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Background: The community-based health insurance (CBHI) program was established in Ethiopia to enhance access to healthcare and protect vulnerable populations, including women, from financial risk.

Aim: This study analyzed healthcare utilization and its determinants between community-based health insurance members and nonmembers of women in Sidama's Central Zone, southern Ethiopia.

Methods: From January 19 to February 20, 2024, a community-based comparative cross-sectional study was conducted among 1280 women (640 insured and 640 uninsured). The study participants were selected using a multistage sampling technique, and data were collected through structured face-to-face interviews using the KoBo Toolbox.

Findings: The analysis revealed that CBHI membership was associated with a 77% higher frequency of health facility visits than non-members (APR = 1.77, 95% CI: 1.52-2.06; P < .001). For insured women, some individual and community-level factors were associated with the frequency of health facility visits. Age was positively associated with health facility visits, with each additional year leading to a 1.0% increase (APR = 1.01, 95% CI: 1.01-1.02; P < .001). Healthcare satisfaction also played a role, with a one-unit increase associated with a 4.0% increase in the frequency of healthcare visits (APR = 1.04, 95% CI: 1.03-1.05; P < .001). Geographical accessibility was a barrier, as women living farther from facilities experienced a 41.0% reduction in health facility visits (APR = 0.59, 95% CI: 0.48-0.73; P < .001). Community literacy and poverty levels were also significant determinants, with women from high-literacy communities having more than twice the visits (APR = 2.11, 95% CI: 1.60-2.80; P < .001) and those from low-poverty areas having higher visit rates (APR = 1.58, 95% CI: 1.24-2.01; P < .001). Family size was a determinant among uninsured women, with each additional household member associated with a 9.6% increase in health facility visits (APR = 1.10, 95% CI: 1.02-1.18; P = .015). Healthcare satisfaction had a positive association with the frequency of health facility visits (APR = 1.05, 95% CI: 1.04-1.05; P < .001). Geographical accessibility remained a barrier, with a 42% reduction in visits for those living farther from facilities (APR = 0.58, 95% CI: 0.44-0.77; P < .001). Community literacy was also a significant factor, with women from high-literacy areas having more than twice the frequency of health facility visits (APR = 2.12, 95% CI: 1.60-2.81; P < .001).

Conclusions: This analysis demonstrated that membership in CBHI substantially increased the frequency of health facility visits, resulting in a 77% rise relative to non-members. Among insured women, significant determinants included age, healthcare satisfaction, geographical accessibility, communit

Healthcare students may experience violence from patients and bystanders while undertaking clinical placements. There is ambiguity around responsibility and strategies used to support students before, during and after incidents. A scoping review was conducted of peer reviewed publications (CINAHL, Embase, Medline, Web of Science) and grey literature (Open Grey, WONDER, WorldCat, Trove, Google Scholar). Twenty-nine studies were identified. Studies varied in the way responsibility for risks was shared between students, clinical facilitators, placement providers and universities. Five studies discussed underreporting of incidents as a known issue. Students on clinical placement who experience violence from patients or bystanders face unique challenges in identifying where to report or find support. While universities are generally aware of the risks of violence towards students undertaking placements there is no consensus between education and placement providers on responsibility for reducing violence or supporting students following incidents.

Background: Clinical quality registries (CQRs) systematically monitor the quality of healthcare by routinely collecting and reporting health-related information. The collection of patient reported measures (PRMs) by CQRs provides a personal perspective on the expectations and impacts of treatment. Reporting of CQR-collected PRMs for quality improvement (QI) is highly variable.

Objectives: To develop a best practice guide (BPG) for CQRs, clinicians and health services to support high-quality and transparent reporting of PRM data for QI purposes.

Methods: The project comprised four stages. The first sought to describe how PRMs were reported for QI purposes in Australia and internationally. The second stage included seven focus groups with 20 Australian CQRs to identify existing practices, issues and impacts regarding PRMs reporting. During stage 3, findings from the literature and focus groups were used to draft a preliminary BPG. Finally, expert workshops involving PRMs experts, consumers, clinicians and representatives from CQRs were convened to refine a preliminary BPG.

Results: We identified 61 international and 45 Australian CQRs that reported PRMs for QI purposes. PRMs were used for shared decision-making in clinical encounters, for developing clinical decision aids, to revise treatment guidelines and to monitor complications after hospital discharge. Several themes emerged from the focus groups. These included: purpose and context, funding and resource requirements, consumer involvement, clinician training, instrument selection and administration, outlier identification, visualisation and interpretation of the data. A preliminary BPG was refined during the workshop discussions.

Conclusion: An increasing number of CQRs use PRMs to enhance QI reporting, however there are no published guidelines currently to support this. Through identifying existing practices, methods and techniques that CQRs use to report PRMs, we developed a practical guideline to support CQRs and standardise their PRMs reporting for QI purposes, with the overarching goal of optimising the value of PRM data within CQRs.

Background: Improving cancer screening participation is increasingly important. However, insufficient medical and financial resources have been reported to hinder program implementation; therefore, enhancing program efficiency is crucial. Although demographic factors have been reported to correlate with public health program efficiency, it remains unclear whether this applies to cancer screening.

Objectives: To evaluate the efficiency of cancer screening programs conducted in Japanese municipalities and analyze their relationship with demographic characteristics, including population size and aging rates.

Design: A cross-sectional study using national open-source data from 2019.

Methods: We collected data from all 1741 Japanese municipalities in 2019 using a national open-source database. After applying inclusion criteria, 1593 municipalities were analyzed. Program efficiency was measured using Data Envelopment Analysis (DEA), with inputs including the number of public health nurses, medical institutions, and healthcare expenditure per target population. Outputs were cancer screening participation rates. Logistic regression was used to examine the relationships between efficiency, population size, aging rates, and their interaction.

Results: Of the 1593 municipalities analyzed, 414 (26.0%) were deemed efficient. A statistically significant interaction between aging rates and population size was observed in the model predicting screening efficiency. In municipalities with aging rates above 31.4% (95% confidence interval [CI]: 29.2-37.1), larger target populations were associated with lower efficiency. Conversely, in municipalities with over 1075 screening targets (95% CI: 552-1381), higher aging rates were linked to lower efficiency.

Conclusion: This study suggests that aging rates and population size may be associated with municipal-level differences in the efficiency of cancer screening programs. Understanding the mechanism underlying this relationship could help inform resource allocation and program design. Further research is warranted to explore these relationships more deeply and to support the development of more efficient screening strategies, particularly in the context of ongoing demographic shifts.

This commentary addresses methodological and interpretive limitations in Geremew et al.'s study on healthcare-seeking behaviour for obstetric complications in Ethiopia, emphasizing the need for clinically validated definitions, analytical exploration of variable interactions, inclusion of all obstetric events, and facility-level cross-validation to strengthen the policy relevance and accuracy of the findings.

Background: The utilisation of healthcare services is critical to maintaining and improving the health status of communities, however, numerous barriers and enablers can either hinder or facilitate an individual's ability to access and benefit from these services, and this is the case in South Africa.

Objective: This study aimed to identify and describe barriers to and enablers of healthcare service utilisation in a rural village of Mpumalanga province, South Africa.

Methods: A quantitative descriptive survey design was conducted with 415 adults who met the inclusion criteria, selected using a systematic sampling technique. Data were gathered through a researcher-administered questionnaire. Descriptive statistics were conducted, using the IBM SPSS version 29 software, to explain and summarise the data. The study was guided by Andersen and Newman's Behavioural Model, focusing on barriers and enabling factors to Health services utilisation.

Results: Key barriers identified in this study included cultural beliefs (58.7%), treatment shortages (54.4%), staff shortages (45.6%), negative staff attitudes (88%), long wait times (84.1%), lack of grievance mechanisms (77.8%), and poor interpersonal skills from nurses (88.5%), leading to low patient satisfaction. Men showed disengagement from chronic care (13%) compared to women (2.9%). A significant portion (20%) had no education, impacting health literacy. Enabling factors included a preference for the local clinic (98.8%) due to its proximity (69.3%) and confidence in nurses' abilities (88.7%).

Conclusion: The study highlighted that healthcare access is hindered by resource limitations, staff issues, attitude and communication problems, and cultural factors. Women, young adults, and less educated individuals underutilise services. This necessitates age and gender targeted programs, culturally sensitive strategies, and improved service delivery and quality assurance policies. Counselling for healthcare workers and accessible feedback mechanisms can enhance patient interactions and satisfaction. Further research is recommended to comprehensively address these barriers to healthcare access and utilisation.

Introduction: Telehealth is revolutionizing healthcare, particularly in post-operative care accessibility. However, technological limitations, costs, and communication barriers hinder its full implementation. This study examines healthcare providers' and patients' perception on telehealth services adoption for post-operative follow-ups at Korle Bu Teaching Hospital (KBTH), Ghana.

Methodology: A descriptive cross-sectional study design was employed to collect data involving 350 participants, (doctors (29), nurses (96), and patients (225)) at KBTH's surgical department using the priori power calculation method. Participants were selected via purposive and convenience sampling. There was a pilot-tested electronic and paper questionnaire administered by trained research assistants. The instrument captured multidimensional perception indices (eg, clinical efficacy, convenience, economic burden) on validated Likert scales alongside socio-demographic and telehealth utilization covariates. Data were managed in REDCap with mandatory fields to minimize missing responses and anonymized identifiers to reduce bias. Analyses comprised descriptive statistics and proportions in IBM SPSS v26 and R v4.2.1.

Results: A substantial 76.6% of stakeholders agree or strongly agree that telehealth reliably monitors minor postoperative conditions. Convenience and efficiency are paramount, with 82.9% of participants finding virtual follow-ups more convenient and 86.6% reporting significant time savings relative to in-person visits. Infection-control benefits are widely recognized (85.2%), and patient-provider rapport remains strong, with only 10.9% expressing discomfort. Major barriers include unstable broadband (83.4%), limited on-site technical support (66.0%), poor audiovisual quality (81.7%), and prohibitive data/device costs (61.4%). Key facilitators encompass robust security measures trusted by 73.8% of users, regulatory confidence (59.7%), perceived clinical equivalence (76.5%), and enhanced access for underserved populations (82.6%).

Conclusion: Telehealth improves accessibility and efficiency in minor post-operative care. However, addressing technological barriers, insurance issues, and communication challenges is crucial. A hybrid approach integrating telehealth with in-person visits is recommended to enhance care quality and patient satisfaction.

Background: Affiliations between community and academic hospitals are increasing. However, their impact on transfer practices remains under-characterized.

Objectives: To understand the impacts of hospital affiliation on transfer practices and hospital resource utilization.

Design: Retrospective cohort study.

Methods: We included patients ⩾18 years who were transferred from a 178-bed community hospital to a tertiary academic hospital between January 2015 to December 2019. Interrupted time series analysis was used to evaluate changes in outcomes after the affiliation in January 2017. Our primary outcome was the change in quarterly rate of early discharge (discharge within 48 hours post-transfer). Secondary outcomes included change in quarterly proportions of low-income patients, patients residing at a far distance from the hospital, and ICU admissions. We performed a sub-analysis in patients transferred to a surgical specialty that evaluated the tri-annual rate of operative management (surgical or interventional radiology procedure performed <72 hours after admission).

Results: Among 144 included patients, 93 (64.6%) were transferred post-affiliation and 63 (43.1%) were transferred to a surgical specialty. No significant trends were seen across outcomes in the pre-affiliation period. Relative to the former period, there was a quarterly decrease in early discharge rates (P = .027) and a quarterly increase in the percentage of patients residing at a long distance from the transferring hospital (P = .027) after affiliation. There was also a relative tri-annual decrease in the rate of operative management (P = .039).

Conclusion: Post-affiliation, the volume of transfers and utilization of resources at the receiving hospital increased. The percentage of transfer patients residing farther from the transferring hospital also increased.

Background: Exercise-based interventions, particularly dual-task training (DT), have been increasingly recognized as effective strategies for improving cognitive, motor, and functional capacities in individuals with Parkinson's disease (PD). This study presented a protocol for a randomized controlled trial (RCT) designed to evaluate and compare the effects of land and aquatic-based single-task (ST) and dual-task (DT) training on physical and cognitive outcomes in individuals with PD. The present study aims to describe the protocol of 4 different physical exercise programs, including single-task and dual-task exercises on land and in the aquatic environment, and their potential impact on the cognitive, motor, functional, and quality of life capacities of people with Parkinson's disease.

Methods: This randomized controlled trial (RCT) involved individuals with PD who were randomly assigned to 1 of 4 intervention groups: (i) Land Single-Task (LST), (ii) Land Dual-Task (LDT), (iii) Aquatic Single-Task (AST), and (iv) Aquatic Dual-Task (ADT). Participants in each group underwent a 12-week exercise program with standardized volume, frequency, and intensity. The interventions focused on improving cognitive and motor functions, balance, dynamic gait, fear of falling, and quality of life (QoL). A battery of validated assessments was used, including the MoCA, SCOPA-COG, TUG, FTSST, Mini-BEST, DGI, ABC, and PDQ-39, administered at baseline, post-intervention, and at a 12-week follow-up.

Objectives: This study aimed to investigate whether dual-task training, particularly in the aquatic environment, offered superior benefits over single-task training in improving cognitive, motor, and functional abilities in individuals with PD. Additionally, the study explored the potential of the aquatic environment to provide unique stimuli that enhance neuroplasticity, balance, and overall mobility.

Conclusions: This protocol outlined a structured approach to evaluating the effectiveness of land and aquatic-based exercise interventions in individuals with PD. The findings from this study will contribute to the development of evidence-based guidelines for exercise prescription in PD, emphasizing the role of aquatic environments in therapeutic interventions.

Background: The COVID-19 pandemic posed unprecedented challenges to healthcare systems worldwide, prompting governments to rapidly expand hospital bed capacity to meet the surge in demand for medical care. This study focuses on evaluating Colombia's healthcare system response by examining the expansion of hospital beds during the health crisis.

Methods: In an observational study, we used a national census of all healthcare facilities in Colombia, compiled by the Ministry of Health and Social Protection (MPSP), to analyze changes in hospital bed allocation from 2010 to 2022. Our analysis accounted for the size of each provider, its public or private ownership, and the types of services it was authorized to deliver. We applied interrupted time series models to assess changes at both the hospital and municipal levels over time.

Results: Findings reveal a significant reduction in hospital beds in 2020, with adult beds decreasing by 1049 units and pediatric beds by 0.709 units compared to 2019. However, there was an increase in ICU beds for adults across all years, which persisted after the end of the crisis. The expansion mainly targeted small hospitals and the public network of providers. Most of the expansion was restricted to areas of the country that already had a supply of ICU and hospitalization beds.

Conclusion: Colombia's healthcare system responded dynamically to the COVID-19 pandemic by reallocating resources and expanding hospital bed capacity, despite the complex command and control configuration of its health system. Yet, it shows that the country needs to modify its financial and organizational structures to ensure better preparedness for future health crises.