This study explores senior health managers' perspectives on COVID-19 response and challenges, lessons learned, and opportunities in Gauteng, one of the most affected provinces in South Africa, and further presents recommendations for health systems strengthening, preparedness, and effective response against future infectious outbreaks or pandemics. Using a qualitative exploratory study, online in-depth interviews were conducted with purposively selected senior managers from the Gauteng Department of Health (GDoH) who were at the forefront of managing the pandemic. Recordings were transcribed verbatim, and saturation was reached with thirteen interviewees (n = 13). Thematic and inductive analyses were performed in NVivo 10 and reported following the Consolidated Criteria for Reporting Qualitative Research (COREQ). The findings are presented in four main themes, namely: GDoH's response to the COVID-19 pandemic, COVID-19-related challenges, lessons learned and opportunities from COVID-19, and participants' recommendations on dealing with future pandemics. The managers' perspectives suggest that GDoH's response to COVID-19 was comprehensive, multi-sectoral, and effective through public awareness, the War Room/nerve Centre that managed the response, resources mobilization like the recruitment of additional nurses and doctors, and vaccination. The challenges included the adverse effects of "long-COVID" and mental health, demised health workers, corruption and embezzlement of COVID-19 funds, high cost of living, and gender-based violence associated with COVID-19. The lessons learned included the importance of technology, surveillance, and data analytics during crises, improved hygiene-like hand washing, to mitigate infection transmission, and the urgency to build resilient health systems. The pandemic also highlighted the need for inclusive and collaborative public-private partnerships in the National Health Insurance (NHI) implementation. Participants' recommendations for dealing with future outbreaks included improvements in ICT, the need for social media regulation, working remotely, pandemic incentives for health workers, improved and accountable leadership, addressing corruption and the need for further COVID-19 research. According to the health managers interviewed in this study, the GDoH response to COVID-19 appeared to be resilient, comprehensive, multi-sectoral and effective despite the challenges emanating from the pandemic. Although the pandemic harmed the health system, lessons were learned with opportunities for leveraging the impact of future outbreaks, particularly as South Africa is in the process of providing universal health coverage, pronounced through the NHI. Not applicable.
Hospital medicine is a young and rapidly growing specialty. As such, most hospital medicine groups have many junior faculty with proportionately few senior faculty to support their career growth through traditional dyadic mentorship. As an alternative that may be more feasible in practice, we propose the development and expansion of peer-led efforts, in tandem with training efforts from organizations such as the Society of Hospital Medicine. In addition to logistical advantages, these approaches bring numerous benefits compared with traditional mentoring: potential for greater psychological safety and reciprocal social support, and opportunities to build career-long relationships. We believe that there are substantial opportunities for innovation and for scholarship to evaluate the impact and outcomes of peer mentorship efforts. We suggest several avenues for advancing peer mentorship within hospital medicine at the national, regional, local, and institutional levels.
Adolescent alcohol use is a significant public health concern in the United States. Protective behavioral strategies (PBS) can minimize risk associated with alcohol use. To date, however, no studies have examined sex differences in PBS use and alcohol-related consequences among high school students. The aims of this study are to examine sex differences in PBS use and to examine sex as a moderator of the relationship between PBS and alcohol-related consequences among high school seniors. Participants (N = 129) completed questionnaires on PBS, alcohol-related consequences, and alcohol use. Females used PBS significantly more frequently than males. Further, the frequency of using Manner of Drinking (MD) strategies was inversely associated with alcohol-related consequences for females and males. Sex moderated the relationship between use of Serious Harm Reduction (SHR) strategies and alcohol-related consequences. Specifically, among females, SHR was inversely associated with alcohol-related consequences. In contrast, SHR was positively associated with alcohol-related consequences for males. Use of Stopping/Limiting Drinking (SLD) strategies was not significantly associated with alcohol-related consequences. Female students may benefit more from the use of PBS, particularly SHR strategies, than male students. Findings provide sex-specific information to guide harm-reduction prevention efforts related to PBS.
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Following the work of Kossoski et al. on hierarchy CI (hCI) we propose an extended way of partitioning the Hilbert space by combining the excitation and the seniority sectors in a more general way. We define the hierarchy parameter, h, involving two "weights" (α values), measuring the importance of excitation (e) and seniority (s) contributions to the wave function according to h = α1e + α2s. This formulation generates alternative orderings of the excitation-seniority lattice and enables a systematic examination of how different balances between excitation and seniority influence correlation recovery. Four partitions are considered: positive slope diagonals (PSDs), which is equivalent to the original hCI scheme; negative slope diagonals (NSD); vertical chess horse (VCH); and horizontal chess horse (HCH). These partitions are evaluated for the BeH2 and for the cubic and linear H8 dissociation. These results show that the efficiency of a partition depends on the specific excitation-seniority sectors it includes at a given number of determinants. For BeH2, the PSD/hCI hierarchical ordering (h = 2) incorporates the dominant low-seniority configurations most effectively and reaches near-CISDT quality with compact expansions compared to other partition schemes. For the H8 systems, NSD and HCH recover static correlation more rapidly in the dissociation regime, whereas VCH remains inefficient across all determinant counts. The present results, obtained in the STO-6G basis for small benchmark systems, are intended as a controlled methodological study of determinant ordering strategies rather than a comprehensive performance assessment. The ehCI framework provides a practical way to analyze how excitation and seniority interact and to design compact CI expansions.
Median sternotomy can cause postoperative adhesions, raising bleeding and organ damage risks during resternotomies. Computed tomography angiography (CTA) and extended reality (XR) are increasingly used to enhance surgical planning and minimize these risks. This study aims to assess the benefits of integrating XR technology into resternotomy planning. This multi-center study, conducted at the Sheba and Wolfson Medical Centers in Israel, evaluated the utility of three-dimensional imaging in surgical resternotomy planning in 24 cases. Pediatric and adult patients selected for resternotomy underwent routine CTA, and those with adequate image quality were used to generate virtual three-dimensional segmentation. The images were evaluated preoperatively. The findings indicated no significant benefit of XR over CTA in terms of resternotomy anatomical data. However, the accuracy of the XR models varied with medical experience: senior physicians rated the XR as less accurate for adult patients than did residents, but the ratings were high in both groups for pediatric cases. The XR models improved the surgeons' understanding of chest anatomy in pediatrics more than in adult patients, whereas for surgical decision-making, XR was seen as more beneficial in pediatric cases, particularly by senior surgeons. Overall, senior physicians reported that XR influenced their surgical decisions more, suggesting that the utility of XR varies with physician experience and patient age. XR technologies have shown considerable potential in enhancing visualization and contributing to determining surgical strategies. However, the extent of their influence in terms of reducing operative durations and minimizing intraoperative complications requires further investigation.
Gathering feedback from medical students about their learning environment plays a vital role in improving the quality of medical education. Moreover, no studies in Vietnam have examined the diversity of factors such as mental health and perceived quality of clinical training in relation to perceptions of the educational environment. We aimed to examine Vietnamese medical doctor students' perceptions of the educational environment and its associated factors. We conducted a cross-sectional study using multistage cluster random sampling technique to recruit medical students who were in their clinical training years (4th, 5th, and 6th year) at Hanoi Medical University in Vietnam from November 2015 to January 2016. Students self-reported their demographic characteristics, academic performance, mental health, academic motivation, and perceptions of the educational environment (via The Dundee Ready Education Environment Measure (DREEM)). The modified Poisson regression models were used to assess the association between potential risk factors and negative perceptions of educational environment (i.e., score ≤ 100/200). Among 484 students enrolled in the study (response rate 77.2%), 87.8% reported positive perception (DREEM score > 100) of medical education environment, with the highest satisfaction for teachers. Senior year status was significantly associated with the negative perception in both sexes, while having self-reported mental health issues (i.e., depression and stress) and no academic motivation were associated with negative perceptions among male students only. Additionally, fulfillment of learning objectives, perceived effectiveness and assessment fairness of clinical training were also important associated factors of students' positive perception of the educational environment. The majority of medical students in this study expressed overall satisfaction with the learning environment, particularly with their teachers. However, the findings underscore the need for targeted improvements in learning effectiveness, fair assessment, especially for students in senior years, those facing mental health challenges or lacking academic motivation.
Adolescent mental health issues are increasingly severe, with the prevalence of depression reaching 26.17%. Existing studies still face issues such as a narrow range of symptoms, cross-sectional designs, and small sample sizes. To address these gaps, the present study applied cross-lagged panel network (CLPN) analysis to a population-based sample of 17,236 secondary school students in Guangzhou, China (aged 12-18; 46.32% female; 66.91% junior high, 33.09% senior high). Participants were assessed on ten symptom dimensions at two time points approximately six months apart, during September-October 2023 (T1) and February-April 2024 (T2). Subgroup comparisons were conducted by gender and educational stage. The findings revealed: (1) cross-sectional networks exhibited robust and stable associations, with depression and anxiety forming the strongest link; (2) longitudinal analyses identified depression, anxiety, and emotional disturbance as central driving nodes that predicted and propagated changes in other mental health symptoms over time, while paranoid ideation functioned primarily as a bridging symptom; and (3) subgroup analyses showed largely consistent structures across gender and educational stages, though subtle differences emerged. Males demonstrated slightly stronger connectivity, with depression and emotional disturbance as core drivers, whereas hostility and interpersonal sensitivity were more central in females. Across educational stages, the "depression → anxiety" pathway remained stable, with emotional disturbance more prominent in junior high and hostility gaining influence in senior high. Overall, these results highlight the central role of anxiety in adolescent symptom networks, reflecting the pervasive influence of China's high-pressure educational environment on students' psychological functioning. They underscore the importance of disrupting the depression-anxiety cycle and suggest that tailored, stage- and gender-specific interventions targeting emotional symptoms may enhance the effectiveness of school-based mental health promotion.
Shadowing is described as an interprofessional education (IPE) learning activity where a student of one discipline shadows a registered health professional or student of another discipline. To date, research examining the educational effectiveness of the shadowing learning activity has largely focused on students shadowing registered health professionals. This study explores if and what students learn, and the factors that influence their learning, when they shadow students from other disciplines. This ethnographic, case study observational research used indepth analysis to undertake a fine-grained examination of interprofessional learning gained through student's peer shadowing of each other in a 5-week IPE programme in a rural setting. Both the students who were shadowing and students who were being shadowed were observed to learn in the activity and this learning was multifaceted. It included learning about another discipline's roles, skills and philosophies and the different training programmes, as well as personal and professional concerns and also wider aspects of health care. Peer teaching resulted in active and sometimes reciprocal learning and students were for the most part confident and enthusiastic. Peer shadowing involving senior students of different disciplines where interaction and social engagement occur, promotes meaningful and comprehensive interprofessional learning, including enhancing understanding of interprofessional collaboration as well as other aspects of professional and social practice. It is important for educators to prebrief the students about the goals of peer shadowing and advise them to prepare themselves for the learning activity, but once done, incorporating peer shadowing within IPE curricula provides an effective learning activity in which all students benefit.
Surgeon fatigue is a recognized risk factor for patient safety; however, reduced working hours may limit surgical training exposure. In 2005, Switzerland introduced a maximum 50-hour workweek for resident surgeons. In view of current discussions on further reductions (42 + 4 h), concerns persist regarding training quality and workforce capacity. This study evaluates the impact of the 2005 Swiss labor law on patient outcomes, operative characteristics, and intraoperative teaching utilizing a standardized trauma procedure. A retrospective analysis of anonymized data from a national database was performed. All patients undergoing operative fixation of trochanteric femur fractures (ICD-10 S72.1) were included. Two four-year periods were compared: pre-regulation (2001-2004) and post-regulation (2016-2019). Primary endpoints were in-hospital complications, mortality, and length of stay. Secondary endpoints included patient characteristics, surgeon seniority, teaching status, operative duration, and time to surgery. Post-regulation patients were older and exhibited higher American Society of Anesthesiologists classifications despite fewer comorbidities. Complications increased from 9.1% to 17.7%, and mortality from 1.6% to 3.5%. Length of stay decreased from 14 to 9 days. Operative duration decreased by 10 min across all surgeon levels. Resident surgeons independently performed 10% fewer procedures, but teaching operations increased significantly among resident surgeons. Following the introduction of working hour limitations, supervised teaching increased substantially. Although complication and mortality rates rose-likely reflecting an older and more complex patient population-hospital stays shortened. The proposed 42 + 4-hour model will require targeted compensatory measures to maintain surgical training quality and patient safety.
Artificial intelligence (AI) presents unique opportunities and challenges in medical education. In this video article, Marc Triola, MD, Director of the Institute for Innovations in Medical Education and Senior Associate Dean for Medical Education at the NYU Grossman School of Medicine, joins host Ali Tejani, MD, to discuss the intentional and ethical integration of AI in medical education, strategies for ensuring that AI literacy is available to all students, and approaches for making AI education sustainable to weather rapid change.
To establish foundational parameters of a gerontology-informed advanced practice nursing (APN) role to support older adults undergoing surgery, using a multi-phase, evidence-informed co-design process. This study adopted a participatory co-design approach informed by the Participatory, Evidence-Based, Patient-Focused Process for Advanced Practice Nursing role development (PEPPA) framework. Data were collected sequentially through a scoping review, semi-structured interviews and surveys with older adults and carers, a pre-workshop clinician survey and a multi-stakeholder co-design workshop. Interviews incorporated a Rose-Bud-Thorn reflective activity, and workshop discussions used dot-voting to support shared prioritisation. Qualitative content analysis and descriptive statistics were used to integrate findings across stakeholder groups. Twelve older adults (including two supported by carers) and 15 clinicians participated across study phases, with 13 attending the co-design workshop. Older adults identified three priority areas for improvement: communication and information needs, coordination and continuity of care and preparation for discharge. Clinicians emphasised frailty-focused assessment, perioperative optimisation, interprofessional coordination and the need for senior APN expertise. Consensus was reached on targeting frail and high-risk surgical patients, adopting a Nurse Practitioner (NP) level for the role and implementing shared governance between perioperative medicine and geriatrics. The foundational parameters of a gerontology-informed APN role were developed through a rigorous, multi-source co-design process, addressing a critical gap in perioperative care for older adults in Australia. The findings provide a robust evidence base for implementing and evaluating a perioperative APN role that aims to enhance continuity, communication and gerontological support for older adults undergoing surgery.
Ultrasound is the main imaging technique used to assess foetal cardiovascular and thoracic diseases. Nonetheless, even when performed by senior physicians, it has some limitations, particularly in cases of suboptimal acoustic window. Foetal chest magnetic resonance imaging is a complementary technique for studying thoracic pathology. Due to its ability to provide tissue characterisation and its multiplanar capabilities, it can diagnose multiple lesions, assess the degree of involvement and detect possible associated anomalies, providing valuable information for management, prognosis and both prenatal and postnatal treatment. Foetal cardiac magnetic resonance is a novel diagnostic tool for studying the foetal heart and circulation and it is useful as an alternative imaging modality when ultrasound is inconclusive. Furthermore, it can provide useful anatomical and physiological information for establishing a prognosis or medical treatment and for planning invasive prenatal cardiovascular interventions.
New technologies are crucial in empowering seniors to overcome disabilities. However, there is a prevalent fear of technology among many older adults, known as technophobia. Understanding the barriers that hinder older adults from embracing new technology can significantly improve their overall health and well-being. Therefore, this systematic review aimed to explore existing studies on technophobia and computer anxiety among older adults to identify effective factors contributing to technophobia. A literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic review was performed across six electronic databases (MEDLINE (PubMed), Scopus, Web of Science, IEEE Xplore, Embase, and the Cochrane Library) with no time limit until October 2025. Studies on technophobia or computer anxiety in older adults were included, and studies that focused solely on the digital divide were excluded to maintain a specific focus on technophobia. The methodological quality of the articles was assessed via the Newcastle‒Ottawa Quality Assessment Scale (NOS), Guidelines for Reporting Evidence-Based Teaching and Learning Interventions (GREET), and Critical Appraisal Skills Programme (CASP). The search initially identified 2,642 records, 21 of which met the inclusion criteria. The analysis revealed that nine studies (42.9%) specifically assessed technophobia with standardized instruments, whereas six studies (28.6%) focused primarily on computer-related technophobia. Additionally, eight studies (38.1%) examined the role of self-efficacy in relation to technology acceptance among older adults. Educational interventions (reported in 33.3% of studies) reduced fear of technology (with reductions ranging from 12.7% to 46.6%) and increased self-efficacy (from 27.8% to 73.7%). Social support (14.3%) indirectly mitigated fear of technology through improvements in self-efficacy and eHealth literacy. The key demographic factors linked to higher levels of technophobia included older age (28.6%), lower educational attainment (23.8%), and lower income (14.3%). Overall, this synthesis underscores the importance of multifaceted strategies that address the psychological, educational, and social dimensions underlying technophobia in older adults. This review revealed that technophobia in older adults can be reduced by educational interventions, self-efficacy, and social support. We recommend age-friendly design standards, digital skills training, and usability testing with older adults. Future research should target emerging technologies, standardized tools, and longitudinal studies.
This study aimed to conduct a SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis of the faculty mentorship program at Aga Khan University Medical College (AKU-MC) Karachi, Pakistan, to assess and enhance its effectiveness. A qualitative exploratory study was conducted, purposive sampling was used to enroll participants, and their consent was obtained before conducting interviews and focus group discussions (FGDs). Program manager and senior leader involved in the program for minimum of one year were also included. Seventeen individuals from AKU-MC participated; informal mentorship, transition to formal mentorship, and voluntary research mentorship, as well as a supportive ecosystem, mentor-mentee matching, training for skills development, and the role model were identified as the strengths of the program. Weaknesses included infrequent mentor-mentee interactions and resource limitations. Opportunities included the development of connections and future development. Challenges identified included low-frequency meetings and inadequate time for mentor-mentee meetings. The faculty mentorship program at AKU-MC significantly contributed to the professional development of the faculty. However, to enhance mentor-mentee dynamics, the study identified a clear need for more frequent meetings and better overall mentor-mentee interactions, likely by addressing the identified resource and scheduling limitations. The study recommends establishing a structured framework to strengthen faculty mentorship practices. This includes formal mentor training programs focused on communication, feedback, and ethical practice; institutional policies that define the roles and integrate mentorship outcomes into faculty evaluation; and the adoption of flexible formats, such as virtual or group mentoring, to enhance accessibility. Regular monitoring and feedback mechanisms should be implemented to ensure sustainability and continuous improvement of the mentoring culture.
Residents lack confidence caring for children with severe neurological impairment (SNI). The novel personal history tool, SHINE (Self, Happy, Ill, Names, and Extra), was codeveloped by families and residents to strengthen residents' confidence in connecting with children with SNI and their families. To describe SHINE's use among residents and its impact on residents' burnout, meaningful work, and confidence in caring for children with SNI. Residents at an academic children's hospital in the United States received small-group teaching on the use of SHINE. Participants completed baseline, one-, and three-month post-intervention surveys, which included resident demographics; self-reported tool use; and resident burnout, meaningful work, and confidence in caring for children with SNI. Data were analyzed descriptively and using Pearson's chi-square tests. Briefly, 88% (n = 37/42) of eligible residents participated (25 interns [67%], 12 senior residents [32%]). After one month, respondents reported they found the tool helpful/very helpful (n = 11, 92%), were likely/very likely to continue using it (n = 11, 92%), and recommended it to future residents (n = 16, 100%). At baseline, residents reported low confidence caring for children with SNI (mean = 2.08, standard deviation (SD) : 0.84 on a 1 = low to 4 = high Likert scale). After one month, respondents reported improvements in (1) understanding the nonmedical needs of patients (mean increase: 0.71, SD: 0.85, p value = 0.006) and (2) understanding life outside the hospital (mean increase: 0.94, SD: 0.87, p value = 0.003). Respondents reporting higher use of the tool experienced larger gains. No significant differences were seen in burnout or meaningful work. SHINE may improve resident self-reported confidence in caring for children with SNI.
Nurses comprise the largest segment of the healthcare workforce. Enhancing their competence is crucial for delivering high-quality healthcare services. This study aimed to evaluate the effectiveness of a competency-based nursing education (CBNE) curriculum in improving nursing educators' knowledge of core competencies relevant to their practice settings. Utilizing Kern's 6-step model, a tailored program was designed for senior nursing educators from colleges in Odisha, India. The Delphi technique was employed during program development to ensure content relevance. The program was delivered through an online platform and evaluated using the Kirkpatrick training model. Thirty nursing educators from the public sector participated in the program, with a mean age of 45.26 ± 5.74 years. Significant improvements were observed in participants' knowledge of adult learning principles (effect size, d = 0.94; P = 0.04) and management and leadership (d = 0.94; P = 0.016). Participants reported high satisfaction with the program, with a median score of 5 on a 5-point scale. This study demonstrates the successful development, implementation, and evaluation of a CBNE program in India. The program led to significant improvements in key competencies, with high participant satisfaction reflecting the relevance, expert facilitation, and practical applicability of the curriculum.
Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to improve recovery, optimize patient outcomes, and enhance overall quality and satisfaction. Successful ERAS implementation requires continuous interprofessional collaboration among anesthesiologists, surgeons, nurses, nutritionists, physiatrists, and gerontologists, extending from preadmission to discharge. This consensus document, developed by the International Union of Angiology (IUA) Youth Committee and senior experts, outlines best practices for ERAS in vascular surgery. It synthesizes current evidence and expert opinions to provide a structured clinical pathway that enhances patient care and facilitates real-world application. This document has outlined key strategies to enhance perioperative outcomes in vascular surgery patients, a population at high risk for periprocedural complications, particularly cardiac events. The authors attempted to clarify and standardize key definitions and provide general guidance on broadly applying ERAS principles based on existing literature and clinical experience. While ERAS protocols for vascular surgery have been recently published by the Society for Vascular Surgery (SVS), this document offers a complementary perspective, addressing key perioperative steps and providing specific recommendations for both open and endovascular arterial procedures.
Public health organizations in Canada play a central role in chronic disease prevention (CDP) but face persistent challenges, including system restructuring, persistent underfunding and shifting policy priorities. The growing complexity of these issues warrants qualitative insight to complement quantitative reports capturing CDP organizations' perspectives. The Public Health Organizational Capacity Study (PHORCAST) is a repeat Canada-wide census of public health organizations engaged in primary CDP at national, provincial, territorial and regional population levels. In 2023, senior managers and staff with in-depth knowledge of their organizations' CDP activities completed a questionnaire that requested optional comments via an open-ended question. The responses were analyzed using qualitative descriptive methods and inductive content analysis to identify and organize recurring issues. Theme frequencies are reported descriptively to indicate prominence across organizations and not to quantify meaning. Across the 55 organizations, 125 coded references to barriers to CDP were synthesized into five key themes: organizational capacity and program delivery challenges (n = 38), including chronic underfunding, workforce shortages and limited infrastructure; COVID-19 pandemic disruptions causing staff redeployment and prolonged service interruptions (n = 30); policy and systemic barriers (n = 28), including political interference and poor interjurisdictional coordination; fragile partnerships and the need for stronger intersectoral collaboration (n = 16); and difficulties engaging diverse communities, digital access issues and lack of culturally responsive programming (n = 13). CDP efforts in Canada are constrained by structural, operational and contextual barriers. Addressing these challenges requires sustained investment, coherent policies and stronger cross-sector partnerships. Alors que les organismes de santé publique au Canada jouent un rôle central dans la prévention des maladies chroniques, ils sont confrontés à des défis persistants, notamment à la restructuration des systèmes, à un sous-financement chronique et à des changements de priorités en matière de politique. La complexité croissante de ces enjeux justifie l’apport de données qualitatives en complément des rapports quantitatifs, qui présentent le point de vue des organismes de prévention des maladies chroniques. L’étude sur les capacités organisationnelles de santé publique (PHORCAST) est un recensement itératif à l’échelle du Canada des organismes de santé publique mobilisés dans la prévention primaire des maladies chroniques à l’échelle de la population régionale, territoriale, provinciale et nationale. En 2023, les gestionnaires principaux et le personnel ayant une connaissance approfondie des activités de prévention des maladies chroniques de leur organisme ont répondu à un questionnaire suscitant des commentaires facultatifs par l’entremise d’une question ouverte. Les réponses ont été analysées à l’aide de méthodes qualitatives descriptives et d’une analyse inductive du contenu afin d’identifier et d’organiser les enjeux récurrents. Les fréquences des thèmes sont présentées de manière descriptive afin d’indiquer leur importance au sein des organismes et non pour quantifier leur signification. Portant sur 55 organismes, 125 références codées aux obstacles à la prévention des maladies chroniques ont été synthétisées autour de 5 thèmes clés : les défis liés aux capacités organisationnelles et à la mise en oeuvre des programmes (n = 38), notamment le sous-financement chronique, la pénurie de main-d’oeuvre et des infrastructures limitées; les perturbations causées par la pandémie de COVID-19, qui ont entraîné un redéploiement du personnel et des interruptions de service prolongées (n = 30); les obstacles politiques et systémiques (n = 28), notamment l’ingérence politique et la mauvaise coordination entre administrations; les partenariats fragiles et la nécessité d’une collaboration intersectorielle plus forte (n = 16) et enfin les difficultés à mobiliser des collectivités diverses, les problèmes d’accès au numérique et le manque de programmes adaptés culturellement (n = 13). Les efforts en matière de prévention des maladies chroniques au Canada sont limités par des obstacles structurels, opérationnels et contextuels. Pour relever ces défis, il faut des investissements soutenus, des politiques cohérentes et des partenariats intersectoriels plus solides. Chronic underfunding and workforce shortages are major barriers to primary chronic disease prevention (CDP) across Canada. Policy fragmentation, political interference and weak interjurisdictional coordination continue to undermine long-term CDP capacity. The COVID-19 pandemic intensified existing challenges through staff redeployment and disruptions to CDP programs. Reaching diverse communities is hindered by digital inequities and a lack of culturally responsive approaches. Partnerships are essential but remain fragile, which emphasizes the need for more stable, crosssector collaboration frameworks. Le sous-financement chronique et la pénurie de main-d’oeuvre sont des obstacles majeurs à la prévention primaire des maladies chroniques à l’échelle du Canada. La fragmentation des politiques, l’ingérence politique et la faible coordination entre administrations continuent d’affaiblir les capacités en matière de prévention des maladies chroniques à long terme. La pandémie de COVID-19 a entraîné l’intensification des défis déjà présents en raison du redéploiement du personnel et des perturbations des programmes de prévention des maladies chroniques. Les inégalités numériques et le manque d’approches adaptées culturellement empêchent d’atteindre les collectivités dans leur ensemble. Les partenariats sont essentiels, mais demeurent fragiles, ce qui fait ressortir le besoin de mettre en place des cadres de collaboration intersectoriels plus stables.