ObjectivesIron deficiency in pregnancy poses significant risks to maternal and fetal health, which are exacerbated by socioeconomic disadvantage. The objective of this study was to assess the socioeconomic distribution of publicly funded intravenous iron therapies for iron deficiency in pregnant women, evaluating the capacity of public policy to promote equal access to medications.Study typeRetrospective, population-based cohort study.MethodsThe Maternity1000 dataset was used to analyse access to and public expenditure on intravenous iron therapies dispensed via the Pharmaceutical Benefits Scheme (PBS) during 176,036 pregnancies (July 2015 to June 2018) in Queensland, Australia; stratified by socioeconomic status. Inequalities were assessed through benefit incidence analyses and concentration indices (C).ResultsDiagnosed iron deficiency was more common among women living in less disadvantaged areas (Q5: 7.58% vs Q1: 5.06%). Access to ferric carboxymaltose showed no significant socioeconomic-related inequality overall (Coverall = 0.004; P = 0.594). However, annual concentration indices increased incrementally over the study timeframe, with a small shift in the distribution of access towards women living in less disadvantaged areas in 2017/18 (C2017/18 = 0.038; P < 0.001). In contrast, access to iron polymaltose showed no evidence of socioeconomic inequality (Coverall = −0.024; P = 0.358). Government expenditure on iron polymaltose was consistently concentrated among more disadvantaged areas; reflecting its lower cost and reduced government contribution for less disadvantaged women. Government expenditure on ferric carboxymaltose was evenly distributed overall (Coverall = −0.011; P = 0.130), with annual stratification showing public expenditure became increasingly concentrated among less disadvantaged areas in 2017/18 (C2017/18 = 0.027; P = 0.011).ConclusionsThe PBS plays an important role in supporting intravenous iron access in pregnancy, although minor socioeconomic disparities may be emerging for newer, higher-cost formulations. Ongoing monitoring is needed to ensure rising public expenditure delivers equitable, high-value maternal care without deepening existing inequalities.
Objectives and importance of studySocial welfare has a critical role in supporting older people accessing long-term care, yet a national evaluation of income support for this population has not been conducted. This study investigates the socioeconomic profiles of older people accessing long-term care in Australia. It focuses on composition and changes in income sources, including social welfare payments and non-government income at individuals’ first interaction with the sector.Study typeCross-sectional analysis using the Registry of Senior Australians National Historical Cohort.MethodsThe study included individuals aged ≥65 years who had a long-term care eligibility assessment between 1 January 2010 and 31 December 2019. Descriptive analyses were employed using income data from the 12 months before assessment, adjusted using the quarterly Consumer Price Index Indicator for January 2020.ResultsThe cohort included 921,208 individuals (median age 82 years, 58.7% female, 60.7% homeowners). Between 2010 and 2019, the percentage of individuals receiving social welfare payments when entering long-term care remained consistent at approximately 91%, and the median (interquartile range, IQR) annual amount received increased from AU$19,852 (IQR $15,964–$21,342) to $20,630 (IQR $17,777–$24,172). The percentage reporting non-government income increased from 12.0% in 2010 to 30.0% in 2019; however, the median non-government income was highly skewed and decreased from $5,438 ($376–$107,389) to $1,679 ($131–$10,867). Those in the highest income quintile received a smaller proportion of their income from social welfare payments (58.8%) compared with the lower quintiles (between 83.6% and 91.3%), and reported higher levels of non-government income, including employment (2.4% in highest income quintile vs 0.5% in lowest quintile), unearned continuous income (18.9% vs 6.7%) and business income (20% vs 1.5%). Non-homeowners reported higher total income than homeowners (median: $23,841 vs $20,800).ConclusionsApproximately nine in 10 older people in Australia accessing long-term care received social welfare payments, with substantial non-government income limited to those in the highest income quintile.
Objectives and importance of studyIntegrated lifestyle and low back pain care is a novel treatment approach. This study describes the fidelity and adoption; barriers and facilitators to engagement and delivery; acceptability, appropriateness and feasibility of the Healthy Lifestyle Program (HeLP) intervention.Study typeMixed-methods process evaluation.MethodsData were included from n = 174 adults with chronic low back pain randomised to HeLP, and delivering clinicians. The 26-week intervention included five consultations , information resources, and referral to telephone support services. We collected quantitative data via fidelity checklists, administrative records and surveys, and qualitative data via semi-structured interviews and focus groups with a subsample of participants and clinicians. We used descriptive statistics, thematic analyses and triangulation to identify meta-themes.ResultsIntervention fidelity was high (clinicians delivered >90% to protocol). Participants’ adoption was moderate attending a mean 3.2 consultations, 54% (referred) engaged with telephone services and 46% used online resources; however, adoption of smoking cessation services was low (6.5% of smokers completed ≥1 call). A total of 23% of participants discontinuted HeLP by 26 weeks. Clinicians and participants considered the intervention acceptable, and addressing lifestyle factors appropriate for low back pain.ConclusionHeLP was acceptable, although uptake varied across components. Improving clinicians’ behaviour change communication and personalising care may optimise implementation.
ObjectivesThis study aimed to assess the levels of job satisfaction and migration intentions among physicians working in public and private hospitals in Sana’a, Yemen, and to identify associated sociodemographic and occupational factors.MethodsA hospital-based, cross-sectional study was conducted from September 2023 to May 2024. A total of 350 physicians were selected through stratified random sampling from 10 major hospitals in Sana’a. Data on sociodemographic characteristics, job satisfaction and migration intentions were collected using a structured questionnaire. Statistical analyses, including descriptive statistics, chi-squared tests and multiple logistic regression, were performed.ResultsA majority of physicians (52.0%) were dissatisfied with their jobs, and an overwhelming 77.4% expressed intentions to migrate abroad. The primary reasons for intending to migrate included seeking better educational and training opportunities (97.8%), improved working conditions (96.7%), and higher income (95.9%). Lower job satisfaction was significantly associated with a higher intention to migrate. Multivariate analysis identified sufficient monthly income (adjusted odds ratio [AOR] 3.37), longer work experience (AOR 2.38) and perceived safety in medical practice (AOR 2.83) as significant predictors of higher job satisfaction. Conversely, being a general practitioner (AOR 17.15) and having children (AOR 2.48) were associated with an increased likelihood of intending to migrate.ConclusionsLow job satisfaction and high migration intentions are common among physicians in Sana'a, Yemen, driven primarily by economic, professional and safety concerns. These findings underscore the urgent need for targeted interventions to improve salaries, ensure safe working conditions and provide professional development opportunities to mitigate the escalating brain drain from Yemen’s healthcare sector.
ObjectiveTo share lessons learnt from the Sydney Local Health District (SLHD) rollout of respiratory syncytial virus (RSV) prevention products, and present data on immunisation uptake for mothers and babies in two maternity hospitals.Type of serviceRollout of the RSV maternal vaccine and the injectable, long-acting monoclonal antibody nirsevimab for newborn infants to protect them from RSV infection and hospitalisation.MethodsDeidentified summary data from the electronic medical record on RSV immunisation status in two SLHD maternity hospitals were analysed descriptively as counts and proportions. The Consolidated Framework for Implementation Research was used as a lens to reflect on the rollout process.ResultsRSV vaccination coverage in women giving birth in two SLHD hospitals improved from 4% in the first month of rollout (February 2025) to a range of 70–74% from June to September 2025. As antenatal coverage improved, the number of live born babies requiring nirsevimab decreased. Among eligible newborns, 36% of families declined nirsevimab, with reason for refusal not recorded. Documentation of RSV immunisation status improved as the rollout progressed.Lessons learntEngaging multidisciplinary leaders and clinicians is critical for a coordinated response and program rollout success. Leveraging existing education structures, staff meetings and using online prerecording can optimise clinician education. New programs take time to embed into routine clinical practice, and programs that involve delivering multiple immunisation products for distinct groups require clear messaging and systemic safeguards to prevent errors. Integrating immunisation into medical record workflows as standard practice can support program adoption and uptake.
