Background: Achieving Universal Health Coverage (UHC) depends on a competent and empowered health workforce. Nurses play a pivotal role in advancing equitable primary health care in Jordan, yet evidence on their readiness and system-level challenges remains limited. Purpose: To examine nurses’ competencies, knowledge, and experiences in implementing UHC within Jordan’s primary health-care system and to identify barriers and facilitators influencing their role. Methods: This study convergent parallel mixed method design integrated findings from a quantitative cross-sectional survey of 145 nurses in governmental health centers and a qualitative inquiry involving eight in-depth interviews with nurses and midwives. Quantitative data assessed professional competencies using a validated tool, while qualitative data explored experiences and perceptions through thematic analysis. Results: The highest professional competency scores were observed in the teaching and selfdevelopment domain (M = 2.58, SD = 0.84), followed by basic care (M = 2.47, SD = 0.68), whereas the lowest scores were in community health management (M = 2.01, SD = 0.82). Nurses who had received training in primary care settings demonstrated significantly higher competency scores across all domains (p < 0.05). Qualitative analysis identified four overarching themes: (1) limited awareness of UHC concepts; (2) barriers to UHC implementation in PHC; (3) facilitators of implementation; and (4) proposed strategies to enhance UHC integration in primary care. Overall, findings indicated moderate competency levels, with strengths in basic care and teaching, and weaknesses in management and research skills. The qualitative themes underscored limited conceptual understanding of UHC, heavy workloads, and insufficient institutional support, but also revealed strong professional motivation and willingness to engage. The synthesis suggests a technically capable, yet systemically constrained, nursing workforce. Conclusion: Nurses are central to UHC advancement in Jordan, but require continuous education, leadership development, and supportive policy environments to translate potential into performance. Implications for Nursing: Integrating UHC principles into nursing curricula and professional development programs can strengthen workforce capacity, enhance equity-driven service delivery, and position nursing as a strategic force for sustainable health-system reform. Keywords: Universal health coverage, Nursing workforce, Primary health care, Competency, Mixed methods, Health system strengthening, Jordan

To provide an updated review of manual small incision cataract surgery (MSICS), including training innovations, advancements in surgical techniques, system-level performance, and equity implications in global cataract care. As global cataract burden continues to rise, MSICS has gained traction as a cost-effective and scalable solution, particularly in low and middle-income countries (LMICs). Simulator-based training and new surgical tools have enhanced early proficiency among trainees. Recent data highlight MSICS as a procedure with comparable complication rates and patient-reported satisfaction to phacoemulsification, assuming proficiency of the surgeon. Key research gaps persist in skill transferability, long-term outcomes, and sex disparities in access. MSICS remains a pivotal surgical technique in the fight against global cataract blindness. Its affordability and adaptability to resource-limited settings make it a critical part of international efforts to expand cataract surgical coverage and promote equitable eye care delivery.

ObjectivesTo explore the quality of end-of-life care in England and Wales using the experiences of bereaved family carers, and to develop person-centred quality of care domains for end-of-life care.MethodsQualitative analysis of free-text responses from a nationally-representative cross-sectional post-bereavement survey. Inductive thematic analysis of free-text responses to open-ended questions about care in last 3months of life, circumstances of death, and experiences of care and bereavement, guided by the Institute of Medicine's quality domains. Participants were adults who registered the death of an adult relative in England and Wales between August and December 2022, identified using mortality data and stratified sampling (by age, gender, cause of death, place of death and geographical area).ResultsOf 1194 respondents, 1083 (90.7%) gave at least one free-text response. Six themes about quality of end-of-life care were identified: (1) accessing care; (2) timely and coordinated care; (3) individualised care; (4) the nature of communication and care; (5) family-centred care and support; and (6) safe and equitable care. Difficulty accessing care, challenges navigating a complex system, and poorly-coordinated care were interpreted as leading to a lack of physical and psychological safety. Timeliness of care was considered paramount but often not achieved. How care was provided was as important as what was provided: empathic relational care (in contrast to transactional, task-based care) led to dying people and their families reporting feeling reassured, supported and safe.ConclusionsWe identify aspects of quality important for care which are currently not always achieved, and provide a refined model of the quality of end-of-life care to guide policy and research.

Non-communicable diseases (NCDs) pose rising challenges to health systems across low- and middle-income countries (LMICs). In Vietnam, chronic disease care remains concentrated in public facilities that struggle with limited capacity. This study examines how private healthcare providers are addressing service delivery gaps in the prevention, management, and treatment of NCDs. Drawing on 21 semi-structured interviews with health professionals specialized in NCDs prevention, management, and treatment, as well as patients living with chronic conditions, we undertook a thematic analysis informed by the political socio-economic context of Vietnam. Both health providers and patients perceived that NCD prevention and treatment at the primary care levels of the public health system fall short of quality expectations. Contributing factors include a shortage of adequately trained medical staff, insufficient medical materials and essential drugs, and weak coordination and integration between primary healthcare and other levels of the system and vice versa. Patients reported disengagement from local health centers, often citing long wait times, fragmented follow-up, and lack of personal communication. In contrast, private providers were perceived to deliver more patient-centered care, offering flexible access, consistent follow-up, tailored guidance, and responsive communication. Many patients described a sense of partnership and trust with private physicians, which enhanced their engagement in treatment decisions and ongoing disease management. Private providers also filled critical gaps in medications and diagnostics and facilitated referrals across sectors, helping patients navigate system fragmentation. This study highlights how private providers are helping mitigate structural deficits in primary care of NCD in Vietnam. These findings underscore the importance of a coordinated governance approach that incorporates both sectors for building an equitable and effective NCD care.

ObjectiveTo evaluate the feasibility and impact of remote consecutive, in-person consecutive, and in-person simultaneous interpreter modalities on clinical workflow, patient experience, and provider experience in a multidisciplinary pediatric craniofacial clinic.DesignMixed-methods study incorporating quantitative clinical workflow and patient survey data with qualitative semi-structured interviews.SettingSingle-site multidisciplinary pediatric craniofacial clinic at an academic medical center.Patients, ParticipantsA total of 170 patients were seen during the study period: 126 (74.1%) English-speaking (for no interpreter comparison) and 44 (25.9%) Spanish-speaking using interpreter services. A total of 105 (61.8%) patients completed voluntary patient satisfaction surveys. Sixteen craniofacial providers and four Spanish-speaking interpreters participated in interviews.InterventionsLanguage interpretation was provided via three modalities: remote (audio and video) consecutive, in-person consecutive, and in-person simultaneous.Main Outcome Measure(s)Clinic cycle time and face-to-face time; patient satisfaction scores; thematic analysis of provider and interpreter interviews.ResultsClinic time and satisfaction scores did not differ significantly across modalities. Interviews revealed that in-person interpretation supported rapport, trust, and clarity, while remote interpretation posed technical and relational challenges. Simultaneous interpretation was valued for efficiency but required greater cognitive effort from interpreters. Preferences for in-person consecutive and simultaneous interpretation varied with patient and clinic needs.ConclusionsWhile quantitative outcomes showed minimal workflow differences among interpreter modalities, qualitative findings highlight important communication benefits of in-person interpretation, especially when interpreters are experienced and integrated into the care team. Tailored interpretation approaches may better promote equitable care in multidisciplinary pediatric craniofacial settings.

Parkinson's disease (PD) caregivers often face significant challenges, including worsening anxiety and depression, declining physical health, reduced quality of life, and a high level of caregiver burden. Research shows LGBTQ+ caregivers also experience poorer health, greater financial strain, higher stress and depression, more disability, and barriers to care, yet little is known about the experiences of LGBTQ+ PD caregivers. This study explored the knowledge, perceptions, and care experiences of LGBTQ+ PD caregivers, including their needs and strategies for ensuring equitable care for underrepresented populations caregiving for individuals living with PD. We conducted semi-structured interviews with 12 LGBTQ+ PD caregivers. Thematic analysis based on grounded theory was conducted to identify key themes. Six prominent themes were identified, including Service Gaps, Prioritizing Self-Care, Geographic Disparities, Meaning in Caregiving, Caregiver Advocacy, and Informed Decision Making. Our findings highlight the unique challenges and strengths of LGBTQ+ PD caregivers. Future research and health service providers should consider ways to address systemic barriers, the importance of culturally competent support, and both the burdens and resilience experienced by LGBTQ+ PD caregivers. Findings underscore the urgent need for inclusive, culturally competent services and resources to support this underserved population.

This retrospective study examined racial differences in disease severity, treatment, and healthcare utilization among patients with autoimmune blistering diseases (AIBDs) at a tertiary care center. Black patients had significantly higher rates of emergency department visits, hospitalizations, and comorbidity burden compared to White patients, despite similar disease severity at presentation. These findings highlight the need for more equitable care in AIBD management.

BackgroundLesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults face substantial psychosocial barriers when seeking care services, support, and resources needed for maintaining their brain health. Studies suggest that LGBTQ+ individuals may face a higher risk for adverse brain health outcomes than their heterosexual, cisgender peers, underscoring the urgency of addressing these disparities. This study aimed to identify the unique healthcare needs of LGBTQ+ older adults living with cognitive impairment in the United States.MethodBetween June 2024 and January 2025, the study team conducted semi‐structured interviews with community‐dwelling LGBTQ+ adults aged 60+ who were diagnosed with mild cognitive impairment (MCI) by a licensed clinician (n = 7); community‐dwelling LGBTQ+ adults aged 60+ who self‐reported significant cognitive problems (n = 8); and licensed clinicians who routinely provide care to LGBTQ+ older adults with cognitive impairment (n = 5). For study participation, LGBTQ+ community members without an MCI diagnosis must score below 19 on the MoCA BLIND English (Version 8.1). Data were coded by the study team using NVivo qualitative data management software and analyzed inductively through grounded theory analysis.ResultPreliminary findings underscore the critical need to identify and address the healthcare needs of LGBTQ+ older adults living with cognitive impairment, emphasizing the importance of fostering equitable memory care for LGBTQ+ people as they age. Three thematic themes emerged in the data: (1) the need for available and high‐quality social support; (2) the need for age‐friendly and LGBTQ+ culturally responsive resources; and (3) the need to reduce stigma when promoting greater resource utilization.ConclusionPreliminary findings highlight the unique needs, experiences, and challenges faced by LGBTQ+ older adults living with cognitive impairment in the United States. Among the key themes, lack of social support emerges as a major concern, with the majority of LGBTQ+ older adult and clinician respondents emphasizing its structural impact on this patient population. The next steps for this study include assembling and collaborating with a Community Advisory Board to develop an evidence‐based program or set of strategies aimed at meeting the needs of LGBTQ+ older adults living with cognitive impairment.

Significant disparities remain in prenatal care utilization across countries, the specific socioeconomic and systemic factors contributing to these gaps have not been consistently synthesized. This review evaluates the gap by comparing barriers to timely and adequate prenatal care between high and low resource settings by focusing on the factors affecting prenatal service utilization through socioeconomic status and geography cultural barriers and system-related factors. The systematic review explored databases such as PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect. The recent studies from 2014 up to 2024 underwent evaluation based on Boolean operators combined with indexed keywords. Eligible studies included quantitative study designs examining barriers to prenatal care among women of reproductive age. Screening was conducted by two reviewers independently by following PRISMA guidelines. A total of 20 studies were included as per the eligibility criteria. Due to heterogeneity in study design, a structured narrative review synthesis was conducted. The main barriers identified were Socioeconomic limitations because of low income and insufficient insurance coverage and the challenges of distance to healthcare facilities and inadequate transportation combined with cultural barriers such as traditional gender roles and stigmatization and traditional beliefs. The barriers identified in high-income settings were that immigrant and refugee women faced challenges due to their status uncertainties, difficulties with language and unfamiliarity with healthcare systems. Depression along with abuse and multiple caregiving duties emerged as a major psychological factor that prevented women from accessing healthcare. System-related factors like Long waiting times and inadequate medical personnel along with insufficient respect from healthcare providers were the major identified factors. The utilization of prenatal care is influenced by a multifaceted interplay of the individual, cultural, socioeconomic, and systems factors. It is important to strengthen these community-based measures, including financial and structural assistance, to enhance equitable, timely, and sufficient prenatal care across diverse settings.

BackgroundIn the realm of cognitive health assessment and dementia research, the recognition of cultural and linguistic diversity among populations has emerged as an imperative consideration. Alzheimer's disease and related dementias (ADRD) pose a global health challenge, affecting individuals from diverse backgrounds. To ensure equitable and accurate assessments of cognitive impairment, it is essential to develop and validate assessment tools that are adapted for the communities they serve. Pacific Islanders, both in their homelands and diaspora, have distinct cultural and linguistic characteristics that require tailored tools. Among the largest Pacific Islander groups in the U.S., Samoans and Tongans also have the highest number of native speakers, highlighting the need for culturally appropriate cognitive assessments.MethodsWe recruited 26 participants (15 Samoan, 11 Tongan), aged 50 or older and fluent in Samoan or Tongan, from diasporic communities in Utah and Hawaii. Recruitment strategies included brain health events, social media, local organizations, churches, news outlets, and word‐of‐mouth referrals. Trained bilingual interviewers conducted data collection and administered cognitive assessments.ResultsThe study validated the Samoan and Tongan versions of the AD8 and CDR through rigorous translation, back‐translation, and expert review. Focus group feedback ensured cultural relevance and clarity. Interrater reliability indicated perfect agreement for the AD8 and strong agreement for the CDR in both languages. Both instruments exhibited robust psychometric properties, with significant correlations among the Samoan assessments (AD8‐SMN and CDR‐SMN: r=0.70, p = 0.004; AD8‐SMN and MoCA: r=0.78, p = 0.0008; CDR‐SMN and MoCA: r=‐0.53, p = 0.042). Strong correlations were also observed among the Tongan assessments (AD8‐TNG and CDR‐TNG: r=0.751, p = 0.008; AD8‐TNG and MoCA: r=‐0.83, p = 0.002). However, the CDR‐TNG and MoCA did not correlate significantly (r = ‐0.39, p = 0.232), likely due to the small sample size.ConclusionsThis study addresses a critical gap in dementia research among minority populations. The validated Samoan and Tongan versions of the AD8 and CDR demonstrate strong psychometric properties, providing reliable tools for early detection, accurate diagnosis, and effective ADRD management. These tools provide a valuable resource for improving cognitive health outcomes and ensuring more equitable dementia care.

Nurse workforce strategies to advance equitable healthcare during evolving federal mandates.

The Crucial Role of Loan Accessibility in Advancing HIV Care.

Maternal mortality in the United States is an urgent public health concern. Despite advances in medical technology and obstetric care, maternal mortality remains elevated in the United States, with disparate burden across racial or ethnic, socioeconomic, and geographic communities. The reasons for these disparities are myriad and include a confluence of structural and social determinants, variation in medical care access and quality, and individual risk factors. This review explores the evolving patterns of maternal mortality in the United States by examining contributing causes, demographic disparities, and systemic challenges, with an emphasis on the limitations of current US maternal mortality surveillance infrastructure. We highlight the urgent need for data-driven policy interventions, equitable health care reforms, and research innovation to enhance maternal health and eliminate disparities.

This study investigates factors influencing the use of Nasoalveolar Molding (NAM) and Feeder Prostheses (FP) in infants with cleft lip and palate (CLP) across five countries: Saudi Arabia, Egypt, Jordan, United Arab Emirates and Pakistan. Data were collected through structured phone interviews with parents, covering sociodemographic characteristics, medical attention-seeking behavior, and healthcare accessibility. Healthcare accessibility was assessed using a previously validated questionnaire. Higher family income and the presence of associated anomalies were significantly associated with increased NAM use (P = 0.02 and P = 0.013, respectively). Both NAM and FP were more commonly used in infants with unilateral complete CLP, though statistical significance was observed only for FP (P 0.025). Family members with CLP (AOR = 3.035; P = 0.025) and mothers with a mean age (AOR = 1.119; P = 0.001) have a significantly increased AOR of NAM use. Mean severity score significantly increased the AOR of FP use (AOR = 1.529, 95% CI: 1.128-2.072, P = 0.006). On the other hand, a low family income (AOR = 0.133; P = 0.009) significantly decreased the AOR of NAM use, while other factors, including associated anomalies and accessibility, did not show a significant impact on NAM or FP use. These findings highlight the role of socioeconomic and family history in determining treatment modalities for CLP infants. Enhancing early healthcare and financial support ensures equitable care through specialized intervention.

The ageing population represents a transformative demographic shift in India. It is posing both challenges and opportunities for public policy. The growing elderly population, now exceeding 100 million, is projected to reach around 20% of the total by 2050. There is an emerging need for a holistic approach. Despite policy frameworks such as the National Policy on Older Persons (1999) and the National Policy for Senior Citizens (2011), India’s approach to geriatric concerns remains fragmented and under-resourced. The Structural deficiencies, weak inter-sectoral coordination, and limited financial resources have constrained effective implementation. This paper critically examines the evolution and scope of India’s social security policies. It analyzes policy planning and identifies systemic healthcare delivery and social protection gaps based on national data and comparative evidence. The paper concludes that achieving equitable geriatric care in India requires multisectoral collaboration, enhanced community-based service models, and sustained investment in preventive and long-term care infrastructure.

The United States neonatal and infant mortality rates have declined substantially over the last six decades. Despite these reductions, significant racial disparities in mortality and other important outcomes have persisted. While increased risk of preterm birth is a major contributor to these differences, racial inequities in risk-adjusted outcomes such as gestational age-specific and major congenital anomaly-associated mortality remain. Race-specific differences in inter- and intra-neonatal intensive care unit (NICU) practices associated with worse outcomes for infants of color suggest opportunities for reducing these disparate health outcomes during and after NICU hospitalization. Identifying NICU-based contributing factors and implementing factor-specific improvement strategies can lead to more equitable outcomes. In this review, we describe examples of racial inequities in risk-adjusted NICU outcomes and inter- and intra-NICU practices associated with worse outcomes for infants of color, provide an overview of current approaches to health equity in NICU care, and identify opportunities, sustainable strategies, and accountabilities for more equitable care and support of NICU patients and, quite importantly, their families. IMPACT: Characterize racial inequities in risk-adjusted neonatal intensive care unit (NICU) outcomes and inter- and intra-NICU practices associated with worse outcomes for infants of color. Provide an overview of current trends in and approaches to health equity in NICU care. Discuss strategies for implementing and sustaining more equitable care and support for infants and families during NICU hospitalization.

Community health centers (CHCs) are a critical component of the dental safety net for people with substantial barriers to dental care access. Recruiting and retaining dentists working in CHCs is essential to effectively serve this population. This study aimed to identify factors associated with dentists' intent to continue practicing in their current CHC in the long term. The data were collected through an online survey administered to United States dentists practicing in CHCs in 2021 by the National Network for Oral Health Access. The dependent variable was dentists' intent to stay at their current CHC in the long term, with 42 independent variables across four domains: individual characteristics, perceptions, motivators, and organizational factors. Descriptive, bivariate, and multivariable logistic regression analyses were employed to determine factors associated with dentists' intent to stay at their CHC. A total of 248 dentists were in the final analytical sample. Multivariable regression results showed that dentists in leadership roles had 3.7 times the odds of intending to stay compared to staff dentists, and those with high professional autonomy had 2.6 times the odds of intending to stay compared to those with low to moderate autonomy. The study underscored the importance of dentists' autonomy and role in their intent to remain at CHCs. Factors typically associated with recruitment packages or length of time in clinical practice were not significantly associated with intent to stay. Distinguishing between recruitment and retention strategies is crucial for CHCs to fulfill their mission of ensuring equitable dental care access.

Background/Objectives: Community paramedicine programs have existed since the early 2000s, and while resource optimization remains a predominant driver, innovation in recent years demonstrates that when community paramedicine is integrated into healthcare, it is well-positioned to support the needs of structurally marginalized communities by focusing services for those facing barriers to accessing equitable care. A recent scoping review described the evolving ways community paramedicine models are addressing health and social needs within communities around the world. We aimed to identify and explore existing community needs assessment tools in Canada to guide the initial development of a needs assessment tool for community paramedicine. Methods: We conducted a document analysis of existing community needs assessment resources to identify current tools or processes used to identify community needs, as well as determine gaps to address and support. Documents were collected for review via a targeted literature search of both published and gray sources, and direct document requests of community paramedicine service providers to review guides informing current service planning in Canada. We presented a draft of the tool to participants at a community paramedicine conference for their review and feedback, and we incorporated this feedback into the final version. Results: We reviewed 38 documents to identify and synthesize key elements within community health and social needs assessment tools and frameworks. Findings informed an interim Community Paramedicine Needs Assessment Tool (CPNAT) that the team presented to 112 community paramedicine experts and partners. We received 33 group responses of detailed feedback that we used to further refine and finalize the tool. Conclusions: The CPNAT can support enhanced health equity by guiding community paramedicine programs to better align services, policies, and funding with the health and social care needs of communities.

Infective endocarditis (IE) remains a prevalent and high-risk condition despite advances in cardiac care. Increasing attention has been directed toward sex-based differences in physiological presentation, disease progression, and surgical management. This review synthesizes evidence on sex-specific differences in IE, with an emphasis on diagnosis, risk factors, disease manifestations, medical management, surgical intervention, and postoperative outcomes. While the incidence of IE is more than twice as high in men, women consistently experience worse outcomes. Women present at an older age, with greater comorbidity burden and greater delays in surgical referral. Postoperatively, women are at higher risk of complications - including embolic events, extended ventilation time, and intensive care unit stays - and have significantly higher short-term mortality. Long-term survival is comparable between sexes, suggesting disparities largely influence short-term outcomes. Awareness of sex-specific differences in risk factors, clinical presentation, intervention bias, complications, and outcomes of IE is essential for optimizing management and equitable care. Further research into sex-based pathophysiology, comorbidity management, and tailored perioperative strategies is critical to advancing patient-centered treatment and optimizing clinical outcomes.

The US Department of Veterans Affairs (VA) aims to ensure all veterans have access to emergency care, whether at VA or community facilities. However, the factors influencing where veterans seek care remain poorly understood. To assess factors associated with veterans use of community vs VA EDs. This retrospective cross-sectional study included all veterans aged 18 years or older with at least 1 VA or community ED visit across the contiguous US and Puerto Rico between October 1, 2021, and September 30, 2022. Data were analyzed from October 3, 2024, to March 10, 2025. Patient demographics, clinical characteristics, prior VA and community health care use, differential distance to the nearest VA and community EDs, and facility complexity. Community or VA ED visit. Logistic regression models were used to assess factors associated with community ED use compared with VA ED use. The sample included 2 777 564 ED visits by 1 359 850 veterans (mean [SD] age, 61.9 [16.1] years; 1 202 964 [88.5%] male). Of these visits, 1 000 437 (36.0%) occurred at community EDs. Community ED use was associated with greater differential ED distance (>64.0 km: adjusted odds ratio [AOR], 16.20; 95% CI, 15.96-16.44), prior community ED use (≥5 prior visits: AOR, 17.87; 95% CI, 17.14-18.63), and high-acuity diagnoses (eg, cardiac arrest and ventricular fibrillation: AOR, 84.57, 95% CI, 65.47-109.25). Prior VA ED visits (1 prior visit: AOR, 0.28; 95% CI, 0.28-0.28) and primary care use (AOR, 0.78; 95% CI, 0.77-0.79) were associated with lower odds of community ED use. Racial and ethnic minority veterans were consistently less likely to use community EDs compared with White veterans (Asian veterans: AOR, 0.64 [95% CI, 0.61-0.67]; Black veterans: AOR, 0.76 [95% CI, 0.76-0.77]; and Hispanic veterans: AOR, 0.73 [95% CI, 0.72-0.74]). In this cross-sectional study, community ED use among veterans was associated with geographic access, prior care patterns, and diagnosis acuity. Targeted strategies appear to be needed to strengthen care coordination and ensure equitable emergency care access.