Care Capacity Research Articles

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Rural Americans experience higher rates of perinatal depression (PND) compared to non-rural Americans yet have decreased access to treatment. To address treatment access disparities, we must build capacity for care within non-mental health settings and leverage technology. This study uses a phenomenological approach, exploring treatment experiences of rural perinatal people with PND who participated in a technology-assisted cognitive behavioral-based treatment program. Participants who completed at least one program session were invited to participate in a qualitative interview about their experience. Four core themes emerged: (1) educational value, (2) factors impacting program engagement, (3) accessibility, and (4) suggested improvements. The program offers a treatment option for rural perinatal people and presents a model for increasing access to care in rural areas.

BackgroundInfant and neonatal health is a critical indicator for assessing a country’s well-being and development. This study aimed to systematically analyze the global burden, long-term trends, coronavirus disease 2019 (COVID-19) impactions and inequalities of neonatal disorders and individual causes between 2000 and 2021.MethodsWe collected global, reginal and national annual data of neonatal disorders and individual causes on incidence and mortality between 2000 and 2021. Estimated annual percentage changes (EAPCs) were used to assess long-term trends and the impact of COVID-19. Lorenz curve and concentration index (CCI) was performed to evaluate the inequalities of neonatal disorders across socio-demographic index (SDI) levels.ResultsIn 2021, there were 27,062,768 new cases and 1,831,535 deaths of neonatal disorders globally. Between 2000 and 2021, the incidence rate of neonatal disorders declined from 23,112.05 to 20,916.69 per 100,000 live births (EAPC= -0.63%), while the global mortality rate declined from 2048.34 to 1415.59 per 100,000 live births (EAPC= -1.76%). Since 2000, neonatal preterm birth has consistently had the highest incidence rate (16,658.81 in 2021, EAPC = -0.47%) and mortality rate (571.69 in 2021, EAPC = -1.73%). South Asia and sub-Saharan Africa were identified as high-burden regions. Globally, the incidence rate of neonatal disorders declined before the COVID-19 pandemic but began to rise during the pandemic, whereas the mortality rate continued to decline at a faster pace than the pre-pandemic period. Additionally, between 2000 and 2021, global burden of neonatal disorders was concentrated in lower SDI countries, particularly in mortality rates.ConclusionsAlthough global progress has been made in reducing the burden of neonatal disorders, Sub-Saharan Africa and South Asia remain high-burden regions requiring particular attention. To reduce global and regional disparities, particularly in the post-COVID-19 era, governments and international organizations are supposed to implement evidence-based strategies, such as increasing investments in maternal and neonatal care, expanding neonatal intensive care capacity, enhancing workforce training, improving health information systems, and addressing social determinants through integrated, multisectoral approaches.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25043-7.

Introduction: Cardiothoracic diseases remain a leading cause of mortality globally, with a significant proportion amenable to surgical intervention. Research Question: Can we quantify and compare national health system capacity to meet the burden of cardiovascular disease amenable to cardiac surgery using publicly available proxy indicators? Methods: We developed the Cardiothoracic Surgery System Pulse Index (CSSPI), a standardized index ranging from 0 to 100 to assess national capacity for cardiac surgical care. The index incorporates proxies of cardiothoracic disease burden, workforce, infrastructure, service delivery, information management, funding, and governance obtained from open access databases. Indicators were normalized using min-max scaling. Two scenarios were created using weighted and unweighted composite scores. Pearson’s correlation was used to measure the correlation between the two scenarios, regional and country income variations were assessed using ANOVA, and a linear regression model was constructed. A p-value <0.05 was considered statistically significant. Results: The mean unweighted CSSPI was 31.4 (SD = 10.3) while the mean weighted CSSPI was 28.9 (SD = 14.8) [median difference = 3.0, (IQR: -2.0, 9.0); correlation coefficient = 0.75, p < 0.001]. Comparison of the unweighted (F (6, 210) = 9.135, p < 0.001) and weighted (F(6, 210) = 16.569, p < 0.001) CSSPI revealed significant regional variations. North America had the highest CSSPI values (mean unweighted = 40.7, SD = 25.6; mean weighted = 50.3, SD = 25.5) followed by Europe and Central Asia (mean unweighted = 36.5, SD = 10.0; mean weighted = 37.8, SD = 15.0). However, sub-Saharan Africa had the lowest regional values (mean unweighted = 24.9, SD = 7.9; mean weighted = 17.7, SD = 7.6). Similarly, disparities were observed between income categories with low-income countries ranking lower consistently (mean unweighted = 24.4, SD = 8.2; mean weighted = 16.0, SD = 6.0). World Bank income category (B = 2.600, p < 0.001) and regional (B = -1.059, p = 0.004) disparities persisted in the regression model. Conclusion: The CSSPI suggests that income level positively influences surgical system capacity, while regional disparities may reflect structural or geographic inequities.

Introduction: Ireland’s clinical education capacity for health and social care faces pressure, exacerbated by a 33% vacancy rate across healthcare profession posts. With the government aiming to increase healthcare students in the education system there is a need for innovative clinical education models. Study Aim: The aim of this project was to co-design technology assisted interdisciplinary learning and simulation, with key stakeholders, to improve sustainable clinical education. Methods: A World Cafe methodology was used to co-design interdisciplinary simulation education for graduate entry physiotherapists, dieticians and graduate nurses specialising in cardiology. This was achieved with students from each discipline, patients, academics, clinicians and educational technologists. Three key themes emerged: (1) The Importance of communication, (2) Straight forward information sharing, (3) A Patient-Centred approach. These themes underpinned the development of two simulation scenarios. The simulations were rolled out and evaluated using the Simulation Effectiveness Tool (SET) [1] and the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) [2]. Results: Seventy students participated in small interdisciplinary groups (25 graduate entry physiotherapy students, 24 Graduate entry dieticians and 21 Cardiac Care Nurses). Fifty-five students responded to SET. The key findings are as follows: 89% (49) of students strongly agreed they were better prepared to respond to changes in their patients’ conditions based on the simulation scenario, with 82% (45) of the students strongly agreeing they felt more confident in communicating with their patient. 48 (87%) students strongly agreed the debriefing session provided opportunities to self-reflect on their performance during the simulation. Fifty students responded to ICCAS. The following key findings were noted, before participating in the simulation only 17% (9) of students felt very confident they were able to address team conflict in a respectful manner, whereas 68% (34) felt very confident post-simulation. Before participating 40% (21) of students strongly agreed they were able to actively listen to the perspectives of interprofessional (IP) team members, compared to 84% (46) after the simulation. 70% (35) of the students felt very confident using an IP team approach to assess the patient’s health situation, compared to only 13.5% (7) prior the simulation. Discussion: The findings of this interdisciplinary simulation project illustrate that students achieved the learning outcomes identified for this module which were: creating a better understanding of roles and responsibilities of colleagues; empowering students to navigate and negotiate the clinical setting while working effectively with other disciplines to improve patient care and improving student knowledge and understanding of patient care. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable

Erratum: Evacuating Patients With Pediatric Cancer From Ukraine: Impact on Medical Care Capacity in Poland.

Introduction: Animal hoarding is a complex, often underrecognized public health problem affecting the health and welfare of humans and animals. Limited peer review literature exists on the conditions, outcomes, and resources needed to care for cats from hoarding environments in shelter settings. This study investigated intake medical conditions and outcomes of cats surrendered from hoarding environments to the New York City sheltering programs of the American Society for the Prevention of Cruelty to Animals (ASPCA). The objectives of this study were to (1) describe the prevalence of medical conditions at intake; (2) identify associations between medical conditions and outcomes; (3) summarize key interventions provided prior to outcome; and (4) compare outcomes of cats surrendered from hoarding environments to other owner/guardian surrendered (OGS) cats. Methods: This retrospective, descriptive study examined case records of cats voluntarily surrendered from hoarding cases to ASPCA sheltering programs between January 1, 2021, and July 31, 2023. Demographic, medical, and outcome data were collected on 613 cats relinquished in 34 case groups. Outcome data were compared to 775 non-hoarded OGS cats in-shelter during the same time period. Results: Only 27.4% of cats were already altered on intake. Dental disease was the most common medical condition (52.8%); 20.3% had moderate to severe disease requiring dentistry procedures. On intake, cats also had otitis externa (33.3%), Upper respiratory infection (URI) (23.8%), ocular disease (21.9%), dermatitis (19.9%), ectoparasites (17.6%), diarrhea (14.2%), dermatophytosis (10.1%), and matting/unkempt fur (4.1%). Once analyzed for interactions, body condition score (BCS) 1–2 (emaciation) at intake (P < 0.001), moderate to severe dental disease (P = 0.007), and increased number of medical conditions per cat (P < 0.001) were associated with non-live outcomes. Over half of cats (57.8%) went to foster homes. Most (63.1%) required antibiotics, and a third (36.4%) received psychopharmaceuticals. Difference in median length of stay (LOS) between hoarded and non-hoarded OGS cats was significant (52 days vs. 28 days; P < 0.001). Proportions of live outcomes for hoarded (89.2%) and non-hoarded cats (88.3%) did not significantly differ (P = 0.6). When euthanasia was the outcome, OGS cats were more often euthanized for medical conditions (64.8%) compared to hoarded cats (45.9%). Behavioral euthanasia rates were significantly higher for hoarded than OGS cats (47.5% vs. 25%; P = 0.017). Conclusion: The significant need in hoarded cat populations for dentistry and spay/neuter procedures and the significantly longer LOS of hoarded cats suggests organizations working with these populations need to proactively strategize to optimize care delivery without negatively impacting shelter capacity for care. Harm reduction approaches to hoarding employ a collaborative, staged means to reduce populations in the home, including offering surrender of some animals and the provision of spay/neuter and/or other services for remaining animals. This approach, in addition to improving animal welfare, enables the shelter to better manage capacity and resources.

Abstract Introduction The US faces a growing mismatch between demand for inpatient psychiatric care and available capacity. Methods Using data from the American Hospital Association Annual Survey, we conducted a descriptive analysis of inpatient psychiatric bed supply across hospital referral regions (HRRs) from 2012 to 2022. Results More than 60% of the US population consistently lived in HRRs with psychiatric bed shortages during this period, defined as fewer than 30 beds per 100,000 people. By 2022, HRRs with severe shortages, relative to those without them, were more likely to be in the West and had higher proportions of Hispanic residents, raising concerns about inequities in behavioral health care access. Hospitals most likely to reduce psychiatric capacity were general, non-profit, and system-affiliated institutions with lower total margins. Importantly, hospitals in severe shortage areas were less likely to have outpatient psychiatric services, indicating that alternative hospital-based resources may not fully offset inpatient shortfalls. Conclusion Addressing the nation’s psychiatric bed shortage will require targeted financial support for general hospitals at risk of closing psychiatric units and investment in broader psychiatric infrastructure to ensure equitable access across regions.

Overwhelming inpatient capacity at referral hospitals undermines both regional healthcare networks and patient outcomes. To address increasing capacity constraints, Intermountain Health implemented a Load Balancing Protocol to redirect stable, lower-acuity admissions from our overburdened quaternary hospital to three community hospitals. By aligning patient acuity with optimal care settings, our strategy preserves advanced care capacity and enhances safe, equitable, and efficient care. In 4 years, our protocol diverted 5112 bed-days from the quaternary hospital and has undergone several iterative improvements. In this article, we describe the barriers and keys to innovation that contribute to the success of this Load Balancing Protocol.

The article explores the psychological specificity of women’s experience of war-related stress in the context of the ongoing Russian invasion of Ukraine. Drawing upon a synthesis of international research and Ukrainian empirical data, as well as an original survey of 30 wives of military personnel, the study analyzes the dominant emotional states, coping strategies, and mechanisms of psychological adaptation among women living under conditions of chronic threat. The findings demonstrate that anxiety, helplessness, guilt, and emotional exhaustion are among the most prevalent emotional reactions. These emotions, while distressing, perform an adaptive function by supporting internal stability and ensuring psychological survival in extreme and prolonged stress. Women’s emotional experience reveals a paradoxical combination of vulnerability and strength. On the one hand, constant tension, fear for loved ones, and moral responsibility generate feelings of fatigue and despair. On the other hand, these same experiences activate internal resources, compassion, and a capacity for care – forming a phenomenon that may be described as “rear resilience.” This resilience manifests through empathy, solidarity, and a deep commitment to family and community, which allow women to transform suffering into meaning and connection. The article highlights the importance of providing complex, gender-sensitive psychological support aimed not only at reducing anxiety and depression but also at integrating the traumatic experience into personal identity. Such interventions should facilitate emotional expression, restore contact with the body, and promote self-compassion. The study contributes to contemporary discussions on gender and trauma by emphasizing that women’s war experience contains not only distress but also a significant potential for growth, spiritual maturity, and renewal.

BackgroundThe global misallocation of healthcare resources has emerged as a critical impediment to public health. In China, healthcare resources are predominantly concentrated in major cities and high-tier hospitals, while primary care facilities suffer from inadequate capacity, contributing to issues such as “difficult and expensive access to healthcare.” Despite numerous healthcare reforms, significant disparities in resource distribution persist.ObjectiveThis study seeks to elucidate the causal effects of healthcare system reform on the misallocation of medical resources and to investigate the underlying mechanisms. Focusing on the healthcare reform implemented in Sanming in 2012 as a quasi-natural experiment, the research employs the synthetic control method (SCM) to assess the policy’s impact on resource misallocation.MethodsThe synthetic control method is applied to estimate the causal impact of the Sanming Medical Reform on the misallocation of healthcare resources. By constructing a weighted control group that replicates Sanming’s counterfactual resource allocation trajectory in the absence of the reform, the model controls for covariates such as industrial structure, GDP, and human resources to ensure precise estimation of the policy effect. Data were obtained from the National Bureau of Statistics, local health commissions, and other sources, forming a balanced panel dataset of 203 cities spanning 2007 to 2022.ResultsThe analysis reveals that the Sanming Medical Reform markedly reduced the misallocation of healthcare resources. Following the 2012 intervention, Sanming exhibited a substantial decline in misallocation, with the misallocation index decreasing by an average of 0.1412 between 2013 and 2017. Both city-level and time placebo tests confirm that the observed policy effect is statistically significant and not attributable to random variation. Mechanism analysis further indicates that the reform achieved its outcomes by increasing government expenditure on health and refining the structure of health insurance.ConclusionThe empirical evidence demonstrates that the Sanming Medical Reform effectively alleviated the misallocation of healthcare resources and bolstered primary care capacity through enhanced government spending and optimized health insurance payment structures. These findings offer valuable insights and empirical support for healthcare reforms in China and other countries, paving the way for more equitable and efficient resource allocation.

Application of a reverse consultation model for pediatric obesity care: A quality improvement initiative

BackgroundBehavioural Supports Ontario (BSO) was created in 2010 as a provincially defined and regionally implemented program in Ontario, Canada, to support older adults living with responsive behaviors in long-term care homes, hospitals, and at home, and to also support their family care partners. There are 14 different BSO regions in Ontario, each with its own service delivery model to provide (1) system coordination and management, (2) integrated service delivery, and (3) knowledgeable care teams and capacity building. In 2023, BSO teams across Ontario supported approximately 33,300 older adults with expressions of responsive behaviors, the majority of whom had dementia, and 20,100 family care partners.ObjectiveThis study aimed to understand how BSO is currently affecting service providers and family care partners across all BSO care settings (ie long-term care, community, and acute care), and how BSO service delivery models can be modified to best meet the current needs of these target populations. This pilot study will be conducted in the western Ontario region, which comprises 4 different BSO regions; this will enable comparison between different BSO service delivery models to identify which service model elements may be best used to support BSO care providers, care recipients, and family care partners in the future.MethodsFollowing a 2-phase mixed methods sequential explanatory design, this study will invite BSO staff and leaders to complete an anonymous web-based survey, followed by focus groups and interviews to share their perspectives on BSO’s current functioning, areas of weakness, and opportunities for growth. Family care partners will also be invited to complete one-on-one interviews to share information about their experiences with BSO, areas of weakness, and opportunities for growth.ResultsThis study began in January 2024; data collection was completed in December 2024. Overall, 360 participants completed the anonymous survey; 51 staff and leaders and 11 family caregivers completed an interview or focus group. Data analysis is anticipated to be completed by September 2025 with results published by December 2025. Quantitative data will be analyzed using descriptive and inferential statistical techniques to identify similarities and differences in the perspectives of BSO staff and leaders across the 4 BSO regions. Qualitative data will be managed and analyzed through descriptive coding and thematic analysis to provide meaningful explanations of BSO staff, leaders, and family care partners’ experiences with the program. This study was approved by the Western University Health Sciences Research Ethics Board (124599).ConclusionsThe study findings will support improvements in BSO services across the western region of Ontario. The findings will also be leveraged to support the modernization of the program to better meet the needs of patients and family care partners who depend on the service each year, while also supporting the needs of service providers within the program.International Registered Report Identifier (IRRID)DERR1-10.2196/69067

The hierarchical diagnosis and treatment system's two-way referral mechanism is crucial for optimizing medical resource allocation, with medical consortia significantly enhancing this process. It evaluates the implementation dynamics of two-way referral systems within China's medical consortia from 2019 to 2024, focusing on policy evolution, regional disparities, and stakeholder engagement. Despite a positive overall trend, referral rates remain low, with notable regional and institutional disparities. The implementation outcomes span various dimensions, including referral metrics, specific services, timing, and costs; however, these effects are inconsistent and warrant further investigation. The current evaluation index system is diverse but tends to prioritize quantity over quality. Additionally, awareness and satisfaction levels among medical personnel and patients regarding the two-way referral system are uneven and influenced by multiple factors. Currently, China's two-way referral system faces challenges, including low referral volumes, an inadequate evaluation framework, limited research perspectives, and insufficient motivation for stakeholder participation. Future efforts should focus on strengthening primary care infrastructure, enhancing resource collaboration, advancing health insurance reforms, refining the evaluation system, and fostering synergy between hierarchical diagnosis and treatment, the Healthy China strategy, and referral model innovation to advance the hierarchical diagnosis and treatment system. Recommendations emphasize strengthening primary care capacity, reforming insurance payment models, and leveraging digital health technologies to align with the "Healthy China 2030" strategic goals.

Environmental and occupational exposures are increasingly recognized as major determinants of population health, contributing to the rising burden of chronic diseases and adverse health outcomes, yet traditional surveillance systems are often inadequate for capturing the complex and evolving nature of human exposures across diverse settings. In response, we propose the Human Sentinel Surveillance Platform (HSSP), a new digital infrastructure based on sentinel surveillance framework, to monitor exposures and health effects in real-time and via trained and motivated health professionals in order to identify emerging exposure trends. This perspective paper defines the foundational pillars, data governance principles, and operational workflows of the HSSP, while critically examining its potential impact on health policy, practice, and exposome research. The platform integrates biomarker-based monitoring, validated questionnaires, and adaptive protocols that can be updated in response to new threats, ensuring methodological relevance over time. Its four foundational pillars include: (1) a structured network of health care professionals, (2) targeted training and capacity building, (3) harmonized data collection using standardized tools, and (4) secure data repository and management aligned with ethical and regulatory standards. By incorporating multidisciplinary data from epidemiology, toxicology, genetics, and exposure science, HSSP enables comprehensive exposure characterization, longitudinal analysis of exposure-health relationships, early warning and timely public health regulatory and preventive interventions. This scalable and adaptable platform bridges critical data gaps in exposome research by capturing dynamic human-environment interactions and generating actionable insights to inform targeted interventions and provide evidence-based foundations for public health policy.

BackgroundCoronary heart disease (CHD) remains one of the leading causes of death worldwide. However, systematic evaluations of CHD management quality at the community level remain limited, thereby constraining improvements in primary medical capacity. This study aims to evaluate community-based CHD management using Donabedian’s model to optimise resource allocation, standardise clinical pathways, and improve chronic disease management.MethodsGuided by Donabedian’s model, this study assessed the quality of CHD diagnosis and management within Shanghai’s primary healthcare system across three dimensions—structure, process, and outcome—from the dual perspectives of community healthcare institutions and general practitioners (GPs). A cross-sectional survey was conducted between April and May 2024, involving 247 primary healthcare institutions selected through census sampling. Within each administrative district, 50% of institutions were randomly selected using cluster sampling. Subsequently, stratified sampling based on professional titles was employed to survey 50% of GPs within these institutions. In total, 247 institutional questionnaires and 2,093 GPs’ responses were deemed valid and included in the final analysis.ResultsStructural analysis indicated adequate CHD-specialised clinics (74.8% with integrated care teams) and essential equipment availability (> 97%), but significant gaps in rehabilitation resources (personnel: 14.6%; equipment: 8.5%). Process evaluation showed high referral rates (91.5%) yet poor patient self-management (18.6%) and limited health record completeness (27.1%). Only 26.7% of institutions adopted CHD-specific information systems. GPs demonstrated strong acute care capacity but had knowledge gaps in advanced concepts (53.6%) and test interpretation (45.4%). Key barriers included equipment shortages (75.5%) and protocol adherence issues (73.1%), with prioritised solutions emphasising medical consortium collaboration (89.4%) and multidisciplinary team development (88.3%).ConclusionCHD management in Shanghai’s community settings is marked by adequate provision of essential resources but notable deficiencies in rehabilitation services and digital infrastructure. Strengthening rehabilitation services, enhancing information system development, and providing targeted training to improve diagnostic and management capacities are recommended. These findings may provide valuable insights for informing similar efforts in other regions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13486-y.

Relational continuity of care is associated with better patient experience and health outcomes. In England, relational continuity of primary care has been declining over a decade, coinciding with an increase in patient complaints. This study investigates the relationship between relational continuity of care and patient complaints. Cross-sectional analysis of linked practice-level data in the English National Health Service (NHS) (2016/2017-2022/2023) obtained from NHS Digital and General Practice Patient Survey (GPPS). A negative binomial model was used to investigate the association between the proportion of patients never or almost never seeing their preferred general practitioner (GP) and new written complaints per 10 000 patients, with adjustment for patient demographics, socioeconomic status, care experiences, practice care capacity and care quality. Mediation analysis was further conducted to examine patients' lost trust and unmet clinical needs as potential mechanisms. A 10 percentage point increase in the proportion of patients reporting low continuity was associated with 1.34 more new complaints per 10 000 patients (95% CI 1.23 to 1.46). The association may be stronger after than before the pandemic, among general practices with historically better continuity, and in more deprived areas. The findings were robust in using different measures of relational continuity, adjusting for primary case demand-supply mismatches, implementing a Poisson model with practice fixed effects and excluding ethnicity from the model specification. Mediation analysis showed that neither lost trust nor unmet care needs were important mediators of the effects of low continuity. Self-reported low continuity of primary care is associated with more patient complaints in England. Future research should explore potential underlying mechanisms and establish whether the same relationship exists between objectively measured relational continuity and patient complaints.

BackgroundHuman resources related to eye health are critical to significant reductions in blindness and low vision on a global and regional scale. Blindness and visual impairment affect the quality of life, poverty rates, and employment and educational opportunities of people with visual impairment. This study aimed to assess the availability and distribution of human resources for eye care to determine gaps in eliminating preventable and treatable blindness.MethodsThis study employed a descriptive cross-sectional design. Data were collected using a structured, self-administered questionnaire distributed electronically via the KoboToolbox platform. The survey targeted all government, private, and NGO/Mission eye care facilities across the two regions. The respondents were primarily heads or coordinators of eye care units; in cases of nonresponse, senior staff members were invited to complete the questionnaire. The tool gathered information on the type, number, and distribution of eye care professionals, as well as the services provided at each facility.ResultOut of the 77 public hospitals and 642 public health centers, only 39 (5.4%) provided eye care services. A total of 48 facilities were provided with eye care services, each of which served 388,765 people in the two regions. Thirty-nine (81.3%) were government owned, 5 (10.4%) were private for profit, and 4 (8.3%) were NGO/Mission owned. In these facilities, a total of 217 eye care professionals were practicing: 30 were ophthalmologists, 10 were cataract surgeons, 93 were optometrists, 62 were ophthalmic nurses, 6 were ophthalmic officers, one was a low vision specialist, and 15 were optical technicians. The only low vision specialist identified was an optometrist with additional training in low vision care. The mean number of cataract operations performed per unit per year was 860 (range: 30–2,800). The CSR of the SNNPR and Sidama regions was 1086 operations/million population/year in 2022. Among all the eye care centers in the study area, 50% provided cataract surgery services, 19% provided glaucoma surgery services, and 90% provided refraction services. Only one facility had panretinal photocoagulation (PRP) and intravitreal injection services. However, none of the facilities provided an in vitro retinal surgery service.ConclusionThe findings of this study indicate that the current human resource capacity for eye care in southern Ethiopia remains below the recommended thresholds outlined by the World Health Organization (WHO) and the IAPB Africa Strategic Plan. Furthermore, the distribution of eye care professionals is uneven, with the majority living in urban centers, whereas many rural areas remain critically underserved. These disparities suggest the need for more targeted workforce planning and support for rural deployment. However, these conclusions should be interpreted cautiously, given the study’s reliance on self-reported data and the absence of a standardized urban‒rural classification. Addressing the quantitative and geographic gaps in human resources for eye health will be essential for improving equitable access to services in the region.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12960-025-01007-1.

BackgroundThe National Ambulance Service (NAS) has operated a Paramedic-staffed Helicopter Emergency Medical Services (HEMS) in the Republic of Ireland since 2012. This study describes patient and mission characteristics, to provide insight into this service and inform future service development.MethodsA nationwide population-based retrospective study of HEMS missions was conducted from routinely collected health data over an 11- year period between 1 July 2012 and 30 June 2023.ResultsIn the study period HEMS in Ireland received 8,392 mission requests, Patient contact occurred in 60.1% of missions (n = 5,045) and 73.4% (n = 3703) were airlifted to hospital. Adults represented 90.3% (n = 4,535) of patients, predominantly male at 69.1%, with a median age of 55 years (IQR: 34 years) [35:69]. Medical patients accounted for 50.3% (n = 2,524), cardiac aetiologies (32.3%) and out of hospital cardiac arrest (OHCA) (30.3%) were the most common medical presentation. Trauma patients account for 49.7% (n = 2,498). Road Traffic Collisions (RTCs) (31.4%) followed by farming and machinery incidents (17.4%) were the most common trauma presentation. HEMS teams significantly reduced pain in both trauma (ꭕ2 = 680, p < .001) and medical cases (ꭕ2 = 186.13, p < .001) during the care provided. The majority 73.1% (n = 6133) of total missions were conducted within a 20 min flight time radius of the HEMS base.ConclusionsOver the past decade, HEMS in Ireland has provided a valuable contribution to the care of seriously ill and injured patients, particularly in the west and southwest. Service use reflects HEMS base proximity, indicating potential benefits from geographic expansion. Current activation criteria appears to target an appropriate patient cohort, however sustained reassessment of dispatch criteria and hours of operation may enhance service availability. Continued development should focus on adopting evidence based-practices and advancing critical care capacity to align with international HEMS standards.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13049-025-01459-3.

Despite significant national declines in infant mortality in Türkiye, marked regional disparities persist, with the Southeastern and Eastern Anatolia regions reporting the highest rates. These regions are characterized by lower health workforce density, the burden of large refugee populations, and potential data limitations. This qualitative study explores the perspectives of pediatricians—frontline healthcare providers—working in these high-mortality areas to understand the underlying challenges driving these persistent poor neonatal and infant outcomes. Through in-depth interviews, the study aimed to gather healthcare providers’ experiences and insights regarding the influence of health system factors (including workforce distribution and the capacity for high-quality care), the impact of demographic shifts, and issues related to vital registration and mortality data completeness. The findings illuminate the complex interplay of socioeconomic, systemic, and demographic pressures that strain healthcare delivery and hinder mortality reduction efforts in these disadvantaged provinces. This work provides critical, context-specific evidence to inform targeted policy interventions aimed at strengthening the health workforce, improving infrastructure, and reducing health inequalities across Türkiye.