The wellbeing of healthcare workers is increasingly recognized as foundational to high-quality care and sustainable health systems. While various leadership frameworks promote wellbeing, there remains a gap in system-wide strategies that integrate equity, psychological safety and health promotion into leadership practice. This paper aims to address that gap by adapting the Okanagan Charter, originally developed for health-promoting universities, into a novel framework for health-promoting leadership in healthcare. This conceptual paper reinterprets the principles of the Okanagan Charter through the lens of inclusive, distributed and compassionate leadership. The authors adapt an established six-domain model to the health leadership context: embed health in all policies, adapt spaces to promote wellbeing, create thriving communities and cultures, support meaningful personal and professional development, promote engagement with health services and collaborate in continuous improvement and evaluation. For each domain, they provide theoretical rationale, leadership strategies and practice-based illustrations. This paper critically examines the applicability of the Okanagan Charter within healthcare leadership, highlights practical implementation challenges and presents a revised leadership case study grounded in real-world complexity. The findings demonstrate the utility of the six-domain model in guiding leaders to embed wellbeing into everyday practice. This paper advances existing scholarship by explicitly extending Okanagan Charter-aligned work into the domain of healthcare leadership. It offers a clear, theory-informed roadmap for leaders to integrate wellbeing, equity and health promotion into the fabric of organizational life, positioning health-promoting leadership as a strategic imperative for resilient, inclusive and high-performing health systems.

Evidence links emotional labor to burnout among hospital workers, yet most studies focus on nurses or aggregate diverse allied health occupations into a single group. This cross-sectional secondary analysis examined whether job satisfaction mediates the association between emotional labor and burnout, and whether the mediation pathway differs by occupation among hospital-based healthcare workers. We analyzed data from a standardized self-administered survey conducted in July 2022 across six hospitals under the Korea Veterans Health Service. Of 570 eligible healthcare workers, 290 responded (response rate 50.9%), including clinical laboratory scientists, radiologic technologists, physical therapists, and dental hygienists. Emotional labor, job satisfaction, and burnout were assessed using validated questionnaires. We applied generalized structural equation modeling to test an occupation-specific moderated mediation model (emotional labor → job satisfaction → burnout), adjusting for age, sex, employment status, weekly working hours, self-rated health status, and hospital. Dental hygienists showed the highest mean emotional labor and burnout levels. In the overall mediation model, higher emotional labor was associated with lower job satisfaction (a = - 0.765; 95% CI - 0.857 to - 0.674) and higher burnout both directly (c' = 0.340; 95% CI 0.261 to 0.420) and indirectly via job satisfaction (indirect effect = 0.096; 95% CI 0.050 to 0.143), corresponding to 22.1% mediation of the total effect (total effect = 0.436; 95% CI 0.357 to 0.516). In occupation-specific models, the indirect effect through job satisfaction was significant for clinical laboratory scientists and radiologic technologists, whereas the direct effect of emotional labor on burnout remained significant across all four occupations. Emotional labor was positively associated with burnout among healthcare workers, and job satisfaction accounted for a meaningful portion of this association. The mediation pathway differed by occupation, suggesting that burnout mitigation strategies may benefit from occupation-tailored approaches, with particular attention to strengthening job satisfaction where mediation is evident.

Acute sinusitis is common in general practice. Although typically self-limiting, antibiotics are frequently prescribed despite guideline recommendations to restrict use. It remains unclear whether antibiotic treatment reduces subsequent health care use or work absence. To assess how initial treatment with or without antibiotics for acute sinusitis is associated with subsequent health care use and work absence, and to compare phenoxymethylpenicillin (PcV) versus other antibiotics. Nationwide registry-based observational cohort study of adults with acute sinusitis (ICPC-2: R75) diagnosed in Norwegian general practice 2012-2019. We compared GP visits, Ear, Nose, and Throat (ENT) specialist visits, repeat antibiotic prescriptions, and sick leave days in antibiotic-treated and untreated episodes. We estimated adjusted differences in outcomes between groups using linear regression (daily outcomes) and negative binomial regression (weekly counts). We included 627 211 episodes from 413 449 patients. Antibiotics were prescribed in 59% of episodes; 53% received PcV. During the index week, antibiotic use was associated with 1.7 fewer GP visits, 0.1 fewer ENT visits, and 25.1 more sick leave days per 100 episodes. Corresponding figures for the following 4 weeks were: 0.9 fewer GP contacts, 10.7 fewer sick leave days, and 0.6 more antibiotic prescriptions. PcV was associated with slightly more GP visits and re-prescribing than other antibiotics. Acute sinusitis is followed by a short-term increase in health care use and work absence. Initial antibiotic use was associated with modest short-term differences, but no meaningful reduction in overall follow-up. Findings are consistent with recommendations for restrictive prescribing and narrow-spectrum use when appropriate.

Perceptions, practices, and gaps in osteomyelitis care in rural Rwanda: insights from patients and healthcare workers.

Although proper donning and doffing of personal protective equipment (PPE) is critical for infection prevention, detailed characterization of problems encountered during these processes in real-world settings during large-scale infectious disease outbreaks remains insufficient. This study aimed to analyze the characteristics and distribution of interception problems in the process of donning and doffing process in a large cabin hospital during the 2022 COVID-19 pandemic in Shanghai. A prospective, real-world study was designed to collect and analyze data on irregularities observed during personal protective equipment (PPE) donning procedures in cabin hospital operations. The proportion of problems encountered during donning PPE was 5.29% (246/4,652), while during doffing PPE, it was 8.44% (382/4,525) (P < 0.001). The primary problem during donning PPE was related to problems with protective clothing, followed by problems with respirators. There was no significant difference in problem distribution among different posts (P = 0.459). The problems related to protective clothing mainly focused on loose fitting around the head and neck, making them prone to exposure during donning (56.25%, 99/176) and contamination of the inner surface of protective clothing during doffing (46.43%, 91/196). Respirator-related problems included failure of the seal test during donning PPE (61.54%, 24/39) and shifting or loosening of the respirator during PPE doffing (73.68%, 14/19). These findings identify critical gaps in PPE procedures and highlight the need for targeted training to address these issues, thereby reducing the risk of infection among healthcare personnel in mobile cabin hospitals.

Against the backdrop of increasing international calls for the development and implementation of integrated person-centered care that address both quality and access issues to improve adolescent and youth health services, this paper aims to develop a conceptual framework for integrating Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs) prevention into pregnancy prevention routineservices in Vhembe District, to improve teenagers' health outcomes. A convergent triangulation mixed methods design was used for comparing and contrasting of quantitative and qualitative data to determine the extent of agreement between the two data types to generate contextual findings. In this study, employing both quantitative data were collected through questionnaires on a sample of healthcare workers (n = 112) providing Adolescent and Youth-Friendly Services to evaluate programme effectiveness on the high rate of teenage pregnancy and HIV infection among youth in Vhembe District. Qualitative data were collected using face-to-face interviews with nurses (n = 24) and teenagers aged 14-19 yrs (n = 28). For a richer understanding of dynamic family planning and HIV programs, face-to-face interview was conducted to explore more deeply the experiences and challenges of teenagers between the ages of 14-19years. Nurses were interviewed on the barriers and facilitators of integrating HIV, STI and pregnancy prevention services in the rural facilities of Vhembe District. Quantitative data were analysed using frequencies and percentages, and qualitative data were analysed using thematic analysis. The findings of the study point out that the integrated HIV, STIs and pregnancy prevention service uptake among adolescents is likely to be influenced by social and institutional factors. It is also evident from this study that adolescents face challenges when it comes to obtaining PrEP, PEP and contraceptives in primary healthcare clinics. Provider competency reveals a disparity, with a majority 67.0% of healthcare providers trained in effective communication with adolescents with 95% Confidence Interval of [0.57-0.75] (n = 112), suggesting a high level of adoption in the population. In comparison, significantly fewer have received specific training in AYFS 16% with 95% Confidence Interval of [0.09-0.24] (n = 112) or on Pre-Exposure Prophylaxis (PrEP) 25.9% with 95% Confidence Interval of [0.18-0.35] (n = 112), underscoring the need for a more balanced approach to training focus. The empirical findings provide evidence on challenges unique to low-resource, rural settings, contributing to global discourse on HIV and Sexual Reproductive Health (SRH) integration. Consequently, 95% of the key stakeholders and experts approved the feasibility and applicability, while 92% approved the acceptability and sustainability of the proposed framework. It is recommended in this study that policy changes be implemented through an integrated health policy that recognizes the interconnectedness of HIV, STIs, and teenage pregnancy prevention to improve access to quality healthcare and education for youth.

We investigated a KPC-2-producing Enterobacterales (KPC-2 CPE) outbreak in a Korean hospital from July to September 2019, which subsided following enhanced surveillance and strict infection control. The study aimed to elucidate transmission dynamics using epidemiological and genomic methods. The study period covered the outbreak and a 9-month post-outbreak observation. Investigations included a matched case-control study and whole-genome sequencing (WGS) of isolates, including long-read sequencing for two isolates. Single nucleotide polymorphism (SNP) analysis (≤ 6 SNPs for clonality, ≤ 15 for relatedness) was used to construct transmission networks. A total of 42 KPC-2 CPE cases were identified: 34 Klebsiella pneumoniae, 4 Escherichia coli, 1 Enterobacter asburiae, and 3 cases co-colonized with K. pneumoniae and E. coli. Among these, 33 were hospital-linked and 9 were imported. Retrospective tracing indicated that covert transmission began a month before the outbreak, and 13 hospital wards were identified as potential acquisition sites. Genomic analysis revealed all but one K. pneumoniae belonged to ST307, cgMLST 439, which grouped into three clades. Clade 1 was linked to a specific hospital ward, supported by the case-control study (adjusted odds ratio, 3.63; 95% confidence interval, 1.36-9.63); Clade 2 was spread between wards via a haemodialysis unit and shared healthcare personnel. Imported cases had the same clones as early hospital-linked cases, suggesting undetected introduction before enhanced surveillance. Additionally, an IncX3 plasmid carrying blaKPC-2 was found in both K. pneumoniae and E. coli, indicating horizontal gene transfer. This study demonstrates that clonal spread of KPC-2 CPE can remain undetected without enhanced active surveillance, underscoring the need for early detection. Genomic analysis clarified ST307 K. pneumoniae transmission through unrecognised epidemiological links and horizontal blaKPC-2 transfer to E. coli.

AimsYouth receiving mental health care often face challenges related to romantic relationships, sexuality, and sexual orientation and gender identity (SOGI). Although widely recognized as relevant, these topics are infrequently addressed in youth mental health care. This study explored how youth and mental health professionals experience discussions about sexuality and SOGI in clinical practice.MethodsIn-depth interviews were conducted with 21 youth aged 15-22years receiving psychiatric care, alongside three focus groups with 20 mental health professionals, at a youth mental health center. Data were analyzed using thematic analysis.ResultsYouth described romance, sexuality, and identity as a normal part of life and closely linked to their well-being, while mental health difficulties often complicated relationships and identity processes. Professionals reported hesitation in raising these topics due to practical and personal barriers. Cultural and religious contexts shaped experiences, particularly for LGBTQ+ youth. Both groups emphasized the importance of addressing sexual side effects of psychotropic medication.ConclusionThis study highlights a gap between the recognized relevance of sexuality and SOGI and their discussion in everyday practice. Youth want these topics addressed in mental health care conversations. Bridging this gap requires proactive, youth-centered and culturally sensitive communication, supported by training and institutional attention.

ABSTRACT Support at work is associated with increased job satisfaction among allied health professionals; however, the mechanisms by which this relationship operates are unknown. This study investigates how perceived organizational support (POS) impacts job satisfaction among allied health professionals, emphasizing the mediating role of emotional labor strategies, including surface acting and deep acting. A cross-sectional online survey was conducted between July 4 and 23 August 2023, with 293 physical therapists. Mediation analysis was used to explore the relationships between POS, job satisfaction, and emotional labor. Findings indicate that POS directly enhances job satisfaction. Surface acting partially mediates this relationship, suggesting that professionals relying on surface acting may experience reduced job satisfaction. However, deep acting was not a significant mediator. Understanding the role of emotional labor in allied health professionals’ job satisfaction is crucial. Organizational support that fosters emotional self-regulation may help mitigate the negative effects of surface acting, promoting well-being and retention. This study offers valuable insights for healthcare administrators and policymakers.

Abstract Vaccine hesitancy was a major concern during the Covid-19 pandemic, and a significant percentage of healthcare workers (HCWs) proved to be hesitant too. Various governments, including that of Greece, reacted aggressively, imposing mandates stipulating dismission of HCWs from work unless vaccinated. Hesitancy was understood as a case of moral failing and against the principle of ‘do no harm’. In this article, we deploy hermeneutics policy analysis based on interviews and analysis of texts to challenge this view. On the basis of qualitative analysis of transcripts of press conferences organized by the Greek Ministry of Health and 74 interviews with hesitant HCWs, we show that government’s and HCWs’ understanding of the risk of infection and the associated threat posed to the public health system were starkly different. For HCWs, hesitancy was linked to distrust toward political institutions, which should be treated in a different manner from a case of moral failing of HCWs. We argue that, rather than mandates, persuasion is a better strategy, since hesitancy raises the question of trust toward the politicoscientific establishment. Therefore, reforming science advice institutions so that they make use of local expertise and engage civil society is key. We focus on Greece, as we consider it to be an interesting case of a newly established science advice system with a distinctive character that we term the ‘look from inside’, based on the model of ‘ethical chief scientist,’ which makes it a brilliant case study for others considering building or reforming their systems.

ABSTRACT Using a sociomaterial perspective based on interviews with health workers, we examine how clinic-based HIV viral load testing and early infant diagnosis technologies reshape health care realities in Papua New Guinea. The use of such technologies redefine professional roles and health care experiences by empowering health workers to translate biomedical data into client-centered clinical management, while also contributing systemic tensions, such as the paradoxical recentralizing of care and heavier workloads. Despite these challenges, health workers view these clinic-based technologies as transformative tools that support ethical decision-making, reduce preventable deaths and expand equitable health care.

Professional quality of life among health care workers in medical camps during Arbaeen mass gathering 2024 in Karbala

While home-based self-sampling for cervical cancer screening is an evidence-based strategy proven to increase screening access and uptake, it is not currently recommended in the US despite recent Food and Drug Administration approval of the first at-home self-sampling device. Little nationally representative research has examined preference for and drivers of home-based self-sampling over clinic-based testing (the standard of care). To assess women's perspectives about, reasons for considering, and factors associated with preferring at-home self-sampling for cervical cancer screening. This population-based cross-sectional study used data from the 2024 Health Interview National Trends Survey (HINTS 7), a nationally representative survey of the civilian, noninstitutionalized US adult population offered between March and September 2024. Respondents included in this study were individuals aged between 21 and 65 years who were eligible for cervical cancer screening per the US Preventive Services Task Force guidelines and who self-reported their gender identity. Respondents who indicated not needing cervical cancer screening or who did not report their preference for any screening modality (home-based self-sampling or clinician-collected sampling) were excluded. Data were analyzed from May 12 to 25, 2025. Age, race and ethnicity, income, educational level, sexual orientation, marital status, health insurance, urbanicity of residence, trust in the health care system, past-year number of visits to a health care practitioner, and prior experience of discrimination or prejudice when getting medical care. The main outcome was preference for at-home vaginal self-sampling over clinic-based testing, measured using the HINTS 7 question, "If you had choice, how would you prefer to do the cervical cancer screening test?" Responses were: preference to have a health care practitioner do the test in his or her office, preference to self-collect specimen for the test at home, not knowing which option to choose, and not applicable. Weights were assigned to improve representativeness of the general US adult population. The proportion of individuals who reported preferring either screening modality was estimated using weighted percentages. Survey-weighted odds ratios (ORs), adjusted for covariates, were calculated to identify factors associated with preference for at-home self-sampling. Among the 2300 women included (mean [SD] age, 45.5 [29.2] years), most were married or living as married (weighted percentage, 58.2% [95% CI, 56.5%-60.0%]), health insured (91.9%; 95% CI, 90.7%-93.1%), and educated up to some college (61.6%; 95% CI, 60.1%-63.0%). Overall, 462 (20.4%; 95% CI, 17.4%-23.4%) preferred at-home self-sampling, 1402 (60.8%; 95% CI, 57.2%-64.4%) preferred clinic-based testing, and 436 (18.8%; 95% CI, 15.5%-22.1%) were uncertain about their choice. Non-Hispanic Black respondents (adjusted OR [AOR], 0.45; 95% CI, 0.21-0.96) had lower odds of preferring at-home self-sampling compared with non-Hispanic White individuals. Women who had experienced prejudice or discrimination when getting medical care had higher odds (AOR, 1.94; 95% CI, 1.16-3.22) of preferring at-home self-sampling. The most commonly self-reported reasons for preferring at-home self-sampling were privacy (54.9%; 95% CI, 49.8%-60.0%), time constraints (35.1%; 95% CI, 29.0%-41.2%), and fear of embarrassment (33.4%; 95% CI, 28.0%-38.8%). In this cross-sectional study, marginalized populations, individuals with low income, and individuals who do not trust the health care system were more likely to prefer at-home self-sampling for cervical cancer screening or not know which option to choose. To address cervical cancer inequities and increase screening uptake, the findings suggest US guidelines should incorporate home-based self-sampling as an alternative to clinic-based testing, women's education and empowerment should be enhanced, and tailored interventions focusing on high-risk groups are needed to increase awareness and self-confidence in performing home-based self-sampling.

Exploring perceptions of cannabis use and employment implications among healthcare workers: a single-institution experience.

Maternal evaluation during routine antenatal care visits may reduce maternal morbidity and mortality by identifying and addressing issues early on. A health recommender system could help health professionals and pregnant women monitor daily health parameters, provide tailored recommendations, and support timely antenatal care. This study aims to qualitatively analyze challenges in the preimplementation of health recommender system for maternal care in Indonesia as perceived by multiple stakeholders, including health care providers, patients, health system managers, government officers, and technology vendors. The methodology used a qualitative approach, where qualitative data were obtained from interviews of 37 respondents from multiple stakeholders, consisting of 15 health workers and 15 patients from private and government health care facilities, 4 officers from government health offices, 2 directors of health application vendors, and 1 manager from a private health clinic. These semistructured interview results were analyzed using thematic analysis. This qualitative study identifies key challenges in implementing a health recommender system for maternal care in Indonesia across the people, process, infrastructure, and policy dimensions. Intercoder reliability for the coding process demonstrated almost perfect agreement (Cohen κ=0.90), supporting the consistency of the coding process. Six major challenges were revealed, mostly regarding skill, accuracy, completeness, timeliness, cost, and standardization. These 6 major challenges were mentioned 96 times, accounting for 64.43% of all codes extracted from the interviews. These findings emphasize the value of user involvement in system design to meet health care professionals' and patients' needs, technical advancements to foster trust and support effective decision-making, as well as enhanced data accuracy, reliable and timely service delivery, cost management, and clear regulatory standards. This formative, preimplementation qualitative study highlights the importance of involving users in system design and future implementation to meet the needs of health care professionals and patients. Reducing input errors and improving system reliability are critical to building trust and supporting effective point-of-care decision-making and, in later phases, facility-level monitoring as part of public health surveillance. Adherence to regulatory standards and the establishment of standardized guidelines will be key to enabling broader implementation. Further usability, feasibility, and pilot studies are required before any evaluation of effectiveness.

COVID-19 vaccines are safe and effective in pregnancy, but vaccine hesitancy limits uptake and effectiveness. This study explored COVID-19 vaccine hesitancy in pregnancy in Kilifi, coastal Kenya, to elicit reasons for vaccine hesitancy and acceptance, and to compile misconceptions around vaccination in pregnancy. Twenty-three in-depth interviews were conducted with pregnant women, mothers who had given birth in the previous 2 years and health workers (community health promoters, nurses, and supervisors). Data were analyzed using thematic template analysis based on the Vaccine Hesitancy Determinants Matrix. Concern about vaccine safety for the unborn baby was a major driver of hesitancy. Many pregnant women had limited knowledge of the potential benefits to the unborn baby, leading to postponing vaccination until after pregnancy. The initial government exclusion of pregnant women from vaccination led many to believe that vaccines were unsafe in pregnancy, long after the eligibility was revised. Aggressive promotion of the vaccine by the government was a source of mistrust and misconceptions. Integrating COVID-19 vaccination into routine antenatal care improved acceptance and development and dissemination of local guidelines boosted healthcare workers’ confidence in offering vaccines to pregnant women. Future rollouts of vaccines for pregnant women should consider vaccination within antenatal care clinics alongside other routine pregnancy vaccines to enhance vaccine acceptance.

Mpox (monkeypox) remains a global public health threat. However, data on mpox-related knowledge, attitudes, and practices (KAP) and vaccination willingness among Chinese medical students, who are key future health care practitioners, remain lacking. This study aimed to investigate systematically the KAP and mpox vaccination willingness of Chinese medical students and identify the factors influencing their vaccination decisions. A nationwide cross-sectional survey was conducted from November 2023 to March 2024. An anonymous self-designed questionnaire was used to assess basic information, KAP toward mpox, vaccination-related behaviors, and willingness. Categorical data were presented as frequency (constituent ratio). The normality of continuous variables was assessed using the Kolmogorov-Smirnov test. Continuous variables that did not conform to a normal distribution were presented as median (IQR). Data were analyzed using the chi-square test, 2-tailed t test, ANOVA, Kruskal-Wallis H test, and multinomial logistic regression. Among the 4098 participants, 84.63% (n=3468) accepted mpox vaccination. The median scores of KAP toward mpox were 43 (IQR 33-50), 33 (IQR 32-36), and 20 (IQR 19-24), respectively, with a median score of 73 (IQR 68-79) for vaccination-related practices. Multinomial logistic regression showed that factors associated with vaccination hesitancy (vs acceptance) included male individuals (odds ratio [OR] 1.416, 95% CI 1.158-1.732), being an only child (OR 1.340, 95% CI 1.098-1.635), no history of COVID-19 in family or friends (OR 1.520, 95% CI 1.161-1.991), no influenza vaccination (OR 1.429, 95% CI 1.146-1.783), and low mpox knowledge (OR 0.948, 95% CI 0.941-0.955). Factors associated with vaccination rejection (vs acceptance) included male sex (OR 1.641, 95% CI 1.003-2.686), high academic grade (OR 1.442, 95% CI 1.154-1.802), family or friends working on COVID-19 frontlines (OR 2.243, 95% CI 1.337-3.764), no internship experience (OR 2.049, 95% CI 1.076-3.901), presence of organic diseases (OR 3.733, 95% CI 1.778-7.838), and low mpox knowledge (OR 0.954, 95% CI 0.938-0.971). Good self-reported health status was a protective factor against refusal (OR 0.748, 95% CI 0.580-0.965). The high willingness to receive mpox vaccination among Chinese medical students and its determinants, as identified in this study, carry clear implications for both education and policy. These findings inform the design of targeted health education programs for students and guide the development of evidence-based prevention strategies on campuses during public health emergencies.

Advancements in monitoring adverse events following immunization in Iraq: Insights from the CIVIE project 2022-2023.

Educators are challenged to keep courses relevant amid fast-changing technology and knowledge, yet systematic approaches for continuous course updates remain underdeveloped. To address this gap, we propose the Course Development-Quality Function Deployment (CD-QFD) framework, which adapts organizational QFD principles that center on creating value for customers as a core objective. Our objective is to provide educators with a streamlined, student-centered framework that can guide the continuous alignment of courses with evolving competency requirements. Methodologically, CD-QFD integrates insights from internal and external sources to identify learner competencies and map them onto interconnected matrices that align with the QFD principles. A case study of digital literacy course development for healthcare workers illustrates the practical deployment of CD-QFD. The contribution of this work lies in offering a systematic, discipline-neutral process for curriculum development that enables educators to refine competencies into specific subject areas, topics, modules, sections, and, finally, lesson objectives.

Vaccination is a highly cost-effective public health measure, and the importance of adult vaccination should not be overlooked. This guideline was jointly developed by experts and clinicians from national, provincial, and municipal centers for disease control and prevention, as well as universities, with the aim of establishing an authoritative, expert-recommended guideline on adult vaccination. During its development, experts referred to the latest domestic and international guidelines and research on adult vaccination. The scientific rigor and practicality of the guideline were ensured through systematic literature reviews and in-depth expert discussions. It primarily covers the following: the current status of adult vaccination domestically and internationally, recommended vaccines for adults, vaccination recommendations for key populations, and the challenges and future directions for adult vaccination. Its core goal is to achieve lifelong immunization across the entire population, promote adult vaccination, and provide scientific and standardized guidance for healthcare workers. This will help increase adult vaccination rates, reduce the risk of vaccine-preventable diseases, and ultimately protect public health.