Introduction Climate change poses a major threat to health and health systems. General practices in England urgently require context-sensitive strategies to become environmentally sustainable in line with the United Kingdom’s (UK) National Health Service (NHS) net zero 2040 goal. Objective To explore systemic barriers, enablers, and feasible solutions for decarbonising general practice in England through stakeholder engagement and knowledge mobilisation, using a systems thinking approach. Design We conducted a qualitative knowledge mobilisation workshop involving 15 stakeholders, including general practitioners, commissioners, policymakers, and public contributors. The workshop was structured to uncover multi-level insights and elicit and synthesise stakeholder perspectives on context-sensitive strategies for environmentally sustainable primary care. Methods Workshop data included audio recordings, rapporteur summaries, and observational notes across three decarbonisation domains and thematic discussion groups: travel, estates and operations, and procurement and supply chains. Framework analysis guided the synthesis across five levels of systemic intervention: structural elements, feedback and delays, system structure, goals, and paradigm. Results Participants identified accountability gaps, policy fragmentation, and perceived tensions between sustainability and care delivery as systemic barriers. Key enablers included leadership engagement, peer learning platforms, integrated urban-health planning, and co-benefit framing. Feasible solutions ranged from emissions tracking tools to paradigm-level redefinitions of general practice’s purpose. Cross-cutting insights emphasised the need to embed equity, scenario planning, and patient voice into all stages of system change. Conclusions Decarbonisation of general practice cannot be achieved through technical interventions alone. A systems thinking lens reveals that meaningful and equitable progress requires change at deeper structural and normative levels. The stakeholder-generated recommendations from this study outline one strategic roadmap for the NHS general practice to operationalise net zero ambitions while reinforcing the values of high-quality, community-centred care. These findings reflect stakeholder perceptions elicited in a single workshop, rather than an empirical systems analysis, and should be interpreted accordingly.
Background Higher absenteeism and turnover rates among healthcare workers stem from increased workloads, highlighting the need for innovative solutions to support staff in this field. An Ontario hospital became the first in Canada to introduce a National Service Dog-certified Facility Dog named Ember in 2022. Objectives This study aimed to assess the association between hospital workers’ interaction with the facility dog and perceived organizational support (POS), and organizational commitment (POC). Design A cross-sectional study was conducted. Methods A voluntary survey involving 263 hospital workers was employed to measure these outcomes, using the Survey of Perceived Organizational Support and the Three-Component Model (TCM) Employee Commitment Scale. Data analysis included descriptive and inferential analyses, specifically logistic and linear regressions to identify facility dog-related predictors of POS and POC. Results Staff who frequently and directly interacted with the facility dog reported higher perceived support than those who did not. Additionally, staff who directly interacted with the facility dog had higher levels of continuance commitment. Conclusion Findings suggest that facility dogs may be associated with higher perceived organizational support and organizational commitment, warranting further research in this area.
Introduction Labor pain management is a core component of respectful maternity care. In Ethiopia, systematic reviews and meta-analyses have reported inconsistent findings, with wide variation in pooled prevalence and methodological quality. This fragmentation limits reliability and hinders evidence-based decision-making. We conducted an umbrella review synthesizing labor pain management practices and associated factors in Ethiopia. Methods This umbrella review was registered in PROSPERO (CRD420251141567). Searches were conducted in PubMed, ScienceDirect, Cochrane Library, Web of Science, African Journals Online, and grey literature (2010–2025). Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews, version 2, overlap with corrected covered area, and evidence credibility with the Ioannidis framework. Random-effects models pooled labor pain management practice prevalence, while fixed-effects models synthesized associated factors. Heterogeneity was assessed using Cochran’s Q and I 2 . Results Seven systematic reviews and meta-analyses comprising 92 primary studies and 31,824 obstetric care providers were initially identified. After reanalysis and exclusion of inappropriate primary studies, 88 studies with 29,875 obstetric care providers were included in the final synthesis. The pooled prevalence of overall labor pain management practice was 43% (95% CI: 39–47). Non-pharmacological labor pain management practice was 43% (95% CI: 42–44), while pharmacological labor pain management practice was 26% (95% CI: 22–31), declining to 21% (95% CI: 12–35) after bias adjustment. Evidence credibility was moderate for overall and non-pharmacological, but low for pharmacological systematic reviews and meta-analyses. Favorable attitudes, knowledge, education, midwifery profession, analgesic availability, supportive environments, work experience, birth companionship, and training were positively associated with systematic reviews and meta-analyses. Conclusions Labor pain management practice in Ethiopia remains suboptimal, with non-pharmacological approaches predominating and pharmacological methods underutilized. Strengthening provider training, ensuring analgesic availability, improving staffing and protocols, and promoting supportive policies may enhance equitable, evidence-based intrapartum care.
Background and objective Diabetes mellitus requires continuous self-management, medication adherence, and regular healthcare follow-up. Tele-pharmacy is an emerging care delivery model that may improve access, engagement, and chronic disease management, but evidence on diabetic patients’ experiences with tele-pharmacy in Saudi Arabia remains limited. This study aimed to assess perceptions and experiences of tele-pharmacy services among adults with diabetes in Saudi Arabia who use them and to describe diabetes self-management behaviours and perceived diabetes-related outcomes. Methods We conducted a cross-sectional survey of adults with diabetes in Saudi Arabia using a structured questionnaire distributed through convenience sampling; analyses were restricted to the 377 respondents who reported using tele-pharmacy services. Associations between categorical variables were assessed using the Chi-square test or Fisher’s exact test, as appropriate. We examined associations between participant demographic characteristics, including gender, age group, educational level, diabetes type, and diabetes duration, and perceived tele-pharmacy outcomes. Results Among the 377 tele-pharmacy users, 84.6% found it easier to access than traditional services. Participants showed favorable self-management behaviors, particularly in adherence, glucose monitoring, and diet. Satisfaction was high across accessibility, convenience, and care quality. Most participants reported improved medication adherence, blood glucose levels, dietary habits, and reduced complications. No statistically significant associations were observed between perceived tele-pharmacy outcomes and gender, age group, or diabetes type. However, diabetes duration was significantly associated with perceived reductions in diabetes-related complications (p=0.010), while higher educational attainment was associated with better disease understanding (p=0.020), blood glucose monitoring (p=0.011), and physical activity (p=0.044). Conclusions In this cross-sectional survey, adults with diabetes in Saudi Arabia who used tele-pharmacy services reported generally favourable perceptions regarding accessibility and satisfaction. These findings describe favourable perceptions among self-selected tele-pharmacy users, cannot be generalized to all adults with diabetes, and should not be interpreted as evidence of a causal effect of tele-pharmacy on clinical outcomes.
Background Most disability research treats functional limitation as a binary outcome, leaving the determinants of severity gradations, and the role of welfare provision in shaping them, poorly understood. Evidence is particularly scarce for developing countries, where formal entitlements often diverge from de facto access. Objectives To examine the individual, household, and welfare-access correlates of disability severity across six functional domains among working-age adults in Thailand, and whether receipt of specific welfare and health-service components is associated with lower or higher severity. Design Cross-sectional analysis set in Thailand, a middle-income country with a formally comprehensive but unequally delivered disability welfare system; given this design, all findings are descriptive and associations should not be interpreted as causal effects. Methods We used the 2022 Thailand Disability Survey (n = 116,809) to estimate binary probit models of disability prevalence and ordered probit models of disability severity across six functional domains; sampling weights were not applied, so results describe sample-based associations rather than population-weighted estimates. Results Preventive health service utilization was most consistently associated with lower probabilities of severe impairment across domains, with marginal effects reaching 16.1 percentage points for mobility. Rehabilitation utilization and medical treatment access were independently associated with lower severe-impairment probability for physical and cognitive domains. Disability allowance receipt was positively associated with impairment severity; this pattern is consistent with, though not sufficient to establish, selective registration of the most functionally limited individuals rather than programmatic harm. Substantial supply-side gaps in assistive technology were concentrated among the severely impaired. Conclusion Strengthening preventive care and closing assistive-device gaps, particularly under the Universal Coverage Scheme, are promising policy priorities for reducing disability severity, pending confirmation from longitudinal or quasi-experimental research.
