This integrative qualitative review examines barriers and facilitators affecting sexual health service access among Asian-born men who are gay, bisexual, or who have sex with men in Australia. Despite advancements in HIV prevention, this group remains under-represented in research and health care, contributing to health disparities. The analysis identified a 'socioecological cascade' where external, structural-level forces such as pervasive stigma and perceived threat of health-related visa requirements are progressively internalised, culminating in individual-level barriers to care. On the positive side, a supportive attitude from the clinic's staff and the connection to the gay community improve access. Findings highlight the need for culturally sensitive outreach, clinician training, and policy reforms.

Although the recent proliferation of telemental health care has transformed delivery of outpatient mental health care for many patients, little is known about population-level access to telehealth, hybrid, and in-person outpatient mental health care in the US. The objective of this report is to characterize patterns of all telehealth, hybrid, and all in-person outpatient mental health care by US adults. An analysis is presented of 2021-2022 Medical Expenditure Panel Survey data (n=39,561) focusing on annual percentages of adults receiving all telehealth, hybrid, and all in-person outpatient mental health care. Results are presented overall and stratified by sociodemographic characteristics. Differences are reported in average marginal estimates from logistic regressions for each sociodemographic characteristic controlling for age group, sex, and psychological distress (Kessler-6). Approximately 12.0% of adults annually received outpatient mental health care, including 3.3% all telemental health care, 2.6% hybrid, and 6.1% all in-person mental health care. After controlling for age, sex, and distress, unemployed adults 65 years of age or younger were less likely than employed adults to receive all mental health care (-1.0 percentage points, 95% CI: -1.6 to -0.4), and uninsured individuals were less likely than those with private insurance (-2.8 percentage points, 95% CI: -3.6 to -1.9). By contrast, college graduates were 3.2 percentage points (95% CI: 2.3-4.0) more likely than those with less than a high school diploma, higher-income individuals were 1.6 percentage points (95% CI: 0.8-2.30) more likely than those below the poverty level, and urban residents were 1.9 percentage points (95% CI: 1.1-2.7) more likely than rural residents to receive all telemental health care. These national patterns highlight differences in US telemental health care access across employment, education, income, insurance, and geographic groups.

Despite significant literature on access to, and utilisation of, health care, less attention has been given to the agency of rural service users to use, or not use, health services. This paper aims to understand the decisions of residents from two rural communities to use, or not use, health services. Participants were recruited from Neighbourhood Houses in two rural communities in northern Victoria, Australia, located relatively close to a regional centre. Twenty participants with significant socioeconomic needs were included. The study used a qualitative design and constructivist paradigm to undertake semi-structured interviews which were analysed thematically. Three types of decisions to access health services were identified. First, regular users prioritised their health, valued health care, and usually had a trusted healthcare navigator. Second, sometimes users identified barriers to accessing services, primarily not having a trusted GP and cost. Third, avoiders of health services suggested they did not prioritise their own health, it was easier to not attend, they did not believe health services led to better health outcomes, and poverty or other social issues prevented use. Some respondents moved between the three types, being regular users for children and when they had a trusted GP, and sometimes users for themselves or when barriers arose. This study identified the strong role of GPs and the relational aspects of accessing and utilising health care. It calls for stronger engagement with disadvantaged rural residents to build trust in health care among those avoiding health services.

Disrupting the information order in health care: Institutions, policy regimes, and the value of data.

Oral health is an important aspect of overall well-being, especially for frail older people, who are increasingly ageing in place. As this population with associated complex health care needs grows, integrated and collaborative oral health care becomes more urgent. Despite its importance, oral health is often overlooked in both practice and policy. This study aims to identify barriers and facilitators at the micro, meso, and macro levels to improve interprofessional collaboration for oral health care of frail, community-dwelling older people. This qualitative study was conducted in the Netherlands and comprised two data collection methods: six semistructured interviews and five discipline-specific focus group discussions, involving a total of 38 health care professionals. Each focus group consisted of professionals from a single discipline, including oral health care professionals, general practitioners, home care professionals, pharmacists, and public health professionals. Participants represented health care professionals both within nationally recognized integrated geriatric care networks and those not yet participating in such networks. Data were analysed inductively using thematic analysis in Atlas.ti. At the micro level, barriers included limited awareness, knowledge, and prioritization of oral health, unclear responsibilities, time constraints, and inconsistent referral pathways. At the meso level, participants reported insufficient standardized protocols, lack of interprofessional education, and poor digital integration of medical record systems. At the macro level, key issues were inadequate funding and reimbursement, fragmented policies, and limited support for home-based oral care. Facilitators at the micro and meso level included raising awareness and interprofessional education, practical tools and clear referral pathways, improved ICT systems, and appointing regional coordinators to strengthen multidisciplinary collaboration. At the macro level, national guidance and structural financial incentives were viewed as crucial for sustainable integration. In conclusion, this study, identified critical barriers and facilitators for effective interprofessional collaboration and better oral health care for community-dwelling frail older people at the micro, meso, and macro levels. Improvement requires increasing awareness and education among professionals, better integration of oral health care in multidisciplinary care networks, shared electronic medical record systems, and adequate reimbursement. These findings should inform guidelines and be validated through implementation studies.

A Qualitative Exploration of How the Pregnancy and Postpartum Journey Was Shaped by the COVID-19 Pandemic: Lessons Learned.

Adolescents are a developmentally vulnerable group in mental health care, yet their experiences of informal coercion remain underexplored. Most existing research reflects adult perspectives, leaving a gap in understanding how adolescents experience such practices. This review synthesises qualitative evidence on the forms and consequences of informal coercion experienced by adolescents in mental health settings. The review followed the PRISMA guidelines and was registered in PROSPERO. A systematic search was conducted across seven databases in February 2025 (PubMed, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, Cochrane Library). Screening and inclusion were performed using Covidence supplemented by manual reference searches. Qualitative content analysis was applied, using a framework informed by previously identified forms of informal coercion. Across 12 studies, informal coercion shaped adolescents' involvement in mental health care. Predominant forms included treatment pressure, silencing and exclusion and appealing to rules and routines, accompanied by threats or disciplinary control. These practices were experienced as undermining autonomy and trust. The adolescents responded through adaptive and resistant coping strategies, such as compliance, concealment, or overt opposition. The experiences were commonly associated with emotional distress, relational mistrust and hindered recovery, although some adolescents interpreted structured pressure as supportive or protective. Informal coercion is present and consequential in adolescent mental health care. Existing adult-based conceptualisations may overlook its relational and subtle nature. Further research is needed to explain how informal coercion is constructed in interactions and how it is justified in adolescent mental health care. Such knowledge is essential for developing ethically sound, rights-respecting nursing practices. Trial Registration: PROSPERO: CRD42025644678.

Summary of best evidence for nutritional and dietary interventions in managing chemotherapy-induced gastrointestinal toxicity in cancer patients.

We describe a novel curriculum designed to build capacity for public health and primary care collaboration. Since the Northwest Public Health & Primary Care Leadership Institute began in 2020, 119 participants have completed the seven-month hybrid curriculum. Application of knowledge and skills learned to workplace or community projects was reported by 84% of participants. Case-based learning and the critical friends group were valued learning methodologies. A cross-sectoral leadership curriculum can promote public health and primary care integration. (Am J Public Health. 2026;116(4):443-446. https://doi.org/10.2105/AJPH.2025.308377).

Active shooter drills (ASDs) are increasingly mandated in public schools, yet limited data exist on their effectiveness, and concerns persist about their psychological impact on students. To understand these perceptions, we partnered with Vermont's Public Health Association to conduct a mixed-methods study. An electronic survey was distributed to school districts in Vermont's most populous county, specifically sent to administrators, educators, mental health professionals, and support staff. Out of 125 survey responses, 42% reported observing adverse psychological effects from ASDs, yet 79% considered the drills worthwhile. Statistically significant differences emerged between teachers and non-teachers in their views on ASD efficacy. Our study can help inform policy changes that focus on the standardization of drills and the use of consistent language within the literature, which can potentially minimize harm. Our research highlights the need for structured guidelines at the state level to ensure consistency across all schools. These findings suggest a complex interplay between perceived value and the psychological impact of ASDs. While many educators report psychological harms associated with ASDs among students, a majority continue to support their use, pointing to the need for thoughtful revisions in policy and practice.

Evaluation of a trauma center-based, technology enhanced stepped care intervention to promote the mental health recovery of adolescent traumatic injury survivors.

A formative service evaluation exploring the experience and levels of satisfaction of patients attending a nurse led bone marrow clinic in one Health and Social Care Trust in Northern Ireland.

Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography. Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021-2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography-associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration. Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million. For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.

To strategically optimize diagnostic capacity in a low-resource, rural hospital setting, we developed a systematic evaluation of diagnostic tool needs and associated costs. This local data-driven method, accounting for patient characteristics and disease prevalence, can be adapted to other contexts. A retrospective patient record analysis was conducted at San Miguel Hospital (SMH) in Sucumbíos, Ecuador, which provides outpatient and emergency care to inhabitants of the Ecuadorian and Colombian Amazon basin. Ethics approval was granted retrospectively by the Research Ethics Committee on Human Beings of the Universidad San Francisco de Quito.Data was retrieved from electronic medical records (EMRs) of the first 796 patients seen after hospital opening. For each of the 1975 diagnoses made, patient characteristics and the presence or absence of appropriate diagnostic tools were recorded. Unavailable tools were further evaluated for accessibility within the local context. Serving a population primarily of mixed and indigenous ethnicities, SMH confirmed 66% of diagnoses using existing resources, with potassium hydroxide (KOH) fungal microscopy, chikungunya and influenza rapid tests, and access to anatomical pathology identified as the diagnostic tools offering the highest return on investment. Data from SMH's EMRs suggest which diagnostic tools would offer the greatest return on investment through increased diagnostic confirmation. This evaluation tool supports improved health care delivery at SMH and, with adaptation, can be applied in comparable health care settings. N/A.

Adolescents with special health care needs (ASHCNs) must develop self-management skills to effectively transition into adult-based care. This requires having the self-efficacy to meet with their health care provider independent of caregivers. This study aims to identify the factors associated with self-efficacy in meeting with a provider alone among ASHCN preparing for this transition.Eighty-three English-speaking 18-year olds with renal, gastrointestinal, neurologic, or rheumatologic diseases, and their English- or Spanish-speaking caregivers were recruited at a large children's hospital, and completed a one-time assessment as the historical control group for a larger intervention study. The main outcome measure was self-efficacy to meet with their health care provider alone. Factors evaluated for their independent association with self-efficacy using linear regression included Self-Determination Theory constructs (autonomy, competence, and relatedness); importance of meeting with their provider alone; and whether they had met with their provider alone in the past 12 months.Seventy-percent of ASHCN had met alone with their provider in the last 12 months. Female gender, perceived competence, perceived provider support for autonomy, and having met with their provider alone in the last 12 months were associated with self-efficacy in meeting with their provider alone.ASHCNs who feel competent in managing their health and who perceive their providers as supporting their self-management autonomy also feel the most efficacious in meeting with their provider alone. Pediatric providers can help prepare ASHCN for transition by meeting with them alone.

How to Start and Sustain a System-Based High-Reliability Medicine Venture for Your Critical Care Organization.

The number of long-duration drug shortages in the United States is increasing annually. These shortages may pose significant risks to patients by compromising or delaying care. They also pose challenges to health care systems by creating operational and financial strain. To minimize the effect on patient care, health care professionals and systems need to establish mechanisms to prepare in advance for drug shortages. In this clinical perspective, we explore the definition of drug shortage, causes of drug shortage, prediction of drug shortage, and potential responses to drug shortage. We additionally review the causes and responses to shortages of five drugs specific to obstetric care. In this era of frequent and unanticipated drug shortages, it is crucial to build the necessary teams and systems to respond to the next drug shortage to protect the health and safety of pregnant people.

Bioethics Peer Review: A Structured Evaluation Framework for Long-Term Care Environments.

To examine how mis- and disinformation about the Public Charge Ground of Inadmissibility final rule ("public charge rule") influences health care access for Latino immigrants in California as seen through the perspectives of leaders in health-serving organizations. This qualitative study included semi-structured interviews with healthcare and community-based organizational leaders serving Latino immigrants in California. Viswanath etal.'s structural influence model of communication and equity guided the analyses and interpretation of the findings. Between May 2024 and April 2025, primary data were collected from 31 organizations, resulting in 32 semi-structured interviews with 38 participants. Interviews were conducted via Zoom and transcribed verbatim. Researchers coded the data based on recurring themes using Dedoose software. Participants identified the public charge rule as a significant barrier to health care access for Latino immigrants. The policy has discouraged many Latinos from accessing public benefits, particularly the state's Medicaid and Supplemental Nutrition Assistance Program. In addition, immigrants' trusted sources of information (e.g., family, friends, and attorneys) were often misinformed about the policy, which amplified confusion and fear. Organizations respond by providing accurate information and connecting individuals with reliable resources to clarify that using public benefits would not necessarily result in being classified as a public charge. However, most efforts focused on education rather than directly countering mis- and disinformation. Healthcare and community-based organizations offer unique perspectives as trusted intermediaries who help Latino immigrant families navigate health care and public benefits. Their close daily interactions reveal how misinformation about the public charge rule deters families from accessing essential services and makes it more challenging for organizations to fulfill their missions. These insights underscore the need for culturally responsive outreach and policy solutions that address information gaps and the climate of fear affecting community health.

The importance of young surgeons in surgical health policy advocacy engagement.