Disparities in access and three-year survival of patients with ST-elevation myocardial infarction treated in percutaneous coronary intervention-capable hospitals within the Brazilian public and private healthcare systems: The VICTIM extended registry.

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).

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.

Burnout among Algerian public healthcare workers: Prevalence, predictors, and the protective roles of self-compassion and communication skills

The relationship between Myers-Briggs type indicator personality types and career satisfaction among radiographers: A cross-sectional study.

Employee performance is an important factor in improving the quality of services in health institutions. The work environment and compensation are considered factors that may influence employee performance either directly or indirectly through job satisfaction. This study aims to analyze the effect of the work environment and compensation on employee performance with job satisfaction as an intervening variable at Barung-Barung Balantai Public Health Center, Pesisir Selatan Regency. This research employed a quantitative approach using Structural Equation Modeling (SEM) based on Partial Least Squares (PLS) with SmartPLS 3.0 as the analytical tool. The population consisted of all employees of the Barung-Barung Balantai Public Health Center totaling 89 employees. The sampling technique used was saturated sampling, resulting in 30 respondents as the research sample. The results show that the work environment does not have a significant effect on job satisfaction, while compensation has a significant effect on job satisfaction. Furthermore, the work environment has a significant effect on employee performance, whereas compensation does not significantly affect employee performance. Job satisfaction also does not significantly influence employee performance. In addition, job satisfaction is not able to mediate the effect of the work environment and compensation on employee performance. These findings indicate that improving employee performance at the Barung-Barung Balantai Public Health Center is more directly influenced by the work environment rather than through job satisfaction as an intervening variable.

Chronic lymphocytic leukaemia (CLL) is a common adult leukaemia, and selecting the most effective first-line treatment is crucial for optimising patient outcomes and managing healthcare costs. While chemoimmunotherapy (CIT) has been the standard approach, targeted therapies offer promising alternatives for treatment-naïve CLL patients. The objective of this study was to evaluate the cost effectiveness of chemoimmunotherapy compared to targeted therapies for treatment-naïve CLL patients in South Africa. A cost-effectiveness analysis was conducted using a Markov model based on three health states: progression-free survival (PFS), progression, and death. The model employed a 15-year time horizon and a 1-month cycle length. Patient-level data were reconstructed, and parametric estimation was used to project long-term clinical outcomes. Cost estimates were derived from national tariffs, reflecting a South African public healthcare perspective, while utilities were sourced from published literature. Outcomes were measured in total costs and quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were calculated and compared to a willingness-to-pay (WTP) threshold, and sensitivity analyses were conducted to test the robustness of the results. Among the evaluated treatment strategies, chlorambucil-plus-obinutuzumab (ClbO) had the lowest cost and served as the reference comparator. Both CIT regimens were cost effective, with fludarabine, cyclophosphamide, and rituximab (FCR) yielding an ICER of US$1645.52 per QALY gained and bendamustine-plus-rituximab (BR) had an ICER of US$1716.79 per QALY gained, both below the US$3407 WTP threshold, under the model assumptions. Ibrutinib generated the highest QALYs but at a higher cost, resulting in an ICER of US$19,679.52 per QALY gained and a 0% probability of being cost effective at the WTP threshold, while venetoclax-plus-obinutuzumab (VenO) was extendedly dominated, and therefore eliminated from the results. Sensitivity analyses confirmed the robustness of the findings across variations in key parameters. In the South African public healthcare setting, CIT regimens (FCR and BR) represent cost-effective first-line treatment strategies for symptomatic, treatment-naïve CLL. Bendamustine-plus-rituximab emerged as the most decision-robust option under uncertainty, while FCR yielded the lowest point-estimate ICER. Among CIT regimens, FCR may be preferred in fit patients, while BR represents a more decision-robust option in older or unfit populations. Targeted therapies such as ibrutinib and VenO, despite superior clinical efficacy, are not cost effective at current prices. Substantial price reductions, generic entry, or targeted use in high-risk subgroups may improve their value and enable equitable access within South Africa's resource-constrained health system.

Comparative Trends in Statin Utilization and Expenditures in the Public and Private Healthcare Sectors in Malaysia: Insights From the Malaysian Statistics on Medicines, 2004-2022.

Purpose Pakistan’s public hospitals face persistent nurse shortages, and high turnover is a major cause of this problem. This study examines whether workplace bullying increases nurses’ turnover intentions. It focuses on two forms of bullying (work-related and person-related), tests job satisfaction as a mediator and examines self-efficacy as a moderator. Design/methodology/approach Data were collected using a stratified sampling approach from nurses working in government hospitals. The final sample included 448 nurses from public hospitals in Sindh Province. The data were analyzed using Statistical Package for the Social Sciences (SPSS) and SmartPLS 4.0. Findings Both work-related and person-related bullying are linked with lower job satisfaction. Job satisfaction is also linked with lower turnover intention. In addition, job satisfaction explains part of the link between bullying and turnover intention. Self-efficacy moderates the relationship between job satisfaction and turnover intention, such that the negative effect of low job satisfaction on turnover intention is weaker among nurses with higher self-efficacy. Originality/value This study provides practical guidance for hospital managers and human resources (HR) staff seeking to reduce turnover by addressing bullying and improving job satisfaction. It also offers policy-relevant evidence for retention strategies in public healthcare settings in developing countries, including Pakistan.

ABSTRACT GLP-1 agonists (e.g. Ozempic, Wegovy, Mounjaro) have been framed as breakthrough drugs for weight loss, often promoted by pharmaceutical companies under the guise of tackling weight stigma. This study examines public discourse surrounding GLP-1 agonists in Spanish digital news media, focusing on how these drugs are discussed in relation to fatness, moralization, medicalization, and pharmaceuticalization. Drawing on a reflexive thematic analysis of 648 user comments posted between 2022 and 2024 in three Spanish media outlets, we identify key narrative patterns shaping public debate. Our findings reveal three interrelated themes. First, discussions of GLP-1s are deeply embedded in fatphobic moralization. Pharmacological weight loss is frequently portrayed as a form of “cheating,” contrasted with supposedly “legitimate” weight loss achieved through effort, reproducing hierarchies that distinguish between “deserving” and “undeserving” fat bodies. Second, these hierarchies extend into debates about public healthcare funding. While users articulated four stances from full public funding to outright refusal, all remained anchored in logics of blame and deservingness, framing fatness as an individual or social burden rather than as a legitimate form of embodiment. Third, although commenters expressed strong skepticism toward pharmaceutical companies and media outlets, often criticizing profit-making and medicalization, this critique did not align with fat-acceptance perspectives and ultimately reinforced the weight-centered health paradigm by leaving intact the assumption that body weight is the primary marker of health and the central object of intervention. Overall, public discourse on GLP-1 agonists in Spain reproduces and reorganizes anti-fat frameworks through processes of pharmaceuticalization.

Introduction Self-admission models allow patients to directly contact their psychiatric ward for brief inpatient care based on self-assessed need. To ensure equitable access across all psychiatric services, a broadly applicable, transdiagnostic model for self-admission was developed in Region Stockholm - Sweden's largest public healthcare provider. This study aimed to explore patients' experiences of access to self-admission and its impact on everyday life during mental health problems. Methods Sixteen semi-structured interviews were analyzed using thematic analysis. Results The analysis yielded one overarching theme, From safety to agency, and three themes: Sense of security, Care that supports and Facilitating recovery. The findings illustrate that the self-admission model fostered safety and autonomy and was perceived as facilitating coping strategies, crisis plans, and greater self-awareness and self-management, helping prevent deterioration and reducing emergency care needs. The model also supported maintaining meaningful routines and social connections. Although generally perceived as empowering, some participants struggled with increased autonomy and emphasized the need for greater involvement of relatives. Discussion The self-admission model appears to effectively promote person-centred care and personal recovery. The study supports previous research as well as demonstrates that a transdiagnostic self-admission model can assist patients with mental health conditions.

The training of health specialists is a strategic component for the operational, human, and territorial sustainability of the public health system. However, Chilean university training models-primarily oriented toward technical efficiency-have tended to marginalize the relational and ethical dimensions of care, weakening the experience of care and diminishing trust in health institutions. From a theoretical-reflective perspective, this article explores the possibilities and tensions that arise when transferring the principles of radical care and their performative version, Embodying Radical Care to the field of specialist medical training in Chile, proposing that these approaches may contribute to reconfiguring medical training processes toward an embodied ethics of care. From this perspective, the article develops a comparative analysis of theoretical approaches that integrates care ethics, the politics of interdependence, and performative practice. Incorporating these perspectives could strengthen relational and affective competencies in clinical teaching, deepening the learning process through the ethics of radical care and recognizing bodily experience and ethical sensitivity as dimensions of professional formation. At the same time, these principles could improve the experience of care by fostering a culture that acknowledges interdependence among people, institutions, and territories, thereby consolidating a more humane and sustainable medical practice. Ultimately, this reflection seeks to offer conceptual foundations for public policies on training and humanization in health that understand care not merely as a technical act, but as an ethical, political, and aesthetic practice essential for the sustainability of the health system.

Culture and health: time to act. But how?

Increased use of the emergency department (ED) creates strain on the single-payer public health care system in Canada. To evaluate trends in ED visits and hospital admission rates for urologic conditions in Ontario, Canada, and to determine trends and associated factors for wait times to see a urologist among patients presenting to the ED. This population-based, retrospective cohort study used health administrative data from all EDs and acute care hospitals in Ontario for all adult patients presenting to the ED with a primary urological diagnosis between January 1, 2007, and December 31, 2022. Analyses were performed from January 2023 to April 2024. The main outcome was the rate of ED visits with new urologic diagnoses over time. Crude, age-standardized, and sex-standardized annual rates were estimated for index ED visits and hospital admissions. Wait times to see a urologist after ED visit were also determined. A total of 2 192 213 unique visits to the ED with a main diagnosis of a urologic disorder were identified (mean [SD] patient age, 52.1 [21.2] years; 66.5% female). Of these, 1 732 356 visits represented a new urologic diagnosis (no visits in the prior 2 years). Age- and sex-standardized ED visit rates rose annually from 2007 (0.91 visits per 100 people) to 2015 (1.0 visits per 100 people) (rate ratio [RR], 1.10; 95% CI, 1.09-1.11), then decreased until 2020 (RR, 0.88; 95% CI, 0.87-0.88), before rising again until 2022 (RR, 0.91; 95% CI, 0.90-0.91). Among people seen in the ED with a urologic diagnosis, 10.0% were admitted to the hospital during the study period. The crude rate of admission rose annually (RR, 1.04; 95% CI, 1.03-1.05; P < .001), from 0.07 (95% CI, 0.07-0.08) admissions per 100 people in 2007 to 0.09 (95% CI, 0.09-0.09) in 2022. Patients with greater continuity of outpatient care had lower odds of being admitted. The mean (SD) wait time to see a urologist after an ED visit increased from 62.5 (80.3) days in 2007 to 84.8 (89.3) days in 2014. It subsequently decreased annually until 2022, to 71.1 (70.6) days. Increased comorbidity was associated with lower risk of outpatient urology visit. In this cohort study, the annual ED visit rates for new urologic diagnoses, hospital admissions, and wait times to see urologists significantly increased over the study period. These trends were associated with decreasing continuity of care. This increasing burden of acute urologic disease necessitates investment in health care.

Exclusive breastfeeding (EBF) is essential for infant growth and immunity during the first six months of life. Despite its benefits, many primiparous mothers face challenges in maintaining EBF due to lack of experience, stress, and insufficient support. Husband support has been identified as a crucial social factor that can influence a mother’s confidence and success in breastfeeding. This study aimed to examine the relationship between husband support and the success of exclusive breastfeeding among primiparous mothers in the Kalibaru Public Health Center area. A cross-sectional correlational design was employed, with 90 primiparous mothers selected through purposive sampling. Data were collected using structured questionnaires measuring husband support, including emotional, informational, and instrumental dimensions, and exclusive breastfeeding practice, following the World Health Organization (WHO) definition. Descriptive statistics summarized participants’ demographic characteristics and levels of support, while inferential analysis using the Chi-square test and Pearson correlation determined the association between husband support and EBF success. The results indicated that higher levels of husband support were significantly associated with successful exclusive breastfeeding among primiparous mothers (p &lt; 0.05). Among the types of support, emotional and informational support were particularly influential in enhancing maternal confidence and overcoming breastfeeding challenges. These findings suggest that encouraging husband involvement through prenatal education, counseling, and family-based interventions can improve EBF rates. In conclusion, husband support plays a vital role in the successful practice of exclusive breastfeeding among first-time mothers. Health programs should actively involve fathers to provide emotional, informational, and practical support, thereby promoting optimal breastfeeding outcomes and infant health in the community.

Background: The COVID-19 pandemic disrupted essential health services globally, including sexual and reproductive health (SRH). Aim: This study examines the impact of lockdown measures on sexual and reproductive health services in Ekurhuleni Health District, South Africa. Methods: An interrupted time series design was utilised to analyse the impact of COVID-19 restrictions on SRH indicators in the Ekurhuleni Health District, Gauteng Province, South Africa. Monthly data (January 2018 to December 2023) from the web-District Health Information System were used. Indicators included primary health utilisation (PHC), couple-year protection (CYP), antenatal care visits (ANC), maternal mortality ratio (MMR), medical male circumcision (MC), male urethritis syndrome (MUS), female and male condom distributions, and cervical cancer screening. Descriptive statistics and segmented linear regression models were conducted using Stata version 17. Results: PHC utilisation declined significantly during the COVID-19 lockdown (Coef: -0.3%, 95% CI: -0.4 to -0.2) with gradual recovery after the lockdown. ANC first visits before 20 weeks decreased by 5.7% during lockdown (Coef: -5.7%, 95%CI: – 2.8 to -8.5). Cervical cancer screening coverage significantly declined during lockdown with no recovery afterwards (Coef: -29.4%, 95% CI: -37.4 to -21.3). In contrast to these declining trends, the CYP rate remained stable and increased significantly by 18.2% during lockdown (Coef: 18.2%, 95% CI: 3.4 to 32.9). MUS declined by 3.3% during the lockdown period (Coef: -3.3%, 95% CI: -5.7 to -1.0). Conclusion: This study revealed a remarkable impact of the COVID-19 lockdown on sexual and reproductive health services indicators. While primary health care utilisation experienced a moderate decline and gradual recovery, other indicators, such as ANC, cervical cancer, and MUS, showed persistent negative disruptions.

This study aims to investigate the role of Green Human Resource Management Practices (GHRMPs) in pro-environmental behaviour (PEB) among healthcare workers in public hospitals in Lagos State, Nigeria. It further examines the mediating role of Green Autonomy (GA) and the moderating effect of sustainable leadership (SL) grounded by the ability-motivation-opportunity (AMO) theory, social exchange theory (SET) and self-determination theory (SDT). An analytical, cross-sectional research design was employed, utilizing convenience sampling to gather data from 326 healthcare workers. The study employed a structured questionnaire adapted from reputable sources to measure the constructs. The proposed model was analysed using partial least squares structural equation modelling (PLS-SEM) with SmartPLS 4.0 to assess both direct and indirect relationships among variables. The results revealed that GHRMPs have a significant effect on PEB and GA. GA also significantly predicted PEB and partially mediated the relationship between GHRMPs and PEB. Additionally, SL moderated the relationship between GA and PEB, such that higher levels of SL weakened the positive effect of GA on pro-environmental PEB. However, SL did not moderate the relationship between GHRMPs and PEB. The study guides healthcare administrators and policymakers in strengthening PEB among healthcare workers. Hospital management can improve environmental performance through effective GHRMPs and bounded support for GA and SL that provides clear direction, standards and accountability. These measures can enhance environmental performance in public hospitals and support broader sustainability goals. This study is the first to examine GHRMPs, GA, SL and PEB together in Nigerian public hospitals through the lens of AMO, SET and SDT.

As artificial intelligence (AI) becomes increasingly embedded in clinical workflows, clinicians encounter ethical challenges that traditional, principle-based medical ethics education may not adequately address. Empirical evidence on clinicians' experiences with AI-related ethics is limited, constraining curricular improvement. This qualitative study explores how early-career doctors in Singapore perceive and negotiate ethical dilemmas arising from clinical AI use and translates findings into an operationalised competence framework for medical education. Between April and June 2025, we conducted semi-structured interviews with 30 early-career doctors (1-5 years post-graduation) from nine public healthcare institutions in Singapore. Purposive sampling ensured diversity across specialties, institutions, gender and ethnicity. Interviews explored participants' AI-related ethical challenges in day-to-day practice and their perceptions of ethics training in medical school. Data were analysed using Braun and Clarke's (2022) reflexive thematic analysis, with codes developed iteratively and informed by the four classical bioethical principles as sensitising concepts-autonomy, beneficence, non-maleficence and justice. Interdisciplinary reflexive discussions guided the construction and interpretation of themes. Participants reported limited formal AI education. Seven recurring practical ethical challenges were identified: (1) system opacity, (2) dataset bias and generalisability, (3) data privacy and consent in networked environments, (4) insufficient patient-specific contextualisation of outputs, (5) risks of hallucinations, (6) ambiguous accountability and (7) cognitive offloading. These themes reframed classical bioethical principles through epistemic, relational and institutional lenses. Ethical competence for AI-mediated care requires integrated epistemic and relational capacities beyond technical literacy or traditional medical ethics. We propose the Digital-Age Clinical AI Ethics Competence (DCEC) framework, comprising four domains of epistemic awareness, relational integrity, reflexive accountability and adaptive professionalism, anchored by ethical digital literacy (EDL). Each domain is operationalised with specific learning activities and assessment strategies such as Objective Structured Clinical Examination(OSCE) stations, reflective portfolios and ethics viva. We discuss implications for curriculum design, faculty development and competency-based assessment.

Testing for high-risk human papillomavirus with genotyping for types 16 and 18 (HPV16/18) and triage by p16/Ki-67 dual-stain immunocytochemistry improves diagnostic performance in cervical cancer screening. We estimated the cost-effectiveness of HPV DNA-based primary screening strategies that detect high-risk genotypes every 5 years with either reflex cytology (hrHPV-Pap-5) or reflex dual stain (CINtec® PLUS, Roche; hereafter hrHPV-CINtec-5) versus cytology every 3 years (SoC (PAP-3)) among women aged 25-64 years, from the Chilean public healthcare perspective. A state-transition microsimulation reflected the natural history of cervical cancer in screening-eligible Chilean women, using local epidemiology and literature-informed inputs. Direct medical costs were obtained from official Chilean sources and converted to USD (1 USD = 938 CLP). Deterministic and probabilistic sensitivity analyses were conducted; a 30-64 years initiation scenario was also evaluated. Both high-risk HPV DNA-based strategies were more effective and cost-saving than SoC (PAP-3). In the 25-64 base case, hrHPV-CINtec-5 yielded the greatest health gain (13,003 incremental Quality-Adjusted Life Year, hereafter QALYs) with $16.65 saved per woman, while hrHPV-Pap-5 saved $32.57 with 12,844 QALYs. Probabilistic sensitivity analysis confirmed dominance (most simulations in the southeast quadrant) and cost-effectiveness acceptability >90% across willingness-to-pay ranges. Deterministic analysis highlighted progression risk from HPV16/18 and the discount rate as key drivers. Transitioning from PAP-3 to high-risk HPV DNA-based primary screening in Chile is projected to improve health outcomes while reducing costs. Among HPV DNA-based strategies detecting high-risk genotypes evaluated, triage with hrHPV-CINtec-5 provided the largest health gain while remaining cost-saving; hrHPV-Pap-5 maximized cost savings. These findings support modernizing the national screening program.

Supplementary information for: Fostering compassionate public healthcare leadership towards sustainability: Evidence from Bihar, India