Search Results (18,213)

Organizations ought to demonstrate a responsibility for conditions that reduce moral stress and enhance moral resilience for their employees. No literature to date has explored how Emergency Management Personnel (EMP) experience both moral stress and distress [(di)stress], building up to stigma during health crises, given their role in emergency management operations. This study draws from a primary study of EMP, including frontline and first responders and those in leadership, who reported structural stigma during the COVID-19 pandemic. Our research question was, In what ways did structural stigma shape the moral landscape of emergency management practice during COVID-19? This qualitative study draws on the paradigm of critical realism to conduct thematic analysis. Interviews and focus groups were collected in 2024 from a total of 23 participants in the Greater Toronto Area, Canada. Participants represented EMP across emergency and public service sectors. System-level stressors revealed disruptions or “cracks” from an overwhelmed public services system. In sum, systemic “cracks” gave rise to organizational mechanisms designed to compensate for system failures, inadvertently propagating structural stigma. At times these mechanisms generated moral distress and/or resilience, through simultaneously expanding and limiting EMP’s responsibility and agency. The authors suggest that EMP build their leadership capacity to enhance skills of structural competency. Full article

Timely access to children’s mental health services depends on accurate identification of service urgency; however, triage practices in Ontario, Canada vary widely, contributing to prolonged wait times and inconsistent pathways to care. This study aimed to develop and validate an empirically based decision-support algorithm to support standardized triaging and prioritization in Ontario based children’s mental health agencies. Data were drawn from 17,564 children and youth aged 4–18 years assessed with the interRAI Child and Youth Mental Health Screener (ChYMH-S) as part of routine clinical practice. Interactive decision tree modelling was used to identify combinations of clinical indicators associated with high service urgency, with age-stratified models for children 7 years and younger, 8–11 years, and 12 years and older. The resulting interRAI Children’s Algorithm for Mental Health and Psychiatric Services (ChAMhPS) classified individuals into seven urgency levels. The algorithm demonstrated good discrimination for services required within seven days (c-statistic = 0.70) and for the urgency of a comprehensive assessment (c-statistic = 0.73), with stable performance across derivation and testing samples. Higher algorithm levels were associated with an increased likelihood of urgent assessment or service need. The ChAMhPS algorithm offers a standardized, empirically derived tool to support clinical decision-making and improve consistency in triage and prioritization of children and youth with urgent mental health needs. Full article

Background/Objectives: Sickle cell disease (SCD) is the most prevalent inherited pediatric hematologic disease. Pain is the most common complaint and primary reason for emergency care. Effective coping is critical to improved quality of life for individuals with SCD and other chronic illnesses. Hope, engendered by provision of comprehensive care, may explain the positive impact of effective coping and improved health outcomes. The relevance of effective coping skills and hope’s impact on repeated hospitalizations and/or length of hospitalization stay (LOS) among adolescents with SCD is considered. A regional, comprehensive pediatric sickle cell center (RCPSCC) provided the services. Methods: Patients with SCD, ages 13 through 21 years seen in a university RCPSCC (URCPCC-SCD), completed surveys: a general scale providing a broad range of positive and maladaptive coping-related issues, and KIDCOPE, a standardized scale measuring pediatric coping strategies. Medical records were reviewed for frequency of hospitalization and length of stay (LOS) for the eight months before study entry. Results: Thirty-four URCPCC-SCD outpatients, mean/median age of 16 years, entered the study, and data were analyzed for 33. All reported some sense of future hopefulness, and almost half reported feeling “tense or wound up” most of the time. Use of avoidant or negative coping strategies in response to daily stress correlated positively with increased LOS. Conclusions: Youths with SCD require effective coping strategies to improve self-efficacy and related hope for brighter futures. Individualized, comprehensive treatment and support to families and individuals at risk for sickle cell crisis are uniquely offered in a URCPCC-SCD. Their contributions to service delivery and clinical outcome are expected to enhance hope, mitigate prolonged hospitalizations, and improve adherence to treatment (N = 268). Full article

This prospective observational study aimed to estimate the annual service-based incidence of individuals with First Episode Psychosis (FEP) and high-risk states for psychosis presenting to a public Community Mental Health Center within a defined urban catchment area in Northwestern Greece. It offers novel real-world insights into early intervention in psychosis within a resource-constrained, post-crisis health care setting. All individuals aged ≥16 years who presented to the Community Mental Health Center of the University of Ioannina between January 2023 and December 2024 were assessed. Those diagnosed with FEP or identified as being at a high risk for psychosis using the Comprehensive Assessment of At-Risk Mental States were included, while duration of untreated psychosis (DUP) was estimated with the Symptom Onset in Schizophrenia inventory. Among 1115 service users, 51 (4.6%) met criteria for FEP (N = 33) or high-risk states (N = 18), rising to 7.5% among those aged 16–36 years. The annual service-based incidence of FEP was 10.26 per 100,000 in the general population, increasing to 51.62 in individuals aged 16–36 and 63.17 in those aged 16–26. Including high-risk cases, service-based incidence reached 109.71 per 100,000 in the 16–26 age group. Mean DUP was 39.4 weeks but was 7.0 weeks among 80% with DUP < 1 year. Most FEP patients (63.6%) required brief hospitalization, and over half reported family history of mental illness. These findings highlight substantial community caseloads and the need to strengthen early intervention services. Full article

Cognitive load theory-informed curriculum design in health sciences education refers to the purposeful organisation of teaching strategies and learning materials based on the principles of Cognitive Load Theory (CLT), a framework developed by John Sweller in the late 1980s. CLT is grounded in cognitive psychology and recognises that the working memory has a limited capacity for processing new information. It identifies three types of cognitive load: intrinsic load, which refers to the inherent complexity of the material being learned; extraneous load, which results from ineffective instructional design or irrelevant information; and germane load, which reflects the mental effort directed toward understanding, integrating, and organising information into long-term memory. In health sciences education, students frequently engage with tasks that require the simultaneous processing of multiple interacting elements, placing high demands on working memory at specific points in time. This includes foundational biomedical sciences such as anatomy, physiology, and pathophysiology extending to applied clinical skills, diagnostic reasoning under uncertainty, health service management within complex systems, and ethically grounded decision-making. Without thoughtful instructional design, learners may be overwhelmed by excessive information and cognitive demands, which can hinder understanding, retention, and performance. Applying CLT-informed strategies, educators can reduce unnecessary cognitive burden, sequence learning activities to align with learners’ cognitive capacity, and promote deeper learning. This approach supports more effective knowledge acquisition and transfer and is particularly valuable in content dense academic environments such as medicine, nursing, allied health education, public health and health service management education. Therefore, integrating CLT-informed principles into curriculum design can help optimise learning experiences and support the development of competent health professionals. Full article

Writing-intensive courses help undergraduate students develop disciplinary knowledge and communication skills, yet many students, particularly first-generation college students and those writing in a second language, enter these courses with low confidence and high writing anxiety. Writing self-efficacy, or students’ beliefs about their ability to succeed as writers, is associated with motivation and academic success, but less is known about how instructional practices shape its development. This qualitative study examined how students experienced instructional practices in a writing-intensive public health course and how these experiences influenced writing self-efficacy. Data were collected through a focus group with six undergraduate students and analyzed using a deductive thematic approach guided by Bandura’s four sources of self-efficacy. Students identified scaffolded assignments, opportunities for revision, and explanatory feedback as key facilitators of writing self-efficacy. Supportive classroom relationships, including proactive instructor outreach and consistent feedback, also appeared to foster confidence. Barriers included linguistic challenges, limited academic role models, and negative experiences with writing support services. These findings suggest writing self-efficacy may develop through the interaction of structured instructional practices and supportive classroom environments. Full article

Background/Objectives: This study aimed to investigate how the disparities in unmet medical needs between immigrants to South Korea and native-born populations evolved during the COVID-19 pandemic. Methods: Using nationally representative cross-sectional data from the 2018 and 2020 Surveys on Immigrants’ Living Conditions and Labor Force in South Korea, we compared unmet medical needs among immigrants at two time points (N = 12,227 in 2018; N = 18,530 in 2020). Standardized prevalence ratios (SPRs) were calculated. Analyses were stratified according to work status, gender, Korean language proficiency, education level, and duration of stay. Results: Working immigrants had lower SPRs for unmet medical needs than Korean nationals (2018: 0.879; 2020: 0.745) but non-workers had consistently higher SPRs (2018: 1.117; 2020: 1.128). The SPRs for male and female non-workers increased and decreased, respectively. The SPRs were persistently higher among individuals with poorer Korean language proficiency, lower education, and shorter duration of stay. Conclusions: Systemic disruptions, such as the COVID-19 pandemic, may exacerbate pre-existing healthcare inequalities among immigrant populations. The persistence and widening of these disparities call for targeted policies that address structural barriers and ensure equitable healthcare access during future public health crises. Full article

Objective: This study examines whether access to basic services is associated with health-related social participation among people with disabilities, with a particular focus on participation in cultural and sports activities. Methods: Using data from the 2022 census of people with disabilities in X Province, China, we estimated Probit models to assess the association between access to three types of basic services—rehabilitation, social welfare, and social assistance—and participation in cultural and sports activities. Results: Greater access to basic services was associated with a significantly higher likelihood of participation in cultural and sports activities. Among the three service categories, rehabilitation services showed the strongest positive association. The positive association was stronger among individuals with lower disability severity. Conclusions: Access to disability-related basic services, especially rehabilitation services, may promote health-related social participation and social integration among people with disabilities. These findings highlight the importance of service access and rehabilitation support for disability healthcare, community inclusion, and quality of life. Full article

Purpose: Oral squamous cell carcinoma (OSCC) carries a substantial burden in low- and middle-income countries as well as underserved subpopulations within high-income settings, where structural barriers contribute to worse outcomes. While evidence supports targeted screening of high-risk groups, practical guidance for designing organized, quality-assured programs remains limited. This review proposes a framework to translate contemporary cancer-screening principles into operational criteria for OSCC. Methods: A review following the Scale for the Assessment of Narrative Review Articles principles was conducted. Conceptual papers, international evaluations, implementation studies, and programmatic guidance were included. The evidence was synthesized narratively, with emphasis on contemporary cancer-screening principles, implementation frameworks, and their applicability to OSCC. Results: Clinical oral examination can improve the detection of OSCC in early stages and reduce mortality among high-risk groups when embedded in coordinated care pathways. Effective programs require governance structures, screening policies, risk-stratified approaches, and robust information systems capable of call-recall, referral tracking, and quality monitoring. Dental schools and academic clinics may serve as feasible regional hubs for programs within mixed health systems. Conclusions: Aligning core OSCC-screening principles with operational enablers offers a practical pathway to develop context-appropriate programs that strengthen capacity, promote equity, and generate evidence for responsible scale-up. Full article

The Street Clinic (Consultório na Rua—CnR) is a strategic component of Primary Health Care in Brazil, aimed at populations experiencing homelessness, a group characterized by high levels of social and health vulnerability. This study critically analyzes the experiences of healthcare professionals working within a CnR team, identifying the meanings attributed to their work, the challenges encountered, and the strategies developed within the territory. This is an exploratory study with a qualitative approach, grounded in health narratives and the philosophical hermeneutics of Hans-Georg Gadamer. Four professionals participated, representing the totality of eligible members of a team in a medium-sized municipality in Southern Brazil, with between one and eleven years of experience in the service. Hermeneutic analysis revealed that the CnR functions as an entry point to Primary Health Care and Psychosocial Care, with the bond between team and users serving as the primary mechanism for overcoming barriers to access. Professionals report ethical suffering arising from the tension between their commitment to comprehensive care and the structural limitations of the service, including shortages of supplies, institutional instability, and precarious employment arrangements. It is concluded that strengthening the CnR requires not only investment in infrastructure and expansion of the teams, but also policies that recognize and support the complexity of street-based work, including care for the caregivers themselves. Full article

Urinary Tract Infections (UTIs) represent one of the most prevalent bacterial infections globally, posing significant health burdens, especially in low- and middle-income countries (LMICs), due to delayed diagnoses, limited access to laboratory services, and rising antimicrobial resistance. This study presents a machine learning (ML)-based diagnostic support framework for early UTI detection, leveraging structured clinical data and explainable artificial intelligence (XAI) techniques to enhance interpretability and trust among healthcare providers. A patient dataset containing 4865 records was used in the study to train and test Extreme Gradient Boosting (XGBoost), Decision Tree (DT) and Random Forest (RF) classifiers, while class imbalance was addressed using Synthetic Minority Over-sampling Technique (SMOTE). The performance of the models was evaluated through accuracy, precision, recall, F1-score, Log Loss, and AUC-ROC, and random forest showed the best results (accuracy: 86.43%, F1-score: 86.71%, AUC-ROC: 0.8695). To ensure that such models can be adopted by stakeholders in the health sector, Local Interpret-able Model-agnostic Explanations (LIME) were integrated, which identified painful urination, urinary frequency, and suprapubic pain as primary predictors in the model. This study shows that interpretable ML models can be helpful in resource-limited regions in predicting UTIs, thereby rendering a solution to improve the management of infections in these regions. Full article

Background: This study develops a transparent, decision-focused framework that integrates the World Health Organization’s defined daily dose (DDD) standard with the planned-backorder economic order quantity (EOQ) model to manage nursing and pharmacy workflows within a unified economic and operational scale. Method: Demand was expressed in DDD per year, and process-based costs were monetized according to National Health Service (NHS) workflow steps, where the holding cost was computed as H = r × cu and the delay cost B was derived from the target fill rate via a closed-form shadow-price relationship. The model was calibrated for a typical NHS acute-care hospital with 600 beds (D ≈ 130,305 DDD/year). Results: Calibration resulted in an ideal order quantity of 7554 DDD, an inter-order interval of 21 days, and a minimum annual total cost of £451. In the national conceptual scenario, the fill rate is about 99.4%, and the minimum annual total cost is £26,366. At this optimum, cost components are symmetrically balanced, with order cost and combined holding–delay cost contributing equally. Conclusions: This repeatable framework, based on the DDD scale, enhances management visibility regarding the cost–service balance, thereby confirming the policy’s robustness. Full article

Background/Objectives: A psychiatric consultation is a professional evaluation aimed at establishing a diagnosis, a prognosis, and developing a treatment plan. The objective was to assess psychiatric consultations (PCs) at the Community Mental Health Center (CMHC), Emergency Room (ER) and General Hospital (GH) to highlight differences across settings. Methods: With a retrospective design, we examined all PCs performed between 1 January 2024 and 31 December 2024 at the CMHC, ER and GH of Baggiovara in Modena. Descriptive statistical analysis and a multivariate logistic regression were performed. Results: We collected a total of 3174 PCs for 1801 patients, performed in the three settings: 52% in ER, 30% in CMHC and 18% in GH. In ER, PCs were most frequently requested for suicide risk (26%), psychomotor agitation (14%) and substance intoxication (14%). In CMHC, the most common diagnoses were depressive disorders (22%), acute anxiety (20%) and acute psychotic episodes (13%). In GH, consultations mainly addressed psychiatric symptoms associated with medical and eating disorders. The overall rate of psychiatric hospitalization after PCs was 16.2%, reaching 23.4% for consultations in ER. Discontinuation of pharmacological therapy was significantly associated with an increased risk of hospitalization (p < 0.001), which rose to 17% when therapy had been interrupted for more than one year. Conclusions: PCs at ER were the access point for most hospitalizations. Therapeutic discontinuation, acute psychosis and substance use represented the main predictors of hospitalization. Strengthening shared care pathways among CMHC, ER and GH represents an effective model of integration between hospital and community services, ensuring continuity of care. Full article

England’s population is living longer, a sign of progress and better health, but adult social care (ASC) services must adapt to support a growing number of older residents, who may need help to remain independent, safe, and well. Kent County Council (KCC), in South East England, projects a 28% and 53% increase in its residents aged 65+ and 85+, respectively, over the next decade. This study aimed to inform the development of KCC’s ASC Prevention Framework using a System Dynamics Modelling (SDM) approach to evaluate the impact of preventive interventions on ASC demand and expenditure. Using linked local health and social care data and the Johns Hopkins ACG® tool, the 1.3 million adult population was stratified into Patient Needs Groups. Analyses showed that higher ASC costs were associated with being older females, living alone, deprivation, and frailty-related indicators such as dementia, history of falls, etc. Around 28% of older adults aged 65+ accounted for 80% of ASC costs within that cohort, and related scenario testing projected a 48% rise in ASC costs over 10 years without interventions, moderated to 33% with targeted prevention. These findings demonstrate the value of integrated data and modelling to inform strategic, prevention-focused ASC planning. Full article

American Indian and Alaska Native (AI/AN) populations experience disproportionately high kidney cancer incidence and mortality compared to other groups in the United States. Literature was reviewed to explore the factors contributing to the unequally higher kidney cancer burden in AI/AN communities and to develop recommendations to reduce these disparities. The incidence of kidney cancer has been rising over the past few decades, and this increase has been especially steep among AI/AN populations. Death rates in AI/AN populations are roughly twice those of the non-Hispanic White population. The elevated kidney cancer burden in AI/AN populations may be driven by both clinical and behavioral risk factors (obesity, diabetes, hypertension, chronic kidney disease, smoking, and environmental factors) and structural drivers of health, which can critically shape these disparities. Systemic inequalities limit AI/AN patients and community members’ access to chronic disease management, smoking cessation programs, primary and specialty care for early detection, and ultimately, treatment. AI/AN patients may have mistrust or other cultural barriers to engaging with the healthcare system and providers, while implicit bias in healthcare providers may lead to undertreatment. Therefore, key interventions and tailored programs aimed at reducing kidney cancer incidence and mortality are needed. Here we highlight some current interventions, including access to disease management and smoking cessation programs, facilitating healthcare access and quality, adopting patient navigation and culturally competent education, and developing strategies for early detection. In partnership with AI/AN communities, a combination of prevention, early detection, and healthcare system improvements is needed to close the kidney cancer gap. Full article