"To move or not to move"exercise adherence in home-based cardiac rehabilitation after coronary artery bypass graft surgery: A qualitative study.

Parkinson's disease is the second most common neurodegenerative disorder globally. Despite growing attention to palliative care in Parkinson's disease, little is known about what constitutes a "good death" from the perspective of people living with Parkinson's disease (PLwPD). To explore the meaning of a good death for PLwPD. In this cross-sectional multicentre qualitative study, we conducted semi-structured interviews with 30 PLwPD recruited through purposive sampling from four geriatric and neurology outpatient clinics between May 2021 and December 2022. Transcripts were analyzed using inductive thematic analysis. The process involved independent coding and iterative discussions grounded in a constructionist paradigm. The sample was diverse in terms of race, gender, age, religious affiliation, educational background, and disease stage. We identified two major themes related to the participants' last days of life: Fears and Coping. Reported fears included experiencing disability, pain and discomfort, fear of feeling shame, fear of being a burden, fear of being abandoned and left helpless. Coping was a multidimensional theme, comprising the relational experience of feeling well cared for (defined by being valued, receiving clear and honest communication, and being treated with love and kindness) alongside the active strategies of finding opportunities for joy and drawing on religiosity and spirituality. Religiosity/spirituality appeared as a key factor in emotional regulation, fostering a sense of purpose and acceptance in the face of death. Our findings suggest that improving palliative care for PLwPD requires an approach that actively addresses specific fears and strengthens the multiple dimensions of coping, which include fostering opportunities for joy, supporting spirituality, and enhancing the relational experience of feeling well cared for. This study illuminates often-overlooked aspects of care and provides a basis for the development of person-centered interventions aimed at enhancing the quality of dying-and of life-in this population.

ABSTRACT The transition from further to higher education is a critical period that can impact success and retention, particularly for traditionally underrepresented students. This study surveyed 54 first-year Sport, Exercise and Rehabilitation students at a UK university to explore expectations and experiences during transition to higher education with a focus on educational background and socio-economic status. Findings revealed differences in expected communication and perceived factors important for success. Transferable skills were undervalued, particularly technological, especially among BTEC-qualified and first-generation students. Those from low participation areas also reported higher work hours, highlighting financial pressures. Recommendations to support an inclusive and flexible transition period are offered.

The association between serum uric acid (SUA) and cognitive function is controversial in previous studies. Hypertension group are prone to cognitive decline. We aimed to investigate the correlation between serum uric acid levels and cognitive function among Chinese hypertensive patients using the Chinese adapted version of Mini-Mental State Examination (CAMSE). We included 9,471 subjects from the China Hypertension Registry study. Serum uric acid was measured using biochemical analysis instruments. The CAMSE assessment was performed to evaluate the cognitive function. Participants with different educational backgrounds used different CAMSE score cutoffs to define cognitive impairment (CI): < 24 for participants with junior high school education or above (≥ 7 years of schooling), < 20 for those with primary school education (1-6 years), and < 17 for illiterate participants. We enrolled 9,471 hypertensive participants (mean age 63.6 ± 9.8 years; 47.9% males, n = 4540), with mean CAMSE score22.1 ± 6.4 and SUA 428.6 ± 121.1 µmol/L. Baseline characteristics differed across SUA quartiles (all P < 0.05). Multivariable and RCS analyses showed SUA was associated with CAMSE score and CI. Fully adjusted, each one-unit lnSUA increase correlated with 0.47 higher CAMSE score (95% CI: 0.02, 0.92) and 28% lower CI (OR: 0.72; 95% CI: 0.58, 0.90). Q1 vs. Q2: 0.35 lower CAMSE score (95% CI: -0.65, -0.05) and 24% higher CI (OR: 1.24; 95% CI: 1.08, 1.43); Q3/Q4 vs. Q2 had no differences. A SUA threshold of 445.9 µmol/L was identified: below it, each lgSUA increase reduced CI by 57% (OR: 0.43; 95% CI: 0.27, 0.69). Subgroup analyses showed no interactions (all P> corrected α). There is a threshold effect of SUA level on CAMSE score and cognitive impairment in Chinese hypertensive patients. In participants with SUA < 445.9 µmol /L, decreased serum uric acid level was independently associated with cognitive decline.

ABSTRACT Sex education in Iranian-Islamic society is shaped by diverse cultural values and sensitivities. Mothers, as primary educators, navigate multiple and sometimes conflicting discourses that create doubt, anxiety, and uncertainty in their parenting practices. This qualitative study aimed to explore Iranian mothers’ perceptions of two contrasting narratives of sex education – the first, comprehensive and evidence-based; and the other abstinence-oriented and traditionally centred – within the Iranian context. Two 5-minute videos, each portraying one of the approaches, were presented in random order to 17 mothers from urban and rural areas with diverse educational, economic, and age backgrounds. Verbal and non-verbal responses were recorded and analysed using comparative reflexive thematic analysis to ensure interpretive depth and methodological alignment between the comparative design and data interpretation. Findings across six key themes revealed that Iranian mothers experience profound uncertainty, decision-making anxiety, fear of premature sexual curiosity, and sociocultural pressures when addressing their children’s sex education since sex education in Iran is deeply intertwined with issues of cultural identity and moral values. To empower parents (particularly mothers), educators, policymakers, and religious leaders should collaboratively design culturally sensitive, incrementally implemented, and evidence-informed programmes that foster open, value-consistent communication between parents and children.

Advances in technology have made the use of mobile health applications (MHAs) by nurses increasingly important. Examining the current landscape and identifying the factors influencing this use are essential for developing strategies that promote appropriate MHAs use among nurses. Therefore, this study aimed to investigate the personal and professional utilization of MHAs and associated factors among clinical nurses in hospitals affiliated with Kashan University of Medical Sciences in 2022. In this cross-sectional study, 250 nurses at Kashan in 2022 were randomly selected. Data were collected on a four-part scale encompassing personal and professional information, perceived knowledge of MHAs, familiarity with MHAs, and use of MHAs. The frequency of personal and professional use of MHAs was estimated with a 95% confidence interval. The data were analyzed via SPSS version 16 and logistic regression. The prevalence rates of MHAs' utilization for nurses' personal use and professional practice were estimated to be 29.2% (95% CI: 23.56%-34.84%) and 26% (95% CI: 20.6%-31.4%), respectively. Observation of MHAs use by healthcare professionals or others (OR = 4.234, 95% CI: 1.881-9.530; p < 0.0001), addressing patient inquiries about MHAs (OR = 5.200, 95% CI: 2.095-12.908; p < 0.0001), and having close relatives or friends with an educational or professional background in information technology or related fields (OR = 2.371, 95% CI: 1.119-5.022; p = 0.024) were identified as predictors of nurses' personal use of MHAs. Observation of MHAs use by healthcare professionals or others (OR = 12.900, 95% CI: 4.802-34.657; p < 0.0001) and addressing patient inquiries about MHAs (OR = 5.622, 95% CI: 1.989-15.893; p = 0.001) were significant predictors of nurses' professional use of MHAs. The use of MHAs for nurses' personal and professional performance in Kashan hospitals appears to be limited. However, increasing nurses' exposure to MHAs could increase their commitment to health programs. It is recommended that nursing management train selected nurses to serve as role models in hospital wards to encourage their colleagues to adopt MHAs practices.

Knowledge about HPV, and whether it differs depending on virus infection status, remains unclear among women in Spain. Thus, the aim of this study was to investigate the level of knowledge, and related outcomes, on HPV in adult women in Spain. A cross-sectional, non-interventional multicenter study was carried out in year 2022. Participants, consecutively recruited from 18 centers across the country, completed a validated questionnaire; the HPV-Know-Q, which examines the knowledge on HPV. A total of 1387 women were enrolled, including 1016 HPV-infected and 371 uninfected. The mean knowledge score was 78.6 points (standard deviation [SD] = 23.2). After adjusting by covariates, HPV-infected women mean score (95% confidence interval [CI]) on the HPV knowledge questionnaire was significantly higher compared to those without the infection; 84.8 (83.9-85.6) versus 80.5 (78.6-82.3), P < 0.001, although the effect size was small: Cohen's d of 0.37 (0.22-0.52). Significant differences between the two groups were found across all areas related to HPV infection. Vaccination rates were higher among the infected women; 58.7% versus 27.0%, P < 0.001. Knowledge about HPV among women in Spain was high, with HPV-infected women showing significantly greater knowledge compared to non-infected, although effect size was small. Higher educational background and premenopause status were explanatory variables, with limited power, but significantly associated with higher HPV knowledge, while being immunosuppressed would reduce it.

Effective communication is essential in healthcare and influences patient outcomes and care quality. While physician-related behaviors toward other healthcare professionals have been widely studied, less is known about interactions with external stakeholders such as medical representatives (MRs). This study aimed to describe problematic or unprofessional physician-related behaviors and related communication barriers experienced by MRs in Japan. A cross-sectional web-based survey was conducted among MRs registered with Doctor's Prime Academia, an online platform for healthcare professionals and industry employees. The survey collected demographic and professional characteristics and assessed experiences of physician-related behaviors, including problematic communication, sexual harassment, and prolonged waiting before meetings. Group comparisons were performed using non-parametric and exact tests. Because of the exploratory nature of the study and the limited sample size, multivariable analyses were not performed. A total of 98 MRs participated (median age 40 years [interquartile range 33-46]; 15.3% female). Overall, 88.8% reported experiencing some form of physician-related problematic or unprofessional behavior, with refusal to respond to work-related matters being the most common (58.6%). Sexual harassment was reported by 14.3% of MRs and was more frequently reported by younger MRs and women. Prolonged waiting (more than one hour) was reported by 38.8% of MRs and was more frequently reported by younger and less experienced MRs, as well as those with higher educational backgrounds. Physician-related problematic or unprofessional behaviors and related communication barriers toward MRs were commonly reported in this study. Younger and female MRs more frequently reported experiences of sexual harassment, whereas younger and less experienced MRs more frequently reported prolonged waiting. Given the exploratory nature of this study, these findings should be interpreted with caution; however, they highlight the importance of addressing physician interactions with external stakeholders as part of broader efforts to promote professionalism in healthcare.

Many pre-pregnancy and gestational exposures, such as maternal physical health, behavioral factors, psychosocial adversities, and environmental conditions during pregnancy, influence birth outcomes. These risk factors can co-occur, particularly among populations that experience health disparities, yet much of past researchers tend to examine them in isolation, which may lead inadvertently to some underestimation or mis-specification of risk. Therefore, this study examined the joint contribution of several maternal physical health, behaviors, psychosocial adversities, and environmental conditions during pregnancy on birth outcomes, and whether disparities were evident according to infant sex, maternal race/ethnicity, and education attainment. Participants were from the Albany Infant and Mother Study, a prospective observational cohort of socioeconomic and racial/ethnic diverse pregnant women and their infants (n = 291). Latent Class Analysis was employed to identify discrete groups with different levels and combinations of the following prenatal exposures: maternal health (pre-pregnancy body mass index, pregnancy conditions), behaviors (smoking, recreational drug use, western diet), psychosocial (depression, adverse childhood experiences, social support), and physical environment (lead exposure, indoor environmental contaminants). Linear regression analysis tested associations between exposure classes and birth outcomes. Three latent classes were identified: Class 1 (47.7%; low-risk in all domains), Class 2 (42.9%; high-risk across all domains), and Class 3 (9.4%; high-risk in behavioral and environmental domains, but lower health and psychosocial risks). Compared to the low-risk referent Class 1, Class 2 was associated with lower birth weight, length, head circumference, more restricted fetal growth, and earlier gestational age at delivery (all p < 0.05). Class 3 infants also had marginally lower birth weight and increased intrauterine growth restriction (all p < 0.10). Associations were strongest among male infants, and participants from racial/ethnic and lower education backgrounds. This comprehensive examination of the combined effects of multiple exposures-encompassing physical health, behavioral, psychosocial and environmental domains- indicated that different patterns of multiple perinatal risks work in combination to influence birth outcomes and disparities at the earliest time in the life course. Research and practice focused on inequalities in maternal and perinatal health should consider the coordinated impacts of multiple risks simultaneously.

The diphtheria-tetanus-pertussis (DTP) vaccine is one of the core vaccines provided through the Expanded Program on Immunization (EPI), which is administered to children in a series of three doses to protect against three bacterial diseases. Previous studies have assessed the factors associated with non-uptake of DTP3 vaccination among children. However, studies incorporating geospatial analysis remain limited, particularly in East Africa. Therefore, this study aimed to assess the spatial distribution and associated factors of non-uptake of DTP3 vaccination among children aged 12-23 months in East Africa. A total weighted sample of 14,200 children were included from demographic and health survey data of seven East African countries conducted from 2018 to 2023. ArcGIS Pro was used to explore the spatial distribution of non-uptake of DTP3 vaccination. Furthermore, spatial clusters were identified using Kulldorff's spatial scan statistics. Multiscale geographically weighted regression analysis was done to assess significant associated factors. The spatial distribution of non-uptake of DTP3 vaccination in East Africa was clustered. SaTScan identified 291 primary spatial clusters, with a relative risk of 3.97 at a p-value of < 0.001, in the central and most of the northern regions of Mozambique. Multiscale geographically weighted regression revealed that no maternal educational background and fewer than four antenatal care visits were positively associated with non-uptake of DTP3 vaccination, whereas health facility delivery was negatively associated with non-uptake of DTP3 vaccination in East Africa. In East African countries, the high rate of non-uptake of DTP3 vaccination was observed in eastern and northeastern parts of Kenya; central and northern parts of Mozambique; northern and southern parts of Madagascar; and southern and eastern parts of Ethiopia. Therefore, it is recommended to launch community-based educational campaigns and strengthen maternal and child health services in these hotspot areas.

BackgroundPostgraduate year (PGY) training in Taiwan is a 2-year program for new physicians. The 360-degree evaluation offers multisource feedback on clinical competencies, yet it remains unclear whether performance varies by educational background or gender, and how self-assessment compares with others’ evaluations.MethodsWe analyzed 116 PGY trainees (2019-2021) at a Taiwanese teaching hospital. Each trainee was assessed in 4 domains—clinical care, medical skills, communication, and teamwork—by attending physicians, chief residents, peers, nurses, and self-assessment. Patients completed an 11-item satisfaction survey. Scores used 6-point Likert scales (1-6), converted to 0% to 100%. Independent t-tests compared scores by academic track (undergraduate vs post-baccalaureate) and gender. Repeated-measures ANOVA examined differences between self- and other evaluators.ResultsThe evaluation showed strong reliability (Cronbach's α = .98). No significant differences appeared between undergraduate and post-baccalaureate graduates (all P > .05). Female trainees received higher scores in communication and teamwork (P < .05) from attending and chief resident evaluators, while males rated themselves higher in clinical care (P < .05). Peer, nurse, and patient ratings showed no gender differences. Across all domains, physicians and peers rated trainees significantly higher than self-assessments (P < .01), whereas nurse versus self scores did not differ.ConclusionGraduates of different medical school tracks received equivalent evaluation ratings in this PGY program. Female trainees received higher ratings in communication and teamwork, whereas males showed greater self-confidence in clinical care. Trainees generally underrated their performance compared with physician evaluations. These findings underscore the value of mentorship and 360-degree feedback in fostering self-awareness and professional growth during early postgraduate training.

ABSTRACT This study adapts the Workplace Age Discrimination Scale (WADS) to the Turkish context and examines how demographic and job-related factors shape perceived workplace age discrimination (WAD). Using survey data from 896 employees, we confirm the scale’s reliability and validity in Turkish workplaces. Findings indicate that both younger and older employees report discrimination, with higher levels among women and single individuals, reflecting Türkiye’s gender norms and marital expectations. Education, job position, tenure, job satisfaction, perceived respect, and experiences of being ignored significantly predict perceived WAD. Crucially, while higher job satisfaction and perceived respect are associated with lower discrimination, elevated educational backgrounds and higher organizational positions paradoxically predict greater levels of perceived WAD, highlighting enhanced cognitive sensitivity toward structural biases. Grounded in Hofstede’s cultural dimensions theory, we interpret these results through Türkiye’s high power distance, collectivism, and uncertainty avoidance, showing how cultural values shape intergenerational dynamics. This study contributes to the sociocultural discourse on aging and offers practical insights for developing inclusive occupational social work practices that promote intergenerational equity.

Burnout has received ongoing attention in the psychotherapist literature, with much of the emphasis placed on examining risks for its development and consequences of its occurrence. However, there is a paucity of research comparing burnout between psychotherapist training levels. The current study examined a sample of licensed psychotherapists (n = 108) from different training levels and educational backgrounds. Differences in emotional exhaustion, depersonalization and personal accomplishment were examined between psychotherapists trained at the master's-level and those trained at the doctoral-level. Findings indicated that master's-level psychotherapists experienced more depersonalization on average compared to doctoral-level psychotherapists. Moreover, exploratory regression analyses found that training-level moderated the relationship between treatment hours provided per week and depersonalization scores, which was additionally moderated by control over client caseload. Specifically, master's level-psychotherapists with less control over their caseload experienced greater depersonalization scores the more time they spent treating clients per week. Whereas no conditional relationships were found for doctoral-level psychotherapists or master's-level psychotherapists who reported greater control over their caseload in relation to treatment hours per week and depersonalization scores. Allowing master's-level psychotherapists to have more control over the topography of their client caseload when feasible may help to reduce burnout-related depersonalization.

Health literacy is an established determinant of health and a key tool in the development of public health interventions. It plays an important role in improving the health and equity of individuals and populations. The Health Literacy Questionnaire (HLQ) is a widely used multidimensional instrument designed to assess various domains of health literacy across diverse populations. However, no culturally and linguistically adapted version of the HLQ is currently available for the Moroccan context, where Moroccan Arabic (Darija) is the primary language of everyday communication, including interactions with healthcare professionals. Therefore, the objective of this study was to carry out the socio-cultural and linguistic adaptation of the HLQ into Darija. The HLQ was culturally and linguistically adapted for Morocco through a collaborative process with the HLQ developers, community members, healthcare professionals, and the project team from the Higher Institute of Health Sciences (ISSS). Forward and backward translation and cognitive interviews with 28 primary healthcare users recruited from two Moroccan provinces (Kenitra and Settat) maximized that each item reflected its intended meaning. Data were analyzed using thematic analysis to refine the adapted version for the Moroccan context. The 28 participants (71.4% women) were aged 18 to 70, with diverse educational backgrounds and resided in both urban and rural areas. Of the 44 translated items, 19 (43%) required further linguistic or cultural adaptation for Darija speakers (Moroccan Arabic dialect). Participants generally understood and responded to the items per each item's intent, but qualitative analysis highlighted important nuances. A marked dependence on medical authority appeared to limit participants' ability to manage their own health and was associated with persistent difficulties navigating the healthcare system and critically appraising health information. In contrast, items related to social support were more readily understood, highlighting the central role of family networks. Collectively, these findings underscore the interplay between cultural norms and structural barriers in shaping perceptions of health literacy in Morocco. The cognitive and cultural adaptation of the HLQ into Moroccan Darija supported the relevance of the nine scales and provided insight into locally grounded conceptions of health. This process highlights the importance of a participatory and context-sensitive approach to achieving conceptual fidelity and cultural appropriateness. However, it should be emphasized that this study represents an initial yet essential step in the overall validation process. While the adapted Darija version of the HLQ cannot yet be considered a fully validated instrument for use in the general population, it provides a robust foundation for subsequent psychometric evaluation. Further research is required to evaluate its psychometric properties, including internal structure and reliability, to determine its suitability for assessing health literacy in the Moroccan context. This study is important because health literacy development is critical to helping individuals and populations access and use health information and services to manage their health. The first step in measuring health literacy is to adapt tools to local languages and cultures. The study focuses on adapting the Health Literacy Questionnaire (HLQ) to the Darija language (Moroccan Arabic dialect) so that the health literacy needs of people in primary healthcare settings in Morocco can be assessed. The methods used in the study helped ensure that the Darija HLQ is relevant and understandable in the Moroccan context. The study found that the Darija HLQ was well understood by most users, though some with lower education levels found certain questions unclear. This means that the tool is adequate for use in Morocco, but further refinement may be needed for certain groups. The questionnaire was translated and adapted through a collaborative translation process to maximize its cultural and linguistic appropriateness for Moroccan users.

With the rapid development of artificial intelligence (AI) technology, its application across various industries, particularly in healthcare and nursing, has been expanding. However, the factors influencing nursing students' acceptance and use of AI tools have not been fully explored. Understanding the key factors that affect nursing students' use of AI tools is crucial to enhancing AI integration into nursing education. This study aims to analyze the multidimensional factors influencing nursing students' use of AI tools during their studies and internships. Using the Technology Acceptance Model (TAM) and nomograms, the study constructs a predictive model to provide theoretical support and practical guidance for the application of AI in nursing education. A survey-based research design was employed, collecting data from 178 full-time undergraduate and graduate nursing students at Anhui University of Chinese Medicine. The questionnaire addressed variables including students' educational background, attitudes toward artificial intelligence, and AI literacy. Multivariate regression analysis was conducted to establish a predictive model for nursing students' use of AI tools. The results indicate that educational background, attitudes toward artificial intelligence, and AI literacy significantly influence nursing students' intention to use AI tools. The predictive model, built on these factors, achieved an AUC value of 0.79, demonstrating strong discriminatory power and predictive accuracy. The study reveals that nursing students' acceptance of AI in nursing education is not only influenced by their technical literacy but also by their attitudes and perceptions toward the technology. Educational background, attitudes toward artificial intelligence, and AI literacy are key determinants of nursing students' intention to use AI tools. The predictive model demonstrated good performance and provides practical guidance for integrating AI into nursing education. Targeted educational interventions focusing on improving AI literacy and fostering positive attitudes may enhance AI adoption among nursing students. Not applicable. This study is an observational investigation focusing on nursing students' utilization of artificial intelligence and does not involve any interventions or treatments. Therefore, it does not meet the criteria for clinical trial registration.

This study aims to analyze the implementation of the sorogan method in learning the Book of Al-Jurumiyyah and to find out the development of students' understanding of nahwu material in Dormitory I of the Ngalah Sengonagung Purwosari Islamic Boarding School, Pasuruan. This research uses a qualitative approach with a case study type of research. Data collection techniques are carried out through observation, semi-structured interviews, and documentation. The results of the study show that the implementation of the sorogan method is carried out individually through the stages of material preparation, submission of readings, direct correction, and continuous evaluation. The students perform muthala'ah before depositing the reading to the ustadzah, then the ustadzah provides corrections to errors in harakat, meaning, and the application of nahwu rules. The application of the sorogan method has been proven to be able to improve the ability to read books without harakat, understanding the rules of nahwu, reading thoroughness, and the courage of students in explaining the material. The development of students' understanding shows diverse results according to their educational background, basic Arabic language skills, and the intensity of each student's practice, but in general the sorogan method is considered effective because it provides personalized, active, and intensive learning. Thus, the sorogan method remains relevant in learning the yellow book as an effort to strengthen basic Arabic language competencies and understanding of nahwu students in the pesantren environment.

Stigma and discrimination compound the burden experienced by informal caregivers of people with mental illness, impacting their wellbeing. Prior caregiver stigma research has relied on qualitative or convenience samples, limiting knowledge of groups most affected. This Australian study is the first nationally representative survey of caregiver experiences of discrimination and positive treatment. Participants (N = 2,164) were recruited from a probability-based online panel using stratified random sampling and weighting for age, gender, education, and language background. Descriptive statistics examined prevalence of stigma, discrimination and positive treatment experiences. Multiple regression models were used to assess sociodemographic differences in experiences and associations with psychological distress and wellbeing. Positive treatment experiences were common, with 67.9% (95% CI: 65.4, 70.2) of caregivers reporting understanding from friends and family and 59.6% (95% CI: 57.1, 62.1) feeling valued by the care recipient's treating team. However, 34.3% (95% CI: 31.9, 36.8) reported role concealment, and 18.8% (95% CI: 16.8, 20.9) unfavourable treatment at least sometimes. Positive treatment experiences were more prevalent among caregivers who were older or with higher levels of education, whereas experiences of discrimination were more common among caregivers from non-English speaking backgrounds. Women were less likely to conceal their caregiving role. Positive treatment was associated with lower distress and higher wellbeing, whereas discrimination was associated with higher distress and lower wellbeing. Despite encouraging levels of support, experiences of caregiver discrimination are common and impact on psychological distress and wellbeing. Multi-pronged strategies are needed to address inequities, strengthen peer support and caregiver-inclusive practice frameworks.

Under the context of sustained low malaria incidence in China, maintaining an adequate number of qualified microscopists remains a critical component to ensure and sustain the success of malaria elimination. Therefore, this paper presents the efforts made, achievements attained, and future prospects regarding the development of human resources in malaria microscopy during and after the malaria elimination phase in China. To confirm the competence of malaria microscopists at the national level, six rounds of the External Competence Assessment of Malaria Microscopists (ECAMM) courses, developed and administered by the World Health Organization (WHO), were conducted in China from 2017 to 2024. The number and frequency of certified microscopists participating in the WHO-ECAMM courses were retrospectively reviewed. To support the establishment of core groups at sub-national levels, a model course for the National Competency Assessment of Malaria Microscopists (NCAMM) was revised in accordance with WHO guidelines and implemented from 2019 to 2024. The course schedule and scoring system were detailed, including improvements in evaluation metrics. Participants' competency levels (A, B, C, and D) were determined based on standardized criteria. The relationship between participants' competency levels and their age or years of experience in malaria microscopy, as well as variations in their scores, was analyzed. To guide the future qualification of microscopists in peripheral areas, a proposed framework for human resource development of malaria microscopists was presented, based on the current malaria situation in China. A total of 64 microscopists participated in the six WHO-ECAMM courses. The average age of these participants in 2024is 41.0 years. Among them, 29 individuals certified at Level 1 and 17 individuals at Level 2 covered National Institute of Parasitic Diseases (NIPD) as well as 29 out of 31 provinces. In addition, among the 72 participants who attended the six NCAMM courses, 10 were certified at Level A (the highest level), and 33 at Level B. Factors such as age, place of employment, educational background, and gender did not show a significant impact on participants' competence in malaria microscopy (n = 72; ρ = 0.2, P > 0.05). However, the number of years of experience in malaria microscopy demonstrated a moderate positive correlation with competence levels (n = 72; ρ = 0.4, P < 0.01). Notably, scores for species identification (SI) improved significantly (Z = - 7.3, P < 0.01). The proposed structure for human resource development of malaria microscopists includes three core groups operating at the national, sub-national (provincial), and sub-provincial levels. This structure recommends the application of four models for assessing microscopists' competence. Based on six WHO-ECAMM courses, the national core group of malaria microscopists was re-affirmed. The NCAMM courses conducted in China have demonstrated effectiveness as both an evaluation system and a refresher training model. They are expected to be widely implemented at both national and subnational levels to support the development of human resources in malaria microscopy. The predefined structure for human resource development of malaria microscopists provides a systematic framework for assessing and defining the competencies of microscopists in peripheral areas.

This study examines school service management policies in improving parents’ understanding regarding the utilization of Program Indonesia Pintar (PIP) funds at MTsN 1 Kota Cirebon. The research aims to analyze the implementation of school management services, identify parents’ understanding of educational assistance utilization, and explore supporting and inhibiting factors affecting policy implementation. This study employed a qualitative case study approach. Data were collected through in-depth interviews, participatory observation, and documentation involving the principal, teachers, administrative staff, and parents of PIP recipients. Data validity was ensured through source, technique, and time triangulation, while analysis followed the interactive model of Miles, Huberman, and Saldaña involving data reduction, data display, and conclusion drawing. The findings reveal that school management services were implemented through socialization programs, administrative assistance, transparent communication, and monitoring of educational fund utilization. These strategies significantly contributed to improving parents’ understanding regarding the proper use of PIP funds for educational purposes. However, parents’ understanding remained influenced by educational background, economic conditions, access to information, and educational awareness. The study further indicates that integrating Islamic values such as amanah, honesty, responsibility, and justice strengthened educational service effectiveness and community trust. Therefore, effective school service management is essential for ensuring the successful implementation of educational assistance policies and strengthening parental participation in supporting children’s education

ABSTRACT This study explores how school principals’ consultation ties shape leadership influence and connectivity within advisory networks. Adopting a convergent parallel mixed methods design, the study involved 38 secondary school principals in Siirt, Türkiye. Quantitative data were analyzed through social network analysis using UCINET 6, while qualitative insights – regarding why certain individuals were frequently consulted – were analyzed using content analysis. Results indicated that functional unit (area of responsibility), educational background, and union membership influenced advice-seeking behaviors. Qualitative findings revealed that centrally positioned principals drew on multiple sources of influence. By combining network centrality metrics with principals’ power attributions in a centralized, non-Western system, the study shows that influence concentrates around a small set of “policy translators” and “procedural brokers” (both peer principals and provincial administrators), and that homophily mechanisms such as union affiliation and educational background shape advice-seeking beyond formal hierarchy.