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Background: The optimal application of medical nutrition therapy (MNT) in treating gestational diabetes remains uncertain. MNT involves individualised nutrition assessment and counselling, which is labour-intensive and is not the sole type of intervention offered by clinical dietitians. Objective: To determine whether pregnancy outcomes differed for individuals with gestational diabetes who were offered MNT on a risk-prioritised (RP) versus universal basis. Methods: Observational data from two cohorts of individuals who were offered MNT only if they met the high-risk criteria following general group-based dietary education (RP1, n = 369; RP2, n = 446) were compared with a baseline cohort who were universally offered at least one MNT consultation (UM, n = 649). The RP1 cohort were seen during community-wide COVID-19 restrictions in 2021, while RP2 were seen after restrictions had lifted in 2022. Furthermore, the RP approach primarily utilised telemedicine, while the UM approach was delivered in person. Results: MNT consultations halved under the RP approach (59 vs. 119 sessions per 100 diagnoses for RP2 vs. UM) and saved more than 20 h of dietitian time per 100 diagnoses (95 vs. 73 h for RP2 vs. UM). No significant increases were observed (p < 0.05) for any pregnancy outcomes in the RP cohorts compared with the UM cohort, including usage of diabetes medications, maternal weight gain below and above target, early deliveries, induced deliveries, emergency caesarean sections, large- and small-for-gestational-age (SGA) infants, infant macrosomia, neonatal hypoglycaemia and neonatal intensive care admissions. The use of both basal insulin (27% vs. 33%, OR 0.62, 95% CI 0.46 to 0.84) and metformin (6% vs. 10%, OR 0.52, 95% CI 0.31 to 0.88) was lower in the RP1 cohort during pandemic restrictions compared with the UM cohort; however, these differences were not retained in the RP2 cohort. Additionally, there were fewer SGA infants under the RP approach, particularly for the RP2 cohort (6% vs. 11% for RP2 vs. UM, OR 0.55, 95% CI 0.34 to 0.89). Conclusions: Risk-prioritised MNT was a more efficient dietetic service approach to gestational diabetes than the universal MNT model, with comparable pregnancy outcomes. Similar approaches may represent a strategic way to address sustainable health service planning amidst the rising global prevalence of this condition. However, further research is needed to investigate consumer perspectives, wider service impacts and post-partum maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

Background: Community needs assessments can provide valuable insights concerning the health of communities. This study aims to measure health priorities according to community members in Jazan, Saudi Arabia, to assess healthcare service utilization, barriers to accessing these services, and preferences for utilizing government or private healthcare services. Method: Multistage sampling was utilized to reach a sample of adults in community settings. The assessment was performed via personal interviews utilizing a structured questionnaire to measure demographics, health priorities, service utilization, barriers, and preferences for healthcare settings. Chi-squared tests, Student's t-tests, and multivariate regression analysis were used to assess the differences between demographics and service utilization according to the preferred healthcare settings. Results: A total of 3411 participants were recruited for the assessment. The mean age of the participants was 34 years, and 51% were male. The participants viewed diabetes as the most important health condition. Emergency services and primary care were viewed as the most important healthcare services, and time constraints were the main barriers to healthcare accessibility. Thirty-six percent of the participants preferred to utilize healthcare services in the private sector, where age, gender, nationality, education, income, housing type, and family size were statistically associated with the preference for seeking healthcare in either the private or government sectors (p < 0.05). Conclusions: Future assessment is required to recruit healthcare providers and decision-makers to understand the process of strengthening multidisciplinary collaboration to tackle chronic diseases such as diabetes, strengthen the role of emergency and primary healthcare services, and address time constraints pertaining to healthcare accessibility. [ABSTRACT FROM AUTHOR]

Background: Early initiation of breastfeeding (within the first hour postpartum) is crucial for maternal and child health, but Jharkhand exhibits the highest prevalence of delayed initiation, with over three-fourths of mothers affected. Existing literature lacks localized insights into district-level disparities and the socio-economic and healthcare determinants of delayed initiation, particularly in socio-economically disadvantaged regions like Jharkhand. Objectives: This study aims to (1) assess the prevalence of delayed breastfeeding initiation across Jharkhand's districts, (2) create a spatial map categorizing districts into three priority zones (P1, P2, and P3), and (3) identify socio-economic and demographic factors associated with delayed breastfeeding initiation. Methods: A cross-sectional analysis of 5,196 breastfeeding mothers from NFHS-5 (2019–2021) was conducted. District-wise prevalence rates were calculated, and a multivariable logistic regression analysis was performed using Stata-MP-17 to identify significant correlates. Results: Jharkhand's overall prevalence of delayed initiation was 77.1%, with Jamtara (86.6%) and Khunti (84.6%) reporting the highest rates. Twelve districts were categorized as Priority Level 3 (red zone). Key determinants included poor economic background (aOR = 1.379, p ≤ 0.05) and caesarean deliveries (aOR = 2.325, p < 0.001), both of which increased the odds of delayed initiation. Institutional deliveries were associated with significantly reduced odds (aOR = 0.653, p < 0.001). Conclusion: High-priority districts such as Jamtara and Khunti require immediate intervention through targeted maternal health programs promoting institutional deliveries. Strategies must include tailored outreach to disadvantaged groups, awareness campaigns on breastfeeding benefits, and addressing cultural barriers, especially in rural and tribal regions, to improve maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background It is vital that health service delivery and health interventions address patients’ needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach. Methods This multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3. Results Overall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas. Conclusions This study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities.

Abstract Background Achieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions. Methods Purposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration. Results Eleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed. Conclusion Our findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems.

Background and purpose: Self-care is recognized as a fundamental approach in the field of providing, maintaining, and promoting health in individuals, families, and society. Providing essential training in the field of self-care is one of the important tasks of primary health service systems to the community, including household health ambassadors. On the other hand, determining the educational needs of self-care in each society should be based on the educational needs assessment in the same society. Therefore, the present study was conducted to determine the educational priorities of self-care using the educational needs assessment of health ambassadors. Materials and methods: The current study is a cross-sectional study (descriptive-analytical). The research community included household health ambassadors living in the Golestan and Mazandaran provinces. Entry criteria included being family health ambassadors, being between the ages of 20 and 60, and volunteering to enter the program. Also, the exclusion criteria included the health ambassador's unwillingness to participate in the evaluation. The study tools included a demographic questionnaire and a researcher-made questionnaire on "self-care educational needs" for health ambassadors. The health ambassadors' needs assessment questionnaire was the result of self-care educational priorities based on a general survey of the community, which was scored by the health ambassadors. Data analysis was done using SPSS version 20 software. U-Mann-Whitney and Kruskal-Wallis tests were used to analyze the data. Results: Results showed that the average age of health ambassadors participating in the study was 38.11±9.64 years. 987 people (57.8 percent) of them were health ambassadors of Golestan province and 721 people (42.2 percent) of them were health ambassadors of Mazandaran province. Also, concerning the participants' gender, 1439 people (84.3%) were women and 269(15.7%) were men. The educational needs assessment showed the top 10 priorities among self-care education topics determined by household health ambassadors, including stress and anxiety, healthy eating, life skills, parenting skills, water hygiene, inactivity, depression, skeletal problems, and lack of vitamins. , and oral and dental health. It was also shown that there is a statistically significant difference between different subgroups of participants such as gender, place of residence, education level, occupation, and ethnicity with self-care educational priorities in household health ambassadors (P

Introduction: Older adults with cancer facing competing treatments must prioritize between various outcomes. This study assessed health outcome prioritization among older adults with cancer starting chemotherapy. Methods: Secondary analysis of a randomized trial addressing vulnerabilities in older adults with cancer. Patients completed three validated outcome prioritization tools: 1) Health Outcomes Tool: prioritizes outcomes (survival, independence, symptoms) using a visual analog scale; 2) Now vs. Later Tool: rates the importance of quality of life at three times—today versus 1 or 5 years in the future; and 3) Attitude Scale: rates agreement with outcome‐related statements. The authors measured the proportion of patients prioritizing various outcomes and evaluated their characteristics. Results: A total of 219 patients (median [range] age 71 [65–88], 68% with metastatic disease) were included. On the Health Outcomes Tool, 60.7% prioritized survival over other outcomes. Having localized disease was associated with choosing survival as top priority. On the Now vs. Later Tool, 50% gave equal importance to current versus future quality of life. On the Attitude Scale, 53.4% disagreed with the statement "the most important thing to me is living as long as I can, no matter what my quality of life is"; and 82.2% agreed with the statement "it is more important to me to maintain my thinking ability than to live as long as possible". Conclusion: Although survival was the top priority for most participants, some older individuals with cancer prioritize other outcomes, such as cognition and function. Clinicians should elicit patient‐defined priorities and include them in decision‐making. In this secondary analysis of 219 older participants (median age 71 years) from a randomized trial addressing vulnerabilities in older adults with cancer, 61% prioritized survival over other outcomes such as maintaining their independence or being free from symptoms. Clinicians should elicit patient‐defined priorities and include them in decision‐making when discussing treatment. [ABSTRACT FROM AUTHOR]

Increased patient advocacy has resulted in a shift toward more active patient engagement in the research. A scoping review was conducted to explore the literature on healthcare research priority settings wherein children, youths, or their families were involved in the priority-setting process. Six databases including MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, and Global Health and the James Lind Alliance website were searched up until September 2019. All primary studies involving children (<18 years of age) or families in developing research priorities in health care were included. All retrieved references were uploaded into Covidence, and two independent reviewers screened the search results. Descriptive thematic analysis was used to identify common themes. A total of 30 studies with 4247 participants were included. Less than half of the participants (n = 1237, (33%) were pediatric patients and their families. A total of 455 research priorities were identified. Three common themes emerged: (i) quality of care delivery, (ii) self-efficacy in health behaviors, and (iii) community engagement in care. This scoping review revealed priority research health topics from the perspectives of children, youths, or their families. The findings may be used as a foundation for future research to improve the health outcomes of children, youths, or their families according to their identified priorities. [ABSTRACT FROM AUTHOR]

Background: Achieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions. Methods: Purposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration. Results: Eleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed. Conclusion: Our findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems. [ABSTRACT FROM AUTHOR]

Background: It is vital that health service delivery and health interventions address patients' needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach. Methods: This multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3. Results: Overall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas. Conclusions: This study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities. [ABSTRACT FROM AUTHOR]

Purpose: To examine associations between sociodemographic variables, social determinants of health (SDOHs) and diabetes using health needs assessment data. Design: Cross-sectional study. Setting: Faith-based communities in the Mid-South U.S. Sample: Of the 378 churches, 92 participated in the study (24% response rate); N = 828 church leaders and members completed the survey. Measure: The Mid-South Congregational Health Survey assessed perceived health-related needs of congregations and the communities they serve. Analysis: Generalized linear mixed modeling examined the associations between sociodemographic variables (age, sex, race/ethnicity, educational level), SDOHs (affordable healthcare, healthy food, employment), and diabetes. Results: Individuals with less education had lower odds of reporting all SDOHs as health needs compared to individuals with more education (ORrange =.59-.63). Men had lower odds of reporting diabetes as a health need or concern compared to women (OR =.70; 95% CI =.50,.97). African Americans had greater odds of reporting diabetes as a health need compared to individuals in the 'Other' race/ethnicity category (OR = 3.91; 95% CI = 2.20, 6.94). Individuals who reported affordable healthcare (OR = 2.54; 95% CI = 1.73, 3.72), healthy food (OR = 2.24; 95% CI = 1.55, 3.24), and employment (OR = 3.33; 95% CI = 2.29, 4.84) as health needs had greater odds of reporting diabetes as a health need compared to those who did not report these SDOHs as needs. Conclusions: Future studies should evaluate strategies to merge healthcare and faith-based organizations' efforts to address SDOHs impacting diabetes. [ABSTRACT FROM AUTHOR]

Though vital to health policymaking processes, little is known about the distribution of attention to issues global health journals focus on or their alignment with commitments to health equity. We developed a new framework and methods to help address these analytical gaps. We used content analysis to systematically identify and novel methods to measure attention to themes, subthemes and geographies represented in more than 2,000 research articles published in two of the longest-running multidisciplinary global health journals, Bulletin of the World Health Organization and Health Policy and Planning, between 2004 and 2018. We found four major themes—health systems and conditions received the most attention, followed by population groups and policy dynamics. Finer grained analysis shows that the broad-based journals feature many common themes and some, including subthemes like communicable diseases, financing and children, are heavily favoured over others, such as workforce and noncommunicable diseases. It reveals publishing gaps for some highly marginalised groups and shows attention to health equity fluctuates. The new framework and methods can be used to (1) check the distribution of publishing attention for consistency with global health and specific journal aims and (2) support inquiry into priority setting dynamics in the broader research publishing arena.

Ibrahim M Gosadi, Mohammad A Jareebi Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi ArabiaCorrespondence: Ibrahim M Gosadi, Department of Family and Community Medicine, Faculty of Medicine, Jazan University, P.O. Box: 2349, Jazan, 82621, Saudi Arabia, Tel +966562137711, Email gossady@hotmil.comPurpose: This study aims to measure the perceived healthcare priorities, barriers, and preferences when selecting private or governmental healthcare services among a sample of university affiliates from Saudi Arabia.Methods: This study utilized a cross-sectional design to reach targeted adults on the Jazan University campus. Data were collected during personal interviews. The questionnaires measured participant demographics, perceived healthcare priorities, barriers, and preferences when selecting private or governmental healthcare services. A chi-squared test was used to detect statistically significant differences between demographic and clinical characteristics according to preferences in their healthcare-seeking behavior.Results: A total of 3083 university affiliates participated in this investigation. The mean age of the participants was 28 years, 49.6% of whom were males. Among the sample, 63% were students, and the remaining were university staff. The health condition perceived as most important was diabetes, and most of the sample viewed primary healthcare as the most vital service. The healthcare-seeking behavior of the sample indicated a higher preference for using governmental healthcare services. However, notable barriers related to the availability of appointments, long waiting times when visiting a healthcare facility, and healthcare costs were identified. Preference for private healthcare services was higher among females, expatriates, non-Arabic speaking affiliates, those with higher socioeconomic status, and health insurance owners (p-values < 0.05). Additionally, higher utilization of private healthcare services was noted among participants who frequently visit dentists and physicians and those performing consistent, routine medical checkups (p-values < 0.05).Conclusion: The findings indicate the importance of strengthening the role of primary healthcare to address the health needs required for preventing and managing chronic diseases, such as diabetes. Additionally, enhancing access to and effectiveness of primary healthcare may reduce the impact of healthcare barriers associated with limited appointments and prolonged waiting times.Keywords: health priorities, barriers, perception, preference, Jazan, Saudi Arabia

Lyazzat Kulembekova,1 David Hailey,2 Maksut Kulzhanov,1 Adlet Tabarov,3 Svetlin Georgiev,4 Magdalena Jaworzynska,5 Antoniya Yordanova Yanakieva,4 Lyazzat Kosherbayeva1,6 1Health Policy and Management Department, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; 2School of Information Sciences and Computer Technology, University of Wollongong, Wollongong, Australia; 3Deputy Director of the National Center for Health Development, Ministry of Health, Astana, Kazakhstan; 4Department HTA, Faculty of Public Health “prof. Tzecomir Vodenitcharov, MD, PhD, Dsc”, Medical University, Sofia, Bulgaria; 5Faculty of Economics, Maria Curie-Sklodowska University, Lublin, Poland; 6Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, KazakhstanCorrespondence: Lyazzat Kosherbayeva, Asfendiyarov Kazakh National Medical University, 88 Tole Bi Street, Almaty, Kazakhstan, Email lyazzat.k@mail.ru; klk.lyazzat@gmail.comBackground: In recent years, involvement of healthcare stakeholders in health technology assessment (HTA) has been discussed as helping the inclusion of social values in the decision-making process. The aim of our research was to identify and compare details from Kazakhstan, Poland and Bulgaria on their stakeholders’ involvement in the HTA process. Information was sought on their identification, responsibilities, and regulation.Methods: We conducted a survey of seven types of stakeholders in the healthcare systems of Kazakhstan, Poland, and Bulgaria. They included patients and the public, providers, purchasers, payers, policy makers, product makers, and principal investigators. They were questioned on their involvement in the HTA process, and on the objectives of their participation.Results: Levels of involvement of different kinds of stakeholder varied between countries, reflecting political and administrative developments. There was full or partial agreement on the objectives of stakeholder participation. All respondents agreed that representatives of the ministry of health should be involved in selection of stakeholders for HTA.Conclusion: Progress has been made in the involvement of stakeholders, with interest in further development in all three countries.Keywords: health priorities, health policy, stakeholder involvement, Universal health coverage, health technology assessment

Abstract Background/Objective Initially established to improve access to healthcare, particularly for primary care, the full potential of the nurse practitioner role is yet to be realised in most countries. Despite this, most countries are working to meet an ageing population’s increasing healthcare needs and reduce healthcare costs and access disparities. Achieving these outcomes requires reform at multiple levels, including nurse practitioner practice pathways, education and regulation, and identifying the barriers and facilitators to optimising their primary care role. Methods A rapid scoping review of nurse practitioner practice pathways, education and regulation inclusive of: (1) a systematic search of Medline and CINAHL for peer-reviewed English language articles, including opinion pieces published between January 2015 and February 2022; and (2) a web-based search of nurse practitioner program entry requirements of International Nurse Regulator Collaborative country members with a protected nurse practitioner title and prescribing rights, plus the Netherlands. The individually summarised search data was integrated and synthesised using Popay’s narrative approach. Results Emerging evidence from the included nurse practitioner courses (n = 86) and articles (n = 79) suggests nurse practitioners working in primary care provide safe, effective care and improve healthcare efficiencies. However, different regulatory and educational models are required if the primary care nurse practitioner is to meet growing demand. Conclusions International variations in entry criteria, curriculum, and regulation shape the global profile of the nurse practitioner primary care workforce and their practice setting. For countries to grow their primary care nurse practitioner workforce to meet unmet needs, different entry requirements, program content and accredited post-registration transitional programs must be urgently considered.

Background/Objective: Initially established to improve access to healthcare, particularly for primary care, the full potential of the nurse practitioner role is yet to be realised in most countries. Despite this, most countries are working to meet an ageing population's increasing healthcare needs and reduce healthcare costs and access disparities. Achieving these outcomes requires reform at multiple levels, including nurse practitioner practice pathways, education and regulation, and identifying the barriers and facilitators to optimising their primary care role. Methods: A rapid scoping review of nurse practitioner practice pathways, education and regulation inclusive of: (1) a systematic search of Medline and CINAHL for peer-reviewed English language articles, including opinion pieces published between January 2015 and February 2022; and (2) a web-based search of nurse practitioner program entry requirements of International Nurse Regulator Collaborative country members with a protected nurse practitioner title and prescribing rights, plus the Netherlands. The individually summarised search data was integrated and synthesised using Popay's narrative approach. Results: Emerging evidence from the included nurse practitioner courses (n = 86) and articles (n = 79) suggests nurse practitioners working in primary care provide safe, effective care and improve healthcare efficiencies. However, different regulatory and educational models are required if the primary care nurse practitioner is to meet growing demand. Conclusions: International variations in entry criteria, curriculum, and regulation shape the global profile of the nurse practitioner primary care workforce and their practice setting. For countries to grow their primary care nurse practitioner workforce to meet unmet needs, different entry requirements, program content and accredited post-registration transitional programs must be urgently considered. [ABSTRACT FROM AUTHOR]

Background: Appropriate priority setting in public health and biomedical research is crucial to make decisions for resource allocation and prioritizing the projects. We studied the research gaps and identified priorities for biomedical research in Sabzevar University of Medical Sciences (SabUMS), located in Sabzevar city in the northeastern part of Iran. Materials & Methods: we used both qualitative and quantitative approaches to determine the public health problems and health research priorities.The processes for priority setting included preparation, problem finding, idea generation, data cleaning and statement development, ranking, and dissemination. We used qualitative research and quantitative surveys for problem findings. We organized two workshops with researchers and public health authorities of Sabzevar city for idea generation, defining criteria for priority setting, and ranking of the research ideas. We used national and international recommendations to prepare a list of research priorities in the region for COVID-19. Results: The criteria for priority setting were concerns of the community, magnitude, and urgency of the problem. In addition, feasibility, the possibility of regional and international research collaboration, and the availability of the infrastructure and capacity to conduct research were used for ranking. The final list of priority areas for research in SabUMS included non-communicable diseases, mental health, drug abuse, accidents, and nutrition respectively. COVID-19 was considered a separate area for research. Conclusion: Experience from this study and follow-up reports would provide best practices in research development in low-resource areas and pave the way for evidence-based public health practice.

Abstract To better understand the specific influences of early life on the long-term health and well-being of local Aboriginal children in Alice Springs, high-quality local longitudinal data is required. The Central Australian Aboriginal Congress and the Murdoch Children's Research Institute are exploring the feasibility of establishing a cohort study to fill this gap. A nested qualitative study was conducted to identify priority issues that can be translated into research questions answerable through the proposed cohort study. Semi-structured interviews and focus group discussions (FGDs) were conducted with a range of key community stakeholders, parents and caregivers of young Aboriginal children from Alice Springs in the Northern Territory between 2020 and 2021. Two Aboriginal and two non-Aboriginal researchers conducted 27 interviews and 3 FGDs with 42 participants. Three broad themes were constructed through reflexive thematic analysis representing the areas of focus community stakeholders and parents want future research to prioritise: (1) social determinants of health (2) building positive connections, and (3) making sure kids grow up strong and healthy. Priority setting for future research should be driven by Aboriginal and Torres Strait Islander peoples in order to be of practical benefit to their community. This qualitative study found that housing, transport and positive connections through nurturing and engaged parents were some of the most important issues raised. Participants also wanted future research to focus on issues specific to children such as nutrition, hearing loss, language development and capacity to learn. These findings will guide future work led by local Aboriginal researchers to co-design the proposed cohort study.

Abstract Background Over half of the European population aged minimum 65 years presents with at least two chronic diseases. Attention towards these diseases exhibits disparities, with limited primary care physician (PCP) attention for osteoporosis. This was confirmed in a previous integrated osteoporosis care (IOC) project in which notable difficulties to enlist PCPs arose. Consequently, this study was initiated in Flemish PCPs for in-depth analysis of underlying mechanisms hampering PCPs to fully commit to osteoporosis care. Methods A qualitative Electronic Medical Record (EMR)-facilitated clinical reasoning study was conducted. A semi-structured interview guide was employed to guide PCPs from reflections on their own patients to broader views regarding osteoporosis care. An inductive thematic analysis was performed using NVivo 12. Results Thirteen PCPs were interviewed. They stated that osteoporosis patients often had complex (medical) profiles. PCPs emphasised the ongoing necessity for prioritisation within this context. This leads to a competition for PCP attention during consultations at three levels: i. between acute versus preventive care; ii. between primary fracture prevention and other preventive services and iii. between secondary fracture prevention and other preventive services; spanning eight areas of competition: disease significance, perceived impact, PCP awareness, the patient agenda, PCP competence, PCP support, perceived patient burden, and efficiency of care provision. Applicability of these areas of competition differed between levels. Conclusion The intricate context in which PCPs operate, creates a competition for PCP attention leading to a lack of attention for fracture prevention. To preserve efforts in fracture prevention, areas of competition should be systematically addressed. Trial registration Approval for the study has been provided by the Ghent University Hospital Ethics Committee (BC-09797).

This study aimed to synthesize and compare the prioritization strategies outlined in the national vaccination plans (NVPs) against Coronavirus Disease 2019 (COVID-19) developed by countries in the Latin America and Caribbean (LAC) region. We conducted a comparative policy analysis based on COVID-19 NVPs. We conducted a search strategy in three stages to identify NVPs for COVID-19 across 41 countries/territories in the LAC region. Sources included official governmental repositories, complementary Google searches, and less formal documentation. We extracted key variables and conducted a comparative policy analysis based on the prioritization criteria and specific prioritization groups. The study identified 52 NVPs for COVID-19, corresponding to 27 (65.8 %) out of 41 countries/territories in the LAC region. Official national websites yielded documents for 12 countries. All NVPs included frontline healthcare personnel in the first prioritization phase/stage, whilst some included residents of long-term healthcare facilities, adults aged 60 years or more, and people with disabilities. The decision criteria for prioritization were declared in 14 countries/territories. Ethical considerations declared in five NVPs included human welfare, equality, solidarity, equity, and social justice as values. The early stages of vaccination rollout in LAC countries prioritized protection of the healthcare system and epidemiological risk for severe disease. Few countries included ethical considerations in their NVPs, and global inequities in vaccine access and distribution led to varied protections for vulnerable populations across LAC. This analysis highlights the need for improved emergency-response capacity, planning, and enhanced multilateral cooperation in the LAC region for future public health emergencies. [ABSTRACT FROM AUTHOR]

This paper addresses normative issues that arise in relation to indicators and measures of health impact. With inspiration from Nicole Hassoun's recent proposal, the paper argues and illustrates that those interested in measuring global health impact face questions about how to prioritize among those with ill‐health, how to weigh benefits to those who cannot lead minimally good lives against benefits to the better off, and how to think about whether someone is badly off. [ABSTRACT FROM AUTHOR]

To better understand the specific influences of early life on the long-term health and well-being of local Aboriginal children in Alice Springs, high-quality local longitudinal data is required. The Central Australian Aboriginal Congress and the Murdoch Children's Research Institute are exploring the feasibility of establishing a cohort study to fill this gap. A nested qualitative study was conducted to identify priority issues that can be translated into research questions answerable through the proposed cohort study. Semi-structured interviews and focus group discussions (FGDs) were conducted with a range of key community stakeholders, parents and caregivers of young Aboriginal children from Alice Springs in the Northern Territory between 2020 and 2021. Two Aboriginal and two non-Aboriginal researchers conducted 27 interviews and 3 FGDs with 42 participants. Three broad themes were constructed through reflexive thematic analysis representing the areas of focus community stakeholders and parents want future research to prioritise: (1) social determinants of health (2) building positive connections, and (3) making sure kids grow up strong and healthy. Priority setting for future research should be driven by Aboriginal and Torres Strait Islander peoples in order to be of practical benefit to their community. This qualitative study found that housing, transport and positive connections through nurturing and engaged parents were some of the most important issues raised. Participants also wanted future research to focus on issues specific to children such as nutrition, hearing loss, language development and capacity to learn. These findings will guide future work led by local Aboriginal researchers to co-design the proposed cohort study. [ABSTRACT FROM AUTHOR]

Ophthalmology fellowship is focusing on the educational advancement, medical research progress and academic productivity by transforming general ophthalmologists into superior clinical capacities in ophthalmology. There is a vast majority of ophthalmologists who wish to undertake fellowship degrees. The fellowship programs have several benefits for ophthalmologists and medical institutions. However, the expansion of ophthalmic fellowships has resulted in a greater number of ophthalmology visits, the possibility of unnecessary subspecialty eye examinations, induced demand and increasing eye-care costs. Moreover, sub-specialized ophthalmic services are not accessible to patients in remote regions. This can lead to a degree of inequity in the provision of healthcare services in the healthcare system. The massive expansion of fellowships in ophthalmology is revitalizing the necessity for evaluation of the need for postresidency education and providing effective planning for the future of the ophthalmic humanresource for eye health. This narrative review includes an integration and descriptive summary of the existing evidence on trends and different aspects that affect the future of ophthalmic fellowship education. Moreover, we pinpointed challenges such as maintaining standards in fellowship education, keeping an efficient production of graduates, and improving productivity in both patient care and education. We explored potential solutions to overcome these challenges. The 7-step framework for future analysis suggested here includes Determining educational needs and desired outcomes, Evaluating the current status of fellowship education, determining the gaps, and appropriate solutions, analyzing possible future trends and their impact on ophthalmology practice, investing in virtual educational technology, developing new educational horizons by foresight expert panels, and human-resource planning. [ABSTRACT FROM AUTHOR]

Though vital to health policymaking processes, little is known about the distribution of attention to issues global health journals focus on or their alignment with commitments to health equity. We developed a new framework and methods to help address these analytical gaps. We used content analysis to systematically identify and novel methods to measure attention to themes, subthemes and geographies represented in more than 2,000 research articles published in two of the longest-running multidisciplinary global health journals, Bulletin of the World Health Organization and Health Policy and Planning, between 2004 and 2018. We found four major themes—health systems and conditions received the most attention, followed by population groups and policy dynamics. Finer grained analysis shows that the broad-based journals feature many common themes and some, including subthemes like communicable diseases, financing and children, are heavily favoured over others, such as workforce and noncommunicable diseases. It reveals publishing gaps for some highly marginalised groups and shows attention to health equity fluctuates. The new framework and methods can be used to (1) check the distribution of publishing attention for consistency with global health and specific journal aims and (2) support inquiry into priority setting dynamics in the broader research publishing arena. [ABSTRACT FROM AUTHOR]

We prioritized injury prevention and management programs, and research and development (R&D) projects using the Delphi method and analytic hierarchy process (AHP) for national plan. We summarized 21 programs and 31 R&D projects based on opinions collected in the opinion survey and brainstorming. Expert panel evaluated program and project relevance in the two Delphi rounds to make consensus. Total scores were calculated by adding criterion weights calculated through the AHP multiplied by the average of scores for each program and project. The top three programs were "Integrated Management System for Injury Data," "Comprehensive Injury Surveillance System," and "Transport System Improvement Program for Major Trauma." The top three R&D projects were researches on "Identification of Vulnerable Workers Injuries to Strengthen Protections," "Data Integration on Injury and Disability," and "Using Public Health Big Data to Identify Injury Status and Risk Factors." Experts highly rated the programs to improve injury surveillance system. [ABSTRACT FROM AUTHOR]

Abstract Background Research priority setting (RPS) studies are necessary to close the significant gap between the scientific evidence produced and the evidence stakeholders need. Their findings can make resource allocation in research more efficient. However, no general framework for conducting an RPS study among public health stakeholders exists. RPS studies in public health are rare and no such study has been previously conducted and published in Germany. Therefore, we aimed to investigate which research topics in public health are prioritised by relevant stakeholders in Germany. Methods Our RPS study consisted of a scoping stage and a Delphi stage each split into two rounds. Firstly, we invited members of the German Public Health Association to gather expert insights during two initial workshops. Next, we defined the relevant stakeholder groups and recruited respondents. Thereafter, we collected research topics and assessment criteria with the respondents in the first Delphi round and aggregated the responses through content analysis. Finally, we asked the respondents to rate the research topics with the assessment criteria in the second Delphi round. Results In total, 94 out of the 140 invited public health organisations nominated 230 respondents for the Delphi study of whom almost 90% participated in both Delphi rounds. We compiled a comprehensive list of 76 research topics that were rated and ranked by several assessment criteria. We split the research topics into two types, substantive research topics and methodological-theoretical research topics respectively, to ensure the comparability among the research topics. In both types of research topics—substantive research topics and methodological-theoretical research topics—the respective top five ranked research topics hardly differed between public health researchers and public health practitioners. However, clear differences exist in the priority ranking of many (non-top priority) research topics between the stakeholder groups. Conclusions This research demonstrates that it is possible, with limited resources, to prioritise research topics for public health at the national level involving a wide range of pertinent stakeholders. The results can be used by research funding institutions to initiate calls for research projects with an increased relevance for health and/or scientific progress.

Health systems have committed their path to universal health coverage using health planning to accomplish their goals of efficiency, equity and sustainability. Chile, a high-income country with a public-private mix health system, has made significant progress through several successive health policies implemented in the last 20 years which have been consistent with this approach. However, in the last 5 years, the national congress has produced several disease-specific laws, which have been mainly promoted by the civil society. These laws indicate the actions the health authority must perform to tackle the needs of the affected population, which ultimately determine the priorities of the health system. We argue that this legal pattern has become an alternative path to priority-setting, as opposed to health planning. We claim this “legal path” is a mechanism used by civil society in a context where the health authority fails to implement a robust and legitimate prioritization process. Although these laws have brought benefits to patients suffering the corresponding conditions, we highlight this approach does not guarantee improvements in equity, efficiency and health system performance. Instead, we advocate for taking back the control of the priority-setting based on health planning, through a new institutionalization of health technology assessment and quality of care.

Background: Over half of the European population aged minimum 65 years presents with at least two chronic diseases. Attention towards these diseases exhibits disparities, with limited primary care physician (PCP) attention for osteoporosis. This was confirmed in a previous integrated osteoporosis care (IOC) project in which notable difficulties to enlist PCPs arose. Consequently, this study was initiated in Flemish PCPs for in-depth analysis of underlying mechanisms hampering PCPs to fully commit to osteoporosis care. Methods: A qualitative Electronic Medical Record (EMR)-facilitated clinical reasoning study was conducted. A semi-structured interview guide was employed to guide PCPs from reflections on their own patients to broader views regarding osteoporosis care. An inductive thematic analysis was performed using NVivo 12. Results: Thirteen PCPs were interviewed. They stated that osteoporosis patients often had complex (medical) profiles. PCPs emphasised the ongoing necessity for prioritisation within this context. This leads to a competition for PCP attention during consultations at three levels: i. between acute versus preventive care; ii. between primary fracture prevention and other preventive services and iii. between secondary fracture prevention and other preventive services; spanning eight areas of competition: disease significance, perceived impact, PCP awareness, the patient agenda, PCP competence, PCP support, perceived patient burden, and efficiency of care provision. Applicability of these areas of competition differed between levels. Conclusion: The intricate context in which PCPs operate, creates a competition for PCP attention leading to a lack of attention for fracture prevention. To preserve efforts in fracture prevention, areas of competition should be systematically addressed. Trial registration: Approval for the study has been provided by the Ghent University Hospital Ethics Committee (BC-09797). [ABSTRACT FROM AUTHOR]

The State University of New York (SUNY) -- University of the West Indies (UWI) Health Research Consortium (HRC) was implemented in 2015 by the SUNY Global Health Institute (GHI) and the SUNY-UWI Center for Leadership and Sustainable Development. The goal was to advance public health in the Caribbean through collaborative research and education among faculty and students at SUNY and UWI. The Consortium is now a dynamic matrix addressing health priorities that were initially agreed upon with the Jamaica Ministry of Health and Wellness. The HRC has built a foundational matrix that is planning for cutting edge laboratory instrumentation, biomedical informatics system, seamless electronic medical records network, national laboratory data management system, and novel biotechnology (e.g., robotic surgery cluster). The SUNY-UWI partnership fills existing gaps through collaborative programs with the SUNY GHI that facilitate UWI faculty interactions with SUNY faculty and core resources and incubators that encourage collaborations while UWI infrastructure expands. The Health Research Consortium utilizes existing academic models at UWI and SUNY to promote collaboration, capacity building, and program implementation. Consortium teams develop sound business development models that foster sustained economic growth and form the pipeline for workforce development and career opportunities. The Caribbean diaspora and UWI alumni are engaged in working together on this effort. In addition, mentoring in K-12 and beyond is needed to create a vision for the next generations. [ABSTRACT FROM AUTHOR]

The article discusses the lack of sustained engagement between research institutions, public health systems, and communities, which hinders efforts to address health inequities. It highlights the racial and social inequities exposed by the COVID-19 pandemic and systemic racism, as well as the need for community engagement to raise awareness and address the needs of marginalized populations. The article emphasizes the importance of community-based participatory research (CBPR) and community engagement in improving research rigor and health outcomes. It also calls for institutional changes to support community engagement, address historical research ethics violations, and promote diversity in research teams. The article concludes by advocating for a science of community engagement that involves dialogue, action, and system change to achieve health justice. [Extracted from the article]

BACKGROUND: Workers are exposed to occupational health hazards from physical, chemical, biological, ergonomic, and psychological agents. Assessing occupational health risks is vital for executing control measures to protect employees' health against harmful occupational agents. OBJECTIVE: The present study aimed to identify, evaluate, and prioritize occupational health risks to assist senior management in determining where to allocate the budget to carry out the required corrective actions in the oilfields project. METHODS: This descriptive-analytical cross-sectional study was performed in 2021 among Iran's Sarvak Azar oil field job groups. The occupational health risk was assessed using the Harmful Agents Risk Priority Index (HARPI) as a semi-quantitative method. Then, to simplify decision-making and budget allocation, we reported HARPI final score in the Pareto principle format. RESULTS: The results show that in this oil field, controlling exposure to adverse lighting, improving the thermal conditions and ergonomics, and preventing noise exposure has the highest priority, with scores of 6342, 5269, 5629, and 5050, respectively. Production, HSE, laboratory, and commissioning need the most health care measures with scores of 8683, 5815, 5394, and 4060, respectively. CONCLUSION: HARPI could be used to prioritize occupational health hazards, and this method can simplify managers' decisions to allocate resources to implement control measures. [ABSTRACT FROM AUTHOR]

Abstract Background There is a large and growing unmet need for rehabilitation – a diverse category of services that aim to improve functioning across the life course – particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. Methods We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. Results The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries’ national government’s health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies – particularly from civil conflict – and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. Conclusions This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.

Tim Bartling,1,2 Carina Oedingen,1,2 Harald Schrem,2,3 Thomas Kohlmann,4 Christian Krauth1,2 1Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany; 2Center for Health Economics Research Hannover, Hannover, Germany; 3General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria; 4Department of Methods of Community Medicine, Institute for Community Medicine, University of Greifswald, Greifswald, GermanyCorrespondence: Tim Bartling, Medizinische Hochschule Hannover / Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str, 1, Hannover, Lower Saxony, 30625, Germany, Tel +49 511 532 9462, Fax +49 511 532 5376, Email bartling.tim@mh-hannover.dePurpose: Organ transplantation systems benefit from guidelines that are harmonious with the preferences of the people involved. Discrete choice experiments are useful tools for eliciting preferences.Patients and Methods: This study evaluated the preferences of patients and their relatives (n=285) to identify their priorities in organ allocation using a discrete choice experiment. In eight hypothetical allocation decisions, the participants were asked to select the candidate they considered the most suitable The candidates differed in years of life gained after transplantation, quality of life after transplantation, waiting time until transplantation, age, compliance and social support.Results: The most important aspects for setting priority in organ allocation were lack of compliance (β= − 2.5, p< 0.001) and good quality of life after transplantation (β = +1.4, p< 0.001). The lack of social support (ß = − 0.8, p< 0.05) and the more years of life gained after transplantation (β = +0.5, p< 0.001) had less but still a significant amount of influence on this decision, while the waiting list was not considered significantly important (β = 0.1, p> 0.05). The comparison of the different relations to transplantation showed that life years gained after transplantation was of high relevance to posttransplant patients (+10 years: β = +0.709, p< 0.001 / +15 years: β = +0.700, p< 0.001) and of no importance to waitlisted patients (+10 years: β = +0.345, p> 0.05 / + 15 years: β = +0.173, p> 0.05) and relatives (+ 10 years: β = +0.063, p> 0.05 / +15 years: β = +0.304, p> 0.05).Conclusion: This study provides useful insights into the unique perspective of patients and their relatives on priority-setting in the allocation of donor organs that should be reflected in improved donor organ allocation rules.Keywords: organ transplantation, health priorities, health resources, ethics, patient involvement, resource allocation, discrete choice experiment

Abstract Introduction Health care systems around the world are struggling with limited resources, in relation to the prevailing health care need. An accessible primary care is an important part of the solution for how to provide affordable care for the population and reduce pressure on the overall health care system such as unnecessary hospital stays and associated costs. As primary care constitutes an important first line of healthcare, the task of prioritising and deciding what to do and for whom lies in practice, primarily with the primary care professionals. Thus, the decisions and behaviour of primary care professionals have a central role in achieving good and equal health in the population. The aim of this study is to explore how primary health care professionals handle situations with limited resources and enhance our knowledge of priorities in practice. Methods Semi-structured interviews with 14 health care professionals (7 nurses, 7 physicians) working in Swedish primary care were interviewed. Data were analysed inductively with content analysis. Findings Three main categories were found: Influx of patients; Structural conditions; and Actions. Each category illustrates an important aspect for what primary care professionals do to achieve good and equal care. The influx of patients concerned what the professionals handled in terms of patients’ healthcare needs and patient behaviour. Structural conditions consisted of policies and goals set for primary care, competence availability, technical systems, and organisational culture. To handle situations due to limited resources, professionals performed different actions: matching health care needs with professionals’ competency, defining care needs to suit booking systems appointments, giving care at the inappropriate health care level, rearranging workhours, and passing on the decision making. Conclusion Priorities in primary care are not, “one fits all” solution. Our study shows that priorities in primary care comprise of ongoing daily processes that are adapted to the situation, context of patient influx, and structural conditions. Healthcare professional’s actions for how influx of patients’ is handled in relation to limited resources, are created, and shaped within this context which also sets the boundaries for their actions.

The State University of New York (SUNY) – University of the West Indies (UWI) Health Research Consortium (HRC) was implemented in 2015 by the SUNY Global Health Institute (GHI) and the SUNY-UWI Center for Leadership and Sustainable Development. The goal was to advance public health in the Caribbean through collaborative research and education among faculty and students at SUNY and UWI. The Consortium is now a dynamic matrix addressing health priorities that were initially agreed upon with the Jamaica Ministry of Health and Wellness. The HRC has built a foundational matrix that is planning for cutting edge laboratory instrumentation, biomedical informatics system, seamless electronic medical records network, national laboratory data management system, and novel biotechnology (e.g., robotic surgery cluster). The SUNY-UWI partnership fills existing gaps through collaborative programs with the SUNY GHI that facilitate UWI faculty interactions with SUNY faculty and core resources and incubators that encourage collaborations while UWI infrastructure expands. The Health Research Consortium utilizes existing academic models at UWI and SUNY to promote collaboration, capacity building, and program implementation. Consortium teams develop sound business development models that foster sustained economic growth and form the pipeline for workforce development and career opportunities. The Caribbean diaspora and UWI alumni are engaged in working together on this effort. In addition, mentoring in K-12 and beyond is needed to create a vision for the next generations.

Introduction: Decision-makers are constantly confronted with the need of balancing limited resources while establishing rationing criteria in health care system. However, there is an emerging trend in involving citizens in rationing debates as mechanism to assuring legitimacy in the decision-making process. This paper aims to explore citizens' opinions on priority setting in health care access in comparison with the perspectives of managers. Methods: An online questionnaire was used to collect the data. A logistic regression was applied to evaluate factors that shape the prioritisation of groups in access to health care services. The collected data comprehends 400 individuals, aged 18 years old and over living in continental Portugal. Results: The study results reveal that managers and the general public, in the context of limited resources, both agree with the need to prioritise some groups over others in access to health care services. The priority groups would include the elderly, children, and people with chronic conditions. The most outstanding finding is that managers prefer children as their first priority group against the general public who has considered as top priority the elder ones. Discussion: This study identified which stakeholders are prone to be included in decision-making processes for effective priority-setting models in the health care systems and evaluated their preferences. [ABSTRACT FROM AUTHOR]

Background: Research priority setting (RPS) studies are necessary to close the significant gap between the scientific evidence produced and the evidence stakeholders need. Their findings can make resource allocation in research more efficient. However, no general framework for conducting an RPS study among public health stakeholders exists. RPS studies in public health are rare and no such study has been previously conducted and published in Germany. Therefore, we aimed to investigate which research topics in public health are prioritised by relevant stakeholders in Germany. Methods: Our RPS study consisted of a scoping stage and a Delphi stage each split into two rounds. Firstly, we invited members of the German Public Health Association to gather expert insights during two initial workshops. Next, we defined the relevant stakeholder groups and recruited respondents. Thereafter, we collected research topics and assessment criteria with the respondents in the first Delphi round and aggregated the responses through content analysis. Finally, we asked the respondents to rate the research topics with the assessment criteria in the second Delphi round. Results: In total, 94 out of the 140 invited public health organisations nominated 230 respondents for the Delphi study of whom almost 90% participated in both Delphi rounds. We compiled a comprehensive list of 76 research topics that were rated and ranked by several assessment criteria. We split the research topics into two types, substantive research topics and methodological-theoretical research topics respectively, to ensure the comparability among the research topics. In both types of research topics—substantive research topics and methodological-theoretical research topics—the respective top five ranked research topics hardly differed between public health researchers and public health practitioners. However, clear differences exist in the priority ranking of many (non-top priority) research topics between the stakeholder groups. Conclusions: This research demonstrates that it is possible, with limited resources, to prioritise research topics for public health at the national level involving a wide range of pertinent stakeholders. The results can be used by research funding institutions to initiate calls for research projects with an increased relevance for health and/or scientific progress. [ABSTRACT FROM AUTHOR]

Background: Appropriate priority setting in public health and biomedical research is crucial to make decisions for resource allocation and prioritizing the projects. We studied the research gaps and identified priorities for biomedical research in Sabzevar University of Medical Sciences (SabUMS), located in Sabzevar city in the northeastern part of Iran. Materials & Methods: we used both qualitative and quantitative approaches to determine the public health problems and health research priorities. The processes for priority setting included preparation, problem finding, idea generation, data cleaning and statement development, ranking, and dissemination. We used qualitative research and quantitative surveys for problem findings. We organized two workshops with researchers and public health authorities of Sabzevar city for idea generation, defining criteria for priority setting, and ranking of the research ideas. We used national and international recommendations to prepare a list of research priorities in the region for COVID-19. Results: The criteria for priority setting were concerns of the community, magnitude, and urgency of the problem. In addition, feasibility, the possibility of regional and international research collaboration, and the availability of the infrastructure and capacity to conduct research were used for ranking. The final list of priority areas for research in SabUMS included non-communicable diseases, mental health, drug abuse, accidents, and nutrition respectively. COVID-19 was considered a separate area for research. Conclusion: Experience from this study and follow-up reports would provide best practices in research development in low-resource areas and pave the way for evidence-based public health practice. [ABSTRACT FROM AUTHOR]

Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders' perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the urban poor. [ABSTRACT FROM AUTHOR]

Background: There is a large and growing unmet need for rehabilitation – a diverse category of services that aim to improve functioning across the life course – particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. Methods: We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. Results: The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries’ national government’s health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies – particularly from civil conflict – and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. Conclusions: This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services. [ABSTRACT FROM AUTHOR]

Mengqian Cai,1 Miaoling Cui,1 Ying Nong,2 Jinlian Qin,1 Sucai Mo1 1Department of Nursing, the First Hospital Affiliated of Guangxi Medical University, Nanning, People’s Republic of China; 2Respiratory Medicine, the First Hospital Affiliated of Guangxi Medical University, Nanning, People’s Republic of ChinaCorrespondence: Miaoling Cui, Tel + 86 138 7813 4966, Email cuimiaoling@126.comPurpose: To explore the health priorities of patients with multimorbidity in COPD and the factors as to why their condition is prioritized.Methods: This qualitative study was conducted from February to April 2022 at a hospital in China. A specially selected sample of 18 patients completed a general information sheet and face-to-face interviews. The Colaizzi method was used to analyze the data.Results: Participants reported their experience which fell into three themes: disease burden, health perception and views of others. In addition, participants explained that health knowledge from short videos on mobile apps influenced them, which in turn influenced their ranking.Conclusion: Our findings suggested that health priorities of patients with multimorbidity in COPD manifest differently. Specifically, our findings suggested that patients’ health priorities are most influenced by disease burden, health perception, and the opinions of those around them. Nursing staff should fully understand each patients’own perspectives and provide them with personalized support.Keywords: chronic obstructive pulmonary disease, health priorities, multimorbidity, multiple chronic conditions, qualitative research

Objectives. To map the timing and nature of regulatory reliance pathways used to authorize COVID-19 vaccines in Latin America. Methods. An observational study was conducted assessing the characteristics of all COVID-19 vaccine authorizations in Latin America. For every authorization it was determined whether reliance was used in the authorization process. Subgroups of reference national regulatory authorities (NRAs) and non-reference NRAs were compared. Results. 56 authorizations of 10 different COVID-19 vaccines were identified in 18 countries, of which 25 (44.6%) used reliance and 12 (21.4%) did not. For the remaining 19 (33.0%) it was not possible to determine whether reliance was used. Reference agencies used reliance less often (40% of authorizations with a known pathway) compared to non-reference agencies (100%). The median review time was just 15 days and does not meaningfully differ between reliance and non-reliance authorizations. Conclusions. This study demonstrated that for these vaccines, despite reliance pathways being associated with numerous rapid authorizations, independent authorization review times were not considerably longer than reliance reviews; reliance pathways were not a prerequisite for rapid authorization. Nevertheless, reliance pathways provided rapid authorizations in response to the COVID-19 emergency.

Abstract In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car’s damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes.

Abstract Background Patients referred to specialised mental health care are usually triaged based on referral information provided by general practitioners. However, knowledge about this system’s ability to ensure timely access to and equity in specialised mental health care is limited. We aimed to investigate to the degree to which patient triage, based on referral letter information, corresponds to triage based on a hospital specialist’s consultation with the patient, and whether the degree of correspondence is affected by the quality of the referral letter. Methods We gathered information from three specialised mental health centres in Norway regarding patients that were referred and offered health care (N = 264). Data consisted of triage decisions for each patient (i.e., the hospital specialist’s assessment of maximum acceptable waiting time), which were determined on the basis of a) referral information and b) meeting the patient. Referral letter quality was evaluated using the Quality of Referral information-Mental Health checklist. The reliability of priority setting and the impact of referral letter quality on this measure were investigated using descriptive analyses, binary logistic regression and Nadaraya-Watson kernel regression. Results In 143 (54%) cases, the triage decision based on referral information corresponded with the decision based on patient consultation. In 70 (27%) cases, the urgency of need for treatment was underestimated when based on referral information compared with that based on information from patient consultation. Referral letter quality could not explain the differences between the two triage decisions. However, when a cut-off value of 7 on the Quality of Referral information-Mental Health scale was used, low-quality letters were found more frequently among patients whose urgency of need was underestimated, compared with those whose need was overestimated. Conclusions Deciding the urgency of patient need for specialised mental health care based on referral information is a reliable system in many situations. However, the possibility of under- and overestimation is present, implying risks to patient safety and inappropriate use of resources. Improving the content of referral letters does not appear to reduce this risk when the letters are of acceptable quality. Trial registration NCT01374035 .

Abstract Background Of the 15 countries with the highest neonatal mortality rates, 13 are characterised by conflict and political instability. Despite well-documented evidence of best practice interventions for neonatal survival, it remains less clear on how these practices are implemented in humanitarian emergency settings. Objective To conduct a systematic review of published and grey literature on the implementation strategies and challenges in addressing neonatal care in humanitarian emergencies. Methods A systematic literature search was conducted in SCOPUS, MEDLINE, Web of Science, CINHAL and Global Health for studies published between 1 January 2003 and 30 June 2018. Additionally, websites of organisations actively working in humanitarian emergencies were searched. Interventions were reviewed against the existing essential newborn care framework according to the standards outlined in the Newborn Health in Humanitarian Settings Field Guide. Results Twenty-one studies were identified: eight reporting on conflict and refugee settings, nine followed natural disasters and four discussed multiple emergency settings. Few studies addressed all the components of essential newborn care outlined in the field guide regardless of the emergency type. The review of literature demonstrated challenges in addressing essential newborn care identified in all humanitarian settings including the lack of adequate equipment, financing, and trained staff. Implementation strategies identified included quality improvement training for staff, the development of evacuation procedures, integrating with local and government resources and generating spaces in health facilities specifically for newborn care. Conclusions The requirements and initiatives needed to deliver essential newborn care in humanitarian settings are highly variable and context dependent. Given the diversity of factors needing to be addressed by the field guide, more research should be directed towards the adaptability of the implementation strategies to differing emergency contexts. Trial registration PROSPERO registration ID: CRD42018098824

Abstract The year 2022 saw COVID‐19 as the primary public health concern, with vaccine rollout and mandates at the forefront. Other viral infectious diseases, such as Monkeypox and Ebola, emerged as public health concerns. Climate change and political conflicts significantly impacted global health, increasing the demand for humanitarian assistance and protection. In 2023, it remains crucial to identify global and public health priority areas to coordinate and implement effective solutions. Through discussions with public health practitioners and researchers, we have identified key priority areas for 2023, namely, health systems, the mental health crisis, substance abuse, infectious diseases, malnutrition and food insecurity, sexual and reproductive health challenges, environmental pollution, the climate crisis, cancer, and diabetes. These priority areas highlight shared concerns that should be addressed to facilitate proactive and innovative health interventions and practices. To achieve universal healthcare targets for 2030, prioritization, financial investment, international cooperation, and collaboration in addressing these global health challenges are crucial. This requires coordination among public health decision‐makers, the private health sector, and opinion leaders to implement country‐specific healthcare financing and food security measures. Research, scientific knowledge, and technical capacities must be leveraged to produce sustainable interventions that effectively reduce health disparities and improve health system responsiveness to prevent these challenges from progressing to public health emergencies.

In India, cancers along with cardiovascular diseases contribute to significant mortality and morbidity. With less than 10 years remaining towards achieving Sustainable development Goals (SDGs), public health systems in India need to be critically assessed and strengthened, for addressing non‐communicable diseases (NCDs) in general and cancers in particular. Our Commentary address the public health response to cancer prevention and control, with specific pointers based on emerging evidence. The relevant issues are stratified as: emphasis on the critical appraisal of national programs, strengthening primary health care (PHC) systems, enhancing focus on client and community centricity, exploring integrative approaches to cancer management and stepping up implementation and multidisciplinary research. Ongoing surveillance is essential to assess the current and future trends of cancer as well as the outcomes of prevention and treatment measures. For revitalizing comprehensive PHC, much depends on our epidemiological capacity and surveillance systems which impart information for local planning. It is imperative to address the cultural barriers and societal norms, which limit the acceptability and participation in screening programs. SDG 3 has ushered the wellbeing agenda at an opportune time. There is a compelling need to conduct research on an integrated approach (ayurveda complimenting allopathic medication) for the treatment of cancer. The unique challenges posed by the rise in NCD morbidity in LMIC, requires horizontal integration of the health systems with new services focused on cancer control. [ABSTRACT FROM AUTHOR]