Pakistan, a lower-middle-income country of some 241 million people, faces a rising cancer burden — an estimated 185,748 new cancer cases and 118,631 cancer deaths in 2022 — that is served by a heterogeneous and largely uncoordinated mix of public, private for-profit, philanthropic, and Atomic Energy Commission cancer facilities. Nationally representative data on oncology infrastructure, diagnostic capacity, therapeutic access, and workforce conditions remain limited. We surveyed oncology professionals to describe, from their perspective, the capabilities of their institutions and their own working conditions. A cross-sectional survey was completed by 111 oncology professionals practising across ten cities in four provinces between July and September 2025. A structured questionnaire captured institutional infrastructure, diagnostic and molecular testing, multidisciplinary practice, therapeutic availability, supportive services, research activity, financial constraints, and workforce perspectives. Data were analysed descriptively with the individual respondent as the unit of analysis. Institutional sector (private, government, or Atomic Energy Cancer Hospital) was assigned post hoc from each respondent’s known institutional affiliation and compared using the χ² test with Freeman–Halton exact confirmation. Respondents comprised radiation/clinical (55.9
Internet-based testing services for sexually transmitted and blood-borne infections have increased in prevalence and altered the testing landscape and testing behaviours in many jurisdictions. Our objective was to understand how system partners perceived the possible benefits and drawbacks of adapting and implementing an online testing program like GetCheckedOnline which was already operating in British Columbia, Canada, into a new provincial context where it did not exist. We conducted in-depth interviews and focus groups with sexual healthcare providers, program managers and developers, and other public health professionals with expertise in sexually transmitted infections testing (N = 41) in Ontario, Canada. Our interview questions were part of a larger study focused on improving equitable access to sexually transmitted infections testing. Transcripts were transcribed verbatim and analysed using NVivo software following grounded theory. We created a conceptual figure to chart tensions from participant accounts onto a model of GetCheckedOnline. We describe five key tensions in the accounts of our participants to elucidate perspectives on the possible benefits and barriers/concerns of implementing a digital testing model like GetCheckedOnline in another province: (1) access, (2) privacy, (3) co-ordination/communication, (4) agency, and (5) health system impacts. We map these five tensions across the core elements of the online testing program (i.e., from creating an online account, completing an assessment, and submitting specimens to getting results and engaging in repeat testing). Our analysis elucidates the multiple advantages that online testing modalities may provide for service users as well as substantive barriers and concerns perceived by health system partners, including the potential (unintended) consequences and paradoxes of introducing digital sexually transmitted infections testing.
The COVID-19 pandemic raised ethical questions about how scarce medical resources should be defined and allocated. Existing debates have largely focused on triage criteria and distributive principles, with less attention to how different social and institutional actors understand the allocation problem itself. This study examined how healthcare providers and civil society advocates in South Korea understood the problem of pandemic resource allocation, and how their perspectives diverged across four dimensions: scarcity, fairness, survival, and preparedness. This qualitative study included 31 participants: 16 healthcare providers with direct experience treating patients during the COVID-19 pandemic and 15 civil society advocates supporting socially marginalized populations. Providers participated in semi-structured individual interviews, while advocates participated in focus group interviews. Both methods incorporated written vignettes based on ethically contested resource-allocation policies implemented in South Korea. Data were collected from August 2025 to March 2026 and analyzed primarily inductively using reflexive thematic analysis. Four interrelated themes were identified. First, providers understood scarcity mainly in terms of beds, personnel, and treatment capacity within clinical settings, while advocates emphasized barriers that prevented marginalized populations from entering or remaining connected to the healthcare system. Second, providers foregrounded clinical need and clinical judgment, whereas advocates explicitly incorporated structural vulnerability and unequal access into their understanding of fair allocation. Third, providers framed survival largely through mortality prevention and treatment capacity, while advocates emphasized social survival, including continuity of care, livelihood, and everyday support. Fourth, both groups stressed the need to establish ethical principles and institutional preparedness before future crises, with advocates calling for standing participatory bodies that include patients, civil society, and healthcare professionals. Pandemic resource allocation was shaped by differing understandings of what counted as a resource, who qualified as a legitimate subject of allocation, and what outcomes counted as survival. Equitable preparedness requires ethical principles, equity safeguards, and participatory governance to be institutionalized before a public health emergency occurs.
Despite increasing policy investment in smart home-based elderly care platforms, participation among older adults and care institutions remains limited. Existing studies have primarily examined participation-related factors from either the demand or supply side, but have paid limited attention to how these factors are interconnected within platform-based elderly care systems. Consequently, the structural relationships among participation-related factors and the factors occupying key positions within the broader care system remain insufficiently understood. To explore the interdependencies among factors related to participation in smart home-based elderly care platforms among older adults and care institutions in China. A three-stage exploratory study design was adopted. First, potential participation-related factors were identified through prior ethnographic research. Second, the identified factors were refined using expert ratings, coefficients of variation, and fuzzy set membership analysis. Third, an expert-informed directed and weighted factor network was constructed based on expert assessments of inter-factor relationships. Social network analysis was applied to examine network structure, brokerage positions, and structural prominence through network-level analysis, block modeling, and node- and edge-level metrics. Factors demonstrating high structural prominence were identified by integrating node-level indicators with block model positions, and robustness was assessed through sensitivity analyses. Initially, 21 elderly-related and 14 institution-related factors were identified. After refinement, 27 factors were retained, forming a fully interconnected expert-informed network with a clear core-periphery structure. Platform-, governance-, and institution-related factors occupied structurally central and intermediary positions, whereas older adult-related factors were more structurally dependent within the network. Twelve structurally prominent factors were identified, including trust in service provision, family support, payment power, inadequacy of existing care arrangements, care service quality, platform quality, service accessibility, service delivery costs, government subsidy support, payment and settlement mechanisms, revenue allocation arrangements, and performance incentive structures. Sensitivity analyses further supported the stability of the network structure and structurally prominent factors. Participation-related conditions in smart home-based elderly care platforms appear to be embedded in interdependent structural relationships rather than operating as isolated factors. The findings suggest that institutional arrangements, platform governance, and service delivery conditions may play central roles in shaping participation dynamics. These findings highlight the value of a system-oriented perspective and suggest that improving participation may require coordinated strategies across service delivery, platform governance, payment mechanisms, institutional incentives, and policy support.
Identifying and understanding implementation determinants is a critical step in the process of tailoring implementation strategies to local contexts. System Support Mapping (SSM) is a method rooted in systems thinking that offers a structured approach to exploring the responsibilities, needs, resources, and wishes of individuals within an implementation context. However, SSM has not yet been systematically described and applied as a methodology for identifying implementation determinants within multi-site implementation studies. This article introduces and illustrates the combined application of SSM and the Matrixed Multiple Case Study (MMCS) approach as a structured six-step methodology for identifying and analysing implementation determinants within and across sites, using data from the Neo-MILK project as an illustrative example. The project aimed to implement a structured lactation support programme for mothers of very low birth weight infants and establish human donor milk banks in German neonatal intensive care units (NICUs). To illustrate the six-step methodology, semi-structured interviews with key persons from five German NICUs, which were conducted during the early intervention phase, served as the empirical basis for demonstrating each methodological step. Transcripts were analysed using directed content analysis, with SSM elements serving as deductive categories and context-specific codes developed inductively. The MMCS approach was used to organise, compare, and synthesise findings within and across sites. Applying the six-step methodology, we demonstrate the type of output each step produces, ranging from individual System Support Maps per key person and NICU (steps 1–3) to a sortable cross-site matrix (steps 4–6). The within-site analysis (step 5) illustrates how the methodology surfaces context-dependent perceptions of the same determinant, showing that a given resource category could be perceived as facilitating, inhibiting, or both, depending on individual responsibilities, needs, and local context. The cross-site analysis (step 6) demonstrates how the matrix structure makes homogeneous and heterogeneous determinant patterns visible across sites, indicating different contextual manifestations of the same determinant. The combined application of SSM and the MMCS approach provides a structured methodology for identifying and analysing implementation determinants that accounts for the perspectives of individual interest-holders and enables systematic within-site and cross-site comparison. The distinction between homogeneous and heterogeneous determinant patterns offers a basis for differentiating between cross-site and site-specific implementation strategies. Further research is needed to evaluate the use of SSM across multiple evaluation timepoints and its integration into initial and ongoing tailoring of implementation strategies. DRKS00025058; registered 6 May 2021.
Neonatal mortality remains a leading contributor to under-five mortality globally, particularly in low- and middle-income countries (LMICs). Kangaroo mother care (KMC) is an effective, low-cost intervention for improving outcomes among preterm and low birth weight infants; however, implementation remains inconsistent in resource-limited settings. We conducted a quality improvement study at a rural Kenyan hospital using three sequential six-week cycles. Interventions addressed key barriers to KMC, including provider knowledge, caregiver engagement, and environmental constraints. Primary outcomes were initiation of KMC within 24 h of delivery and mean daily duration of KMC. Secondary outcomes included the proportion of eligible hospital days during which neonates received ≥ 1 h of KMC and the proportion of eligible hospital days during which neonates received ≥ 8 h of KMC. A total of 45 neonates were enrolled. KMC initiation within 24 h increased from 8.3
Infertility is a critical public health issue that reduces the quality of life for many women and has become increasingly prevalent among Iranian couples in recent years. This study aimed to investigate the barriers that infertile women face in accessing and utilizing infertility treatment services. This is a quantitative cross-sectional study that was conducted on 450 infertile women with primary or secondary infertility in Tehran in 2023. The context included 5 large public and private centers providing Infertility treatment services. The data were gathered through interviews using a structured questionnaire developed mainly based on Saurman’s conceptual model and Hosseini Esfidarjani’s study questionnaire and then analyzed by descriptive statistics and also Spearman’s correlation, ANOVA and logistic regression model. Among the barriers to access, the highest average score is related to financial affordability barriers (8.66±15.22) and integration (81±11.45), and in the barriers to utilization, it is related to personal and cognitive issues (11.7±12.9) and service quality (5.5±6.9). According to Spearman’s correlation and ANOVA yesy, statistically significant associations was observed between access barriers and type of insurance, spouse’s employment status, ethnicity, place of residence, creating a break or gap between diagnosis and treatment, as well as the history of changing the treatment center. Also, a statistically significant associtions was observed between utilization barriers and type of insurance, employment status of the couple, creating a break or gap between diagnosis and treatment. In both dimensions, a negative correlation was observed between monthly income and barriers to access and utilization. However, according to the logistic regression analysis, only medical center where provided the ITSs was significantly related to the barriers to access and utilization of ITSs. Also an association was found between the place of residence (Cof = −2.26, p = 0.038) with access barriers, so that women living in rural areas faceed more access barriers. According to these findings, the access and use of infertility treatment services among infertile women is strongly influenced by affordability, factors related to the health system (accommodation and quality of services) and other cultural and socio-economic factors. Therefore, the development of policies and support mechanisms by the government, continuous education and support of the patient and providing a culturally safe environment can help in improving the access and utilization of infertility treatment services.
Artificial intelligence (AI) is increasingly promoted as a tool for strengthening health systems, but evidence on how it can be implemented in fragile, low-resource settings remains limited. This study examined AI-related practices and implementation readiness in one urban health zone in the Democratic Republic of Congo (DRC) and used African pilot experiences to contextualize the local findings. We conducted a secondary thematic analysis of semi-structured interviews with 11 purposively selected health professionals in the Ibanda Health Zone and integrated the findings with a critical narrative review of 56 scientific and grey-literature documents from the DRC, Rwanda, Kenya, and South Africa. The two evidence streams were coded against a common framework covering use cases, institutionalization, reported effects, and health-system prerequisites. No institutionally implemented clinical AI system was identified in Ibanda. Some professionals reported informal use of consumer generative AI, while Google Search, DHIS2, and routine laboratory automation formed part of the broader digital-readiness environment but were not classified as AI. Participants perceived potential benefits for diagnosis, laboratory turnaround, and data management, but reported major barriers related to training, connectivity, paper records, regulation, and governance. Individual African pilot studies reported promising results, but heterogeneous designs and settings precluded direct comparison or pooled conclusions. Ibanda illustrates a pre-emergent stage of AI readiness rather than established AI implementation. The combined evidence suggests that any future deployment should be gradual, locally validated, and preceded by investment in data systems, infrastructure, workforce capacity, and accountable governance. These exploratory findings are context-specific and should not be interpreted as evidence of AI effectiveness in the DRC.
Mental health integration into primary health care (PHC) is widely advocated as the most feasible strategy to address the large treatment gap in low- and middle-income countries. However, baseline clinical decision-making skills of frontline primary healthcare workers (PHCWs) in the assessment, management, and referral of common mental, neurological, and substance use (MNS) disorders remain poorly documented, particularly in Northern Nigeria. This study assessed mental health knowledge, diagnostic accuracy, treatment, and referral skills among PHC workers in Kano, Nigeria. A cross-sectional study was conducted among 180 PHC workers selected through simple random sampling. Mental health knowledge was evaluated using the Mental Health Knowledge Questionnaire. Clinical decision-making skills were assessed with four culturally adapted clinical vignettes. Data were analysed using descriptive statistics, independent t-tests, ANOVA, and multivariable linear regression in IBM SPSS version 26, with statistical significance set at p < 0.05. The mean (SD) mental health knowledge score was 12.27 (2.62) out of 20 (61.35
This study aimed to assess the association between socioeconomic status (SES) and healthcare service utilisation in Spain, considering explanatory factors based on Andersen’s behavioural model and examining patterns across the 2017–2023 period, including the COVID-19 pandemic. Population-based cross-sectional study using data from national health surveys conducted in Spain in 2017, 2020, and 2023, including individuals aged ≥ 15 years. Dependent variables were general practitioner (GP) visits, specialist consultations, hospital admissions, and emergency department use across public and private sectors. SES (high, medium, low) was the main explanatory variable. Predisposing, need-related, and enabling factors were included. Generalised linear models with negative binomial distribution and robust standard errors were fitted. Models included interaction terms between SES and survey year. Analyses were stratified by gender. A total of 66,193 responses were analysed (22,038 in 2017; 22,077 in 2020; 22,078 in 2023). In primary care, lower SES was associated with higher use (IRR = 1.11; 95
Pharmaceutical residues resulting from patient excretion, incorrect disposal and manufacturing of medicines contribute to environmental pollution and related risks. Designing active pharmaceutical ingredients of inherently lower environmental risk (‘greener APIs’) is one potential solution to this issue. To assess the current level of preparedness to adopt potentially greener APIs as a part of more sustainable medical care, the perspectives of healthcare professionals on greener APIs were evaluated by investigating related opportunities, barriers and the needs to overcome these barriers. Semi-structured interviews were conducted with professionals working in the healthcare sector in European countries between February and April 2024 (n = 16). The interviewees included doctors (3), pharmacists (3), experts in procurement (3), reimbursement (1), market authorisation (2), healthcare provision (2) and industry’s sustainability reporting (1), as well as a professional working for an environmental NGO (1). Data was evaluated using qualitative content analysis. Interviewees’ answers showed that some strategies already exist to account for environmental aspects in decision-making, e.g. by adding environmental criteria to the tenders of procurement agencies. Criteria on environmental properties of APIs can be expected to play a more significant role in the decision-making of HC professionals in future. Balancing molecular properties related to patient benefit and risk against environmental properties could be product specific. Frequently expressed needs to enable this include: access to reliable scientific data and evidence of environmental impacts of APIs, legislative and regulatory frameworks and guidance to ensure environmental properties are assessed and weighed in a centralised and harmonised manner. The evident interest among HC professionals to consider environmental properties in their decision-making may stimulate data sharing by pharmaceutical companies in the short-term and efforts to design greener APIs in the long-term. The marketing authorisation process is viewed as the main intervention point in the life cycle of pharmaceuticals to strengthen considerations of environmental risks. The authors conclude that future research should target the identified barriers and their solutions. The study evaluates on the preparedness to adopt greener APIs into use. Qualitative interview study with 16 European healthcare (HC) professionals. Findings show interest by HC professionals to minimise environmental impacts. Barriers and needs to consider environmental criteria were identified.
Service quality is an important aspect of customers’ experiences and behavioral intentions in community pharmacies. This study aimed to provide initial psychometric validation of a multidimensional service quality scale and examine its associations with customer satisfaction, loyalty, and word-of-mouth (WOM) intention in Da Nang, Vietnam. A cross-sectional survey was conducted from January to March 2024 with the participation of 409 customers. Service quality (six dimensions, 23 items), satisfaction (single item), loyalty (3 items), and WOM intention (2 items) were assessed using five-point Likert scales. Exploratory Factor Analysis and Confirmatory Factor Analysis were performed to evaluate the measurement model. Covariance-based Structural Equation Modeling was applied to test the hypothesized relationships. Additional regression and moderation analyses examined the associations of customer characteristics and pharmacy type with the three outcomes. The measurement model demonstrated good reliability and validity, with satisfactory factor loadings (> 0.65), composite reliability (> 0.78), and average variance extracted (> 0.53). The robust fit indices indicated adequate model fit (χ²/df = 1.722, CFI = 0.960, TLI = 0.952, RMSEA = 0.046, SRMR = 0.041). Customer satisfaction, loyalty, and WOM intention were generally favorable, with mean scores of 3.91 ± 0.75, 3.74 ± 0.77, and 3.63 ± 0.78, respectively; 80.2
Chronic diseases, including diabetes, are significant health challenges globally, particularly in low- and middle-income countries. Diabetes management is profoundly influenced by cultural beliefs and practices of providers and patients, necessitating culturally competent care by the providers to improve health outcomes. This qualitative phenomenological study explores healthcare providers’ perspectives on cultural competency in diabetes care at Tikur Anbesa Specialized Hospital in Ethiopia. A phenomenological qualitative design was employed, using in-depth individual interviews with 7 healthcare providers, including doctors, nurses, and pharmacists. The interview guide was based on Seeleman’s cultural competence model. The data were analyzed thematically, identifying key themes related to cultural competency of providers in diabetes care. Major thematic categories identified included: challenges in delivering culturally competent care due to cultural and religious influences; knowledge gaps in cultural competence; building trust and patient relationships; openness, respect, and curiosity toward patients’ beliefs; communication strategies and language barriers; shared decision-making; cultural competence training needs; and perceptions regarding outcomes. Providers emphasized the necessity of cultural competence training and formal guidelines to better understand and respect diverse cultural beliefs to enhance diabetes care outcomes. The lack of such training hindered effective communication and treatment adherence. Strategies employed by providers—including the use of interpreters and culturally adapted educational materials—highlighted the importance of building trust and fostering open communication. Despite systemic barriers, healthcare providers demonstrated attitudes of openness and respect toward patients’ cultural backgrounds, underscoring the critical need for comprehensive cultural competence training to improve patient engagement and health outcomes. Healthcare providers at Tikur Anbesa Specialized Hospital struggle to deliver culturally competent diabetes care due to inadequate training and resources. Effective communication and understanding of cultural beliefs are essential for improving patient outcomes. Structured cultural competence training programs integrated into healthcare curricula and professional development are crucial to enhance diabetes care and address the unique needs of diverse patient populations.
Exposure to tobacco smoke remain major public health concerns due to its’ association with multiple morbidities and increased health-services use. This cross-sectional study aimed to, (i) assess the prevalence of exposure to tobacco smoke (first-hand and second-hand) among students at a public university; (ii) assess the prevalence of tobacco smoke-related concurrent morbidities; (iii) assess the prevalence of health-services use (≥ 1 vs. none) during the past one-year; and (iv) evaluate the association between demographics, tobacco smoking, concurrent morbidities, and health-services use during the past year. A cross-sectional study was conducted in October 2022 among undergraduate students at Kuwait University using a structured electronic questionnaire. Participants were recruited as a sample of convenience. The prevalences (
International evidence on the impact of community health on health outcomes is generally positive; however, the effect on reducing hospitalisations is mixed and often depends on the specific settings and institutions. Evidence from Australia is limited. This study assesses how community health affect hospital care utilisation under the Victorian Community Health Program, which provides a range of services to priority populations at risk of poorer health under a social model of care. To account for differences between community health users and non-users, this study used Propensity Score Matching to address the non-random assignment of individuals into the Community Health Program. Administrative data were extracted and linked across (i) the Community Health Minimum Dataset, (ii) the Victorian Admitted Episodes Dataset, and (iii) the Victorian Emergency Minimum Dataset. Compared with non-users, users of the Community Health Program had fewer unplanned hospital readmissions. In contrast, users of the Community Health Program had a longer length of stay, more potentially preventable admissions, more admissions with hospital acquired complications, and more emergency department presentations. No significant difference was found in the total number of hospital admissions. Access to the Community Health Program was found to have mixed effects on hospital utilisation, which may reflect previously unmet health needs among users. Further research is needed to examine potential factors driving these results. A key limitation is the lack of data on primary care use, health improvements allowing hospital avoidance and changes in well-being. Access to additional linked data is necessary before these results can meaningfully inform policy decisions.
Gender and equity are critical determinants of health and healthcare access. The perceptions of health workers can shape how gender and equity are integrated into primary care services, influencing both the quality and fairness of care delivery. To assess health center staff perceptions of gender and equity in the Conakry health region, Guinea. A descriptive cross-sectional survey was conducted in 19 health centers across the five communes of Conakry. The study included 412 health workers: physicians, nurses, midwives, technicians, and other patient-facing staff. Perceptions of gender and equity were measured using a structured questionnaire, and data were analyzed with descriptive statistics. Health workers predominantly held a biological view of gender, with most agreeing that biological characteristics mainly determine gender and that men’s and women’s roles are naturally different. A large proportion did not perceive gender as influencing daily work, career progression, or patient treatment. Despite generally positive views on organizational equity, the visibility of formal gender-related policies and structures was limited. More than half of the participants reported the absence of a gender-equity policy or focal point, while a strong majority supported training and sensitization on gender and equity. Primary health care staff in Conakry report limited recognition of gender’s influence in their professional setting, alongside weak institutionalization of gender-responsive mechanisms, yet express a strong demand for targeted capacity-building. Strengthening policies, establishing clear focal points, and linking training to practical implementation tools are key opportunities for reinforcing gender and equity in Guinea’s primary health care system.
Neck pain (NP) is a leading cause of disability among older adults. Clinical practice guidelines recommend nonpharmacological therapies as a first-line approach. However, prior studies suggest substantial geographic variability in the availability and utilization of nonpharmacological therapies in the United States. Characterizing care utilization patterns among older adults with NP yields critical insights into equitable access to, and utilization of, guideline-concordant services. Aims were to (i) investigate spatial variation in rates of outpatient provider utilization, with attention to potential disparities in access and (ii) assess predictors of initial provider specialty for new onset NP among Medicare fee-for-service (FFS) beneficiaries in 2021. We conducted a retrospective observational study, using Medicare claims data to calculate state-level rates of care utilization for NP overall and for frequently utilized provider types for NP: chiropractic and primary care. Spatial distribution of care utilization for NP and provider utilization was visualized and investigated through spatial autocorrelations. Associations between provider utilization and sociodemographic risk factors were assessed. Predictors of chiropractic and primary care utilization were analyzed using regression models. We identified 236,995 Medicare FFS beneficiaries with an outpatient visit for new onset NP. The mean state-level rate of care utilization for NP was 188.72 per 1000 beneficiaries. Northern plains and mountain states exhibited higher rates of care utilization for NP, higher chiropractic utilization, and lower primary care utilization. Chiropractic care utilization was positively associated with better population health status and low back pain (LBP) prevalence, whereas LBP prevalence was negatively associated with primary care utilization. This study demonstrates significant geographic variation in utilization for NP by provider specialty among Medicare FFS beneficiaries, and significant associations between provider utilization and sociodemographic factors. Future research should investigate disparities in care access and utilization for NP across sociodemographic groups to inform efforts toward health equity.
Neonatal jaundice (NNJ) is a prevalent condition requiring timely detection and management to prevent severe hyperbilirubinemia and its long-term sequelae. In Malaysia, NNJ screening in primary care predominantly relies on Kramer’s Rule (KR), followed by total serum bilirubin (TSB) testing if it is necessary. Given the similar safety outcome incorporating transcutaneous bilirubin (TcB) screening with KR versus KR-TSB strategy, this study aimed to compare the cost implication between two different screening strategies: KR-TcB-TSB versus the conventional KR-TSB. A retrospective cost-minimization analysis was conducted using data from the TRANDLAB study, involving 765 neonates screened for NNJ across six Malaysian government-run primary care clinics, using two different strategies: KR-TcB-TSB (n = 384) and KR-TSB (n = 381). Direct medical costs over a 10-day neonatal monitoring period were analyzed via decision-tree models that captured all potential clinical pathways. Probabilities were derived from TRANDLAB study data, and costs incorporated personnel time, consumables, equipment acquisition, calibration, and maintenance for both TSB and TcB testing. Sensitivity analyses included variations in TcB per-measurement costs and comparing with KR-TcB-TSB using American Academy of Pediatrics (AAP) screening threshold. Decision-tree modelling revealed significantly lower mean (SD) costs per neonate in the KR-TcB-TSB cohort [USD 4.15 (SD 2.33)] versus the KR-TSB cohort [USD 5.41 (SD 2.75)]. The KR-TcB-TSB cohort yielded significant cost savings of USD 1.25 per neonate compared to the KR-TSB cohort (P < 0.001). Threshold analysis indicated cost savings were maintained unless TcB per-measurement costs exceeded USD 1.17. The AAP-guided KR–TcB–TSB strategy reduced mean cost per neonate by 6.4
Physical activity is a key component in public health frameworks to maintain functional ability through ageing. In Norway, healthcare services such as home health nursing and long-term institutional stays for older adults account for a significant amount of healthcare expenditures, but little is known about the association between physical activity levels through adulthood and utilisation of these services later in life. To this end, we wanted to explore an association between physical activity and the use of these specific healthcare services. We used data from three waves of the Trøndelag Health Study, that surveyed physical activity levels through questions about physical activity frequency, duration and intensity (HUNT1, 3 and 4). These questions allowed the calculation of minutes per week of moderate intensity physical activity, in addition to assessment of weekly physical activity frequencies (low-high). We included all who were either ≥ 65 years in HUNT3 or took part in all three surveys. Time-series of home health nursing and long-term institutional stays was collected from the combined Individual-based Statistics for Nursing and Care Services (IPLOS) and the Norwegian Registry for Primary Health Care (NRPHC) between 2007 and 2022. Multiple Cox proportional hazard models were built to assess the association between time to healthcare utilisation and physical activity levels. Of the 15,737 participants who took part in HUNT1 and HUNT3, 9318 also participated in HUNT4. Moderate-intensity physical activity could be calculated for 8882 participants aged ≥ 65 years in HUNT3 (53
This study aimed to identify latent suicide risk subtypes among first-episode, treatment-naive adolescents with major depressive disorder (MDD), and to explore the item-level association patterns across subtypes, so as to provide evidence for optimizing stratified suicide risk screening and supporting future longitudinal intervention research. Latent profile analysis (LPA) and regularized partial correlation network analysis were adopted to analyze data from 930 first-episode, treatment-naive adolescents with MDD aged 12–18 years. Suicide risk subtypes were identified based on the Suicide Behaviors Questionnaire-Revised (SBQ-R). Scale item association networks were constructed using items from the Patient Health Questionnaire-9 (PHQ-9), SBQ-R, and dimensions of Adolescent Self-Rating Life Events Checklist (ASLEC). Differences in high-centrality items and network structural characteristics were compared across subtypes. Three suicide risk subtypes were identified among adolescents with MDD: a low suicide risk group (n = 248, 26.7
