This study aimed to explore and synthesise interpreters’ perspectives on the provision of sexual and reproductive health (SRH) care to Eritrean and Somali migrant women in Switzerland, and to identify and analyse the professional and ethical challenges they encounter in this context.

An exploratory qualitative study from a social constructionist perspective. The interviews were recorded, transcribed, categorised and analysed through thematic analysis.

The study was conducted in the canton of Basel-Stadt, northwestern Switzerland. We have purposively selected 10 Eritrean and Somali intercultural interpreters serving as crucial intermediaries in assisting immigrant women to access SRH services.

Our analysis of the interpreters’ perspectives revealed three key thematic areas that they identified as central challenges for their Eritrean and Somali immigrant women: (1) perceived limited health literacy among patients, (2) sociocultural barriers that interpreters observed hindering patient provider communication and (3) structural difficulties that interpreters reported their patients faced in navigating the Swiss healthcare system. These challenges have now persisted for a long time, and research findings and recommendations do not appear to have changed practices. For example, while abortion services are fully covered by Swiss health insurance, contraceptive methods often require out-of-pocket payments. This financial disparity may discourage appropriate use of SRH services among immigrant women. The lack of culturally competent care and the limited availability of funding for intercultural interpreters were among important bottlenecks identified.

This study explored interpreters’ perspectives on the provision of SRH care to Eritrean and Somali immigrant women in Switzerland. Despite the outstanding Swiss healthcare system, a majority of Eritrean and Somali refugee women struggle to benefit from SRH services due to limited health literacy, language barriers and challenges in navigating the Swiss healthcare system. Partnerships and integration of community entities, such as the Swisso-Kalmo association for Somali women and different Eritrean communities, could contribute via facilitating entry points for access to SRH healthcare.

Floods and heatwaves are becoming more frequent and intense and can disrupt routine maternal and child health (MCH) services. Previous reviews have not systematically examined how context and mechanisms may shape adaptation outcomes. This realist-informed systematic review examines how, why and under what conditions interventions support access to, utilisation of and continuity of routine MCH services during flood and heat events.

The search strategy was developed by integrating terms from 17 related reviews, refined with the author team and checked by an experienced London School of Hygiene & Tropical Medicine librarian. The initial database search was conducted on 16 May 2025 and the search was updated on 30 April 2026. Eight databases were searched: Web of Science, Ovid MEDLINE, EMBASE, Global Health, EconLit, GreenFILE, CINAHL and ProQuest Environmental Science & Public Policy. Records published between January 2000 and April 2026 were eligible. Search results were imported into EndNote and deduplicated. Title-and-abstract screening and full-text assessment were conducted independently by two reviewers for the initial search and are ongoing for the updated search, with ASReview being used to prioritise records during title-and-abstract screening. Data extraction across the full review evidence base remains ongoing using a structured template covering study context, intervention characteristics, mechanisms, outcomes, costs and implementation conditions. Study settings will be classified by country income group, health system context and Köppen–Geiger climate zone to compare evidence across settings and, where appropriate, to identify possible climate analogues for exploratory, context-specific assessment. Climate-zone similarity will not be used to infer intervention transferability or future effectiveness. The synthesis will be guided by the WHO Climate-Resilient Health Systems framework, Meadows’ leverage-points framework and realist-informed C–M–O reasoning. Interventions will be grouped to identify where they operate within the health system and which health system components and vulnerabilities they address. Findings will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.

Ethical approval is not required because the review uses published literature and does not involve human participants. The findings will be disseminated through a peer-reviewed systematic review publication. They will inform the design, improvement and scaling of interventions intended to maintain routine MCH services and strengthen health system resilience to floods and heatwaves across diverse settings.

The review was not prospectively registered with PROSPERO.

To examine geographical accessibility to primary care in Sweden by estimating driving distances and travel times to primary care centres, assessing the availability of alternative providers within predefined travel-time thresholds and describing variation by municipality type.

Descriptive cross-sectional nationwide study.

Primary care in Sweden, including all primary care centres operating nationally during 2019–2020.

Individual-level residential grid coordinates for all residents of Sweden as of 31 December 2019 were obtained. After exclusion of observations with missing coordinate data, the final analytical sample comprised 9 946 509 individuals. A total of 1167 primary care centres were included after merging duplicate administrative units at the same physical location.

Outcomes were driving distance and driving travel time by car from place of residence to the nearest primary care centre. Furthermore, driving distance and travel time to the second- to fifth-nearest centres, and the number of centres reachable within 5, 10, 20 and 30 min by car were used as outcomes.

Nationally, the mean travel distance and time to the nearest primary care centre were 3.84 km (SD=5.8) and 5.6 min (SD 6.3), respectively (median distance 1.63 km, IQR 0.90–3.67; median time 3.3 min, IQR 2.0–6.2). Overall, 15.8% of residents could not reach a primary care centre within 10 min by car while 0.9% had travel times exceeding 30 min. Mean travel time to the nearest centre was 15.1 min (SD 18.9) in very rural municipalities compared with 3.0 min (SD 2.5) in large cities.

Geographical accessibility to Swedish primary care is high on average but substantial urban–rural disparities remain. Residents of sparsely populated areas face markedly longer travel times and more limited practical provider choice. Future studies should complement geographical measures with indicators of staffing, waiting times and multimodal transport to better assess medical deserts and effective access.

Engagement with the arts is advocated to reduce stigma and to increase the social inclusion of people living with dementia since the arts powerfully support non-verbal communication, affect and the opportunity to participate in activities that are meaningful to self and others. An example is Sharing Dance Older Adults (SDOA), an innovative, community dance programme that is offered by Canada’s National Ballet School (NBS) intended to support social inclusion by making dance accessible to older adults with a range of physical and cognitive abilities, including people living with dementia. Despite the benefits that SDOA offers people living with dementia and their carers, individuals from historically excluded populations, and more specifically those from racialised groups, have had only limited engagement with the programme. This study thus aims to co-develop with dance artists in the three largest racialised communities in Canada (Black, Chinese and South Asian) culturally relevant SDOA-informed dance opportunities for people living with dementia.

This 3-year study (2024–2027) is a multiple-case and intrinsic-case study design informed by critical participatory action research and the Critical Realism and the Arts Research Utilisation Model. For each of the three racialised communities, implementation and data collection will develop across five phases (preimplementation of professional development for dance artists; implementation of professional development for dance artists; postimplementation of professional development for dance artists; implementation of dance programming; and postimplementation of dance programming). Drawing on organisational partnerships in two Canadian provinces for three racialised communities, we plan to recruit older adults living with/without dementia who will attend the dance programming (n=90), formal/informal carers such as nurses and family (n=30), site managers such as directors of care (n=15), dance artists from the case communities (n=15) and NBS dance trainers who teach SDOA (n=2). Data collection strategies include: semistructured e-diary entries; active interviews; and video recordings of dance classes. All e-diary entries, transcriptions of interviews and video clips selected for full verbatim transcription will be analysed concurrently and recursively, using standard thematic analysis techniques.

All five phases of this study have been approved by the Clinical Trials Ontario (CTO Project ID: 4997, 11 June 2026), which is a streamlined ethics review system for multisite studies. All participants will provide written informed consent before taking part in the study. The outcomes will be shared through articles published in journals, presentations at academic and professional conferences, arts-based community events and other knowledge mobilisation forums that include all partners and collaborators.

The Philippines faces physician shortages, exacerbated by their propensity to practise in urban centres. Despite government placement programmes, recruitment and retention of physicians in many areas throughout the country remain difficult. This study aims to: (1) describe the distribution of general physicians and board-certified specialist physicians and (2) identify the individual, work environment, local environment, national environment and international environment factors that may influence physicians to establish their practice in areas with below-optimal physician-to-population ratios in the Philippines.

To describe the distribution of general physicians and board-certified specialist physicians, we will map Philippine Health Insurance Corporation (PhilHealth)-accredited physicians at the regional and at the provincial level, superimposing medical schools and corresponding training institutions. To identify the individual, work environment, local environment, national environment and international environment factors that may influence physicians to establish their practice in areas of the Philippines with below optimal physician-to-population ratios, we will conduct three rounds of data collection: (1) an online survey of current Philippine Department of Health (DOH)-deployed physicians; (2) online or face-to-face focus group discussions and key informant interviews with a subset of DOH-deployed physicians, senior general and specialist physicians practising in Metro Manila and outside and DOH personnel involved in the implementation of these physician placement programmes at the national, regional and local level; and (3) a stated preference experiment administered to resident physicians of the specialties under study to determine which government interventions can encourage them to establish their practice in areas with lower than optimal physician-to-population ratios in the Philippines.

We have obtained ethics clearance from the Ateneo de Manila University School of Medicine and Public Health Research Ethics Committee. We will disseminate our findings in online or face-to-face dissemination sessions with the DOH, Philippine Health Insurance Corporation, Association of Philippine Medical Colleges, the Philippine Statistics Authority, the Professional Regulation Commission Board of Medicine, the Commission on Higher Education and partner specialty societies. We will also publish our results in peer-reviewed medical or public health journals.

To investigate the effect of terrorism-related attacks on modern contraceptive uptake and to assess the effects of recent family planning (FP) interventions in Burkina Faso.

Nationwide longitudinal study using a multiple interrupted time-series analysis.

Public primary healthcare centres and district hospitals in Burkina Faso, from January 2013 to December 2023.

Monthly data on new FP users were drawn from Burkina Faso’s National Health Information System, covering 132 months. Data on terrorist attacks were extracted from the Armed Conflict Location and Event Data Project.

The main exposure was the occurrence of terrorist attacks at the commune-month level. Secondary exposures were the 2020 FP user-fee exemption policy and national family planning weeks (NFPWs).

The primary outcome was the monthly count of new FP users used as an indicator of modern contraceptive uptake. Secondary measures were predicted gains and losses in visits by new FP users associated with terrorist attacks, user-fee removal and NFPWs.

The monthly number of visits by new FP users decreased by 13% (95% CI 11% to 15%) in the month of and following a terrorist attack. NFPWs were associated with a 152% increase in new users (95% CI 147% to 156%), while the 2020 FP fee exemption policy was associated with a 22% immediate increase (95% CI 18% to 25%). Predicted gains were greater for NFPWs (+4 31 846 new users) than for the free FP policy (+3 52 006). Terrorist attacks were associated with a predicted loss of 133 688 new users since January 2013.

Terrorist attacks were associated with reduced modern contraceptive uptake in Burkina Faso, likely through disruptions in both service supply and access. Combining user-fee removal with active outreach strategies such as NFPWs may help sustain reproductive health service coverage in settings affected by protracted insecurity.

Proximity healthcare interventions aim to provide or support health services geographically close to, or in, citizens’ own homes, involving the actors needed to deliver appropriate care across sectors. However, the field remains conceptually ambiguous, and systematic knowledge of how such interventions are organised is limited. This study therefore aims to develop an empirically grounded typology of proximity healthcare interventions in Denmark and explore system-level characteristics that characterise their development and organisation.

Exploratory qualitative study based on semi-structured interviews with key informants responsible for cross-sectoral healthcare planning and implementation.

The Danish healthcare system, a publicly funded, decentralised system undergoing structural reform to strengthen proximity healthcare and cross-sectoral coordination.

28 informants across the 5 Danish regions, including health cluster coordinators, regional administrators and municipal representatives.

Data were collected through 20 semi-structured interviews and analysed using thematic analysis informed by Braun and Clarke’s approach. A typology was developed inductively from the data and iteratively refined through collaborative coding and analytical discussion.

The analysis revealed a heterogeneous field of proximity healthcare interventions differing in objectives, organisation and scope. The typology comprised healthcare delivery functions, including hospital outreach, delegation of treatment to municipal staff, shared healthcare models and self-administered healthcare supported by professionals, alongside supporting functions such as coordination roles, advisory partnerships, training and patient and family education. Across categories, three system-level characteristics were identified: substantial functional and organisational variation, including hospital anchoring of many interventions; reliance on short-term project funding and locally negotiated arrangements; and greater patient and relative involvement supported by digital infrastructure. These findings characterise proximity healthcare as both adaptive and fragmented within a decentralised system.

This study provides a system-level overview of proximity healthcare in Denmark through a typology that brings together healthcare delivery and supporting functions. By highlighting their interdependence and the characteristics shaping intervention development, the study contributes conceptual clarity in a policy field often ambiguously defined. The typology and identified system-level characteristics offer a practical tool for policymakers and planners to navigate a complex intervention landscape and a foundation for comparative and practice-oriented research on strengthening sustainable proximity healthcare in decentralised health systems.

Not applicable.

Home care services face increasing challenges driven by population ageing, ageing-in-place policies, growing complexity of care needs among home care recipients and shortages of qualified personnel. These developments underscore the need to better use the available workforce and its competencies. Workforce composition refers to the skill mix and organisational structures of home care services, including professional backgrounds, team configurations and work scheduling practices. Competence utilisation refers to how effectively health personnel apply their skills and qualifications in service delivery. This scoping review aims to map existing knowledge on how workforce composition and professional skill sets influence (1) the organisation of tasks, roles and responsibilities and (2) competence utilisation in home care services. By examining the relationship between workforce organisation and competence use, the review seeks to identify factors that support or constrain the optimal use of workforce competence in home care services.

This scoping review will be conducted according to the Arksey and O’Malley methodological framework as refined by Levac. The review process will be guided by the Joanna Briggs Institute methodology for scoping reviews. The review has been conducted between April and August 2026. The literature search will be conducted on MEDLINE, EBSCOhost CINAHL, Scopus, ProQuest and Embase to include peer-reviewed primary research studies published in scientific journals. The search will also be supplemented by Google Scholar to identify additional and grey literature in order to improve search coverage. The search strategy has been developed with support from an experienced university librarian. Using the Population–Concept–Context (PCC) framework, inclusion criteria are: (1) employees in home care services, (2) workforce organisation and competence utilisation and (3) municipal or district-based home care services. Exclusion criteria are: (1) volunteers or staff without care responsibilities, (2) studies focusing only on patient outcomes without addressing competence or workforce structure and (3) institutional or hospital-based settings. An online platform will be used to share search results and perform record screenings by two reviewers independently to enhance accuracy and reliability. Data from included sources will be charted and synthesised narratively, supported by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews flow diagram (PRISMA-ScR).

The scoping review will not require ethics approval, as all data will be obtained from publicly available literature. The review authors will adhere to principles of honesty and transparency throughout the data extraction and reporting processes and enhance the trustworthiness of the synthesised findings. Findings will be submitted for publication in a peer-reviewed journal and disseminated through presentations at relevant conferences.

Depression is a prevalent mental health condition often occurring after traumatic brain injury (TBI) in both children and adults. Sex, gender and other social determinants of health (SDoH) (e.g., race/ethnicity or socio-economic status) play an important role in depression-related and TBI-related healthcare utilisation (e.g., diagnosis, treatment and management of the conditions). Despite this, no reviews have examined how sex and gender, along with other SDoH, influence depression-related healthcare utilisation among individuals who sustained a TBI ≤19 years of age. The review’s objective will be to synthesise evidence on sex-based and/or gender-based findings, along with other SDoH, in depression-related healthcare utilisation among individuals who sustained a TBI ≤19 years of age.

Searches will be conducted on Ovid Medline, Embase, American Psychological Association PsycINFO and Cumulative Index of Nursing and Allied Health Literature from database inception to the search date. The review will follow the Joanna Briggs Institute evidence synthesis framework for knowledge synthesis and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)-P, PRISMA-Equity guidelines and PROGRESS-Plus for reporting results. Included studies will be peer-reviewed articles published in any language that examined individuals who sustained a TBI at ≤19 years of age, reported depression-related healthcare services and provided sex-stratified and/or gender-stratified results. Studies will be excluded if they were grey literature, included individuals who sustained a TBI at >19 years without age-stratified results, reported healthcare services for conditions other than depression without depression-specific stratification or did not provide sex-stratified or gender-stratified results. A narrative synthesis will be conducted to identify themes and attributes describing how sex, gender and other SDoH influence depression-related healthcare utilisation. Methodological quality will be assessed using the National Heart, Lung and Blood Institute Quality Assessment Tool.

No institutional ethics approval will be required as this study will not conduct primary data collection. The review will be disseminated as a peer-reviewed publication.

CRD420261301669.

Measurement-based care (MBC), defined as the routine use of patient-reported outcome measures (PROMs) to monitor symptoms and inform collaborative treatment decisions, has demonstrated benefits in youth mental healthcare. However, evidence on how to implement MBC within specialised child and adolescent obsessive-compulsive disorder (OCD) services remains limited. Existing MBC implementation studies in paediatric mental health services have largely focused on community, school-based or general outpatient settings, leaving an important knowledge gap in specialised multidisciplinary tertiary care. This protocol aims to assess organisational readiness, guide implementation planning and evaluate early implementation outcomes of MBC within a specialised paediatric OCD programme in Calgary, Alberta.

This protocol describes a single-site, three-phase mixed-methods implementation study that includes organisational readiness assessment, theory-informed implementation planning and evaluation of early implementation outcomes of MBC within a specialised child and adolescent OCD programme. Phase 1 employs an explanatory sequential mixed-methods approach to assess organisational readiness and contextual determinants using the Readiness Thinking Tool, informed by the Consolidated Framework for Implementation Research (CFIR). Phase 2 focuses on developing and operationalising the implementation plan, guided by the Quality Implementation Framework, through stakeholder co-design, workflow integration, staff training and iterative refinement. The MBC model integrates five PROMs: two general mental health measures and three OCD-specific domains. Phase 3 employs a convergent mixed-methods formative evaluation to assess implementation outcomes, using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, while CFIR guides the assessment of contextual and organisational determinants. Data sources include clinician, youth and caregiver surveys and interviews, PROM completion and score data and implementation field notes. Quantitative data will be analysed descriptively, while qualitative data will be analysed using a CFIR-guided directed content analysis approach.

Ethics approval was obtained from the University of Calgary Conjoint Health Research Ethics Board. This study will generate implementation knowledge to inform the integration and sustainment of MBC within specialised paediatric mental health services. By linking readiness assessment, structured implementation planning and formative evaluation, it will produce a context-specific, practice-oriented implementation blueprint for MBC in paediatric OCD clinic. Findings will be disseminated via peer-reviewed publications, conference presentations, stakeholder workshops, clinic feedback sessions and policy-focused knowledge exchange activities.

Pancreatic cancer is diagnosed in approximately 1% of individuals with new-onset diabetes, increasing to 3% among those aged ≥60 years with weight loss. UK clinical guidelines recommend abdominal imaging to rule out pancreatic cancer in this high-risk group. In June 2025, National Health Service (NHS) England launched a case-finding pilot to test approaches to improve primary care referrals for imaging in these patients and improve the quality of body weight and diabetes-related data recorded in electronic healthcare records (EHRs). This study reports referral and imaging rates among the eligible group and the availability of body weight and glycated haemoglobin (HbA1c) measurements in people with diabetes, providing baseline data prior to implementation of the NHS England pilot.

Retrospective cohort study.

Primary care. The database of 8 million patients from 781 general practices from the Royal College of General Practitioners Research and Surveillance Centre.

Adults diagnosed with diabetes between 2015 and 2021.

Proportions of eligible individuals who received a referral and imaging within 12 months before or after diabetes diagnosis and the number of body weight and HbA1c measurements recorded for individuals with diabetes.

Among 180 815 individuals diagnosed with diabetes, 92 210 (51.0%) were aged ≥60 years (median age 71, 46% women). Overall, 152 300 (84.2%) had at least one body weight and 161 631 (89.4%) had at least one HbA1c measurement recorded in EHRs. Among the 1411 patients with new-onset diabetes and weight loss, 372 (26.4%) had a referral, 141 (10.0%) imaging and 40 (2.8%) had pancreatic cancer recorded.

This study demonstrated potential underutilisation of referral guidance and under-referral among the eligible population. The findings provide baseline data to support the launch of the NHS England pilot. Further research is needed to better understand current practice and support the implementation of cancer referral guidelines.

To elicit and quantify registered nurses’ (RNs’) preferences for key shift attributes and to estimate the trade-offs between shift pattern characteristics and pay.

Cross-sectional online discrete choice experiment with d-efficient design; 12 choice tasks per respondent. Preferences were estimated using multinomial logit models with clustered standard errors; willingness to accept (WTA) values were derived as ratios of attribute coefficients to the pay coefficient.

United Kingdom.

1449 registered nurses (RNs) recruited via the Nursing and Midwifery Council distribution list.

Utility coefficients (β) for shift length, schedule predictability, shift request flexibility, weekend working frequency, pay level and night-shift frequency; WTA derived from the pay attribute; subgroup and interaction analyses by age, pay band, current shift status, caring responsibilities, sector and satisfaction.

All six attributes were statistically significant predictors of shift pattern choices. The strongest aversions were to night-only working (β=–1.113) and having no whole weekends off (β=–0.790), which required an estimated 29% additional compensation in the primary model and 21% additional compensation, respectively. Unpredictable rotas (β=–0.220), restricted shift-choice flexibility (β=–0.189 for only swaps) and absence of pay increase (β=–0.525) also reduced utility. Nine-to-ten-hour shifts were preferred over 8-hour shifts (β=0.144), whereas 12.5-hour shifts were disliked (β=–0.179). Subgroup analyses showed significant heterogeneity by age and current shift status, with more limited evidence of pay-band differences. Interaction analyses suggested broadly consistent aversion to night work and weekend loss across the nursing workforce.

Nurses strongly prefer rota designs that avoid exclusive night work and protect whole weekends off. Predictability and meaningful scope to request shifts also matter. These preference estimates provide policy-relevant benchmarks for rota design and unsocial-hours compensation.

Parenting interventions have shown promise in improving mental well-being for parents and children and strengthening family relationships. Parenting for lifelong health (PLH) is an open-access, evidence-informed programme that aims to improve positive parenting practices, reduce family violence and promote mental health, particularly in low-resource settings. This study will evaluate the implementation and (cost-)effectiveness of an adapted version of the PLH for Parents and Teens programme. It will focus on supporting positive parenting, communication, mental health and well-being of adolescents and their caregivers in North Macedonia and Moldova.

This multicountry hybrid type 1 effectiveness-implementation randomised waitlist-controlled trial will recruit 660 adolescents aged 10–14 years and their caregivers through schools, Youth Clinics and community partner organisations, including vulnerable and linguistically diverse families. The intervention group will receive the adapted PLH programme with assessments conducted postintervention and at 6-month follow-up. The waitlist control group will receive the adapted PLH programme after completion of the intervention group’s 6-month post-baseline assessment. Primary outcomes include adolescent emotional problems, family functioning, parenting practices, adolescent and caregiver quality of life. Secondary outcomes assess a range of mental well-being, family and other psychosocial outcomes. Other prespecified outcomes include implementation and cost outcomes. Primary analyses will compare intervention and waitlist control groups at postintervention and 6-month follow-up using intention-to-treat, baseline-adjusted linear mixed models. A within-trial economic evaluation will include cost–utility analysis and cost-effectiveness analysis. A macroeconomic analysis will assess broader economic impacts using public financing and budget impact analysis. The study uses a mixed-methods process evaluation, and integrates qualitative data, budget impact analysis and simulation modelling to inform scale-up considerations.

The study has received ethical approval from all relevant sites. Results will be disseminated through peer-reviewed publications, scientific conferences and webinars, newsletters, social media and open-access platforms, alongside engagement with researchers, clinicians, policymakers and the public. The Family-Focused Adolescent & Lifelong Health Promotion project uses a targeted communication and dissemination strategy for families, implementers and policy stakeholders to promote the adoption and scale-up of evidence-informed, open-access parenting interventions for adolescents and caregivers in low-resource settings. Dissemination focuses primarily on North Macedonia and Moldova while also engaging actors across the wider Eastern European region.

NCT07240571.

This study aims to assess socioeconomic differentials in the prevalence of multimorbidity among adults ≥65 years, health and social care expenditure and its effect on total care expenditure.

Population-based cross-sectional register study.

Region Stockholm, Sweden.

Persons ≥65 years (N=371 583), in Region Stockholm in 2019.

Total health and social care expenditure per individual in 2019.

Prevalence and sociodemographic patterns of multimorbidity, differences in care expenditure across socioeconomic groups and the composition of services used.

Multimorbidity prevalence was 62.6% among adults aged ≥65 years (N=371 583), increasing with age and occurring earlier in lower income groups. Average total care expenditure increased from 34 346 Swedish Kronor (SEK) among individuals with no chronic conditions and 55 606 SEK among those with one condition to 143 063 SEK among those with ≥4 chronic conditions. Social care expenditure exceeded healthcare expenditure from age 80 years onwards. In adjusted gamma regression models, multimorbidity was associated with 11.6% higher total care expenditure (cost ratio (CR) 1.116, CI 1.114 to 1.118). Compared with the highest income group, expenditure was also higher among those in the lowest (CR: 1.038, CI 1.036 to 1.040) and second-lowest income groups (CR: 1.011, CI 1.009 to 1.013).

Multimorbidity is increasingly prevalent in older ages and is associated with higher health and social care expenditure. This poses a challenge to organising and financing healthcare, and critically, social care services, in the future. More resources should be allocated to health promotion and prevention to delay onset, targeting lower socioeconomic groups. Alternative approaches to organising care that balance quality, equity and cost-effectiveness should be explored.

Improving the quality of outpatient obstetric care is essential for achieving better maternal and perinatal outcomes, especially in resource-constrained settings. Despite guideline recommendations, substantial gaps remain in the delivery of evidence-based services and patient-centred care during routine antenatal encounters. Unannounced standardised patient (USP) methodology provides a robust and reproducible approach to objectively measure clinical performance. However, its large-scale application and value for multidimensional service quality assessment in obstetric outpatient settings remain underexplored, especially in low-income and middle-income countries (LMICs).

We present a protocol that uses USPs to evaluate the quality and efficiency of outpatient obstetric care delivery. The study will be conducted across six cities in China’s Hebei, Shanxi and Yunnan provinces. Trained USPs will conduct a total of 108 clinical visits from October to December 2025, with a projected study end date of December 2026. Primary outcomes will encompass two core dimensions: (1) technical capabilities, assessed through four metrics—(a) completeness of key history-taking items (continuous, 0–1 scale), (b) adherence to essential testing protocols (continuous, 0–1 scale), (c) diagnostic accuracy (ordinal: 0=incorrect, 1=partially correct, 2=correct) and (d) therapeutic appropriateness (ordinal: 0=incorrect, 1=partially correct, 2=correct); and (2) patient-centred care, quantified using the validated Chinese version of the Revised Patient Perception of Patient-Centeredness scale (PPPC-R; continuous, range 1–4, lower scores indicating more patient-centred care). USPs will receive comprehensive training to guarantee strict protocol adherence and consistent case presentation across all study sites. We will use OLS regression for continuous outcomes and logistic regression for binary outcomes to assess differences in case management across provider levels and USP-scenario interactions, controlling for city indicators. Logistic regression will also examine links between provider characteristics and quality outcomes, adjusting for city and USP dummies. This study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines ().

Ethical approval has been granted by the ethics committee of Peking University Health Science Center Institutional Review Board (IRB00001052-24044). The results from this study will be actively disseminated through manuscript publications and conference presentations.

Chinese Clinical Trial Registry (ChiCTR2500106140).

To explore stakeholder perspectives on care coordination barriers and facilitators in regionalised neuro-oncology delivery, using brain tumours as a model for examining complex care pathways serving mixed rural-urban populations.

Reflexive thematic analysis of semistructured interviews from stakeholders across the neuro-oncology care pathway was used to identify themes of care system strengths, barriers to effective service delivery and priorities for system improvement.

Regionalised Canadian health system serving one of Ontario’s largest catchment areas, characterised by predominantly rural populations and substantial geographic distances to tertiary care.

36 stakeholders purposively sampled to represent diverse roles across the care pathway, including family caregivers (n=6), healthcare providers from multiple specialties and care settings (n=28) and Indigenous community advisors (n=2).

Thematic analysis identified seven themes organised within two broad domains: care system strengths and barriers to care continuity. Care system strengths included three themes: responsive palliative care integration, provider dedication and compassionate commitment, and intra-institutional coordination infrastructure. Barriers to care continuity included four themes: insufficient pathway standardisation across settings; inadequate educational infrastructure for patients, families and providers; absent cross-institutional coordination infrastructure and limited regional clinical trial access. Participants described relatively coordinated processes within the tertiary centre, while communication and follow-up were more fragmented at interfaces with referring hospitals and community services, with participants describing patients becoming ‘lost in transitions’.

Findings reveal how regionalised cancer systems can achieve localised coordination while experiencing fragmentation at interfaces between organisations. Participants described relatively coordinated processes within the tertiary centre, alongside more fragmented communication and follow-up across interfaces with referring hospitals and community services. These stakeholder perspectives highlight potential directions for service redesign, including standardised pathways, shared information systems and clearer cross-site accountability structures, which warrant future evaluation alongside consideration of resource allocation and local feasibility. Brain tumours, requiring rapid multidisciplinary coordination, expose these interface failures with clarity, offering transferable insights for improving integrated cancer care in regionalised health systems serving geographically dispersed populations.

Targeted next-generation sequencing (tNGS) offers promise in the rapid detection of drug-resistant tuberculosis (DR-TB) directly from sputum. While pilot studies on tNGS are emerging, there is limited empirical qualitative evidence on tNGS implementation. This study, therefore, aimed to explore the experiences of tNGS programmatic implementation by clinicians, laboratory technicians and policymakers to identify perceived key operational barriers and enablers.

An exploratory qualitative study employing inductive thematic analysis. Data were collected via semi-structured interviews and focus group discussion. Analysis was guided by the theoretical framework of acceptance.

This study was conducted between March and October 2025 as part of a broader implementation study evaluating tNGS potential programmatic integration in West Java, Indonesia. Participants were recruited from a DR-TB reference laboratory and a tertiary care hospital.

A purposive sample of 18 tNGS users participated, including clinicians (n=7), laboratory technicians (n=9) and policymakers (n=2).

Analysis revealed a dual challenge for tNGS implementation: technical-operational complexity and unguided clinical utility. Technical barriers include laboratory workflow optimisation and the need for highly skilled technicians for routine operation. From a clinical point of view, lack of local tNGS guidelines for clinicians and absence of local evidence such as cost-effectiveness and diagnostic performance at the policy levels hampered clinical adoption. Several enablers for tNGS implementation were identified, namely technicians with prior sequencing experience, perceived clinical value for complicated cases and advocacy within professional networks.

Successful scale-up of tNGS for DR-TB in high-burden settings requires a coordinated multisectoral strategy. Generating local evidence on robust laboratory data for technical guidelines, clinical utility and cost-effectiveness are warranted to support tNGS adoption. This evidence can then be integrated into the national tNGS roll-out strategy to enable sustainable and nationwide adoption of tNGS.

To evaluate the feasibility and acceptability of an online research capacity-building (RCB) education programme for the health and care workforce and explore its preliminary outcomes.

Mixed-methods pilot study incorporating quantitative survey data and a qualitative group interview.

Single Health Innovation organisation in England’s North West region.

Staff working in research, evaluation and innovation-related roles.

16 one-hour online RCB education sessions, informed by the Research Capacity and Culture Tool (individual domain), were delivered weekly via Microsoft Teams between February 2024 and October 2024.

The primary outcomes were feasibility and acceptability of the programme, assessed through attendance and a participant group interview. The secondary outcome was change in behaviour intention measured pre–post education sessions using the Continuing Professional Development Reaction (CPD-R) questionnaire.

Attendance per RCB education session ranged from 2 to 11 participants. Post-session CPD-R completion was low, limiting matched pre–post analysis, but median scores were generally higher post-session across most constructs. Four themes and eight sub-themes were identified from qualitative data. The four core themes were: establishing a common ground for research capacity building; creating pathways for meaningful involvement; translating knowledge within organisational contexts; and bridging individual development and collective momentum. The online format was received well for its accessibility and convenience, fitting within busy working schedules. Participants also reported increased confidence and perceived skill development.

This pilot study demonstrates initial feasibility and acceptability of an online format for RCB education within the health and care workforce. The format has potential for delivery at scale, where time and service pressures limit access to face-to-face programmes. Session length and content support require refinement in future iterations. Further research should examine implementation across diverse settings with larger samples.

Emergency departments (EDs) operate under conditions of high demand, uncertainty and resource constraints, making efficient personnel rostering a critical component of healthcare delivery. Poorly designed staff schedules may contribute to increased waiting times, staff burnout, reduced quality of care and inefficient use of resources. Operations research (OR) methods, including mathematical programming, heuristics, metaheuristics and simulation-based optimisation, have been widely applied to workforce scheduling problems in healthcare. However, the specific application of these methods to rostering and shift scheduling of ED personnel (eg, nurses and physicians) has not yet been systematically synthesised. This systematic review aims to identify, categorise and analyse OR algorithms used for rostering ED personnel, and to examine their modelling approaches, optimisation techniques and reported outcomes.

This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search will be conducted from database inception to the final search date in Google Scholar, Web of Science, MEDLINE, Embase, Scopus and ABI/Inform, with no start-date restriction. A provisional search was run on 20 March 2026; the final search will be updated before completion of study selection. Results will be restricted to articles published in English, French, Spanish or Italian. The search strategy will combine terms related to EDs, staff rostering or scheduling and OR or optimisation methods. Eligible studies will be peer-reviewed articles that apply OR or optimisation techniques, such as integer programming, constraint programming, exact algorithms, heuristics, metaheuristics, matheuristics or simulation-based approaches, to rostering or shift scheduling of ED personnel (eg, nurses and physicians); studies addressing workforce scheduling outside EDs, or not using OR or optimisation methods, will be excluded. Two reviewers will independently screen titles, abstracts and full texts according to predefined inclusion and exclusion criteria. Data will be extracted on study characteristics, modelling techniques, algorithmic approaches, decision variables, constraints, objectives and reported performance outcomes. The methodological characteristics of the models and algorithms will be synthesised using a narrative and descriptive analytical approach.

Ethical approval is not required as the study will analyse data from previously published studies. Results will be disseminated through publication in a peer-reviewed journal and presentations at relevant academic conferences.

CRD420261337311.

Falls are a major global health issue among older adults, leading to substantial physical, psychological and economic burdens. Fall risk screening is essential for early identification of high-risk individuals and enables targeted preventive interventions. Primary care, as the first point of contact in healthcare, is well-positioned to implement screening due to its accessibility and broad population coverage. However, existing reviews have examined fall prevention in primary care broadly, while evidence on the factors influencing the implementation of routine fall risk screening, including barriers and facilitators, remains fragmented and has not yet been comprehensively synthesised. This scoping review aims to systematically identify and synthesise determinants influencing the implementation of fall risk screening in primary care, guided by the Consolidated Framework for Implementation Research and Normalization Process Theory.

The scoping review will be conducted following the methodological guidelines suggested by the Joanna Briggs Institute and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Eight electronic databases (Web of Science, PubMed, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, China National Knowledge Infrastructure, SinoMed and Wanfang) will be searched from database inception to 31 July 2026 without language restrictions. Targeted searches of relevant grey literature sources will also be conducted. Two reviewers will independently screen and conduct data extraction. Any discrepancies that arise will be resolved through consultation with a third reviewer. The data will be analysed and presented in tables, flow diagrams and narrative text.

Ethical approval is not required for this scoping review. The results will be submitted to a peer-reviewed journal and presented at academic conferences.

Open Science Framework (https://osf.io/8jh64).