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Objective: Evaluating user satisfaction and its associated factors in two primary healthcare centers in Ucayali, Peru.

Methods: The study was cross-sectional analytical study conducted in April 2025 among patients who received care at two primary healthcare centers located in Ucayali, Peru. To assess their satisfaction with the care received, we used the Ambulatory Medical Consultation Satisfaction Scale (ESCOMA). To identify the factors associated with the ESCOMA satisfaction score, we used linear regression models.

Results: A total of 465 patients were included; 66.5% of those surveyed were women, and the median age was 40 years (IQR 31-52). Of these, 74.8% lived in the same city as the healthcare center. The median ESCOMA score was 7 points (range 6.17-8.28). Medical care received the highest dimensional score (mean: 7.94 ± 1.5), while facility infrastructure recorded the lowest (mean: 6.37 ± 1.9). The questions with the highest and lowest scores were "How would you rate this facility regarding the treatment by medical staff?" (mean: 8.33, SD ± 1.7) and "How would you rate this facility regarding the equipment?" (mean: 5.71, SD ± 2.7), respectively. Age ⩾ 47 years (β = .34; 95% CI: 0.02-0.67) was the main factor associated with a higher ESCOMA satisfaction score; on the other hand, patients who lived 2 hours from the health center had lower satisfaction (β = -.68; 95% CI: -1.09 to -0.28).

Conclusion: User satisfaction with primary healthcare centers in Ucayali is favorable regarding medical care and staff treatment. However, perception is significantly lower concerning infrastructure and equipment availability. As the distance from homes to the health centers increases, satisfaction with medical care decreases. These findings highlight the need to improve physical conditions and equipment to optimize the quality of care in these institutions.

Background: When parents or other guardians of children need treatment for a substance use disorder, it presents challenges impacting both them and their children, as a lack of childcare can be a barrier to treatment access. However, some treatment facilities provide childcare services to increase access. Little is known about how local economic factors like childcare costs and income levels are associated with the availability of childcare services in addiction treatment programs in the United States.

Objectives: This study's objectives were twofold: (1) assess whether county-level childcare prices are associated with the availability of childcare services in substance use disorder treatment facilities, and (2) assess whether county-level median household income is associated with the availability of childcare services in substance use disorder treatment facilities.

Design: This is a cross-sectional study.

Methods: This study examined n = 9003 substance use disorder treatment facilities in the United States. Childcare costs and median income estimates were linked with facilities based on the county in which they were located. Univariable and bivariable statistics were used to examine the facilities. An adjusted logistic regression model was used to evaluate associations between childcare availability and county-level economic indicators, while controlling for facility-level characteristics.

Results: Approximately 5.7% (n = 514) of the facilities in the sample had childcare services. The multivariable logistic regression model identified factors associated with facilities having childcare including having outpatient and residential treatment (compared to having only outpatient only), accepting females only (compared to accepting males only), having a pregnant or postpartum program/group, accepting Medicaid, slightly higher county-level toddler center prices, and slightly higher county-level preschool center prices.

Conclusion: Local childcare costs, but not median income appears to be slightly associated with the availability of childcare services in substance use disorder treatment settings. Economic investment in family-friendly services may help reduce access barriers for parents seeking treatment.

Background: The colorectal cancer (CRC) screening adherence rate among the uninsured population in the United States (US) is lower than the overall rate across all US adults aged 45 to 75.

Objectives: To assess the cost-effectiveness of community health worker (CHW) navigation services promoting CRC screening in a low-income, uninsured population.

Methods: Using internal cost and effectiveness data from the Texas A&M Cancer Screening, Training, Education, and Prevention (CSTEP) program, which included 3196 participants, along with published sources such as the U.S. Preventive Services Task Force (USPSTF) recommendations, we estimated incremental cost-effectiveness ratios (ICERs) for CRC screening with CHW navigation versus usual care. The analysis was conducted from a societal perspective using Excel-based modeling in hypothetical cohorts initiating screening at age 45.

Results: Under base-case assumptions, a 10 percentage-point improvement in CRC screening attributable to the program increased LYG by 0.160 at an additional lifetime cost of $101, resulting in an ICER of $3098 per LYG. One-way and two-way sensitivity analyses were conducted, varying program costs, screening rate improvements, lifetime CRC costs, and life-years gained (LYG).

Conclusion: Our findings underscore the importance of CHW navigation services incorporating CRC screening promotion strategies tailored to uninsured populations to alleviate disparities in colorectal cancer screening and outcomes. Further research should consider the characteristics of uninsured populations, and the applicability of the program targeted for various types of underserved populations.

Background: Low vision care and rehabilitation (LVCR) remains critically underdeveloped in sub-Saharan Africa, despite a high prevalence of moderate to severe visual impairment.

Objective: This study assessed the current state of LVCR in five sub-Saharan African countries using a modified World Health Organization (WHO) health systems framework.

Method: A qualitative design was employed, involving semi-structured interviews which were based on a modified WHO health system building blocks: governance and leadership, health service delivery, human resource, low vision aid and technology, and financing. Optometrists providing low vision care in Ghana, Nigeria, Malawi, Kenya, and South Africa were recruited as participants through a combination of stratified random sampling and snowballing. Thematic analysis was conducted to identify the underlying themes.

Results: Practitioners reported systemic deficiencies across all five blocks investigated. Governance and leadership lacked clear policies, coordination, and data infrastructure. Health service delivery was characterized by poor coverage, the absence of dedicated LVCR centres, and limited integration into public health systems. Human resources were inadequate, with no structured training or recruitment of practitioners, and low recognition of the sub-specialty. Essential assistive technologies were largely inaccessible due to high costs and procurement challenges. Financing was insufficient, with patients primarily paying out-of-pocket and health insurance schemes offering limited support.

Conclusion: None of the five blocks of the WHO health systems framework were adequate for LVCR in this study. Consequently, strengthening each block particularly governance, workforce development, and financing is essential for advancing equitable and sustainable LVCR systems in sub-Saharan Africa.

Introduction: Considering the global increase in cancer, integrative medicine combines conventional and complementary methods, offering a holistic approach to treating cancer patients. To optimize care and support care continuity for oncological patients, the integrative healthcare structure CCC-Integrativ provided evidence-based, interprofessional counseling in four oncology centers in Southern Germany. A process evaluation explored the program's perceived effects and factors relevant to the implementation process to identify opportunities and challenges for a sustainable implementation of the program.

Methods: In a qualitative study, semi-structured guide-based interviews with medical and nursing staff directly and indirectly involved in the program were conducted to explore their perspectives. The generated data were analyzed in a content analysis. Participant perceptions regarding potential program effects and factors influencing its' implementation were first identified through open inductive coding. The Consolidated Framework for Implementation Research (CFIR) was then used as a categorizing analytical framework to guide further coding and facilitate a deeper understanding of the implementation process.

Results: N = 21 interviews were analyzed (n = 12 directly involved in counseling; n = 9 indirectly involved through leadership position). Participants perceived an added value of the integrative care approach and expressed a positive attitude towards a continuation of the program. Patient interest in complementary medicine and care, their positive response to the program, and a perceived supportive effect of the interprofessional collaboration were reported as promoting factors. Still, insufficient evidence and a perceived low acceptance of some complementary medicine methods by hospital staff, skepticism, lack of space, and recruitment problems, were identified as key challenges for successful long-term implementation.

Conclusions: A variety of factors need to be addressed for sustained implementation. Promoting acceptance of supportive complementary methods is essential for evidence-based, patient-centered cancer care. Consideration of interprofessional care could be a key factor for the long-term implementation of consultations on complementary and integrative healthcare.

Background: Interest is growing in the use of Artificial Intelligence (AI) technologies in health care. Health AI innovations have been explored in a range of clinical contexts, yet their implementation into routine practice remains challenging. The aim of this study was to understand the factors that influenced the implementation of AI innovations into routine practice in Australian Healthcare organisations, from the perspective of implementers.

Methods: The study used a qualitative methodology. AI implementers were identified via an environmental scan of publicly available information, combined with passive snowballing. In-depth research interviews were undertaken between November 2021 and June 2022. Interviews were audio recorded and transcribed into text for data analysis. Transcripts were inductively coded by the researchers, followed by deductive categorisation of the data using the Consolidated Framework for Implementation Research (CFIR).

Results: The study identified 11 different AI innovations being introduced in Australian healthcare organisations, and a total of 12 implementers working on the implementation of these innovations were recruited to participate in the study. Factors influencing the implementation of AI innovations into routine practice were identified across all five domains of the CFIR framework, but the innovation and implementation process domains were emphasised the most in the data. Implementers faced many barriers integrating their innovations into practice including challenges with stakeholder engagement, data access and other technical hurdles, resourcing constrains and lengthy timeframes for implementation.

Discussion: The number of Health AI solutions being implemented in routine practice in Australian healthcare organisations is small relative to the uptake of innovation seen in research and industry. This gap is likely a reflection of the length and complexity of the implementation process for Health AI solutions, and barriers that need to be overcome as part of this process.

Introduction: The need for tailored services for individuals with young-onset dementia (YOD) is well established. Specialised services exist but regional disparities may hinder timely and appropriate care and support. Yet, a comprehensive overview of such services is currently lacking.

Objective: To examine regional disparities in the delivery, access and management of YOD-specialised services in the Netherlands, revealing service gaps and opportunities for future development.

Design: An exploratory cross-sectional survey (YOD self-scan) was developed and distributed to 39 Dutch healthcare organisations affiliated with a national YOD knowledge infrastructure, ensuring broad geographical representation.

Methods: Quantitative and qualitative data were collected through open- and closed-ended questions between July and August 2023. Descriptive statistics and manifest content analyses were used to assess the delivery and management of YOD-specialised services in terms of utilisation, capacity, accessibility, variety and organisational factors.

Results: A total of 1707 individuals with YOD utilised outpatient services, and 801 received permanent residential care. Service delivery and management varied across regions. Rural organisations reported shorter waiting times, more employees who had received specific YOD training, and higher day care utilisation per organisation. Urban organisations offered a broader range of services and more involvement of local governments. Most organisations (72.4%) reported service gaps, including limited day care options, inflexible residential services, and insufficient support for carers, especially children of individuals with YOD. Also, the need for more innovative services and improved coordination was identified.

Conclusions: YOD-specialised services are underutilised, likely due to unequal accessibility and regional disparities in the delivery and management of services. Addressing service gaps, expanding capacity, and enhancing knowledge exchange are important for equitable, high-quality care. These findings may inform future research and international efforts to improve equitable access and management of specialised dementia services.

Background: Palliative care units and specialised palliative home care teams are well established in many countries. Palliative day-care clinics, however, are not. Studies assessing which patients benefit from this setting of care are rare.

Aim: This is the first routine data analysis of patients treated in three settings of specialised palliative care within a single geographical region. Our aim was to gain understanding of how patients in this region, where specialised palliative care structures are well-established, differ in their characteristics and treatments, and to explore the potential role of a palliative day-care clinic.

Design: Retrospective data were extracted from medical records and analysed using SPSS^® and R^®. Data were analysed using the Shapiro-Wilk, Chi-Square, and Kruskal-Wallis tests. Setting/Participants: Patients (n = 603) were included if they received treatment at either a palliative day-care clinic, a palliative care unit, or a specialised palliative home care service. To cover the "normal" pre-pandemic period, the analysis was conducted retrospectively from 31 December 2019.

Results: Patients attending the palliative day-care clinic were more likely to have cancer (90%, P < .001), were younger than those receiving specialised palliative home care (66.1, P < .001), had a better ECOG performance status (2, P < .001) and fewer high-complexity symptom domains (3.4, P < .001). Patients in the palliative day-care clinic and the palliative care unit underwent similar numbers of medical procedures and interventions. The majority of patients were admitted to the palliative day-care clinic from home (76%, P < .001) and discharged to the palliative care unit (41.5%, P < .001).

Conclusions: The three care models differ in their patient populations, time-based criteria and symptom burden-with the palliative day-care clinic treating younger patients at earlier stages of the disease, with a lower ECOG score and a less complex symptom burden. These variations emphasise the importance of tailoring palliative care to the needs of patients and the progression of their disease. Recognising these differences can enhance integrated care pathways and patient-centred outcomes in various settings.

The "Goldilocks Zone", a term borrowed from astrophysics, describes the optimal range where conditions are just right to support life. In healthcare, this metaphor captures the imperative to balance underuse and overuse of medical services, ensuring care is neither excessive nor insufficient but instead maximally effective, equitable, and sustainable. As health systems confront rising costs, workforce constraints, and growing demands for person-centred care, the search for this balance has become increasingly urgent. This review explores how the concept of the Goldilocks Zone can be operationalized in modern healthcare systems. We examine two core dimensions that define this balance: person-centredness and operational efficiency. Person-centredness requires attention to accessibility, patient satisfaction, and equity. Drawing on global data, we explore how barriers such as cost, geography, and social inequality limit access to care, and we highlight the role of robust primary care systems and tailored wait-time benchmarks in ensuring responsive, equitable delivery. At the same time, we caution against the misuse of performance metrics that may obscure real disparities. Operational efficiency is evaluated across the continuum of screening, diagnosis, and care management. We review frameworks such as Wilson and Jungner's screening principles and their modern adaptations, as well as diagnostic threshold models and strategies to reduce inappropriate care utilization. Key indicators, including avoidable hospitalizations and ambulatory care-sensitive condition rates, offer insight into system inefficiencies and opportunities for reform. We propose a practical framework for identifying whether a healthcare system is within the Goldilocks Zone and recommend policy levers to help maintain or widen this zone. Ultimately, the Goldilocks Zone is not a fixed destination but a dynamic and evolving balance that requires continual adaptation. As healthcare systems grow more complex, the value of this metaphor lies in guiding both conceptual thinking and concrete policy design.