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Background: With the advancement of childhood cancer therapy, long-term survivors are on the rise. Reports on childhood cancer survivors in Saudi Arabia are scarce. This study aims to assess the spectrum and burden of long-term complications among survivors of childhood cancer in Saudi Arabia.

Methods: This cross-sectional study, conducted at multiple cancer centers in Saudi Arabia, enrolled survivors who had been diagnosed with cancer before the age of 14 and had completed at least 5 years after completion of cancer therapy. The primary outcome was to estimate the prevalence of chronic health conditions (CHC) among these survivors. The secondary outcome was to assess the impact of primary cancer diagnosis and cancer therapies on the occurrence of CHC.

Results: A total of 305 survivors met the inclusion criteria as of July 2022. Females were 165 participants. The median follow-up and age at evaluation were 8.5 and 14 years, respectively. Leukemia was the most common cancer type (49.3%), followed by lymphoma (16.7%) and solid tumors (15.7%). Chemotherapy was administered to 287 survivors. Radiotherapy and surgery were used in 29.2% and 22.3% of cases, respectively. Seventy-eight percent of participants experienced at least 1 CHC, with 31.1% and 14.2% having 2 and 3 CHC, respectively. A multivariate logistic regression identified significant association between CHC and solid tumors compared to hematological malignancies (OR 2.2; 95% CI: 1.1-4.3; P = .023). Growth impairment was the most common CHC, followed by endocrinopathy. Radiotherapy was significantly associated with short stature (95% CI: 1.2-3.6; P = .008). The majority of CHC, 77.3%, were mild in severity, while 19.3% were moderate, 2.9% were severe, and .5% were life-threatening.

Conclusion: The long-term complications of childhood cancer have revealed a prevalent concern. To optimize health outcomes, it is essential to implement well-structured and long-term follow-up tailored to risk profiles, utilize cost-effective screening methods, and promote prospective clinical research and establishment of a registry.

Objectives: To investigate the levels of change fatigue among clinical nurses in public hospitals and identify the potential contributing factors.

Design: A cross-sectional, multi-stage sampling study was conducted in accordance with the STROBE guideline.

Methods: This study surveyed 2,228 nurses in China from October to December 2023 using Wen Juan Xing (www.wjx.cn) and employed stepwise multiple linear regression analysis to assess factors associated with change fatigue.

Results: The average change fatigue score of nurses was found to be at a medium to high level. Factors such as female, professional title, average overtime hours, workflow changes, workload increase, work-content changes, work pressure increases, new technology implementation and the change frequency were all identified as exacerbating nurses' experience of fatigue related to change. Contrary to this, the support of change resources, communication and transmission of change information, distributed leadership, inclusive climate, readiness for change, change efficacy and workforce agility were found to alleviate the change fatigue to some extent.

Conclusions: It is urgent and challenging for nursing managers to manage change fatigue. All of these identified predictors in study significantly contribute to the understanding of change fatigue among nurses and can provide valuable insights for health policies aimed at improving the effectiveness of nursing changes. Furthermore, they also offer a theoretical foundation for managers to develop targeted intervention programs for preventing and mitigating the negative impact of change fatigue on nurses and organizational outcomes.

Background: Homelessness remains a public health concern in the United States (U.S.) and ending veteran homelessness has been a significant priority for the U.S. Department of Veterans Affairs (VA) for over a decade. However, veterans experiencing homelessness (VEH) have unmet healthcare needs and face numerous barriers to accessing and engaging in healthcare.

Objectives: The Veterans Health Administration's (VHA) Homeless Programs Office (HPO) implemented mobile medical units (MMUs) within the tailored primary care model established in 2011 called the Homeless Patient Aligned Care Team (HPACT) program to expand access to care for hard-to-reach VEH. This article outlines the evaluation protocol for the HPACT MMU program to examine the impact of MMUs on engaging and retaining homeless veterans in VA primary care and other supportive services.

Design: Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will assess how mobile services engage VEH in VA primary care and preventive care. This 4-year program evaluation includes a plan to collect individual and organizational level quantitative and qualitative data.

Discussion: The first stages of program adoption and implementation have been completed resulting in 25 MMUs being deployed across the U.S. that are fully operational and ready to serve VEH. Early outcomes demonstrate the significant impact of the ability MMUs in reducing barriers such as transportation for VEH, while increasing positive veteran health outcomes.

Conclusion: This evaluation will provide insight on the innovative ways in which mobile medical units (MMUs) may expand the boundaries of the VA and external health care systems in efforts to improve health equity and access among our most vulnerable populations. Preliminary outcomes show significant engagement with VEH in the community and interest in the model of care. The program has the potential to play an essential role in achieving VA's goal of ending veteran homelessness.

Objectives: This study aims to investigate patients' privacy experience when receiving care in emergency departments (EDs) in Newfoundland and Labrador, Canada. We aim to assess the level of satisfaction with privacy and to assess for factors that improve or worsen the privacy experience, not limited to patient demographics, length of stay, and hospital location.

Methods: This study used a mixed-methods design, gathering quantitative and qualitative data using a telephone survey and semi-structured interviews. Our primary outcome measure was patients' privacy experience in the ED. The independent variables in our study were age, gender, ED location, patient-reported wait times, reason for ED visit, and healthcare provider involved in care.

Results: Among the 821 patients who participated in the interviews, 1 in 4 patients (24%) did not have satisfactory ED privacy experiences. Multinominal logistic regression showed patients who waited 4+ hours before being examined by a provider [aOR = 0.34, 95% CI: 0.17-0.69] and those who visited the urban EDs [aOR = 0.17, 95% CI: 0.09-0.35] reported low levels of privacy. Furthermore, those whose overall length of stay was 4 to 8 hours [aOR = 0.44, 95% CI: 0.23-0.84] and 8+ hours [aOR = 0.36, 95% CI: 0.17-0.78] also reported dissatisfaction with ED privacy experience. Our qualitative analysis found privacy concerns in waiting rooms, triage areas, and curtain rooms, with females voicing more concerns than males.

Conclusion: Patients with longer wait times and who have been seen in urban EDs experience less privacy. Our qualitative data shows that women also raised more privacy concerns than men and that waiting rooms and triage areas are the locations with the most reported privacy concerns. Patient experience and outcomes would benefit from improving patient privacy when receiving care in EDs.

Maternal waiting homes (MWHs) are structures built near the healthcare facility, which aim to reduce the distance to accessing maternal health services and bring pregnant women closer to the health facility, near the time of delivery. This reduces the risk of pregnancy complications which can cause maternal and neonatal deaths, or low birth weight. Tsholotsho district adopted the use of Maternal waiting homes as there was an increase in pregnancy-related complications and incidents of maternal death. The study aimed to evaluate the effectiveness of maternity waiting homes in reducing pregnancy-related complications in Ward 5, Tsholotsho District. A 1:1 case-control study was used for the study, which recruited 248 women who attended Sipepa clinic. Data was collected using structured questionnaires and analysis for frequencies, means, proportions and odds ratios at 95% CI was done using SPSS version 29. The study established that Maternal waiting home use was a significant factor for reducing pregnancy complications (AOR = 0.16, 95% CI 0.09-0.28). Number of antenatal care visits less than 4 was found to be the significant independent risk factor for pregnancy complications (AOR = 2.9, 95% CI 1.3-6.2). The odds of adequate knowledge of the benefits of maternal waiting homes was 6.9 times higher among women who used MWHs than those who did not (OR = 6.9, 95% CI: 3.9-12.2). The study provides evidence that MWHs can significantly reduce pregnancy-related complications and improve maternal health outcomes in Sipepa, Tsholotsho. However, barriers to non-use of MWHs, such as lack of privacy, no food variety, and no cooking utensils, must be addressed to maximize the effectiveness of this intervention. There is a need for policymakers and healthcare providers to prioritize the implementation and expansion of MWHs in rural areas of Zimbabwe, where they can have the greatest impact on reducing maternal mortality and morbidity.

Approximately 1.33 million pregnancies are recorded in South Africa annually. About 30% of all pregnant women are HIV positive, posing a serious risk to unborn children. However, effective interventions such as prevention of mother-to-child transmissions (PMTCT) services have been shown to significantly reduce the risk of mother-to-child or vertical transmission. Migrant women in South Africa face challenges in accessing [free] healthcare services. This study aims to assess the cost-effectiveness of providing free PMTCT services to migrant women living in South Africa. We employed cost-effectiveness analysis methodology to establish the cost and outcomes (averted pediatric infections and averted disability-adjusted life years (DALYs)) associated with free PMTCT services for migrant women. The comparator was provision of only antenatal care (ANC) while the intervention was ANC + PMTCT services. A Microsoft Excel-based decision tree model was designed to achieve the study objectives. Data on costs and health outcomes for each intervention was sourced from the literature on HIV/AIDS. The prevalence-based study is conducted from a public sector healthcare payer perspective. Provision of ANC + PMTCT services to migrants will prevent 14 562 new infections among 52 762 HIV positive pregnant women. The estimated total expected cost of ANC + PMTCT service was US$52 889 per 1000 live births compared to US$191 000 for ANC only per 1000 live births. The expected cost for the do-nothing scenario was US$73 535 per 1000 live births. The expected health benefit (ie, averted DALYs) associated with do-nothing scenario, ANC, and ANC + PMTCT were 277, 265 and 76 DALYs, respectively. ANC + PMTCT service provision produces the lowest DALYs at lower cost thereby producing cost-saving of US$733/DALY averted per 1000 live births. Further, an average of US$1.5 million would be required annually to achieve 100% coverage of HIV+ migrant women. Therefore, provision of ANC and PMTCT services to migrant women is cost-effective when compared to not offering PMTCT services and allows the government to avoid the long-term cost of antiretroviral therapy (ART) provision.

Background: Zimbabwe lacks information on physical activity levels, the available information is based on estimates.

Aim: This study compared physical activity levels in rural and urban settings. The relationship between the level of physical activity and metabolic risk factors for non-communicable diseases was also analysed.

Setting: The study took place in Bulawayo city (urban) and Mashonaland East province (rural).

Methods: Multi-stage probability-based sampling was used to select 200 male respondents from Bulawayo Province (urban) and 200 male respondents from Mashonaland East Province (rural). The study used the enumeration areas (EAs) used during the 2012 census and represented wards. In total, 10 enumeration areas were randomly selected, and 40 households were randomly selected in each of these enumeration areas. Logistic regression was used for all statistical analyses.

Results: Rural respondents were 62% more likely to meet the World Health Organisation (WHO) required physical activity level than urban respondents. The rural group was 158% more likely to have intermediate physical activity levels (600-2999 METs) than the urban group. Those meeting the WHO recommended physical activity level were 51% less likely to have elevated blood glucose. Facilities to promote physical health are not being used.

Conclusions: The rural group was more physically active than the urban group. High physical activity reduces the risk of metabolic risk factors for non-communicable diseases such as diabetes.

Contribution: Promotion of good health by reducing risk factors for non-communicable diseases.

Addressing the mental healthcare needs of the population at the Primary Health Care (PHC) level has gained global consensus as a key strategy to realising the mental health targets of the United Nations (UN) Sustainable Development Goals (SDGs), especially SDG3. This research explored the question 'What is the nature and level of community participation and ownership in the development and integration of mental healthcare service provision at the PHC, especially at Community Health Planning and Services Centre (CHPS) level(s) in Ghana?'. A cross-sectional study that adopted concurrent mixed quantitative and qualitative research methods was undertaken to explore and answer the question. The quantitative data of the study was collected through a survey questionnaire. Key informant interviews and focus group discussions were used to collect the qualitative data. Thematic analysis with the use of NVivo 12 was applied for the qualitative field data and Stata SE16 used for quantitative data. Data triangulation strategy was used to report both the qualitative and quantitative data sets. The study findings show that community participation and ownership was low, requiring more concerted efforts to engender that into mental health care policy and services development and implementation to realise the seamless integration of mental healthcare into general healthcare at the PHC level. Community participation and ownership will substantially enhance the (re-)organisation and resourcing of mental health services in Ghana to make them more responsive and inclusive.

Cholera remains a major healthcare issue in the Democratic Republic of the Congo with recurrent cholera outbreaks in its eastern provinces since 1994. Cholera cases and deaths increased from 18 403 and 302 in 2022 to 52 570 and 470 in 2023. From October 1st to December 31st, 2022, we conducted a mixed descriptive study to analyze the management process underpinning the cholera vaccination campaign in the Katana health district, South Kivu province, DRC. The survey targeted households (n = 404) with 1 adult person per household responding on behalf of all the members of the household and key informants (KI) who were health workers (n = 6) in 5 health areas of the Katana health district. The overall cholera prevalence in the surveyed households was 4.7% (95% CI 2.9-7.3), and the overall vaccination rate was 25.0% (95% CI 20.9-29.5). Most interviewed household respondents (54.5%) were eager for their household members to get vaccinated, and 61% had to walk for more than 1 hour to reach the vaccination center. Cholera vaccine for children under 2 years was available in all the 5 health areas investigated, only 2 out of 5 health areas had enough vaccine stockpiles. Only 33.3% of KI administering vaccines were trained at least once during the past 3 years. All the KI (100%) complained about delays or absence of payment for their services which negatively impacted their implication. Our findings highlight weaknesses in the planning of the last cholera vaccination campaign in the health district of Katana.