Benzodiazepines (BZDs) remain widely used across Europe for anxiety, insomnia, and related indications, despite longstanding recommendations limiting treatment duration and prioritising non-pharmacological care. Alongside sustained prescribing, Europe is characterised by a “legal–illegal continuum” in which authorised medical use, diversion and non-medical consumption, and illicit markets—including novel BZDs monitored as new psychoactive substances—interact and amplify clinical harm. Recent European data demonstrate marked inter-country variability in consumption patterns and high prevalence among older adults, raising safety concerns in both community and long-term care settings. The associated clinical burden extends beyond physiological dependence and withdrawal to include falls, cognitive impairment, driving impairment, and elevated overdose risk, particularly in the context of polysubstance use involving opioids or alcohol. Deprescribing has therefore emerged as a key public health priority. Available evidence indicates that single-component interventions produce modest and inconsistent effects, whereas multicomponent approaches combining gradual tapering with behavioural or educational support are associated with higher discontinuation rates, although certainty of evidence varies. This narrative review examines European epidemiological, toxicological, and clinical evidence across the legal–illegal continuum, examines system-level drivers of persistent exposure, and proposes a pragmatic conceptual framework for European practice integrating stepped care, risk stratification, coordinated tapering, and implementation strategies at primary care, pharmacy, and policy levels.
In Ethiopia, inequitable access to essential health care persists, especially among hard-to-reach and mobile pastoralist communities. To address this gap, the Ethiopian government introduced an integrated Mobile Health Service (iMHS) delivery modality, deploying multidisciplinary teams from primary health care units to provide services close to underserved, mobile and hard-to- reach populations. This study explored operational challenges encountered during the implementation of the iMHS in the pastoralist setting of Ethiopia. A descriptive phenomenological study was conducted to explore operational challenges of iMHS among program implementers. Since June 2023, the district-led, community-based iMHS delivery modality was implemented in five pastoralist regions. Interviews were conducted among 143 key informants who were implementers of the iMHS across the five regions from February to March 2024. Collected data were transcribed and coded using ATLAS. ti software, and analysed thematically. The operational challenges were thematised into five healthcare dimensions: accessibility, availability, affordability, adequacy, and acceptability. While the district-led iMHS platform improved access to essential health services among pastoralist communities, significant barriers persisted. These included resource constraints, high staff turnover, dispersed populations, inadequate transportation and telecommunication infrastructure, privacy at service points, absence of cost recovery mechanisms, and lack of integration with existing community-based health insurance schemes. High staff turnover, poor infrastructure, and resource limitations hindered effective iMHS delivery. Local resource mobilisation, innovative financing, developing staff retention strategies, enhancing local information-sharing platforms and integrating the health management information system are required to address challenges. Policy dialogues are crucial for ensuring sustainable government-owned iMHS delivery modality in Ethiopia.
Maternal healthcare inequalities remain a significant challenge in India, particularly in Uttar Pradesh, where socioeconomic and demographic factors greatly influence access to essential services. Despite initiatives like the National Rural Health Mission (NRHM) and the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH + A) framework, disparities in healthcare utilisation persist. This study examines the variations and socioeconomic inequality in maternal healthcare utilisation, specifically focusing on antenatal care (ANC), institutional delivery, and postnatal care (PNC). The study utilised data from the 71st (2014–15) and 75th (2017–18) rounds of the National Sample Survey (NSS). Descriptive analysis was conducted to examine healthcare utilisation across different socioeconomic groups, including wealth status, education level, caste, and rural-urban residence. Multinomial logistic regression assessed factors influencing the choice between public, private, and no care for ANC, delivery, and PNC services, identifying key predictors and their effects across subgroups. Concentration curves were used to visualise inequality by comparing healthcare utilisation across wealth quintiles with the line of equality. The results reveal significant socioeconomic disparities: wealthier households predominantly use private facilities, while poorer households rely on public services or receive no care. Public facilities show relatively equitable access across wealth groups, particularly in the 75th round, indicating improved reach among disadvantaged populations. However, the persistence of the “No Care” pattern among the poorest households underscores ongoing barriers. Socioeconomic factors, including caste, education, wealth, and regional disparities, play crucial roles, with backward castes, less educated women, and those from weaker regions favouring public healthcare. The study highlights that maternal healthcare utilisation is influenced by socioeconomic determinants, and while greater utilisation of public maternal healthcare services was observed in the later survey round, improvements in public facilities are essential to expand care among higher-income households. Addressing regional disparities and focusing on economically weaker districts will be crucial in reducing maternal healthcare inequalities in Uttar Pradesh.
During the Coronavirus Disease 2019 (COVID-19) pandemic, women in low-resource settings faced significant disruptions to healthcare access and household stability. While existing research has documented service barriers and vulnerability, less attention has been given to how women interpret and navigate health-related decision-making under crisis conditions. This study aimed to examine how selected Nigerian women described and interpreted health-related and household decision-making during the COVID-19 pandemic, with particular attention to different forms of agency expressed within social and institutional constraints. A secondary qualitative analysis was conducted using semi-structured interview data collected between August and November 2022 as part of a larger study on women’s health-seeking behaviour in Nigeria. Interpretative Phenomenological Analysis (IPA) guided in-depth examination of narratives from 15 purposively selected participants whose interviews contained detailed reflections on decision-making processes. Analysis focused on experiential meaning, relational negotiation, moral reasoning, and faith-informed coping practices. Three interpretive layers of agency expression were developed inductively, drawing on Smith’s concept of “gems” in IPA: “shining” (public and relational decision-making), “suggestive” (negotiated and situational strategies), and “secret” (interior and faith-informed coping). Across these layers, women described exercising agency through coordination with family members, ethical management of limited resources, and culturally embedded meaning-making practices. Agency was often expressed in context-dependent and relational ways rather than through overt individual autonomy. The findings highlight the diverse ways agency may be enacted during crisis conditions and underscore the value of qualitative approaches for understanding health decision-making in constrained settings. Although not intended to be statistically generalizable, these insights may offer insight for more context-sensitive health communication strategies.
Forecasting health expenditures is essential for sustainable health financing and achieving Universal Health Coverage (UHC) by 2030. This study analyzes historical trends in Iran’s health expenditures from 2001 to 2022 and projects future values up to 2030 using ARIMA models. Data were obtained from official National Health Accounts. Separate ARIMA models were fitted to log-transformed series for Total Health Expenditure (THE), Current Health Expenditure (CHE), public health expenditure, private health expenditure, and Out-of-Pocket (OOP) payments. Models were selected based on the lowest Akaike Information Criterion (AIC), validated using 2019–2022 out-of-sample data, and refitted on the full dataset for forecasting. The best-performing models showed acceptable out-of-sample accuracy (MAPE ranging from 12.5
To analyze dietary intake in the Brazilian population between the 2013 and 2019 editions of the National Health Survey (PNS). A cross-sectional study that assessed dietary intake (DI) using two scoring systems that classified foods into two groups: unprocessed/minimally processed (UNMP) and ultra-processed (UPF/UPA), based on the frequency, extent, and purpose of food processing. Scores were derived from two instruments: a habitual food frequency questionnaire and a 24-h dietary recall. The first score assessed the combined consumption of UNMP and UPA in the two waves of the survey, ranging from 0 (highest consumption of UNMP and lowest consumption of UPA) to 40 points (lowest consumption of UNMP and highest consumption of UPA). The second score, based on a 24-h dietary screener applied in 2019, assessed UNMP and UPA separately. Scores ranged from 0 to 7 for UNMP and from 0 to 10 for AUP, with a cutoff point of 5. Higher AUP scores indicated lower diet quality, while higher UNMP scores reflected better diet quality. The study included 158,462 individuals in both waves of the survey. In 2013, the mean pooled score was 27.65 (27.55–27.76), increasing to 30.95 (30.88–31.04) in 2019. In the 2019 PNS, mean intake scores were 3.25 (3.23–3.27) for UNMP and 2.49 (2.47–2.52) for AUP. Both scoring approaches showed consistent patterns in 2019. An improvement in diet quality was observed in the Brazilian population between 2013 and 2019.
Surveillance of wastewater from airplanes and airports has emerged as a promising tool to monitor pathogen importation. While these strategies expanded during the COVID-19 pandemic, most efforts remained proofs-of-concept, and few have become institutionalized. Airport and airplane wastewater sampling involve distinct operational constraints, partnership networks, and surveillance roles, which must be understood to inform sustainable system design. We conducted a scoping review following PRISMA-ScR guidelines. 41 studies from 20 countries were retrieved from PubMed, Embase and manual searches, describing first-hand efforts to detect pathogens in wastewater from airplanes, intermediate collection points, airport terminals, or airport-adjacent wastewater treatment plants. Data were extracted using a framework adapted from the U.S. Centers for Disease Control and Prevention’s surveillance system evaluation concepts, covering purpose, operational characteristics, stakeholder roles, analytical challenges, and public health applications. Aviation wastewater was demonstrated as a reliable source for early-warning, often detecting SARS-CoV-2 variants days to weeks ahead of clinical or municipal wastewater surveillance. Airplane and airport wastewater surveillance emerged as complementary approaches; while airplane wastewater provided targeted insight into pathogen importation and flight origins, airport wastewater reflected broader patterns of local transmission. Together, they provide situational awareness at the interface between global mobility and community spread. This scoping review presents the first synthesis of published literature on aviation wastewater surveillance comparing airplane and airport sampling across operational and epidemiologic characteristics. Realizing aviation wastewater’s full potential requires coordinated partnerships, expansion of initiatives to new regions, and clear pathways for translating signals into public health action.
Tuberculosis (TB) and human immunodeficiency virus (HIV) remain major global health challenges, particularly in sub-Saharan Africa where co-infection and chronic immune activation are highly prevalent. Interferon-gamma (IFN-γ) plays a central role in host defense against Mycobacterium tuberculosis, yet its determinants in real-world, high-burden populations especially in the context of metabolic and systemic inflammation are not fully understood. This study investigated clinical, inflammatory, and metabolic factors associated with circulating IFN-γ levels in adults in a high HIV/TB burden setting. This was a cross-sectional study of 227 adults attending medical clinic at Livingstone University Teaching Hospital, Zambia. Circulating IFN-γ and a panel of inflammatory, metabolic, and renin–angiotensin–aldosterone system (RAAS) biomarkers were measured. Associations were assessed using simple and multivariable linear regression models, with log transformation applied to skewed variables. Statistical significance was defined as p < 0.05. Among participants (median age 50 years; 64.3
Blood donation is a vital component of modern healthcare systems, as blood cannot yet be fully synthesized for routine clinical use and depends entirely on voluntary human donors. College students represent a large and healthy pool of potential donors; however, evidence regarding their knowledge, attitudes, and donation practices in geographically remote regions such as Jumla, Nepal, remains limited. This study aimed to assess the knowledge, attitude, and practice (KAP) of blood donation and identify associated factors among college students in Jumla, Nepal. A cross-sectional analytical study was conducted among 647 students from three educational institutions in Jumla: Karnali Academy of Health Sciences (KAHS), Karnali Technical School (KTS), and Jumla Multiple Campus (JMC). Participants were selected using an institution-based stratified convenience sampling approach and completed a structured self-administered questionnaire. Data were analyzed using descriptive statistics and Chi-square tests with SPSS version 23. Among the 647 participants, 73
This paper demonstrates how a principle-based interpretation of the Project Management Body of Knowledge (PMBoK) 8th Edition can enhance the initiating and planning phases of complex research projects, using a multicenter maternal health initiative—Active Pregnancy—as an illustrative case. Building on PMBoK’s emphasis on value delivery, adaptability, and tailoring, the project is framed as a health-focused endeavor that must balance scientific rigor with stakeholder needs, ethical constraints, and organizational strategy across multiple sites. The paper adopts a qualitative, document-based approach to map project charters, management plans, and governance structures onto PMBoK’s performance domains and value delivery system. It shows how explicit definition of scope, schedule, cost, quality, communication, and risk management in the early phases provides a coherent architecture for later execution, monitoring, and closure. Particular attention is given to the translation of PMBoK principles into practical mechanisms, including a detailed stakeholder matrix, an organizational breakdown structure, and a work breakdown structure that covers management, intervention, resource development, digital product design, and dissemination. Another contribution is the illustration of a hybrid lifecycle tailored to a research-intensive, ethically sensitive environment. Predictive elements are used for ethics approval, protocol development, and trial logistics, while adaptive, agile components guide iterative co-creation of educational materials, digital tools, and communication strategies responsive to participant feedback and contextual changes. The paper also discusses how success criteria, key performance indicators, risk registers, and sustainability plans can be aligned with both project-level objectives and broader organizational and societal goals, including health equity and the Sustainable Development Goals. By abstracting from the specific maternal health context, the case study offers a transferable model for project managers seeking to operationalize PMBoK in other complex, multi-stakeholder research and innovation projects, demonstrating how a principle-based framework can improve planning effectiveness, coordination, and value realization beyond traditional commercial settings.
Equitable access to health services remains a major challenge to achieving universal health coverage (UHC). In Senegal, the National Family Safety Net Program (PNBSF) aims to reduce vulnerability among poor households through cash transfers and free enrolment in community-based health insurance. However, barriers to effective healthcare access persist. This study examines determinants of healthcare utilization among PNBSF beneficiaries in rural Senegal. A mixed-methods study was conducted in the departments of Koungheul and Foundiougne. The quantitative component was based on a cross-sectional survey of 254 PNBSF beneficiaries who reported a health problem in the four weeks prior to the survey and were eligible for the analysis of healthcare utilization. Determinants of healthcare utilization were analyzed using the Andersen behavioral model, including predisposing, enabling, and need factors, and multivariate logistic regression. The qualitative component included 41 semi-structured interviews exploring healthcare experiences and access barriers. Findings were integrated using an explanatory mixed-methods approach. Overall, 69.7
Influenza is a serious viral respiratory disease, and vaccination is the primary means of prevention. The purpose of the present study was to evaluate the effectiveness of an intervention program in improving university students’ knowledge and attitudes regarding the seasonal influenza vaccine. A quasi-experimental design was employed, with convenience sampling of 204 students (102 intervention, 102 control) over a period of six months at Thi-Qar University (TQU) in southern Iraq, across six colleges selected via a simple random lottery. Students’ knowledge and attitudes were measured using a structured educational program, brochures, and pre- and post-tests. Independent- and paired-samples t-tests were used to analyze the data, with a significance level of p < 0.05. At pre-test, 40.2
Family planning offers numerous benefits, including helping couples achieve their preferred family size and lowering infant, perinatal, and maternal mortality rates. This study uniquely leverages the Afghanistan Health Survey 2018 (AHS) to provide an update on modern contraceptive use and examine additional correlates such as husband’s education and women’s pregnancy desire, which were not previously assessed. A total of 20,106 currently married women, aged 15–49 years were included in this study. The primary outcome was the self-reported use of modern contraceptive methods (pills, injectables, intrauterine devices, condoms, female sterilization, lactational amenorrhea method, and implants). Bivariate and multivariable logistic regression models identified factors associated with the use of modern contraceptive methods. The analysis was conducted using STATA version 18.0. Of the total women, only 18.3
Corporate social responsibility (CSR) refers to organizational actions that mitigate the negative impacts of operations on society. In hospitals, implementing CSR enhances healthcare delivery effectiveness and competitiveness. This study aimed to identify and prioritize hospital CSR programs in Iran using a three-phase approach. First, a literature review identified relevant CSR criteria and initiatives. Next, the Delphi method engaged 30 experts to assess and refine these criteria, sub-criteria, and initiatives. Finally, the Fuzzy Analytical Hierarchy Process (F-AHP) was applied, using pairwise comparison questionnaires completed by 20 hospital managers, to determine the relative weights and importance of CSR elements. The results identified six main criteria, nine sub-criteria, and 50 CSR initiatives. The patient-related criterion was the most significant (weight 0.266), followed by hospital governance (0.250), staff (0.216), social (0.093), environment (0.092), and suppliers (0.083). In conclusion, hospitals should integrate social, environmental, ethical, and human rights considerations with patient-centered care into their operations and strategic planning. This integration can help prevent and mitigate potential negative impacts. The findings also provide a foundation for developing a comprehensive evaluation and ranking model for hospital CSR, highlighting their contributions to community well-being.
The increasing prevalence of poor mental health amongst young people is a public health concern, and physical activity (PA) is a potential intervention that has both physical and mental health benefits. While education settings are important contexts for intervention delivery, little is known about the role of PA in student mental health in Further Education (FE) Colleges. This qualitative study aimed to explore the perspectives of college staff regarding the role of PA to support student mental health. Twenty nine college staff from 5 colleges in the South-West of England took part in semi-structured interviews. Interviews were recorded, transcribed and anonymised, and then analysed using the Framework Method. Staff perceived barriers to using PA to support student mental health in FE colleges were identified across four key themes; a missing link between PA and mental health, physical activity having no core place in further education, negative attitudes towards physical activity and practical limitations to physical activity provision. Opportunities identified for future implementation included a more joined-up approach between PA and mental health, systemic changes to policy and funding structures, and strategies to address student-level barriers to improve engagement with PA at college. While PA is a potential preventative and supportive mental health strategy within FE colleges, staff suggested meaningful future implementation requires structural, cultural and policy-level changes to ensure equitable access and engagement. Future research should explore young people’s perspectives and evaluate recommended strategies for embedding PA within FE to support college student mental health.
Stress levels are increasingly elevated across all segments and age groups of Jordanian society. Psychosocial stress has been observed to influence the risk of developing coronary heart disease (CHD) in the general population. To evaluate the association between perceived stress and cardiovascular disease risk among the Jordanian population. A cross-sectional study was conducted. People without a history of any cardiovascular diseases (CVD) and aged ≥ 18 years in the Jordanian population were targeted through an online questionnaire. Two validated tools were used: the Perceived Stress Scale (PSS-10) and the INTERHEART non-laboratory (BMI version) risk score. A positive association between perceived stress and cardiovascular risk was revealed, indicating a higher cardiovascular risk with increasing stress levels. A 5-point increase in PSS-10 was associated with approximately 32
Mobile Medical Units (MMUs) are increasingly used to improve access to primary healthcare services among geographically underserved rural populations. However, evidence regarding healthcare utilization patterns, repeat consultations, and spatial variation in MMU service use remains limited, particularly in private medical college-supported outreach settings in India. This study aimed to describe healthcare utilization patterns, morbidity profile, repeat consultations, and village-level variation in service use among beneficiaries attending a rural MMU. A retrospective descriptive analysis of MMU outpatient records from April 2024 to March 2025 was conducted in Mulshi block, Pune district, Maharashtra, India. All recorded consultations were included. Variables analysed included age, sex, village of residence, morbidity profile, repeat consultations, and village-wise consultation load. Diagnoses were grouped into broad morbidity categories for analysis. Descriptive statistics, chi-square tests, and effect size estimation were performed. Andersen’s Behavioral Model of Health Service Utilization was used as a broad interpretive framework rather than a formally operationalized explanatory model. GIS-based spatial visualization using QGIS was undertaken to explore geographic variation in consultation patterns. A total of 18,296 consultations involving 12,901 unique beneficiaries were recorded during the study period, of which 5,395 consultations (29.5
Health seeking behaviour is a key determinant of health outcomes and health system performance, particularly in low- and middle-income countries. Despite Tanzania’s commitment to Universal Health Coverage (UHC), timely and appropriate use of formal healthcare services remains suboptimal. This study assessed patterns and determinants of health seeking behaviour among adults attending health facilities in Ifakara, Tanzania. An analytical cross-sectional study was conducted among 300 adult patients attending St. Francis Regional Referral Hospital and Kibaoni Health Center. Data were collected using interviewer-administered structured questionnaires. Descriptive statistics were used to summarize participant characteristics. Bivariate and multivariable logistic regression analyses were performed to identify factors independently associated with good health seeking behaviour. Statistical significance was set at p < 0.05. Overall, 39.7
Despite the legalization of abortion in Nepal in 2002 and the provision of free, safe abortion services (SAS) since 2016, significant barriers persist. This study explores the nature and extent of abortion stigma and its impact on access to SAS, examining the beliefs and perceptions of key stakeholders in Nepal. A qualitative study was conducted in four districts (Jhapa, Gorkha, Parsa, Surkhet), representing diverse ecological regions and provinces. Data were collected through 20 in-depth interviews (IDIs) with post-abortive women (PAW), 5 key informant interviews (KIIs) with policy representatives, and 16 focus group discussions (FGDs) with community men and women. Purposive and snowball sampling were used. Data were analyzed using thematic analysis guided by the SABAS framework. Key findings indicate widespread lack of clarity about the legal status and availability of SAS. Abortion is highly stigmatized, perceived as immoral, sinful, and equivalent to “killing a child,” leading to guilt, social exclusion, and discrimination, particularly against unmarried women. Findings are organized around four stigma domains: internalized, enacted, perceived, and structural stigma. Stigma is perpetuated by community members, religious adherents, and patriarchal structures, creating barriers to safe access. Abortion stigma remains a profound barrier to realizing legal abortion rights in Nepal. Reducing stigma requires comprehensive strategies including education, provider training, and engaging men, religious leaders, and youth as advocates. Specific policy recommendations and future research directions are outlined.
Abstract In early 2026, Somalia reached a critical threshold in pediatric malnutrition, with admissions hitting five-year highs. This surge is exacerbated by the simultaneous closure of nearly 500 nutrition clinics due to international funding cuts and a sharp, conflict-driven rise in fuel costs, which has fundamentally severed healthcare access for rural and displaced populations. This perspective examines the “empty shell” syndrome of Somalia’s aid-driven health system, which stems from reliance on off-budget, vertical programming. We analyze the combined mortality rates resulting from the interaction of severe acute malnutrition (SAM) with preventable infectious diseases such as measles and cholera. Addressing the largely overlooked child survival emergency requires a strategic shift from emergency handouts to comprehensive health system integration. We propose urgent interventions, including transport subsidies and the decentralization of stabilization centers, as immediate measures to save lives.
