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To explore the perceptions and experiences of managers in residential aged care settings regarding personal care workers' intention to stay and build a career. Specifically, this study sought to identify enablers and challenges influencing personal care workers' retention and to explore strategies that could improve workforce sustainability.
A qualitative study utilising semi-structured interviews underpinned by the Theory of Planned Behaviour.
The study was conducted in Australia from July 2023 to March 2024. Eleven managers participated in this study. Data were analysed using inductive thematic analysis.
Four themes emerged from the analysis and were conceptualised to illustrate the intricate relationship between recruitment practices, work environment, organisational culture and leadership in influencing personal care workers' intentions to stay in residential aged care. A botanical metaphor was used for each theme. The ‘Diverse Seeds of Varied Potential’ theme highlighted how ad-hoc recruitment processes were a primary driver of workforce instability. Challenging work conditions and differing expectations from personal care workers and management led to ‘Wilting in Adverse Environments’, which also contributed to a broader misalignment between facility culture and values, encapsulated within ‘Mismatched Habitats’. Participants emphasised the need for ‘Building a Greenhouse’, a metaphor for cultivating sustainable leadership and workforce development to address these issues.
This study's findings underscore the critical need for a cohesive approach to workforce development strategies in residential aged care. Transitioning from reactive, ad-hoc recruitment to strategic workforce planning, fostering a supportive organisational culture that aligns with personal care workers' expectations, and prioritising sustainable leadership practices are essential steps. Addressing these interconnected challenges can help build a more stable, committed and skilled workforce, ultimately enhancing the quality and continuity of care for residents.
Strategic workforce planning and sustainable leadership development are essential for building a stable workforce, which directly impacts the quality and continuity of resident care.
This study addressed the critical issue of high turnover among personal care workers in residential aged care facilities, specifically examining managers' perspectives on retention challenges: an underexplored area that is crucial for developing sustainable workforce strategies. The findings revealed that current ad hoc recruitment practices, misalignment between diverse personal care worker profiles and established organisational cultures, have great impact on long-term engagement and retention. These insights are particularly valuable for residential aged care facilities struggling with staffing stability, industry bodies focused on workforce development and educational institutions preparing future aged care workers. Furthermore, the findings can inform policy development aimed at strengthening the aged care workforce, ultimately benefiting the quality of care received by residents.
The Consolidated Criteria for Reporting Qualitative Research (COREQ).
There was no patient or public contribution.
(1) To analyse individual and institutional-level factors associated with urinary incontinence in older adults living in nursing homes; (2) to estimate the prevalence of urinary, faecal and double incontinence in nursing home residents.
Cross-sectional study.
Residents aged 65+ living in 22 nursing homes in Catalonia (Spain) were included. Descriptive, bivariate, and multilevel analyses were performed.
The final sample comprised 452 residents (75.9% female, mean age of 87.0 years). The prevalence of urinary, faecal and double incontinence was 77.5%, 46.1% and 45.7%, respectively. Urinary incontinence was statistically significantly associated with neurological conditions, moderate cognitive impairment, moderate dementia, severe cognitive impairment, very severe cognitive impairment and age.
Approximately three out of four nursing home residents suffered from urinary incontinence and almost half of the sample from faecal or double incontinence. Individual-level factors (cognition, neurological conditions and age) played a more important role than institutional-level factors for urinary incontinence.
The findings of this study highlight the importance of individual-level interventions to prevent and manage urinary incontinence in nursing homes.
In Catalonian nursing homes, individual factors such as cognitive impairment and neurological conditions were more strongly associated with urinary incontinence than institutional factors. This has implications for improving care provided to older adults, particularly those with dementia and neurological conditions.
STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
Nursing home residents were not involved in this study.
Venous leg ulcers occur due to chronic venous insufficiency in the lower extremities and are often difficult to heal. Platelet-rich plasma and platelet-rich fibrin are products that contain high concentrations of platelets. This systematic review evaluated the effectiveness, safety and cost-effectiveness of these products for the treatment of venous leg ulcers. Guided by the 2020 Joanna Briggs Institute systematic review of effectiveness guideline, this review included original studies that investigated platelet-rich plasma and platelet-rich fibrin in the treatment of venous leg ulcers from databases including the Cochrane Library, Embase, Medline, CINAHL, PubMed, World Health Organisation International Clinical Trials Registry, Clinical Trials.gov and Australian New Zealand Clinical Trials Registry. Methodological quality was assessed using relevant appraisal checklists. Information related to general characteristics of included articles and relevant outcomes of interest were extracted and synthesised narratively. Of thirty-six eligible studies, 24 studies used platelet-rich plasma, eleven investigated fibrin-rich plasma and one study used both platelet-rich plasma and fibrin-rich. Most studies reported these products were effective in promoting wound healing, reducing other symptoms, and were safe to use. The use of platelet-rich plasma and platelet-rich fibrin resulted in significantly higher healed venous leg ulcers compared to control using conventional treatment (RR: 2.93, 95% CI, 1.90–4.53, p = 0.01). These products were safe to used topically and promoted to wound healing, reduced pain, either along or combined with other treatments. Platelet-rich plasma and fibrin-rich plasma improves wound healing and appears to be safe to use in the treatment of venous leg ulcers.
The use of economic evidence to prioritise vaccines and delivery strategies to optimally use in immunisation systems is becoming a global priority, especially in low- and middle-income countries (LMICs), in view of challenges in funding and the need to make more efficient use of available resources. We undertook a scoping review to identify and synthesise available evidence on strategies that have been used to enhance the use of economic evidence in policy and decision-making in the immunisation ecosystem in LMICs. The review was also used to identify the facilitators and constraints to the use of economic evidence for vaccination policy and decision making in LMICs and the sustainability of the identified strategies.
A scoping literature review was undertaken to generate the evidence. The review adhered to the first five steps of Arksey and O’Malley’s methodological framework (identifying and refining the research questions, identifying relevant articles, selection of studies, data extraction and charting and data synthesis) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.
Full-text articles were searched on PUBMED, HINARI and DOAJ using different combinations of search words as of 16 December 2024
We included articles from LMICs, including Africa, and global experiences, including those from LMICs. Papers must be written in English or have an English language translation available and published between 1 January 2004 and 16 December 2024.
Two independent reviewers used standardised methods to search, extract, and screen included studies. The findings from the review were summarized in themes that were synthesized qualitatively.
18 eligible articles met the inclusion criteria and were included in the synthesis. It was found that economic evidence was systematically requested and demonstrably influencing vaccine introduction or prioritisation decisions in only eight out of 32 LMIC settings with functional National Immunization Technical Advisory Groups (NITAGs) and in fewer than 20% of documented new vaccine introduction processes since 2015. In the majority of cases, decisions were reported as being driven primarily by disease burden, political priority, donor recommendations or historical precedent, with economic analyses either absent, produced post hoc or acknowledged but not used as a decisive factor.
There is minimal use of evidence from economics in decision-making within the immunisation ecosystem. Expert advisory committees in LMICS can, however, enhance the use of economic evidence in vaccination policy and decision-making. Hence, in order to use economic evidence for decision making, national advisory committees such as NITAGs need enhanced capacity, independence and close collaboration with researchers. LMIC NITAGs could also benefit from tailored adaptations, such as simplified cost-effectiveness tools and regional economic data hubs, to bridge this gap in decision-making and bring economic evidence to the fore of their decisions.
This study aims to examine the reflections of doctoral education in nursing on clinical practice, focusing on the perspectives of doctoral students and graduates.
This study was conducted as qualitative research.
The study was conducted in February 2025 with 14 nurses who were either pursuing or had completed doctoral education in nursing and were working as nurses in Türkiye. Data were collected through face-to-face interviews using an introductory information form and a semi-structured interview guide. The data were analysed using an inductive content analysis method.
Four main themes were depicted throughout the study: the visibility of doctoral education in clinical practice, the reflection of doctoral education on nursing identity, challenges encountered during the doctoral education process and recommendations to strengthen the reflection of doctoral education in the clinic.
The study highlighted the importance of doctoral education, which has positively contributed to the professional development of nurses and nursing care.
Collaboration between clinical administrators and faculty members is needed to support the transfer of the gains achieved by doctoral nursing students and graduates during their doctoral education to clinical practice and to overcome the challenges encountered.
No Patient or Public Contribution.
The study was reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Commentary on: Szymczak JE, Hayes AA, Labellarte P, et al. Parent and clinician views on not using antibiotics for mild community-acquired pneumonia. Pediatrics. 2024 Jan 1;153(2):e2023063782.
Implications for practice and research Awareness of the possibility to abstain from antibiotic treatment in mild community-acquired pneumonia in young children has to increase. Not only is research needed on improvement of diagnostics and safety of the ‘no antibiotic’ strategy, but also on how to address social, emotional and logistical barriers.
Mild community-acquired pneumonia (CAP) in children under 5 years is often viral in origin. Because of this, routine antibiotic treatment of mild CAP is discouraged in the 2011 Pediatric Infectious Diseases Society (PIDS)/Infectious Diseases Society of America (IDSA) guideline.
Pneumonia remains a leading cause of under-5 mortality in sub-Saharan Africa, accounting for approximately 14% of deaths in this age group. In Malawi, pneumonia accounts for 12% of under-5 deaths, with recent data revealing a concerning trend of over 110 000 new cases reported in 6 months. The Malawi government has made significant strides in reducing childhood mortality through the Integrated Community Case Management (iCCM) strategy, resulting in an 11% reduction in under-5 mortality over a 5-year period. However, the current iCCM strategy does not include the management of chest indrawing pneumonia in children aged 2–59 months and fast-breathing pneumonia in infants aged up to 2 months. This implementation research aims to increase pneumonia treatment coverage for under-5 year-old children in Kasungu District, Malawi, by expanding the community-based management of pneumonia by the iCCM-trained Health Surveillance Assistants (HSAs).
The current implementation research using both qualitative and quantitative data collection methods will assess the feasibility and acceptability of iCCM-trained HSAs managing chest indrawing pneumonia and fast-breathing pneumonia in children under 5 with oral amoxicillin at the community level in district Kasungu using the existing district health system. The study will employ a district health system model, leveraging existing trained iCCM HSAs to enrol and manage infants aged 7–59 days with fast-breathing pneumonia and 2–59-month-old children with chest indrawing pneumonia in the community with 7-day and 5-day oral amoxicillin, respectively. HSAs will also use pulse oximetry to identify hypoxaemic children for prompt referral to a hospital for further care. Sociodemographic features of enrolled children will be documented. Enrolled children will be followed up on treatment compliance using follow-up forms. The pneumonia treatment coverage will be assessed using baseline, midline and end-line surveys using both qualitative and quantitative data collection methods.
Ethical approval was obtained from the National Health Research Sciences Committee and the WHO Ethics Committee. The implementation research findings will be disseminated to national-level stakeholders and specifically targeted at District Health Offices, which are responsible for implementing the interventions.
Inguinal hernia repair is one of the most frequently performed operations in the paediatric population and can be performed according to two approaches: open or laparoscopic. At present, decisive evidence about the best treatment strategy is lacking and consequently, there is an ongoing debate about the most (cost-)effective treatment for the paediatric inguinal hernia. The aim of the Hernia Endoscopic oR opeN repair In chIldren Analysis—trial (HERNIIA2-trial) is to estimate the (cost-)effectiveness of the laparoscopic percutaneous internal ring suturing (PIRS) technique compared with open repair in children aged 0–16 years with a primary unilateral inguinal hernia.
A national multicentre randomised controlled trial will be performed including 464 children aged 0–16 years with a primary unilateral inguinal hernia. Patients will be randomised between the open or PIRS technique. The primary outcome is the number of reoperations within 2 years after primary surgery. Secondary outcome measures are: operative and postoperative complications, total duration of surgery, postoperative pain, length of admission, time to normal daily activities, cosmetic appearance of the scar, social and healthcare costs and health-related quality of life. Furthermore, cost-effectiveness will be assessed from a societal and healthcare perspective.
The protocol was approved by the ethics committee of the Amsterdam University Medical Hospital. Informed consent will be obtained by parents and, if possible, according to age, by patient. The study will be conducted according to the principles of the Declaration of Helsinki (2013) and in accordance with the Medical Research Involving Human Subjects Act (WMO) and Good Clinical Practice. Study findings will be disseminated through scientific publications, conferences and patient-friendly materials. The national study network of participating centres will facilitate rapid dissemination and implementation within the Netherlands and potentially abroad.
ClinicalTrials.gov PRS (ID NCT06451432).
This study aims to identify the inequalities encountered during the nursing doctoral process and propose potential solutions.
This study was conducted as qualitative and descriptive research.
The study was conducted between January and February 2025 with 18 students who were pursuing doctoral education in nursing and working as nurses in Türkiye. Data were collected through face-to-face interviews using an introductory information form and a semi-structured interview guide. The data were analysed using an inductive content analysis method.
Four main themes emerged from the study: Challenges: Dancing at Two Weddings at the Same Time, Academic Competition and Inequalities, Glass Ceilings in Hospitals and Solution Strategies for Inequalities.
The study highlighted the inequalities experienced by students who were simultaneously continuing their doctoral education while working as nurses in the same clinical setting.
Faculty members providing doctoral education could organise meetings to help students overcome the challenges they face during their educational process. Nurse managers, on the other hand, should organise regular meetings where nurses can share the difficulties they encounter and offer suggestions for improving their units.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting the study.
No patient or public contribution.
Telerehabilitation (TR) programmes are increasingly recognised for their feasibility and potential benefits, such as eliminating travel time, reducing costs and providing a more comfortable rehabilitation experience at home. However, the comparative efficacy of remote physiotherapy compared with traditional in-person sessions for individuals with Parkinson’s disease (PD) remains uncertain. This study aims to evaluate the effects of TR compared with in-person physiotherapy in individuals with PD, focusing on both motor and non-motor outcomes.
This is a randomised, single-blind clinical trial with a mixed-methods approach. A total of 22 individuals diagnosed with PD will be randomly assigned to one of two groups. The experimental group will receive TR, consisting of remote physiotherapy sessions conducted once a week for 1 hour over a 4-month period. The control group will receive the same interventions in person. Interventions will include global muscle strengthening exercises, balance training, gait and motor coordination exercises, and cognitive training. The primary outcome will be motor function, measured using part III of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale. Secondary outcomes will include cognition (Montreal Cognitive Assessment), gait (Functional Gait Assessment), mobility (Timed Up and Go Test) and quality of life (Parkinson’s Disease Questionnaire). Data will be analysed using repeated measures analysis of variance to compare outcomes between groups across four assessment points (baseline, midpoint, postintervention and 2 months follow-up). Additionally, a qualitative phase will explore participants’ perceptions and experiences regarding TR and in-person interventions, with assessments carried out 2 months after the completion of the 24-week interventions, through semistructured interviews that will be analysed using Bardin’s Content Analysis technique.
This protocol was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte (approval number: 5.553.701). All participants will provide written informed consent before inclusion. Results will be disseminated through peer-reviewed publications, scientific conferences and communication with participants and healthcare professionals.
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by Esther Ariyo, Victoria Awortwe, Ebenezer Cudjoe
This systematic review examined the effectiveness of perinatal interventions aimed at preventing infant removals, with attention to service features, implementation barriers, and enablers. We searched six electronic databases and 15 relevant websites for peer reviewed studies published between 2014 and 2024. Eligible studies evaluated interventions targeting pregnant parents at risk of having another child removed and reported on infant removal outcomes. Independent reviewers screened studies using Covidence. A total of 256 records were obtained, of which six peer reviewed studies covering eight interventions, involving 3,254 pregnant women and 20 professionals met the inclusion criteria. Three studies included comparison groups, including only one randomized controlled trial. Five studies assessed program-level interventions, and one study evaluated a policy change. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). Two of the three comparative studies indicated that targeted interventions may help reduce infant removals. Four of the six studies highlighted that trauma-informed, relationship-based, and multidisciplinary approaches delivered during pregnancy were associated with reductions in infant removals and improvements in maternal wellbeing, housing stability, substance use, and service engagement. Facilitators of successful implementation included continuity of care, culturally safe and non-judgmental support, and flexible services tailored to family needs. Common barriers were late referrals, limited intervention timelines, mistrust of services particularly among families with prior removals and insecure funding that constrained scale and sustainability. Despite generally positive outcomes, the evidence base remains weak due to small samples, limited diversity, lack of comparison groups, and short follow-up periods. This first systematic review of perinatal interventions for preventing infant removals highlights the need for long term, inclusive, comparative research. It underscores the importance of embedding early, holistic support in routine services and offers valuable insights for policy and practice on supporting parents with complex needs within the child protection system.
This study explored the perceptions of weight, shape and physical activity of Palestinian refugee adolescent girls and their mothers living in Baqa'a camp, Jordan.
A descriptive qualitative design.
A purposive sampling approach was employed to recruit 12 Palestinians (six adolescent girls and their mothers) from a Palestinian refugee camp between March 2019 and mid-January 2020.
The socioecological model framed the analysis process and revealed four main themes. At the individual level: ‘The Perfect Body’ explained how mothers and daughters conceptualised ideal body weight and shape and factors that influenced this perception. At the relationship level: ‘it's tough love I give, it's tough love I accept’ explored the tumultuous mother–daughter relationship and impact on weight, shape and physical activity. At the community level: ‘The camp community is insular and the setting, spartan’ highlighted how people within the community and the environment itself impacted on healthy behaviours, and at the society level: ‘The influence of where you are and who you are’ explored how the broader levels of society and the culture determined attitudes and perpetuated body weight and shape ideals among women.
Greater effort involves collaboration among nurses, educators, community leaders, parents, media professionals and researchers to deliver positive health messaging on weight, shape and the importance of physical activity, with further investment in resources and infrastructure to support behaviour change.
Findings assist nurses in addressing sociocultural issues regarding body image among women and girls in refugee camps and in advocating for policies and practices that reduce health disparities.
The findings provide nurses, educators and community leaders' insight in designing interventions that incorporate family dynamics and parenting styles to promote healthy body image, weight management and physical activity among adolescents and their mothers. Schools, with the support of school nurses, can implement programmes that promote open communication and positive modelling of body image, leading to healthier self-esteem and attitudes among adolescents.
We have adhered to relevant EQUATOR guidelines using the COREQ reporting framework for qualitative research.
No patient or public contribution.
It has been reported that pregnant women used more cosmetics daily than non-pregnant women. Phenoxyacetic acid is the main metabolite of phenoxyethanol, the most frequent preservative in cosmetics used in Europe, previously associated with reproductive effects (longer time to conception, endocrine disruptors in newborns and poorer verbal comprehension in children). In France, specialised platforms (PREVention ENvIronment Reproduction (PREVENIR)) in university hospital maternity wards are dedicated to evaluating environmental and occupational exposures in patients with pregnancy-related pathologies and supporting targeted prevention efforts. These platforms are composed of occupational health physicians, obstetrician-gynaecologists, midwives, occupational health nurses, and occupational health and environmental engineers. To assess the efficacy of these platforms, we developed a randomised clinical trial, the protocol for which is presented in this paper. The primary objective of the PREVENIR-G Study is to compare the change in urinary phenoxyacetic acid concentrations from baseline to 3 months postintervention between an intervention group and a control group. To date, the intervention has been integrated into routine care in certain facilities; however, its efficacy remains unproven. It is therefore essential to assess the relevance of this intervention, considering both its potential benefits and any adverse effects, such as increased stress or anxiety.
This study is an unblinded, randomised clinical superiority trial with two parallel groups (intervention vs no intervention) in four university maternity hospitals in France. We will include 300 pregnant women (aged 18 years or older) who are under 24 weeks of gestation (150 per group) referred to the participating PREVENIR platforms for management. The intervention will consist of clinical prevention management through the PREVENIR platforms, involving a consultation with an environmental health expert for an assessment of environmental and occupational exposures. During the consultation, targeted prevention messages will be provided based on identified exposures. The no intervention comparator will be a waiting-list control group. At the inclusion visit, patients will receive urine collection vials for samples to be collected at baseline and again at 3 months. Urine samples will be collected twice in a single day, on three separate days, during the collection week at home. In the week following the urine collection period, only participants in the intervention group will engage with the PREVENIR platforms. The primary outcome will be the difference in the urinary phenoxyacetic acid concentration between baseline and 3 months postintervention, compared between the intervention and control groups.
The study has been approved by the hospital ethics committee (CCP Ouest 2, no. 2023-A00941-44). All participants will provide written informed consent. Results will be shared through presentations and publications.
Patient involvement in healthcare has become increasingly important, not only as an expression of respect for autonomy but also as a means of empowering individuals to safeguard their care. In blood transfusion, informed consent is a critical tool for shared decision-making. This protocol outlines a scoping review to map how transfusion consent processes and forms are used globally and to characterise their key features. We aim to identify technologies used to obtain consent, evaluate compliance with international recommendations, describe practices in special populations and examine patients’ and families’ understanding of the consent process.
Following the Joanna Briggs Institute methodology, we will search PubMed, Embase, LILACS, Web of Science and Scopus; grey literature will be explored via Google Scholar and the Open Access Theses and Dissertations platform. No language or date restrictions will be applied. Reference lists of included studies will also be screened. Two reviewers will independently screen studies and chart data; disagreements will be resolved by a third reviewer. Synthesis will be diagrammatic/tabular with structured narrative, reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses: extension for Scoping Reviews. Where data allow, findings will be stratified by clinical setting. A stakeholder consultation with two transfusion medicine experts and two patient representatives will be undertaken to validate and refine interpretations.
Only publicly available sources will be used; research ethics approval is not required. Findings will be submitted to a peer-reviewed journal and presented at scientific meetings.
10.17605/OSF.IO/NU69J.
Inappropriate medication use among surgical patients poses significant risks, including antibiotic resistance, complications, mortality, increased healthcare costs and challenges in pain management. This study aimed to assess the extent of inappropriate antibiotic and analgesic prescriptions, treatment adequacy and contributing factors.
A hospital-based cross-sectional study was conducted among patients admitted to surgical wards in three comprehensive specialised hospitals in northwest Ethiopia.
All eligible adult patients admitted to the surgical wards during the data collection period were included in the study.
The primary outcomes were the appropriateness of antibiotic and analgesic prescriptions. To assess patients’ pain perception and the effectiveness of pain management strategies, the American Pain Society Patient Outcome Questionnaire was used. The Pain Management Index was employed to evaluate the treatment adequacy. The RAND (Research and Development)-modified Delphi method was applied to reach expert consensus on best practices for antibiotic prescribing. Additionally, the national standard treatment guideline was used to benchmark prescribing practices. Binary logistic regression was used to identify factors associated with inappropriate prescriptions of antibiotics and analgesics.
The prevalence of inappropriate antibiotics use was 67.5% and 42.2% of patients received inappropriate analgesic prescriptions. Moreover, 51.6% of patients experienced inadequate pain management. Significant factors associated with inappropriate antibiotic prescription included the presence of comorbidities (adjsuted OR (AOR) 3.34, 95% CI 1.88 to 5.92), lack of laboratory tests (AOR 0.26, 95% CI 0.16 to 0.43, higher number of medications (AOR 2.71, 95% CI 1.62 to 4.52) and contaminated wound class (AOR 3.13, 95% CI 1.58 to 6.20). For inappropriate analgesic prescription, pain due to disease (AOR 8.69, 95% CI 1.73 to 4.62), mixed causes of pain (AOR 7.20, 95% CI 1.43 to 6.31), head and facial pain (AOR 0.14, 95% CI 0.05 to 0.39) and an increased number of medications (AOR 2.75, 95% CI 1.72 to 4.41) were significant factors.
The majority of the patients admitted to surgical wards were found to receive inappropriate antibiotic and analgesic medications. Prescribers should pay attention to patients with comorbid diseases, receiving multiple medications. Additionally, routine laboratory tests are essential for guiding antibiotic therapy and improving patient outcomes in surgical wards.
This study aimed to estimate reductions in travel-related carbon dioxide (CO2) emissions, travel time and distance resulting from a telemedicine service for patients with chronic conditions, and to assess its potential to contribute to more equitable access to specialised care in Northeast Brazil.
Cross-sectional study.
Primary healthcare units in the Northeast region of Brazil.
Patients between birth and 104 years of age with chronic conditions who received video-based teleconsultations between June 2022 and November 2023.
The primary outcome was the reduction in travel-related carbon emissions due to avoided in-person referrals. Secondary outcomes included travel time and travel distance savings. Round-trip distances between primary healthcare units and referral centres were estimated using geolocation data. CO2 emissions were calculated using the Greenhouse Gas (GHG) Protocol adapted to Brazil (Brazilian GHG Protocol Programme), focusing on Scope 3 emissions from patient travel.
A total of 4642 teleconsultations were conducted with 4106 patients. Of these, 4021 (86.6%) avoided in-person referrals, resulting in estimated savings of 226 900 miles in travel distance and 488 584 min in travel time. The estimated CO2 emissions avoided totalled 21 593 kg (21 930 kg CO2 equivalent), with a mean of 5.37 kg (SD±5.5) per teleconsultation (5.4 kg CO2 equivalent ; SD±5.5). Greater travel distance savings were observed among patients living in municipalities with lower Municipal Human Development Index (mean 92.3±104.2 miles vs 17.3±8.4 miles; p
Telemedicine use in Northeast Brazil significantly reduced patient travel, leading to substantial savings in CO2 emissions. These savings were more pronounced for patients in smaller, less developed municipalities. By reducing the need for travel, telemedicine can improve access to healthcare for remote or underserved populations, while also supporting environmental sustainability.
This study aimed to assess the prevalence and determinants of vaccine hesitancy among pregnant women in South-West Nigeria.
An explanatory sequential mixed-methods study was conducted between January and March 2023. Participants for the quantitative phase were selected using a systematic sampling technique, while those for the qualitative phase were purposively selected. A modified parent attitude about childhood vaccines questionnaire was used for data collection and analysed using IBM SPSS V.25.0. Qualitative data were collected through focus group discussions and analysed using NVivo V.14. Univariable, bivariable and multivariable logistic regression analysis was done. A p
A tertiary health facility in South-West Nigeria.
Three hundred and forty-five pregnant women participated in the quantitative phase, while 24 pregnant women were involved in the qualitative phase.
The overall prevalence of vaccine hesitancy was 32%. Based on the domains, only 15.4% of the respondents were hesitant due to vaccination behaviour, 38.6% for safety and efficacy, and 49.6% were hesitant due to general attitude and trust for healthcare providers. Maternal age, number of children, religion and occupation showed significant association with vaccine hesitancy. Regarding the predictors of vaccine hesitancy, employed pregnant women (adjusted OR (aOR), 4.33; 95% CI: 1.60 to 9.70) and younger pregnant women (aOR, 2.53; 95% CI: 1.04 to 7.70) had a significantly higher odds of being vaccine-hesitant. The qualitative analyses revealed several major themes that contributed to vaccine hesitancy, including concerns about vaccine safety and efficacy, distrust of healthcare providers and the government, and the spread of misinformation through social networks and peers.
A significant proportion of pregnant women in this study were vaccine-hesitant. The major reasons for vaccine hesitancy are concerns about the safety of vaccines and lack of trust for healthcare providers. Policies and programmes should be aimed at improving vaccination behaviour, addressing safety concerns and building trust in vaccination systems.
Medication administration errors are high-risk patient safety issues that could potentially cause harm to patients, thereby delaying recovery and increasing length of hospital stay with additional healthcare costs. Nurses are pivotal to the medication administration process and are considered to be in the position to recognize and prevent these errors. However, the effectiveness of interventions implemented by nurses to reduce medication administration errors in acute hospital settings is less reported.
To identify and quantify the effectiveness of interventions by nurses in reducing medication administration errors in adults' inpatient acute hospital.
A systematic review and meta-analysis was conducted up to 03/24. Six databases were searched. Study methodology quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools, and data extraction was conducted. Meta-analysis was performed to combine effect sizes from the studies, and synthesis without meta-analysis was adopted for studies that were not included in the meta-analysis to aggregate and re-examine results from studies.
Searches identified 878 articles with 26 studies meeting the inclusion criteria. Five types of interventions were identified: (1) educational program, (2) workflow smart technologies, (3) protocolised improvement strategy, (4) low resource ward-based interventions, and (5) electronic medication management. The overall results from 14 studies included in meta-analysis showed interventions implemented by nurses are effective in reducing medication administration errors (Z = 2.15 (p = 0.03); odds ratio = 95% CI 0.70 [0.51, 0.97], I 2 = 94%). Sub-group analysis showed workflow smart technologies to be the most effective intervention compared to usual care. Findings demonstrate that nurse-led interventions can significantly reduce medication administration errors compared to usual care. The effectiveness of individual interventions varied, suggesting a bundle approach may be more beneficial. This provides valuable insights for clinical practice, emphasizing the importance of tailored, evidence-based approaches to improving medication safety.
PRISMA guided the review and JBI critical appraisal tools were used for quality appraisal of included studies.
This review aims to map oral health plans, programmes and policies worldwide in countries with universal health coverage.
This protocol describes a scoping review that will follow the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review checklist, guided by the PCC framework: Population—countries with universal health coverage (78 globally recognised); Concept—oral health plans, programmes and policies; Context—integration into health systems. Searches will be conducted in MEDLINE (PubMed), Scopus, Web of Science, Embase, Health System Evidence and Epistemonikos, with no restrictions on date, language or study type. Grey literature will be accessed through Google Scholar, OpenThesis and the Brazilian Digital Library of Theses and Dissertations. Official documents from ministries of health and international bodies, including the WHO and the International Monetary Fund, will also be reviewed. Two independent reviewers will screen titles and abstracts; a third will resolve disagreements. Eligible records will undergo full-text review. Data will be extracted into predefined categories reflecting health system components: population, structure, services, governance and oral health indicators. Results will be presented using tables, charts and figures to illustrate strategies and innovations.
This review does not involve primary data collection and does not require ethical approval. Results will be disseminated through a peer-reviewed publication and presentations at academic conferences and scientific events.
Open Science Framework (DOI 10.17605/OSF.IO/RCP8N).
Non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases and cancer, are major global public health concerns. Diet quality—particularly the consumption of ultra-processed foods—has been associated with increased risk of NCDs. Traditional cohort studies are often expensive and logistically complex. The NutriNet-Brasil cohort leverages a web-based approach, offering a cost-effective and practical solution for comprehensive data collection and long-term follow-up.
Recruitments began in January 2020 through mass media, social media campaigns and collaborations with health organisations. Eligible participants are adults (aged ≥18 years) living in Brazil with internet access. Participants complete self-administered online questionnaires covering dietary intake, health status and other health determinants. Dietary assessment is based on the Nova classification system, which categorises foods by their level of processing.
Over 88 000 participants have completed the initial questionnaire. The cohort is predominantly women (79.9%) and highly educated (67.9% had completed higher education). The web-based design enabled the development and application of innovative dietary assessment tools, including the Nova24h and the Nova24hScreener, specifically designed to evaluate food processing levels. These tools have shown good performance in capturing dietary patterns and are central to the cohort’s aim. The online platform facilitates efficient recruitment, data collection and participant retention.
NutriNet-Brasil is pioneering the development of web-based cohort methodologies and instruments tailored to food processing research. Future work includes leveraging collaborations with national and international research centres to conduct multidisciplinary analyses and inform public health policies.
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