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Background: Evidence from high-income countries indicates that midwifery-led continuity of care improves maternal satisfaction and health outcomes throughout pregnancy and postpartum. In Ethiopia, low maternal satisfaction with care indicates systemic problems, including ineffective communication and substandard service quality. This study aimed to evaluate how midwifery-led continuity care impacts maternal satisfaction during antenatal, intrapartum, and postpartum care in the Sidama region's general hospitals in Ethiopia.

Methods: A prospective non-randomized controlled trial was conducted from October 2023 to June 2024 in four general hospitals in the Sidama region of Ethiopia. A total of 478 low-risk women were allocated into two groups: midwifery-led continuity of care (n = 239 and shared care n = 239). Quantitative data were gathered through face-to-face interviews to evaluate maternal satisfaction, and average satisfaction scores between groups were analyzed using bootstrapping linear regression.

Results: Women in the midwifery-led continuity of care reported significantly higher satisfaction with continuity of care compared to shared care, with an adjusted mean difference of 0.28 (95% CI 0.13-0.40; P < .001). Specifically, during antenatal care, the adjusted mean difference was 0.20 (95% CI 0.06-0.33; P < .003), intrapartum care was 0.31 (95% CI 0.17-0.45; P < .001), and postnatal care was 0.44 (95% CI 0.29-0.59; P < .001).

Conclusion: Women receiving midwifery-led continuity of care reported higher satisfaction levels, making this model a viable alternative for improving satisfaction in maternity services by offering a more personalized and supportive approach to care.

Background: Implementation of eHealth technologies has the potential to improve healthcare delivery, but is complex. Successful adoption depends on organizational readiness, effective change management and active involvement of healthcare professionals. Leadership plays a critical role in fostering a supportive climate for digital transformation. However, many managers lack the tools, knowledge and clarity needed to lead implementations effectively. This study explores how middle managers in primary care in Sweden prepare for and lead a large-scale, top-down implementation of a digital service system (1177 Direct) for symptom assessment, triage, referral and chat.

Objectives: By examining middle managers' experiences, the study aims to identify best practices, barriers and enabling factors that support successful digital transformation.

Methods: Semi-structured interviews were conducted with 26 middle managers within primary healthcare. Interviews were conducted 2 weeks before each unit launched the digital service system. The data were analysed using conventional content analysis.

Results: The analysis yielded four categories describing the managers' experiences of preparing for implementation of the digital service at their workplace: (1) how the managers navigated their role when driving top-down organizational change, having the responsibility to lead the change no matter their thoughts about it; (2) the importance of preparing tailored strategies for the implementation; (3) important preconditions for leadership in change; (4) the ability to adjust the innovation and implementation process to the local setting.

Conclusion: Middle managers have a pivotal role in preparing for and leading implementation. Managers' efforts focused on supporting staff, navigating uncertainty, and applying local strategies to foster readiness and engagement. When leading change, there is a need for clear communication, contextual adaptation and bidirectional feedback to ensure sustainable implementation. Strengthening these preconditions can enhance middle managers' capacity to lead complex digital transformations effectively and promote long-term success.

Background: Medication errors (MEs) pose a significant challenge to patient safety and healthcare efficiency. In addition to clinical consequences, MEs contribute to increased healthcare expenditures and resource utilization. However, comprehensive cost assessments of MEs, including staff time and service costs, remain limited.

Objectives: The aim of this pilot study is to examine the costs associated with MEs regionally and nationally in Finland.

Design: Cross-sectional study.

Methods: This study assessed the financial and resource burden of MEs in the Finnish public healthcare system using a survey conducted in the wellbeing services county of North Savo in Eastern Finland. The study perspective is economic and healthcare system-focused. Healthcare professionals in charge of patient safety reporting estimated the workforce impact of MEs by assessing the time spent, the corrective measures taken, and the additional interventions required to manage these events. Cost calculations were based on salary data from the 2023 financial administration statistics and service costs from the Finnish Institute for Health and Welfare (THL) database, adjusted to 2023 monetary value. An estimator, derived from regional data, was applied to extrapolate the nationwide economic burden of MEs.

Results: Medication errors (MEs) impose a substantial financial burden, with an estimated mean cost of €138 per event and a total annual cost of €686 274 in the wellbeing services county of North Savo. Extrapolated to the national level, the annual impact was estimated at €15.5 million. The main cost drivers were the work time expenditures of nurses and physicians involved in managing these events.

Conclusion: Managing MEs demands extra work of healthcare personnel, which is a considerable waste of resources. Most of the events are preventable. That is why effective safety strategies are needed, and prompt action taken to improve quality of care and reduce unnecessary costs.

Background: Adolescents and youth from socially and culturally underserved communities face a disproportionate burden of depression, exacerbated by systemic barriers to accessing timely and culturally appropriate mental health care. In contexts where health systems are under-resourced, community-based initiatives may offer promising strategies for promoting youth mental well-being.

Objective: This study explores how adolescents and youth from underserved communities in Mexico perceive and cope with depressive symptoms, with the aim of identifying community-informed strategies that can inform culturally relevant mental health promotion and prevention initiatives.

Methods: Using an exploratory qualitative design, the study combined participant observation with focus group discussions involving people aged 15 to 25. A thematic analysis guided by resilience and participatory frameworks was conducted to examine youths' emotional experiences, stressors, and coping mechanisms within their family, school, and social environments.

Results: Participants reported depressive symptoms such as sadness, social withdrawal, fatigue, and hopelessness. Key stressors included family conflict, exposure to violence, and school-based pressures like bullying and academic demands. Although many youth used positive coping strategies-such as seeking social support and participating in recreational activities-some also exhibited maladaptive responses, including avoidance and silence. Focus groups emerged as empowering spaces for youth to articulate emotions and co-develop potential solutions.

Conclusions: Findings highlight the urgent need for holistic interventions that integrate family and school-based programs with youth-centered, community-led mental health initiatives. Participatory methods are proposed as culturally sensitive, scalable approaches to address service gaps in under-resourced settings. These community-driven responses not only support individual coping but also contribute to the resilience of local health systems by aligning services with the lived realities of underserved populations.

Background: There is a lack of studies concerning the end of life (EOL) of patients with head and neck cancer (HNC).

Objectives: To investigate whether the timing of palliative care decision (PCD), that is, decision to terminate life-prolonging anticancer treatments, is associated with reduced secondary health care utilization and medical procedures at the EOL among patients with head and neck cancer.

Design and methods: A total of 108 patients with HNC treated at the Helsinki University Hospital Comprehensive Cancer Center were reviewed retrospectively. Three study groups were formed according to the timing of PCD: (1) the early PCD group (PCD >30 days prior to death), (2) the late PCD group (⩽30 days prior to death), and (3) the no PCD group.

Results: PCD was made for 78 patients (72%), of which 57 (73%) were considered as early PCD and 21 (27%) as late. The median interval between PCD and death was 71 days (IQR 108). During the last month of life, a significantly smaller proportion of patients with an early PCD was hospitalized (19% vs 67%, OR = 0.12, CI [0.04-0.37], P < .001 and 19% vs 47%, OR = 0.27, CI [0.10-0.72], P = .007) and readmitted (5% vs 29%, OR = 0.14, CI [0.03-0.62], P = .004 and 5% vs 20%, OR = 0.22, CI [0.05-0.96], P = .032) in secondary health care compared with the patients with late or no PCD. Early PCD also associated with less ED visits (28% vs 52%, OR = 0.36, CI [0.126-0.997], P = .045) compared with the late PCD in the last month of life. Compared with the late PCD group, early PCD group was more likely to receive palliative radiotherapy (42% vs 14%, OR 4.36, 95% CI [1.15-16.51], P = .022).

Conclusion: Early PCD associated with reduced utilization of secondary health care and emergency services at the EOL. The disease trajectories for patients with HNC should warrant more attention to the earlier timing of PCD.

Background: Long-term care (LTC) expenditure in Norway has increased by a far higher rate than GDP. While aging is still seen as the predominant challenge, younger users (<60 years) are disproportionately represented among the top-5% high-cost users, who accounted for 39% of LTC costs in 2019.

Aim: This study investigates how municipal leaders perceive the main drivers of LTC expenditure growth and what they consider to be the most pressing challenges.

Methods: We conducted semi-structured interviews with 13 municipal leaders between November 2023 and February 2024. Using thematic analysis, we explored their perspectives on expenditure growth, causes, and challenges. Municipalities were selected across KOSTRA groups to ensure variation in demographics and finances.

Results: Three main themes emerged. Municipal leaders identified younger users with complex mental health needs requiring intensive services, workforce shortages forcing reliance on expensive purchased services, and expanding rights creating gaps between expectations and capacity. These pressures are compounded by fiscal asymmetries-national policies expand mandates while implementation costs fall on municipalities with constrained budgets and labor markets.

Conclusions: Expenditure growth stems from both demographic drivers and governance challenges. While young users and workforce shortages directly increase costs, fiscal asymmetry makes these pressures difficult for municipalities by removing their flexibility to adapt services to available resources.

Implications for health services management: Managers need tools to manage fiscal asymmetries between national policy and local implementation.

Background: Premenstrual Dysphoric Disorder (PMDD) is associated with higher suicidality and reduced functioning. Diagnosis and treatment can improve symptoms and quality of life. Poor quality healthcare experiences for people seeking help for PMDD have been documented in other countries, but not in Australia.

Objective: To quantitatively and qualitatively describe experiences of healthcare for PMDD in Australia, including variations in experience by healthcare provider (HCP) type.

Methods: We employed mixed methods including an online survey and semi-structured interviews in adults who had sought healthcare in Australia for PMDD symptoms. Quantitative data was analysed using descriptive statistics, chi-square analyses, t-tests, and multilevel logistic modelling. Qualitative data was analysed using reflexive thematic analysis.

Results: Survey participants (n = 267) had sought help from an average of 5.1 different HCPs in seeking PMDD diagnosis and perceived an average of 51% of HCPs they had seen to have poor PMDD awareness. GPs were the most frequent HCP type seen first (74%) when seeking diagnosis. More than half reported experiencing medical gaslighting (54%) and misdiagnosis (56%). Interview participants (n = 11) reported misdiagnoses such as depression, anxiety, bipolar disorder, and personality disorders. Interview participants reported feeling that their symptoms were minimised by healthcare providers and that their health care concerns were dismissed. Participants were more likely to report poorer experiences with GPs compared to other HCP types. Less than a fifth of the survey sample (19%) had experienced diagnostic methods consistent with DSM-TR recommendations. Diagnosis was described by interview participants as resulting in increased coping, a mindset of self-compassion and reduced self-perceptions of feeling 'crazy' or having fundamental personality flaws.

Conclusions: People in Australia face similar PMDD healthcare barriers to those documented elsewhere. GP training in PMDD screening and clearer patient care pathways with specialist referral are needed to improve healthcare provision and reduce the burden of PMDD.

Background/objective: Healthcare services must provide high-quality patient care and continuously work to improve the quality of the organization. Continuous quality improvement (QI) involves systematic and ongoing enhancements of individual treatments as well as large organizational structures. To facilitate QI, suitable organizational structures are required. This study aims to describe and explore how administrative leaders organize for continuous QI in a Norwegian municipal setting.

Methods: This qualitative study examines how administrative leaders organize for QI in Norwegian municipalities by conducting semi-structured interviews with leaders and quality advisors (N = 19) in three Norwegian municipalities. The data were analyzed inductively by reflexive thematic text analysis and the software NVIVO 14.

Results: The municipalities used three main approaches to organize QI, aimed at integrating QI into their governing structures. The vertical approach aligned QI formalities with hierarchical structures. The horizontal approach created tailored structures for operationalizing and implementing QI. In the mediating approach, leaders actively and continuously worked vertically, horizontally, and across levels and units to reconcile differences, cooperate, communicate, and monitor activities, securing trust and commitment toward QI. Their responsibilities were extensive, supported by delegating responsibility to lower-level leaders and quality advisors, the latter with key roles in QI. QI functioned as a planned activity and continuous process. Trust and commitment were essential across approaches. Leaders' continuous mediating activities helped address the tensions between autonomy and commitment, specialized or integrated assistance, and balancing change, trust and control. These were critical to QI's success.

Conclusion: The different approaches to organizing QI facilitated the implementation of QI in various situations and alleviated tensions regarding the autonomous units' commitment to decisions and the integration or specialization of QI. The various approaches to QI, integrated with different bureaucratic models, created complex processes of layering new elements into existing structural forms, thereby modernizing municipal structures.

Background: High-cost older patients utilize a significant share of the economic resources in Norwegian somatic hospitals due to their complex healthcare needs and often require continued care beyond hospital settings. However, there is limited evidence on how they utilize municipal healthcare services.

Objective: This study examines how high-cost older patients utilize municipal healthcare services, emphasizing variations across age categories, and comparisons with non-high-cost older patients.

Design: Cross-sectional registry study using national registry data.

Methods: The study population included 189 336 patients aged ⩾65 years with at least one unplanned contact with somatic hospitals in 2019, consisting of 18 933 (10%) high-cost and 170 403 (90%) non-high-cost older patients. High-cost status was defined as the top 10% of patients with the highest diagnosis-related group weights. Logistic regression was used to examine differences in the odds of receiving municipal healthcare services in the study population adjusted for individual characteristics. Among those who received services (n = 61 171), gamma regression was used to examine the duration of service use (hours/days). Both regression models were stratified by age categories (65-74, 75-84, ⩾85 years).

Results: A higher proportion of high-cost than non-high-cost older patients received municipal healthcare services (54% vs 30%). This was also true after adjusting for patient characteristics (odds ratios 1.27-3.59, depending on age and type of healthcare service). High-cost patients had longer duration of service use (hours/days) than non-high-cost patients for institutional short-term treatment/examination (exp β = 1.12, P < .001) and rehabilitation/habilitation (exp β = 1.21, P < .001), but shorter duration for institutional long-term care (exp β = 0.80, P < .001).

Conclusion: High-cost older patients have substantial healthcare needs that extend from somatic hospitals into municipal healthcare, highlighting the importance of such transitional services in caring for these patients.

Background: This qualitative systematic review aims to identify, analyse and discuss barriers and facilitators to formal dementia services for South Asians in the UK with dementia. South Asian individuals in the UK are more likely to face a dementia diagnosis than the White British demographic; a trend which is expected to grow over the following decades. Despite this greater need for support, the UK South Asian demographic is less likely to access formal dementia services.

Methods: MODEM, Web of Science, PubMed, CINAHL via EBSCO, The Cochrane Library, and Scopus were searched (22nd July 2025) using a SPIDER search strategy and included studies' bibliographies were checked, in addition to existing review literature. Data on included studies was extracted using an adapted Cochrane Library data collection form and quality assessed using the JBI critical appraisal instrument for qualitative research. Themes were extracted and analysed using reflexive thematic analysis. Ten articles were found to meet the inclusion criteria and therefore included in this systematic review. While this review is framed as considering UK South Asians, data was only available from Bangladeshi, Indian and Pakistani individuals. However, much literature which claims 'South Asian' only defines South Asia as consisting of these three countries. Therefore, calling this paper a review of the 'South Asian' demographic allows us to critique this homogenisation.

Results: Five main themes were identified: Lack of Knowledge, Racism/Culturally Inappropriate Care, Stigma, a Familial Duty of Care and Service Delivery. There was disagreement in the literature regarding the existence of stigma. Previously unrecognised interrelations between these themes were identified, as a lack of knowledge had a potentially causal effect on both stigma and a familial duty of care.

Conclusion: The results indicate a need for review of current policy and practice, however further research is needed, particularly with regard to facilitators, which lacked data in comparison to barriers.