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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]

The National Institute of Health has, for the first time, identified National Priorities for Oral Health Research, this process was carried out by the Subdirectorate of Research and Laboratories of Noncommunicable Diseases of the National Center for Public Health with the technical advice of the Directorate of Research and Innovation in Health and in coordination with the Executive Directorate of Oral Health of the General Directorate of Strategic Interventions in Public Health of the Ministry of Health, using a participatory methodology with three key actors: researchers/specialists, experts and decision-makers. This article aims to describe the process used to identify these priorities, which consisted of five phases: i) identification of the strategic objectives of the Ministry of Health, ii) identification of needs in oral health research, iii) review by experts and assessment of needs according to criteria and v) presentation of the priorities. As a result, 12 priorities were obtained, which were subsequently approved by Ministerial Resolution No. 262-2022/MINSA, for a period of 2022-2026. In addition, we provide recommendations for future processes. [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:Traditional hierarchical approaches to research give privilege to small groups with decision-making power, without direct input from those with lived experience of illness who bear the burden of disease. A Research Justice framework values the expertise of patients and communities as well as their power in creating knowledge and in decisions about what research is conducted. Preterm birth has persisted at epidemic levels in the United States for decades and disproportionately affects women of color, especially Black women. Women of color have not been included in setting the agenda regarding preterm birth research. METHODS:We used the Research Priorities of Affected Communities protocol to elicit and prioritize potential research questions and topics directly from women of color living in three communities that experience disproportionately high rates of preterm birth. Women participated in two focus group sessions, first describing their healthcare experiences and generating lists of uncertainties about their health and/or healthcare during pregnancy. Women then participated in consensus activities to achieve 'top-priority' research questions and topic lists. The priority research questions and topics produced by each group were examined within and across the three regions for similarities and differences. RESULTS:Fifty-four women participated in seven groups (14 sessions) and generated 375 researchable questions, clustered within 22 topics and four overarching themes: Maternal Health and Care Before, During, and After Pregnancy; Newborn Health and Care of the Preterm Baby; Understanding Stress and Interventions to Prevent or Reduce Stress; and Interpersonal and Structural Health Inequities. The questions and topics represent a wide range of research domains, from basic science, translational, clinical, health and social care delivery to policy and economic research. There were many similarities and some unique differences in the questions, topics and priorities across the regions. CONCLUSIONS:These findings can be used to design and fund research addressing unanswered questions that matter most to women at high risk for preterm birth. Investigators and funders are strongly encouraged to incorporate women at the front lines of the preterm birth epidemic in research design and funding decisions, and more broadly, to advance methods to deepen healthcare research partnerships with affected communities.

BackgroundTo enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients' identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients' reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.MethodsCTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal. SM-Problems included: BMI, diet (fruits and vegetables, salt, fat, sugar sweetened beverages), physical activity, missed medications, tobacco and alcohol use, health-related distress, general life stress, and depression symptoms. Descriptive analyses documented SM-Problems and SM-Priorities, and alignment between SM-Priorities and Goal Selection, followed by mixed models adjusting for clinic.Results446 participants with ≥ one chronic diseases (mean age 55.4 ± 12.6; 58.5% female) participated. On average, participants reported experiencing challenges in 7 out of the 12 SM-Problems areas; with the most frequent problems including: BMI, aspects of diet, and physical activity. Patient SM-Priorities were variable across the self-management areas. Patient- Healthcare team member Goal selection aligned well with patient SM-Priorities when patients prioritized weight loss or physical activity, but not in other self-management areas.ConclusionParticipants reported experiencing multiple SM-Problems. While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas. Aggregated results can assist with the identification of high frequency patient SM-Problems and SM-Priority areas, and in turn inform resource allocation to meet patient needs.Trial registrationClinicalTrials.gov ID: NCT01945918 .

All patients with hepatocellular carcinoma meeting United Network for Organ Sharing T2 criteria currently receive the same listing priority for liver transplant (LT). A previous study from our center identified a subgroup with a very low risk of waitlist dropout who may not derive immediate LT benefit. To evaluate this issue at a national level, we analyzed within the United Network for Organ Sharing database 2052 patients with T2 hepatocellular carcinoma receiving priority listing from 2011 to 2014 in long wait time regions 1, 5, and 9. Probabilities of waitlist dropout were 18.3% at 1 year and 27% at 2 years. In multivariate analysis, factors associated with a lower risk of waitlist dropout included Model for End-Stage Liver Disease-Na

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]

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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.

BackgroundDespite the high burden of adverse adolescent sexual and reproductive health (SRH) outcomes, it has remained a low political priority in Kenya. We examined factors that have shaped the lack of current political prioritization of adolescent SRH service provision.MethodsWe used the Shiffman and Smith policy framework consisting of four categories-actor power, ideas, political contexts, and issue characteristics-to analyse factors that have shaped political prioritization of adolescent SRH. We undertook semi-structured interviews with 14 members of adolescent SRH networks between February and April 2019 at the national level and conducted thematic analysis of the interviews.FindingsSeveral factors hinder the attainment of political priority for adolescent SRH in Kenya. On actor power, the adolescent SRH community was diverse and united in adoption of international norms and policies, but lacked policy entrepreneurs to provide strong leadership, and policy windows were often missed. Regarding ideas, community members lacked consensus on a cohesive public positioning of the problem. On issue characteristics, the perception of adolescents as lacking political power made politicians reluctant to act on the existing data on the severity of adolescent SRH. There was also a lack of consensus on the nature of interventions to be implemented. Pertaining to political contexts, sectoral funding by donors and government treasury brought about tension within the different government ministries resulting in siloed approaches, lack of coordination and overall inefficiency. However, the SRH community has several strengths that augur well for future political support. These include the diverse multi-sectoral background of its members, commitment to improving adolescent SRH, and the potential to link with other health priorities such as maternal health and HIV/AIDS.ConclusionIn order to increase political attention to adolescent SRH in Kenya, there is an urgent need for policy actors to: 1) create a more cohesive community of advocates across sectors, 2) develop a clearer public positioning of adolescent SRH, 3) agree on a set of precise approaches that will resonate with the political system, and 4) identify and nurture policy entrepreneurs to facilitate the coupling of adolescent SRH with potential solutions when windows of opportunity arise.

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.

Bloom syndrome (BS) is a rare, autosomal recessive genetic disorder characterized by short stature, a skin rash associated with sun exposure, and an elevated likelihood of developing cancers of essentially all types, beginning at an early age. Cancer is the leading cause of death for persons with BS, and its early onset results in a reported median lifespan of

The Commission on Investing in Health (CIH), an international group of 25 economists and global health experts, published its Global Health 2035 report in The Lancet in December 2013. The report laid out an ambitious investment framework for achieving a "grand convergence" in health-a universal reduction in deaths from infectious diseases and maternal and child health conditions-within a generation. This article captures ten key elements that the CIH found important to its process and successful outcomes. The elements are presented in chronological order, from inception to post-publication activities. The starting point is to identify the gap that a new commission could help to narrow. A critical early step is to choose a chair who can help to set the agenda, motivate the commissioners, frame the commission's analytic work, and run the commission meetings in an effective way. In selecting commissioners, important considerations are their technical expertise, ensuring diversity of people and viewpoints, and the connections that commissioners have with the intended policy audience. Financial and human resources need to be secured, typically from universities, foundations, and development agencies. It is important to set a clear end date, so that the commission's work program, the timing of its meetings and its interim deadlines can be established. In-person meetings are usually a more effective mechanism than conference calls for gaining commissioners' inputs, surfacing important debates, and 'reality testing' the commission's key findings and messages. To have policy impact, the commission report should ideally say something new and unexpected and should have simple messages. Generating new empirical data and including forward-looking recommendations can also help galvanize policy action. Finally, the lifespan of a commission can be extended if it lays the foundation for a research agenda that is then taken up after the commission report is published.

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]

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. [ABSTRACT FROM AUTHOR]

Working with PAHO/WHO to prioritize childhood cancer in the context of systems strengthening is central to St. Jude Children's Research Hospital (SJCRH)'s role as WHO Collaborating Centre for Childhood Cancer. This manuscript focuses on how SJCRH and PAHO/WHO have partnered to apply C5 (Country Collaboration for Childhood Cancer Control) to define and implement priority actions regionally, strengthening Ministry programs for childhood cancer, while implementing the Global Initiative for Childhood Cancer since 2018. Using C5, a tool developed by SJCRH, PAHO/WHO and SJCRH co-hosted regional/national workshops engaging authorities, clinicians and other stakeholders across 10 countries to map health systems needs and prioritize strategic activities (spanning Central America, Dominican Republic, Haiti, Brazil and Uruguay). SJCRH provided English/Spanish/Portuguese C5 versions/templates for analysis/prioritization exercises, and worked with PAHO/WHO and country teams to implement C5, analyze findings, and develop outputs. In an eight-country regional workshop, countries defined priorities within national/regional initiatives and ranked their value and political will, incorporating country-specific surveys and stakeholder dialogues. Each country prioritized one strategic activity for 2022-2023, exchanged insights via storytelling, and disseminated and applied results to inform country-specific and regional action plans. National workshops analyses have been incorporated into cancer control planning activities and collaborative work regionally. Implementation success factors include engaging actors beyond the clinic, enabling flexibility, and focusing on co-design with stakeholders. Joint implementation of C5 catalyzed prioritization and accelerated strategic activities to improve policies, capacity, and quality of care for children in the Americas, supporting Ministries to integrate childhood cancer interventions as part of systems strengthening. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify key policy objectives by investigating the perception of important stakeholders and affected professionals concerning relevance and feasibility of a successful primary care (PC) reform. Background: Since 2013, the Austrian PC system has been undergoing a reform process to establish multiprofessional primary care units. The reforms have various defined objectives and lack clear priorities. Methods: After the definition and consensus-based selection of 12 policy objectives, a cross-sectional online survey on their relevance and feasibility was distributed via email and social media to PC and public health networks. The survey was conducted in the period from January to February 2020. Results were analyzed descriptively, and further, Pearson Chi-Square Test or Fisher's Exact Test was performed for group comparison regarding respondents' characteristics. Open-ended responses were analyzed using qualitative content analysis. Findings: In total, 169 questionnaires were completed. A total of 46.3% of the responders had more than 20 years of professional experience (female: 60.5%). A mandatory internship in general practice, vocational training for general practice, and a modern remuneration system were the three top-rated policy objectives regarding relevance. A mandatory internship in general practice, specialization in general practice, and coding of services and diagnosis were assessed as the most feasible objectives. The group comparisons regarding working field, years of professional experience, age, and sex did not show any meaningful results in the evaluation of relevance and feasibility. Discussion: In the view of the study participants, easily obtainable objectives include adapting the duration and setting of internships for medical students, as well as mandatory vocational training for GP trainees. Further efforts are necessary to achieve complex objectives such as the adoption of a modern remuneration scheme and a comprehensive quality assurance program. Building capacity and creating team-oriented environments are also important aspects of a successful PC reform. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To amplify the voices of people living with atraumatic shoulder pain, their relatives, and health care practitioners, and to establish research questions. DESIGN: A priority-setting study using a modified approach originally formulated by the James Lind Alliance (JLA). METHODS: The process consisted of 6 phases (initiation, consultation, collation, prioritization, validation, and reporting), and included 2 e-surveys and 2 separate virtual workshops. We included people with atraumatic shoulder pain, relatives, health care practitioners managing shoulder pain, and researchers conducting research within the field. RESULTS: Six hundred and eight people participated (n = 383 [63%] patients, n = 213 [35%] health care practitioners, and n = 12 [2%] carers). In the first survey, 297 participants submitted 1080 potential research questions, which were collated into 16 main themes and 94 subthemes and transformed into research questions. These research questions were featured in the second survey, where 290 participants prioritized the questions, resulting in a compilation of the top 25 questions. Based on discussions from 2 separate online workshops with a total of 21 participants, a top-10 list was created. CONCLUSION: In the final priority list, the 3 research questions with the highest ranking were, first, "how can we improve the translation of research into clinical practice?"; second, "how can we prevent atraumatic shoulder pain?"; and third, "who benefits from surgery, and who does not?" J Orthop Sports Phys Ther 2025;55(3):1-12. Epub 12 February 2025. doi:10.2519/jospt.2025.13059 .

Background: Health Impact Assessment (HIA) advances Health in All Policies by identifying impacts of proposed actions on health and equity and recommending changes to address these impacts. Since the Gothenburg Consensus Statement in 1999, HIA has been applied to policies, plans, programmes and projects in multiple sectors and settings across the world. Despite demonstrated effectiveness, its use across the world is inconsistent with few nations systematically using HIA. In a global context of increasing health inequities, pandemics, climate change, and economic crises, HIA can help integrate health and equity into decision making. There is a need for research to support the ongoing evolution and development of HIA. This paper presents a research agenda for the field of HIA., Methods: We used a mixed method approach utilising insights of approximately 280 participants through an international online survey and participatory workshops. We compared priority areas of research identified through the survey, workshops, and literature review to inform the development of a research agenda. The team drew on their own positioning and experience as HIA practitioners and researchers to shape this agenda., Results: We identified four research priorities: (1) Institutionalisation - Sustaining and institutionalising HIA in varying contexts and levels. (2) Influence - Identifying mechanisms and strategies that can be employed to effectively influence stakeholders and decision making. (3) Equity and Participation - Analysing the role of equity, justice, power and participation in HIA, and (4) Methodology - Improving HIA Methods to understand the complex relationships between proposed actions, health and health equity outcomes and identifying what to do. We developed research questions for each theme., Conclusions: The research agenda advocates for sustained research and practice to strengthen impact and address knowledge gaps in the field. Functioning as a roadmap for both researchers and funders, it aims to contribute to a healthier and more equitable world. Recognising the valuable role of HIA in addressing global health challenges, the agenda encourages researchers to investigate, develop, and advance the field of HIA., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was granted by University of New South Wales Human Ethics Advisory Panel (HC220581). Informed consent was provided by all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. Crown.)

This article suggests that the concept of global health - and to an extent the field that it designates - is problematic in various ways. Within public health, the concept of the 'public' has been widely investigated. However, "global health" has been introduced in academic, policy, and public discussion with comparably lower level of conceptual, philosophical scrutiny. Thus, while public health ethics addresses the ethical and political issues that the different meanings of 'public' allow to identify, global health ethics tends to leave ethical and political issues raised by the concept of 'global health' implicit and insufficiently analysed. I will briefly present the debate around the 'public' in public health, describing some of the ethical and political questions that might arise, depending on what 'public' is taken to mean. I will then use this discussion as a conceptual map for an analogous analysis of the concept of 'global' in global health. I will discuss what dimensions 'global' adds to the concept of 'public'. In the second part of the article, I will briefly introduce the philosophical debate on the concept of health, before suggesting that its cultural sensitivity makes it ill-suited to be qualified as 'global'. All in all, this article wants to bring to light the ethical implications that the terminology of 'global health' introduces in academic research and public policy that goes under that heading, as a first step towards better defining the ethical contours of this discipline., (© 2025 The Author(s). Developing World Bioethics published by John Wiley & Sons Ltd.)

Background: The general surgery prioritization tool (GSPT) was implemented in 2018 to equitably prioritize non-cancer elective general surgery waitlists. It combines patient-reported Impact On Life (IOL) scores and clinician-reported values for a total score which determines access to the waitlist. In New Zealand there are inequities in surgical access and outcomes, particularly for Māori, and this study evaluates whether the GSPT may contribute., Method: A retrospective review of general surgery prioritization events at Capital & Coast District Health Board, New Zealand, between May 2018 and August 2022 was conducted. The patient-reported IOL score (6-36), total score (0-100), waitlist access, and time to surgery in days were recorded and analyzed for ethnic, age and gender differences., Results: 4527 events were included. Median IOL score and total score were 20 and 68. 4231 (90.8%) met the waitlist threshold with a median time to surgery of 99 days. Higher average IOL scores were associated with being female (P = 0.005), Pacific Peoples (P = 0.007) and Other Ethnicity (P = 0.006). The average total score for Māori was 1.13 points higher than Europeans (P = 0.013). There was no evidence of associations between the odds of surgery booking and patient age, ethnicity and gender when adjusted for deprivation and procedure type., Conclusion: This study shows that despite differences in the IOL and total scores across ethnicity, no evidence of difference was found in the odds of surgical booking based on patient ethnicity, age or gender. Amendments to weighting of IOL scores and ethnicity score adjustment could be considered to remedy this., (© 2025 Royal Australasian College of Surgeons.)

Purpose: Publicly funded healthcare systems struggle to govern and determine how finite resources should be allocated in relation to political goals within a pre-determined budget. Primary healthcare (PHC) has a central multipurpose function, not least in terms of political strategies, but PHC governance is still largely underexplored. The aim is to explore how politicians responsible for making decisions pertaining to healthcare coverage navigate the governance of public PHC and disentangle it in the form of narratives based on different types of underlying rationales., Design/methodology/approach: Semi-structured interviews were conducted with 15 politicians from 3 Swedish regional healthcare authorities. The data were analysed abductively based on scientific, clinical and cultural rationales using thematic content analysis., Findings: Our study provides insights into how PHC's multipurpose function implicates tensions between politicians' different responsibilities regarding healthcare coverage. It shows how politicians navigate various coexisting rationales, with some being more dominant than others and where tensions also exist between them. In this balancing act, they create narratives addressing different stakeholders and priority-setting dilemmas, reflecting the diverse rationales. Our study reveals that politicians play a crucial role in PHC governance and priorities, balancing rationales that might otherwise become overly dominant., Originality/value: This paper contributes new knowledge by displaying how politicians balance tensions within and between rationales through different narratives regarding goals/commissions, problematic situations and preferred solutions in PHC governance., (© Suzana Holmér, Barbro Krevers, Kristin Thomas and Ann-Charlotte Nedlund.)

Background: It is essential to embed patient and public perspectives into every stage of the research journey, including setting the future research agenda. The substantial gaps in our understanding of prematurity-associated lung disease presented a timely opportunity to determine the community's research priorities., Objective: To conduct a priority setting partnership (PSP) to determine the top 10 research priorities for preterm lung health., Design: We undertook a modified James Lind Alliance methodology comprising three main stages: (1) an idea generating survey with open questions to ascertain the community's most important ideas for future preterm lung health research, (2) prioritisation survey to distill the main themes into a shortlist of 20 and (3) consensus workshop where participants were tasked with ranking their final top 10. This PSP is reflective of the view of preterm-born individuals, parents of preterm children and healthcare professionals in an Australian healthcare setting., Results: We collated 144 submissions from the idea generating survey from which 27 prioritisation themes were developed. From the 150 prioritisation survey responses, the 20 themes receiving the most votes were taken to the consensus workshop . Participants identified the following top 10: (1) lifelong impacts; (2) interventions, treatments or supports; (3) ongoing lung health follow-up; (4) diagnostic tools, resources and education for primary healthcare providers; (5) resources to inform and empower families; (6) relationship to physical health and developmental issues; (7) preventing and/or treating lung infections; (8) additional supports, resources and research for minority groups; (9) impact on mental well-being; and (10) likelihood of asthma diagnosis., Conclusion: Priorities identified through the PSP will be invaluable in informing future research into prematurity-associated lung disease., Competing Interests: Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: Inclusion body myositis (IBM) is a rare neuromuscular disease that confers significant functional disability. Understanding the priorities of IBM patients and carers is critical to directing care interventions where resources are limited. This Australian patient-led study aimed to identify current challenges for IBM patients and carers; prioritisation of these challenges; and self-reported ability to cope., Methods: This phased study used a mixed methods approach. An initial qualitative 'discovery' phase, involving a small cohort of patients and carers (n=23), determined key challenges (themes). A subsequent quantification phase, involving 149 Australian IBM patients and carers, utilised an online survey to prioritise themes and determine current level of coping., Results: The study identified 10 inter-related themes, and their relative importance was then determined. Ninety-five percent of total importance came from 7 themes: (1) Uncertain future; (2) Coping with daily frustrations; (3) Lack of cure, treatment and understanding; (4) Impact on carer's capabilities and own needs; (5) Change of roles and relationships; (6) Getting information, education and support; and (7) Significant impact on mental health. Other themes identified were: (8) Financial impact; (9) Issues with government-provided care provision; and (10) Concerns around access to voluntary euthanasia. Participants reported low mean 'coping scores' across all themes., Conclusions: This study identified gaps in care, education and support. The highest priority themes focussed on practical challenges of living with IBM in addition to significant impact on mental health. Understanding the priorities of IBM patients and carers is critical in directing resources and providing person-centered care and support.

Recognizing and prioritizing research areas in emergency care is crucial for generating evidence and advancing research programs, aiming to enhance health outcomes for both individuals and populations. The objective of this review is to document global clinical and nonclinical research priorities. The Emergency Medicine Education and Research by Global Experts network, consisting of 22 sites across six continents, conducted a mapping review of publications on emergency medicine research priorities (2000-2022) across seven databases. We included studies with replicable methodologies for determining research priorities, excluding those limited to individual diseases. Three reviewers independently screened, selected, and categorized results into clinical and nonclinical topics. Discrepancies were resolved by an independent investigator and consensus. Outcomes measures and analysis include descriptive analysis of research priorities grouped into clinical and nonclinical topics, characteristics of publications including countries represented in the author list, target audience (such as researchers or policy makers), participants (e.g. patients), and methods (e.g. Delphi) of priority setting. Among 968 screened papers, 57 publications from all WHO regions were included. Most (36, 63%) had authors from only a single country, primarily in North America and Europe. Patient representatives were included in only 10 (18%). Clinical research priorities clustered into resuscitation, cardiology, central nervous system, emergency medical services, infectious disease, mental health, respiratory disease, and trauma. Distribution was broad in North America and Europe but focused on infectious diseases and resuscitation in Africa and Asia. Eleven nonclinical topics included access to care, health policy, screening/triage, social determinants of health, staffing, technology/simulation, shared decision making, cross-sectoral collaboration, education, patient-centered care, and research networks. Nonclinical topics were broad in Europe and America, focused on access to care and health screening in Africa, and mostly absent in other WHO regions. Published research priorities in emergency medicine are heterogeneous and geographically limited, mostly containing groups of authors from the same country. The majority of publications in global research priority setting stem from Western countries, covering a broad spectrum of clinical and nonclinical topics. Research priorities from Africa and Asia tend to focus on specific issues more prevalent in those regions of the world., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To study the prioritization effects of the of COVID-19 pandemic on Swedish cataract surgery using a national healthcare registry with high coverage., Setting: A study from the Swedish National Cataract Register (NCR), involving all patients undergoing cataract surgery in Sweden during 2019-2022 - before, during and after the COVID-19 pandemic., Results: With the pandemic outbreak, the number of cataract surgeries fell by 22% in 2020 (15 369 procedures), albeit with large regional differences (-43% to +58%). The numbers recovered in 2021, and in 2022, a new top notation was seen (n = 149 952). On a national level, the patients were younger (-0.46 years, p < 0.001), with a larger proportion of less difficult cases (p < 0.001) and the proportion of males was higher (p < 0.001) during the pandemic, but all these variables also differed substantially between different regions and clinics., Conclusion: A national registry with high coverage can map the consequences of an event disrupting elective surgery in detail. During the COVID-19 pandemic, the impact on Swedish cataract surgery varied largely between different regions, clinics, and healthcare providers, leading to inequality in the availability of surgery. These differences likely owed to variations in healthcare policy approaches in different parts of the country. The present study shows that outcomes at one clinic or region cannot be extrapolated to larger regions under these circumstances. It actualizes the need to aim for a healthcare on equal terms, but it also shows a system that delivers care to many despite difficult times., (© 2024 The Author(s). Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: Research into epilepsy has experienced decades of chronic underfunding compared to other neurological conditions despite its prevalence and seriousness. To evidence the need for greater investment, the Epilepsy Research Institute (formerly Epilepsy Research UK) funded, led and managed a James Lind Alliance (JLA) Priority Setting Partnership (PSP). This "industry standard" methodology brings together healthcare professionals, patients, carers and patient group representatives to identify and prioritise research uncertainties within a defined area of health or care., Methods: The UK Epilepsy PSP is a once-in-a-generation, national consensus that collated and ranked the research priorities of the UK epilepsy and associated condition community. Following JLA methodology, this 18-month project engaged over 100 patient groups and 5000 people affected by and working in epilepsy, including medics and allied healthcare professionals, from across the UK., Results: Over 5400 priorities were received, with anti-seizure medication, sudden unexpected death in epilepsy (SUDEP) and epilepsy in women among the most frequently reported themes. The responses received were categorised and translated into distinct, researchable questions. Questions were excluded if deemed to be "answered" following an evidence check, while research uncertainties (i.e. unanswered and partially answered questions) formed the basis of a second, shortlisting survey. The shortlisted questions were then discussed and debated at the final workshop by participants that broadly represented the UK epilepsy and associated condition community. The final ranking and Top Ten priorities for research into epilepsy were then agreed., Conclusion: The aim of the UK Epilepsy PSP is to encourage and inspire researchers to investigate the research areas prioritised by those most affected by the condition and provide the evidence of need to aid future policy making discussions and support research funding applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Publicly funded regional primary health care investments are usually informed by analysis of locally collected data, surveys, focus groups and consultations. We wanted a deeper understanding of baseline health and social care priorities in culturally diverse Western Sydney. If WentWest could understand the priorities, the operational agenda for commissioning services could be tailored around them. This research describes the organisation, conduct and recommendations of a citizens' jury in 2023., Methods: Thematic analysis of the transcribed facilitated discussions identified the well-informed priorities of a diverse and representative group of Western Sydney citizens. Listening to internal and external advisory groups delivered communication pathways, expert presenters, handbook preparation and practical support for the jury event. Consistent with the principle that research about the community should include the community, four consumer advisors were colleagues in the research team., Results: The jury supported a focus on prevention, including early intervention to keep children thriving and connected at school, and better cross-sectoral bonds via coalitions to enable social care to be linked to health care. Team-based care in general practice for proactive data use and building a culture for relationship-based care, developing a patient-centred workforce through incentivising students and expediting registration of overseas trained health workers were recommended. Assets-based community development was seen as an essential approach in linking the community with these recommendations., Conclusion: The use of citizens' juries in primary health settings is rare. In this culturally diverse community, WentWest now has a foundational understanding of what investments will deliver and has committed to institutionalising this deliberative approach into a permanent citizens assembly., Patient and Public Contribution: The design of the jury was guided by several advisory groups across the local region. The research team included four consumer advisors to provide overarching feedback and external insights. The jurors were selected to be representative of the regional community. They developed the recommendations reported in this article., Trial Registration: This research does not involve clinical trials., (© 2025 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Recent years have seen significant positive changes and developments in oral health-related policy and data on oral health and oral health care in Canada. Simultaneously, on the international stage, the momentum for oral health and related research continues to build. These changes have led to an initiative to create Canada's first National Oral Health Research Strategy (NOHRS), which was recently published by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis (Allison and Rock 2024). In this communication, we describe the process that was used to undertake this work. We present the resulting guiding principles, the research priority areas, and the framework that emerged, which included 6 strategic priorities grouped into 3 themes: (A) Leading Issues: (1) access to care, (2) inequities, identities, and oral health; (B) Emerging Methods: (3) artificial intelligence, (4) omics; and (C) Overarching Approaches: (5) environmental sustainability, (6) knowledge mobilization and implementation science. In addition, NOHRS includes a series of proposed goals and a timeline over the coming years. The point is to encourage a broad range of individuals and groups of people to engage with this high-level strategy and create plans to implement it. This strategy directly answers the call by the World Health Organization for countries to establish a national oral health research strategy (World Health Organization 2024). We have engaged in an extensive, broad consultative process, resulting in a Canadian NOHRS that is tailored to the needs of our community. Its aim is to galvanize our community into action to address the priorities we have identified. By engaging in this process, we build upon multiple oral health-related initiatives in Canada and on the international stage. We hope to inspire and facilitate similar, much-needed work elsewhere., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Regional anaesthesia provides important clinical benefits to patients but is underutilised. A barrier to widespread adoption may be the focus of regional anaesthesia research on novel techniques rather than evaluating and optimising existing approaches. Research priorities in regional anaesthesia identified by anaesthetists have been published, but the views of patients, carers and other healthcare professionals have not been considered previously. Therefore, we launched a multidisciplinary research priority setting partnership that aimed to establish key regional anaesthesia research priorities for the UK., Methods: Research suggestions from key stakeholders (defined by their interaction with regional anaesthesia) were gathered using an online survey. These suggestions were analysed to identify common themes and then combined to formulate indicative research questions. After an extensive literature review, unanswered and partially answered questions were prioritised via an interim online survey and then ranked as a top 10 list during a final live virtual multidisciplinary prioritisation workshop., Results: In total, 210 individuals completed the initial survey and suggested 518 research questions. Fifty-seven indicative questions were formed, of which three were considered fully answered after literature review and one not feasible. The interim online survey received 335 responses, which identified the 24 highest priority questions from the 53 presented. At the final live prioritisation workshop, through a nominal group process, we identified the top 10 regional anaesthesia research priorities. These aligned with three broad thematic areas: pain management (two questions); patient safety (six questions); and recovery from surgery (two questions)., Discussion: This initiative has resulted in a list of research questions prioritised by patients, carers and a multidisciplinary group of healthcare professionals that should be used to inform and support future regional anaesthesia research in the UK., (© 2024 Association of Anaesthetists.)

The field of artificial intelligence (AI) has entered a new cycle of intense opportunity, fueled by advances in deep learning, including generative AI. Applications of recent advances affect many aspects of everyday life, yet nowhere is it more important to use this technology safely, effectively, and equitably than in health and health care. Here, as part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2025 initiative, which is designed to provide guidance on pressing health care issues for the incoming presidential administration, we describe the steps needed to achieve these goals. We focus on four strategic areas: ensuring safe, effective, and trustworthy use of AI; promotion and development of an AI-competent health care workforce; investing in AI research to support the science, practice, and delivery of health and health care; and promotion of policies and procedures to clarify AI liability and responsibilities.

In 2016, ahead of the US presidential election, the National Academy of Medicine launched the strategic initiative Vital Directions for Health and Health Care-a series of papers on critical areas of US health care written by the nation's experts and intended to provide nonpartisan guidance to the incoming administration. The National Academy of Medicine continued the initiative in 2021. The current series, titled Vital Directions for Health and Health Care: Priorities for 2025, contains six articles on priority areas in US health and medicine that demand urgent attention. Here we provide an overview of the articles, which spotlight key areas for action and transformative change: revitalizing the biomedical research enterprise, modernizing public health, charting new directions for women's health, safely integrating artificial intelligence throughout the health care system, addressing the impact of climate change on health and equity, and transforming the US health care system to one that performs at par with the systems of other industrialized nations. Common themes include coordinating a strategic vision, correcting adverse economic incentives, investing in the health care workforce, reducing fragmentation, and emphasizing equity. Each article offers actionable priorities for the new administration to improve health outcomes for all Americans.

The treatment of obesity remains underprioritized. New pharmacologic options for the treatment of obesity have shown effectiveness and safety but are not widely reimbursed. Despite the unmet need and the existence of effective prevention and treatment strategies, substantial barriers exist to effectively address obesity as a disease. The purpose of this scoping review was to investigate the barriers for decision makers in prioritizing interventions for obesity and to seek out interconnection between barriers to prevention and treatment. A scoping review was conducted using a systematic search of both scientific databases and Health Technology Assessment (HTA) databases. Studies that addressed barriers to reimbursement or prioritization of obesity treatment and prevention were included. A total of 26 articles and 14 HTAs were included. Four main barriers for decision makers to prioritize new interventions for obesity were identified: perceptions, knowledge, economics, and politics. There was a high degree of interconnectedness among barriers, as well as large overlaps between barriers in relation to bariatric surgery, pharmacologic treatments, and prevention regulation. Multiple barriers exist that impact decision makers in prioritizing interventions for treating obesity. A strong interconnectedness of the barriers was found, indicating a systems approach to improve global prioritization to address the disease. This study suggests that decision makers should carefully consider all main barriers when addressing the obesity epidemic., Competing Interests: Competing interests: The current analysis was funded by a research grant from Novo Nordisk to Nordic Institute of Health Economics. The sponsor contributed to the design and the protocol of the study, but the academic authors made the final determination as to which analyses to present and how to best interpret them. LHE has received consultancy fees or research funding from AbbVie, AstraZeneca, Boehringer Ingelheim, Contura, Gilead, GSK, Janssen, Merck, Novartis, Novocure, Novo Nordisk, Pfizer, Radiometer, and Specsavers. ClR reports grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board; serves on advisory boards and speakers panels of Novo Nordisk, Roche, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, Irish Life Health, Boehringer Ingelheim, Currax, Zealand Pharma, Keyron, AstraZeneca, and Rhythm Pharma; is a member of the Irish Society for Nutrition and Metabolism outside the area of work commented on here; and provides obesity clinical care in the My Best Weight Clinic and Beyond BMI clinic and is a shareholder of these clinics. PM have received funding and honoraria from Novo Nordisk and other pharmaceutical companies. JCH have received honoraria from Novo Nordisk and Rhythm. JCH provides training and treatment. NWR and RHO have no competing interest to declare., (© 2024. The Author(s).)

Clinical practice guidelines (CPGs) and consensus-based recommendations (CBRs) require considerable effort, collaboration, and time-all within the constraints of finite resources. Professional societies, such as the International League Against Epilepsy (ILAE), must prioritize what topics and questions to address. Implementing evidence-based care remains a crucial challenge in clinical practice. Using rigorous processes to ensure that the best available research evidence informs health care recommendations is of the utmost importance. We aimed to develop a structured and transparent process for prioritizing future CPGs and CBRs supported by the ILAE. A multidisciplinary group of researchers and experts from the ILAE Prioritization Task Force conducted a scoping review to identify prioritization approaches for CPG and CBR development. This scoping review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Cochrane recommendations. A Problem/population, Concept, and Context (PCC) strategy was applied to the literature search and selection of the studies. We searched Medline/PubMed, Embase, Web of Science, and Scopus without time or language limits. The findings were synthesized qualitatively. A consensus-based process was followed to develop a prioritization scoring tool for CPGs and another for CBRs. Thirty-nine participants, including clinicians, experts in the field, methodologists, and other relevant stakeholders, contributed to developing the final instrument (based on a 5-point Likert scale). Of 721 unique citations, 8 papers reporting prioritization approaches for guideline development were included. Based on these, we developed an initial tool with 10 criteria. It was iteratively optimized and revised by the ILAE Standards and Best Practice Council, which unanimously approved the instrument. The ILAE Executive Committee subsequently approved its final version. The ILAE Prioritization Tool is intended to standardize the prioritization processes and optimize the ILAE's use of resources to select CPGs and CBRs for endorsement., (© 2025 International League Against Epilepsy.)

Background: In the context of research priority-setting, participants express their research priorities and ideas in various forms, ranging from narratives to explicit topics or questions. However, the transition from these expressions to well-structured research topics or questions is not always straightforward. Challenges intensify when research priorities pertain to interventions or diagnostic accuracy, requiring the conversion of narratives into the Participant, Intervention, Comparator, Outcome (PICO) format., Scope and Findings: This project aimed to understand the challenges of engaging a diverse, multilingual population in setting oral health research priorities. While not a comprehensive priority-setting effort, we modified James Lind Alliance's (JLA) methods and used thematic analysis to establish a list of priority research topics and questions. This was accomplished by conducting interviews with 40 community participants and 14 dentists from various ethnic backgrounds in Malaysia. The interview language depended on participant preferences, including English, Malay, and Mandarin, with translations handled collaboratively by bilingual research assistants. The process involved thematic analysis, discussion with a research committee, and necessary modifications. Our interpretations revealed distinct categories of participant statements: explicit, complicated, implicit and incomplete. In this study, we identified a three-step approach to translate research ideas that are presented either as explicit statements or as complicated narratives., Conclusions: Translating community research priorities poses inherent challenges. Our model, although not exhaustive, provides a valuable tool to assist research priority-setting groups in translating these priorities into meaningful research topics and questions, facilitating the equitable inclusion of diverse perspectives. Future research priority-setting endeavours should document their translation processes, thus aiding researchers in understanding and tackling the intricacies of this task., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved in accordance with the Declarations of Helsinki by the Research and Ethics Committee of Melaka-Manipal Medical College, Melaka, Malaysia (ref no. MMMC/FOM/Research Ethics Committee-2/2019 dated 15 September 2019) and the Ethics Committee of the University of Plymouth, Plymouth, United Kingdom (ref no. 19/20 – 1199 dated 11 March 2020 and 28 April 2020). Informed consent was obtained from all the participants and translators. Consent for publication: We have obtained consent from the participants and translators to share the anonymized data in publications, presentations and other scholarship activities. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Demand for transcatheter aortic valve implantation (TAVI) has increased in the last decade, resulting in prolonged wait-times and undesirable health outcomes in many health systems. Risk-based prioritization and wait-times benchmarks can improve equitable access to patients., Methods and Results: We used simulation models to follow-up a synthetic population of 50 000 individuals from referral to completion of TAVI. Based on their risk of adverse events, patients could be classified as 'low-', 'medium-', and 'high-risk', and shorter wait-times were assigned for the higher risk groups. We assessed the impacts of the size and wait-times for each risk group on waitlist mortality, hospitalization, and urgent TAVIs. All scenarios had the same resource constraints, allowing us to explore the trade-offs between faster access for prioritized patients and deferred access for non-prioritized groups. Increasing the proportion of patients categorized as high-risk, and providing more rapid access to the higher-risk groups achieved the greatest reductions in mortality, hospitalizations and urgent TAVIs (relative reductions of up to 29%, 23%, and 38%, respectively). However, this occurs at the expense of excessive wait-times in the non-prioritized low-risk group (up to 25 weeks). We propose wait-times of up to 3 weeks for high-risk patients and 7 weeks for medium-risk patients., Conclusion: Prioritizing higher-risk patients with faster access leads to better health outcomes, however this also results in unacceptably long wait-times for the non-prioritized groups in settings with limited capacity. Decision-makers must be aware of these implications when developing and implementing waitlist prioritization strategies., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Introduction: Mental health problems are the most significant cause of disability and have high annual economic costs; hence, they are a priority for the government, service providers and policymakers. Consisting of largely coastal and rural communities, the populations of Norfolk and Suffolk, UK, have elevated burdens of mental health problems, areas with high levels of deprivation and an increasing migrant population. However, these communities are underserved by research and areas with the greatest mental health needs are not represented or engaged in research. This National Institute of Health and Care Research-funded project aims to bring together key stakeholders to conduct extensive scoping work to identify mental health needs and priorities as a basis for conducting larger research to address the identified priorities over the next 5 years., Methods and Analysis: This 12-month mixed-methods research-priority-setting project consists of five phases. It is being conducted in Norfolk and Suffolk counties in the East of England, UK. Underpinned by Delphi methodology, it will adopt the James Lind Alliance approach to identify priorities for mental health research for the populations of Norfolk and Suffolk. The project will use multiple methods, including mapping and identification of stakeholders, online questionnaires, face-to-face focus groups and interviews, and consensus meetings with experts and mental health stakeholders. Key evidence-informed priorities will be collaboratively ranked and documented, and a final top 10 research priorities will be identified to inform future research, policy and service provision., Ethics and Dissemination: This study was approved by the University of East Anglia's Faculty of Medicine and Health Research Ethics Committee (reference: ETH2324-2542), Norwich, UK. Research findings will be disseminated through workshops with stakeholders and collaborators and via peer-reviewed scientific publications, presentations at academic societies, blogs and social media., Competing Interests: Competing interests: On behalf of all authors, the corresponding author states that there are no conflicts of interest., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Objective: This study aimed to characterize the perceived priorities of state and county policy makers for youth mental health services and the factors that influence those priorities., Methods: Mental health agency officials (N=338; N=221 state officials, N=117 county officials) representing 49 states completed a Web-based survey in 2019-2020. On 5-point scales, respondents rated the extent to which 15 issues were priorities for their agency in providing youth mental health services and the extent to which nine factors influenced those priorities., Results: Suicide was identified as the highest priority (mean±SD rating=4.38±0.94), followed by adverse childhood experiences and childhood trauma and then increasing access to evidence-based treatments. Budget issues (mean=4.27±0.92) and state legislative priorities (mean=4.01±0.99) were perceived as having the greatest influence on setting priorities., Conclusions: These findings provide insights into youth mental health policy priorities and can be used to guide implementation and dissemination strategies for research and program development within state and county systems., Competing Interests: Dr. Nelson was an employee of Merck and ViiV Healthcare during manuscript development and owns stock in GlaxoSmithKline. The other authors report no financial relationships with commercial interests.

Aims: Prolonged waits for hip and knee arthroplasty have raised questions about the equity of current approaches to waiting list prioritization for those awaiting surgery. We therefore set out to understand key stakeholder (patient and surgeon) preferences for the prioritization of patients awaiting such surgery, in order to guide future waiting list redesign., Methods: A combined qualitative/quantitative approach was used. This comprised a Delphi study to first inform which factors patients and surgeons designate as important for prioritization of patients on hip and knee arthroplasty waiting lists, followed by a discrete choice experiment (DCE) to determine how the factors should be weighed against each other. Coefficient values for each included DCE attribute were used to construct a 'priority score' (weighted benefit score) that could be used to rank individual patients waiting for surgery based on their respective characteristics., Results: In total, 43 people participated in the initial round of the Delphi study (16 patients and 27 surgeons), with a 91% completion rate across all three rounds. Overall, 73 surgeons completed the DCE. Following the final consensus meeting of the Delphi component, the seven final factors designated for inclusion were Pain, Mobility/Function, Activities of Daily Living, Inability to Work/Care, Length of Time Waited, Radiological Severity, and Mental Wellbeing. Output from the adjusted multinomial regression revealed radiological severity to be the most significant factor (coefficient 2.27 (SD 0.31); p < 0.001), followed by pain (coefficient 1.08 (SD 0.13); p < 0.001) and time waited (coefficient for one month additional wait 0.12 (SD 0.02); p < 0.001)., Conclusion: These results present a new robust method for determining comparative priority for those on primary hip and knee hip arthroplasty waiting lists. Evaluation of potential implementation in clinical practice is now required., Competing Interests: L. Farrow is currently in receipt of a Chief Scientist Office Scotland Clinical Academic Fellowship, and reports which is focused on improving the clinical care pathway in those referred for hip and knee arthroplasty, and reports a grant from University of Aberdeen Knowledge Exchange Commission, related to this study, as well as support for attending meetings and/or travel from LINK, unrelated to this study. R. M. D. Meek reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from DePuy Synthes, Stryker, and Palacademy, unrelated to this study. K. Gillies reports consulting fees from Boehringer & Ingelheim, unrelated to this study. N. D. Clement and R. M. D. Meek are both members of the editorial board of The Bone & Joint Journal., (© 2025 Farrow et al.)

Introduction: Though the disease burden addressable by prehospital and out-of-hospital emergency care(OHEC) spans communicable diseases, maternal conditions, chronic conditions and injury, the single largest disability-adjusted life year burden contributor is injury, primarily driven by road traffic injuries(RTIs). Establishing OHEC for RTIs and other common emergencies in low- and middle-income countries(LMICs) where the injury burden is disproportionately greatest is a logical first step toward more comprehensive emergency medical services(EMS). However, with limited efforts to formalize and expand existing informal bystander care networks, there is a lack of consensus on how to develop and maintain bystander-driven Tier-1 EMS systems in LMICs. Resultantly, Tier-1 EMS development is fragmented among non-governmental organizations and the public sector globally., Methods: A steering committee coordinated a 9-round, modified Delphi-based expert discussion to identify current challenges, opportunities, and priorities in Tier-1 EMS development globally. 11 panelists represented seven Global Prehospital Consortium(GPC) member organizations with a mean 9.57 years of organizational Tier-1 EMS development/implementation experience(median = 9 years). The consortium represents the largest collaboration between organizations directing Tier-1 EMS programs globally across 12 countries on 3 continents(Americas, sub-Saharan Africa, and South Asia) with 22,000 first responders., Results: The GPC identified seven priority areas for Tier-1 EMS development: infrastructure/operations, communication, education/training, impact evaluation, financing, governance/legal, and transportation/equipment. A high level of consensus exists regarding priorities for investigation, including Tier-1 responder density/distribution, Tier-1 patient data variable standardization for trauma registries/quality improvement, dispatch technologies/protocols, modular curricula, broader cost-effectiveness and impact evaluation indices capturing secondary impacts of EMS, standardizing legal protections for first responders, and transportation/equipment standards., Discussion: Consensus is necessary to avoid duplicative and disorganized efforts due to the fragmented nature of parallel Tier-1 EMS efforts globally. A Delphi-like multi-round expert discussion among the members of the largest collaboration between organizations directing Tier-1 EMS programs globally generated relevant priorities to direct future efforts., Competing Interests: Declaration of competing interest Members of the Global Prehospital Consortium are representatives from operating Tier-1 EMS organizations. Though we do not intend to over-represent participating organizations, corresponding organizational representation is a by-product of utilizing expert consensus, with much of the available literature having been authored by the called-upon experts., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This article endeavours to make public health professionals aware of key priorities for promoting positive health based on the Ottawa Charter. The authors recommend the use of optimum or positive health indicators. They argue that in so doing we may see a paradigm shift in our thinking away from purely sickness and ill health, towards more positive visions of health.