AMR acquisition from soilborne pathways. Studies should quantify soilborne AMR exposure and evaluate associations with animal management/enclosure practices.

Non-communicable diseases (NCDs) are a growing health burden in low- and middle-income countries, with hypertension and poor glycaemic control being key contributors. This study aimed to assess the prevalence, awareness, and misinformation surrounding hypertension and diabetes in Bangladesh, identifying high-risk groups. Data from the nationally representative 2022 Bangladesh Demographic Health Survey were analysed, covering 13,344 adults aged 17-95&#xa0;years. We applied complex survey weighted regression modelling, spatial analysis, and machine learning techniques to explore trends, regional disparities, and factors influencing NCD awareness. The prevalence of hypertension (&#x2265;&#x2009;140/90&#xa0;mm Hg) or diabetes (blood glucose&#x2009;&#x2265;&#x2009;126&#xa0;mg/dL or 7.0&#xa0;mmol/L) was 31%, rising to 52% among adults aged 50&#x2009;+&#x2009;. Notably, 17% of affected individuals in this age group were unaware of their condition. Among adults aged 50&#x2009;+&#x2009;, 34% had undiagnosed hypertension, while 38% across all ages were unaware of their diabetes. Females developed hypertension earlier than males. Regional disparities were evident, with the highest NCD prevalence in Feni (40%), Naogaon (37%), and Natore (36%). Awareness varied by age, sex, BMI, and mobile phone ownership, which was linked to misinformation. Adults aged 30-39 had 2.11 times higher odds of unawareness (95% CI: 1.75, 2.56), rising to 5.61 times in those aged 70&#x2009;+&#x2009;(95% CI: 4.36, 7.20) compared to those under 30. Obese individuals were 3.07 times more likely to be unaware than those classified as underweight (95% CI: 2.33, 4.05). This study reveals gaps in health literacy and screening access, contributing to the escalating NCD burden in Bangladesh.

Administrative workload, the work required to understand systems and complete tasks and associated with navigating complex care for families, is an underrecognized yet powerful driver of inequity in pediatric hospital care. We present the case of Mateo, a 7-year-old child with medical complexity admitted with respiratory distress whose hospitalization and subsequent readmission were shaped not by caregiver disengagement but by the cumulative effects of fragmented systems, language barriers, and administrative demands placed on his family by the complex health system. Despite attentive caregiving, Mateo's mother encountered unreliable transportation, job-related pressures impacting her ability to attend appointments, inconsistent interpreter use and incomplete explanations, and limited institutional ownership of care coordination. These challenges were repeatedly reframed in the medical record as "nonadherence" and "inconsistent follow-up," contributing to moralized interpretations of risk and consideration of punitive responses rather than supportive interventions. Using this case, we examine administrative workload as a structural driver of health and a mechanism through which inequities are produced and reinforced. We describe how routine hospital processes, such as scheduling, prior authorizations, discharge planning, and documentation practices, externalize complexity to families least resourced to absorb it. We situate these dynamics within broader historical and policy contexts that shape surveillance, deservingness, and accountability in health care systems. Finally, we outline actionable interventions to reduce administrative workload as an effort to promote equity, with a focus on the role of pediatric hospitalists. These include reframing documentation, redistributing coordination tasks across teams, and standardizing hospital processes. Recognizing and addressing administrative workload is essential to improving patient safety, preventing avoidable harm, and advancing equity in pediatric hospital care and beyond discharge.

Skin neglected tropical diseases (NTDs) pose significant diagnostic and management challenges in resource-limited settings due to constrained dermatological expertise, frontline health worker (FHW) training, and limited access to diagnostic resources. Mobile health apps with artificial intelligence (AI)-enabled diagnostic imaging capabilities have the potential to enhance clinical decision-making and professional development at the primary care level. The World Health Organization (WHO) skin NTD mobile app uses convolutional neural networks to analyze images of skin lesions and generate differential diagnoses, intended to be used alongside clinical history and examination, to support FHWs in identifying 12 skin NTDs and 24 common skin conditions. Beyond clinical decision support, the app also aims to upskill FHWs in the recognition and management of these diseases. However, the success of such tools depends on understanding users' needs and the realities of implementation in diverse clinical contexts. This study aimed to explore FHWs' perspectives on the real-world use and impact of the AI-embedded WHO Skin NTDs app on diagnostic workflows, dermatological understanding, clinical decision-making, and FHW-patient interactions across diverse health care delivery settings in Kenya. This qualitative study involved 36 FHWs from 5 skin NTD-endemic counties in Kenya. Following a training workshop, FHWs integrated the app into routine clinical workflows from June to October 2024. Data were collected through 15 semistructured interviews (each 30-45 minutes) and 4 focus group discussions (1-1.5 hours) exploring FHW experiences across diverse health care delivery contexts. All sessions were audio-recorded, transcribed verbatim, and thematically analyzed using NVivo (QSR International), using a bottom-up inductive coding approach. FHWs reported that the app facilitated a shift from habitual referral to more proactive case management at the local-level facility, reinforcing clinical ownership and positioning them as local dermatology reference points. It was perceived to enhance diagnostic confidence, strengthen patient trust, and encourage community engagement. Some FHWs described how the app helped mitigate situations for patient stigma due to decreased reliance on public colleague consultations. However, technical limitations (eg, internet dependency and algorithmic errors) constrained consistent use. While most FHWs used the app in line with its intended role as an assistive tool, a minority reported situations of diagnostic deferral to the AI output, highlighting potential considerations of clinical autonomy. The WHO Skin NTDs app shows strong potential to strengthen frontline dermatological capacity that aligns with WHO strategies to decentralize NTD care and promote "skin health for all." Our findings underscore the importance of embedding such tools within ethical and pedagogical frameworks that protect clinical autonomy and foster sustainable capacity building. Further research will examine real-world use in situ to guide context-specific governance, ensuring that this AI-embedded tool enhances-rather than displaces-clinical reasoning and epistemic authority.

Despite policy-level progress, implementation of oral HIV preexposure prophylaxis (PrEP) remains limited in Latin America. In Peru, men who have sex with men (MSM) account for most new HIV diagnoses, yet uptake remains low. Widespread smartphone ownership and the use of digital platforms present an opportunity to expand access through mobile health (mHealth) interventions. However, limited data exist on user preferences to guide the design of mHealth tools in Spanish-speaking Latin American settings. This study aimed to assess preferences for mHealth features to support PrEP engagement among Peruvian MSM and their association with PrEP cascade stages. We conducted a cross-sectional online survey (June-August 2023) among 600 HIV-negative MSM residing in Peru (median age 29, IQR 24-35 years), recruited via Facebook, Instagram, WhatsApp (Meta Platforms, Inc), and Grindr (Grindr LLC). The survey assessed communication platform use, interest in mHealth features measured on a 4-point Likert scale, and PrEP cascade stages. Exploratory factor analysis (principal axis factoring with Promax rotation) identified domains of mHealth preferences, from which median domain scores were calculated. Bivariate analyses used chi-square tests and Wilcoxon rank sum tests. Multivariable logistic regression models (&#x3b1;=.05), with covariates selected using stepwise procedures from candidate sociodemographic and behavioral variables, estimated associations between each domain score and PrEP cascade stages, each modeled as a separate binary outcome. Nearly all participants (589/600, 98.2%) reported owning a smartphone. WhatsApp was the most frequently used and preferred platform for PrEP support, with 547 (91.2%) reporting frequent use and 302 (50.3%) ranking it first. Exploratory factor analysis identified three mHealth preference domains: informational support (Cronbach &#x3b1;=0.94), self-management tools (Cronbach &#x3b1;=0.94), and interactive communication (Cronbach &#x3b1;=0.91). Among participants, 483 (80.5%) had decided to use PrEP, 190 (31.7%) had sought PrEP, and 109 (18.2%) had initiated PrEP. Higher informational support was associated with the decision to use PrEP (adjusted odds ratio [aOR] 4.54, 95% CI 3.36-6.28; P<.001), seeking PrEP (aOR 1.43, 95% CI 1.10-1.89; P=.001), and PrEP initiation (aOR 1.64, 95% CI 1.16-2.44; P=.009). Self-management tools showed similar associations with the decision to use PrEP (aOR 3.23, 95% CI 2.51-4.22; P<.001), seeking PrEP (aOR 1.34, 95% CI 1.06-1.70; P=.02), and PrEP initiation (aOR 1.49, 95% CI 1.11-2.05; P=.01). Interactive communication was associated with the decision to use PrEP (aOR 2.74, 95% CI 2.15-3.53; P<.001) but not with initiation. Preferences for mHealth features were associated with engagement at multiple stages of the PrEP cascade among MSM in Peru. Informational support features demonstrated the most consistent associations with cascade engagement. These findings provide empirical evidence on user-prioritized digital functions that could support early engagement in HIV prevention services in a Latin American implementation context. Integrating culturally tailored mHealth tools within widely used platforms such as WhatsApp may strengthen early PrEP cascade engagement and support scalable digital strategies for HIV prevention in Peru and similar settings.

To explore the factors that influence the fertility intention of female medical staff of childbearing age in Shenzhen and analyse the association of noise exposure with their psychological status and their correlation with fertility intention. A questionnaire survey was conducted among 615 female medical staff members. Data on basic demographics, fertility intentions, and the general well-being scale were collected. Individual noise dosimeters were used to measure objective noise exposure during working hours. Logistic regression, chi-square test, and hierarchical regression were used for analysis. A mediation model based on logistic regression was tested using the bootstrap method (5000 resamples). Age, occupation, professional title, education level, income, home ownership, overtime, health, marital status, spousal support, family living pattern, working hours, and noise exposure level were significantly associated with fertility intention ( P < 0.05). The high noise exposure group (>65&#x2009;dB[A]) had significantly lower pleasure or happy mood scores (10.00 [8.00, 12.00]) than the medium (12.00 [10.00, 14.00]) and low groups (13.00 [11.00, 15.00]), with higher anxiety symptoms ( P < 0.05). Living with children and a spouse (OR&#x2009;=&#x2009;2.170, P < 0.001) and better psychological well-being (OR &#x2009; =&#x2009;1.071) were promoting factors for high fertility intention (ideal number of children >2). Medium noise exposure (OR&#x2009;=&#x2009;0.478, P < 0.001), high noise exposure (OR &#x2009; =&#x2009;0.246, P < 0.001), and working in high-noise departments (OR &#x2009; =&#x2009;0.412, P < 0.001) were inhibiting factors for high fertility intention. Psychological status partially mediated the noise-fertility association (indirect effect&#x2009;=&#x2009;-0.134, 23.32% of the total effect). Female medical staff of childbearing age in Shenzhen were generally less willing to have more than two children. Noise exposure is associated with fertility intention both directly, by increasing psychological burden, and indirectly, by reducing positive emotions. Family support patterns also play an important role.