Search Results (15,746)

Background/Objectives: Dental caries remains one of the most prevalent chronic diseases in childhood, influenced by a combination of hygiene, dietary, and access-related behaviours that are largely shaped by parental involvement. This study aimed to evaluate oral hygiene habits, dietary risk factors, access to dental services, awareness of caries prevention, and the impact of oral health on the child, in relation to parent-reported dental caries in Romanian children and adolescents. Methods: A cross-sectional study was conducted using a structured online questionnaire completed by parents or legal guardians of 508 children and adolescents aged under 18 years. Associations between categorical variables and reported caries were assessed using chi-square tests and Cramér’s V. Ordinal variables were compared using the Mann–Whitney U test. A multivariable logistic regression identified independent predictors of reported caries, with robustness examined through sensitivity analyses. Results: Parent-reported caries was present in 61.2% of children. The strongest associations with caries were the absence of parental supervision during brushing (Cramér’s V = 0.364), the age at which children began brushing unsupervised (V = 0.354), and the reason for the last dental visit (V = 0.426). In the multivariable model, older age, absence of brushing supervision, sweets before bedtime, less frequent dental visits, and rural residence were independent predictors (all p < 0.05; Nagelkerke R² = 0.361). All six assessed dimensions of oral-health impact on the child were significantly associated with caries, with physical discomfort showing the largest effect (V = 0.349). Conclusions: Parent-reported caries risk in this population clustered around a small number of modifiable behaviours rather than any single dominant factor, while reported caries was associated with a substantial burden on children’s daily functioning. These findings point to sustained parental supervision and routine, non-symptomatic dental care as priority targets for future prevention efforts, although intervention studies are needed to confirm their effectiveness. Full article

Background: Kazakhstan is among the most highly endemic countries for hepatic echinococcosis worldwide, yet no study systematically characterised the national hepatobiliary surgical burden of cystic (CE) and alveolar (AE) echinococcosis using administrative health data. Methods: National operative data from the Guaranteed Volume of Free Medical Care (GOBMP) and Compulsory Social Health Insurance (OSHI) Systems (1 January 2023–31 December 2025) were combined with institutional case series from the National Research Oncology Center (NROC), Astana (2021–2025). Cases were identified using ICD-10 diagnosis codes and ICD-9-CM procedure codes. Regional and species-specific differences in surgical approach were assessed using Pearson’s chi-square test; continuous variables were compared using the Mann–Whitney U test. Results: A total of 143 hepatic echinococcosis surgeries were performed nationally over the three-year period, with a 12.8% increase in annual volume (47 in 2023, 43 in 2024, 53 in 2025), though this year-to-year variation was not statistically significant (χ² = 1.06, df = 2, p = 0.59). CE accounted for 74.8% of cases (n = 107), AE for 18.9% (n = 27), and unspecified hepatic echinococcosis for 6.3% (n = 9); the proportion of AE rose from 17.0% in 2023 to 26.4% in 2025. Astana performed 46.2% of all operations nationally, with its share increasing from 34.0% to 58.5% over the study period; together with Almaty, it accounted for 92.6% of all AE cases. Partial hepatic resection was the predominant procedure overall (81.1%), while AE was managed exclusively by resectional or lobar procedures (χ² = 15.37, p = 0.004), with no percutaneous approaches used. In the NROC case series (n = 63), AE patients were older (median 43.5 vs. 33 years, p = 0.036) and had longer postoperative hospital stays (median 12 vs. 10 days, p = 0.015) than CE patients. Conclusions: Surgical management of hepatic echinococcosis in Kazakhstan is increasingly centralised in Astana and Almaty, with AE consistently requiring more extensive resectional surgery and greater healthcare resource use than CE. These findings support the development of a national echinococcosis registry and formal referral pathways to guide resource allocation and surgical planning. Full article

Background/Objectives: This pilot study aimed to develop and compare advanced machine learning models, specifically a Bayesian-regularized artificial neural network (ANN) and a transformer-enhanced physics-informed neural network (PINN), by integrating periodontal health indices and hematological inflammatory markers for the prediction of GDM. Methods: Utilizing a prospective case–control study design, a clinical dataset comprising 80 pregnant women (40 with GDM and 40 healthy controls) was evaluated to develop and compare advanced machine learning models. Clinical, periodontal, and complete blood count-derived inflammatory parameters were integrated into two predictive models: a Bayesian regularization-based artificial neural network (ANN) and a transformer-enhanced physics-informed neural network (PINN). Model performance was evaluated using the coefficient of determination (R²), mean squared error (MSE), root mean squared error (RMSE), mean absolute error (MAE), and residual error analyses. Results: The ANN demonstrated superior predictive performance, achieving an R² of 0.9872 and an MSE of 3.38 × 10⁻³, compared with an R² of 0.9833 for the PINN model. Residual analysis showed that the ANN provided greater prediction stability, with a mean deviation of 0.5691 and a standard deviation of 3.6400. The findings demonstrate that the integrated analysis of periodontal and hematological markers through advanced neural architectures, particularly the Bayesian-regularized ANN, provides a high-fidelity diagnostic signal for GDM prediction. This integrated feature set, when processed by the proposed machine learning framework, enables the identification of complex biological patterns with remarkable precision. Conclusions: The proposed machine learning framework provides an accurate, non-invasive, and clinically applicable approach for predicting GDM. Integrating routinely available periodontal and hematological data may improve early risk stratification and support personalized prenatal care. Further validation in larger and more diverse populations is warranted before clinical implementation. Full article

Background: Loneliness in older adults is a global public health problem. Although robust evidence exists regarding its consequences, the evidence base is marked by a bias towards high-income countries and urban contexts. The rural Peruvian Amazon is a territory virtually absent from the scientific literature on ageing and loneliness. Methods: We conducted a descriptive–interpretive qualitative study based on 34 semi-structured interviews with adults aged 60 years and over, recruited through Cáritas-Requena. Analysis followed the reflexive thematic analysis framework. Purposive sampling with maximum variation criteria was employed. The study was complemented by a quantitative characterisation using the Barthel Index, the LSNS-6 scale, and the DUKE-UNC-11 questionnaire. Results: Four themes emerged: (1) structural and functional conditions as the substrate of loneliness; (2) family reconfiguration driven by internal migration, with notable prominence of skipped-generation households (grandparents caring for grandchildren); (3) lived experiences of emotional and social loneliness, including a contextual pattern of feeling lonely despite the physical presence of others, which we descriptively label “paradoxical loneliness”; and (4) coping resources, including faith, work, neighbourhood networks, non-human companionship, and habituation. The descriptive relational measures showed different distributions: objective social isolation (LSNS-6 < 12) was observed in 12.5% of participants, whereas low perceived functional social support (DUKE-UNC-11 < 32) was observed in 68.8%; these measures assess distinct constructs and were used solely to contextualise the qualitative findings. Conclusions: Among the service-connected older adults included in this study, loneliness was shaped by the interaction of family reconfiguration, material and health-related conditions, and locally available coping resources. The experience of feeling lonely despite the physical presence of others was compatible with Perlman and Peplau’s cognitive discrepancy model and is presented here as a context-specific interpretive pattern rather than as an independent dimension of loneliness. Full article

Background: Polypharmacy remains a significant challenge, often leading to adverse drug events and increased healthcare costs. One effective strategy to mitigate these risks is deprescribing, the systematic and intentional discontinuation or reduction of medications. Despite growing recognition of deprescribing’s importance, limited research has examined the impact of interprofessional education interventions on developing deprescribing competencies among healthcare professional students. This study aims to examine the perspectives of healthcare students, including student pharmacists, medical students, and nurse practitioner students, regarding their roles and responsibilities in the deprescribing process. Methods: Following completion of a Deprescribing Interprofessional Education Simulation activity (DIPE-SA), participants were invited to join focus groups. The study included students from the University of Tennessee Health Science Center (UTHSC) Colleges of Medicine, Nursing, and Pharmacy. Constructivist Grounded Theory (CGT) underpinned the qualitative research approach, informing the development of the study framework. Each focus group was facilitated by two researchers and recorded. Recruitment continued until saturation was achieved. Data were transcribed verbatim and analyzed for themes using Dedoose, qualitative analysis software. Results: A total of 19 participants attended four focus groups. Three major themes emerged and guided the development of the Roles–Collaboration–Communication (RCC) interprofessional framework. The first theme, roles, focuses on the unique responsibilities and functions healthcare professionals assume within the team and throughout the deprescribing process. The second theme, collaboration, emphasizes coordinated efforts and shared decision-making among members of the interprofessional healthcare team in deprescribing. Finally, the third theme, communication, highlights the importance of effective information and intention exchange, serving as both a mediator and connector, linking roles and collaboration, and ultimately enabling successful deprescribing. Conclusions: This study’s findings, together with the RCC interprofessional framework, demonstrate the interplay of roles, collaboration, and communication in medication management. The RCC framework highlights the value of dynamic team processes for achieving safe and effective deprescribing, which in turn improves patient care and health outcomes. Full article

Individuals with a history of suicide attempt may face complex decisions about whether, when, and how to disclose their suicidal behavior history. However, little is known about how they navigate these decisions within family, social, and mental health care contexts. This qualitative study examined disclosure decision-making among biological mothers with a documented history of suicide attempt whose children aged 5–17 years had received behavioral health services. Structured clinical and demographic assessments were used to characterize the sample, followed by semi-structured qualitative interviews. Eleven audio-recorded interviews were included in the qualitative analysis. Mothers described disclosure decisions within the context of prior experiences of judgment and dismissal, stigma surrounding mental health and suicide, distrust of mental health care, structural and family stressors, and discomfort with vulnerability. Mothers also described conditions that facilitated disclosure, including close relationships with trust and open communication, and pro-mental health care attitudes. Findings suggest that disclosure of suicide attempt history is a context-dependent decision shaped by experiences across interpersonal, social, structural, and individual contexts. Rather than supporting disclosure as uniformly beneficial or harmful, these findings highlight the need for individualized, developmentally appropriate support for individuals considering whether, when, and how to discuss a suicide attempt history. Full article

Background/Objectives: Informal caregivers of older adults are a high-burden population for psychological problems, yet evidence on the relationship between physical activity (PA) and mental health in this population is still limited. The aim of this work is to examine the association between PA status and self-reported mental health indicators (psychological distress and the number of poor mental health days) among caregivers of older adults. Methods: This cross-sectional study used data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) caregiver module. The analytical sample included 1785 informal caregivers of older adults whose care recipients’ main condition was old age/infirmity/frailty or Alzheimer’s disease, dementia, or another cognitive impairment disorder. Physical activity was classified into three groups: meeting both aerobic and muscle-strengthening recommendations, reporting some PA but not meeting both recommendations, and being inactive. The self-reported mental health indicators were psychological distress (≥14 poor mental health days in the past 30 days) and the number of poor mental health days. Survey-weighted logistic regression and quasi-Poisson regression models were fitted, adjusting for sociodemographic, health-related, and caregiving-related covariates. Results: The weighted prevalence of psychological distress was 18.8%, and the mean of poor mental health days was 5.99 days in the previous 30 days. The weighted prevalence of psychological distress was 16.3% among caregivers meeting both recommendations, 18.2% among those reporting some PA, and 23.2% among inactive caregivers; however, differences across PA groups were not statistically significant. The weighted mean number of poor mental health days was 5.5, 6.2, and 6.1 days, respectively, with no significant differences across PA groups. In adjusted logistic regression models, physically inactive caregivers had higher odds of psychological distress than those meeting both activity recommendations (OR = 3.10, 95% CI: 1.58–6.09; p = 0.001). In adjusted quasi-Poisson models, physically inactive caregivers also reported more poor mental health days (RR = 1.51, 95% CI: 1.08–2.10; p = 0.016) compared to those who met both recommendations. No significant differences were observed for caregivers who met only aerobic recommendations or only muscle-strengthening recommendations, or had insufficient physical activity relative to the reference group. Conclusions: In this survey-weighted BRFSS caregiver-module sample from participating US jurisdictions, physical inactivity was associated with poorer self-reported mental health indicators among caregivers of older adults. These findings suggest that physical inactivity may help identify caregivers at higher risk of poorer self-reported mental health, although longitudinal and intervention studies are needed to clarify directionality and causality. Full article

The extensive use of plastic-based materials in healthcare services has raised concerns about micro- and nanoplastic contamination in hospital environments, with potential implications for occupational health, environmental health, and public health nursing. This scoping review aimed to map the available evidence on occupational exposure to micro- and nanoplastics in healthcare settings, identifying exposure sources, pathways, potential health implications, and knowledge gaps, with particular attention to healthcare workers and nursing professionals. It was conducted following JBI methodology and reported according to PRISMA-ScR. Searches were performed in PubMed/MEDLINE, Scopus, Embase, LILACS, and SciELO for original studies published between January 2015 and December 2025 in English, Portuguese, or Spanish. Of 759 records identified, six studies met the eligibility criteria. Evidence was derived mainly from high-complexity healthcare settings, including operating theatres, anaesthetic rooms, laboratories, emergency departments, physiotherapy units, intensive care units, blood banks, and clinical areas. Indoor air, settled dust, disposable medical devices, plastic packaging, personal protective equipment, and plasticised materials were identified as potential exposure sources. Inhalation was the most frequently reported/inferred pathway, followed by dermal contact and indirect ingestion. Current evidence remains limited and heterogeneous, with scarce direct biomonitoring of micro- and nanoplastic particles and limited epidemiological data. Hospital environments may represent under-recognised settings for occupational exposure to micro- and nanoplastics, requiring standardised exposure assessment, environmental surveillance, biomonitoring, and preventive strategies aligned with occupational and public health nursing. Full article

Background: The COVID-19 pandemic simultaneously affected vascular risk and healthcare utilization. We evaluated whether monthly trajectories of Brazilian Unified Health System (Sistema Único de Saúde; SUS)-financed hospitalizations for different cerebrovascular categories changed differently during the pandemic in the municipality of São Paulo. Methods: We conducted an ecological time-series study using monthly Hospital Information System of the Brazilian Unified Health System (SIH-SUS), Department of Informatics of the Unified Health System (DATASUS) data from January 2017 through December 2021. Nontraumatic intracranial hemorrhage (I60–I62), cerebral infarction (I63), unspecified stroke (I64), and other cerebrovascular diseases (I65–I69) were included. The analytical dataset comprised 240 monthly observations. Annual IBGE population estimates were used as denominators. The primary analysis used segmented negative-binomial regression with log(population) offset, temporal trend, an immediate level change from March 2020, post-intervention slope change, and annual harmonic terms for seasonality. Poisson and negative-binomial models were compared using overdispersion diagnostics and Akaike information criterion (AIC). Residual autocorrelation, category-by-intervention interactions, alternative intervention dates, and leave-one-month-out influence were assessed. Results: A total of 60,756 hospitalizations were identified. Descriptive differences in mean annual counts between the pre-pandemic and pandemic periods were +3.7% for intracranial hemorrhage, +15.2% for cerebral infarction, −16.2% for unspecified stroke, and −27.2% for other cerebrovascular diseases. All categories were overdispersed (Pearson ratios 2.16–5.05), and AIC was consistently lower for negative-binomial models. In the primary segmented model, March 2020 was associated with an immediate 39.3% decrease in other cerebrovascular diseases (incidence rate ratio [IRR] 0.607; 95% confidence interval [CI] 0.512–0.720; p < 0.001) and a 10.0% decrease in unspecified stroke (IRR 0.900; 95% CI 0.817–0.991; p = 0.032). No statistically significant immediate level change was found for intracranial hemorrhage (IRR 1.018; p = 0.760) or cerebral infarction (IRR 0.868; p = 0.086). No category showed a significant post-intervention slope change. The formal category-by-level-change interaction was significant (Wald p = 0.004), indicating heterogeneity among categories. LjungBox tests at 12 lags showed no significant residual autocorrelation. Conclusions: SUS-financed cerebrovascular hospitalizations showed heterogeneous temporal changes during the pandemic, particularly immediate decreases in I64 and I65–I69. The findings support differences in trajectories across diagnostic categories but do not demonstrate diagnostic migration, individual biological mechanisms, or causality. Changes in care-seeking, referral, coding, diagnostic availability, and healthcare organization remain plausible but untested explanations. Full article

Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article

Aims: International diabetes guidelines recommend inpatient glycaemic management protocols for bolus enteral feeding in people with diabetes to improve clinical outcomes. This study aims to evaluate before and after hospital-wide implementation of an inpatient bolus enteral feeding protocol: (1) the incidence of hyperglycaemia (>13.9 mmol/L) and hypoglycaemia (<4.0 mmol/L), (2) medication prescribing practices and capillary blood glucose monitoring and (3) health care professionals’ knowledge and confidence levels. Methods: We implemented an inpatient glycaemic management protocol for bolus enteral feeding developed by a multidisciplinary team of diabetes nurse educators and endocrinologists and approved by the institutional medical board in July 2024. This before-and-after quality improvement study was conducted over 3 months across eight inpatient wards. Adult inpatients were consecutively enrolled if they met the inclusion criteria: (1) a documented diagnosis of diabetes mellitus, (2) receiving bolus enteral feeding and (3) treatment with glucose-lowering medication. Patients listed as critically ill were excluded. Nurses working in the pilot wards were also recruited. Before implementing the protocol, diabetes nurse educators trained inpatient nurses on understanding and executing the protocol for administering capillary blood glucose monitoring and medications for patients with diabetes on enteral feeding. Nurses’ pre- and post-knowledge levels and perceived confidence were assessed using a structured questionnaire. Electronic medical records were reviewed to evaluate the incidence rates of hypoglycaemia and hyperglycaemia before and during the 3 months following protocol implementation. We also assessed adherence to protocol-recommended capillary blood glucose monitoring frequencies based on the diabetes medication regimen. Results: A total of 31 patients were observed during the 6-week baseline period and 28 patients following protocol implementation. A total of 192 clinical care episodes were audited, comprising 78 in the pre-intervention phase and 114 in the post-intervention phase. The incidence of hyperglycaemia decreased from 43.6% to 10.5%, while hypoglycaemia decreased from 3.8% to 2.6%. After adjusting for protocol adoption rates, protocol implementation was associated with significantly lower odds of hyperglycaemia (odds ratio [OR] 0.22, 95% CI [0.07, 0.65], p = 0.006). A significant increase in appropriate nursing practices was observed post-intervention (p < 0.001). Adoption of the protocol by nurses decreased the odds of hyperglycaemia by 70% (p = 0.014). Nurses’ knowledge scores improved significantly from baseline to 3 months post-implementation (p < 0.001). Conclusions: Implementation of a standardised inpatient glycaemic management protocol for PWD receiving bolus enteral feeding was associated with reduced rates of hyperglycaemia and hypoglycaemia. Larger-scale studies are warranted to evaluate the effectiveness and sustainability of wider implementation in improving clinical outcomes. Full article

Background/Objectives: Primary healthcare in Hungary faces acute physician shortages; in the Heves district, eight general practices are permanently vacant, leaving 11,191 residents without continuous care. In September 2025, the Hungarian Charity Service of the Order of Malta launched the Heves Haziorvosi Pilot (HHP), combining on-site nurse triage with remote telemedicine consultations. This study qualitatively evaluated its implementation and early operation. Methods: Three focus group discussions were held in two rounds, before and after implementation, with all 19 professionals delivering the programme (10 practice nurses, 4 general practitioners, 5 degreed professionals). Verbatim Hungarian transcripts were analysed in NVivo 15 (Lumivero, Denver, CO, USA) using the thematic analysis framework of Braun and Clarke with hybrid deductive-inductive coding by three independent researchers until full consensus. Results: Daily physician availability rose from approximately 2 to 8 h, and one remote physician concurrently supported four practices. Participants reported reduced professional isolation among nurses, longer and more focused consultations, and perceived, though unquantified, decreases in non-urgent ambulance use. Implementation was constrained by duplicate paper and digital documentation, patients’ limited familiarity with triage, and unresolved software interoperability and IT ergonomic problems. Conclusions: The hybrid model was perceived as operationally feasible; national scaling would require nursing curriculum reform, administrative simplification, interoperable medical software, and community health literacy programmes. Full article

Background: Appropriate diagnostic testing is essential to quality pediatric allergy care, affecting diagnostic accuracy, treatment decisions, resource use, and patient outcomes. This study aimed to develop evidence-based recommendations for specialist consultations and diagnostic investigations in children with food allergies, eosinophilic gastrointestinal diseases, urticaria, angioedema, and atopic dermatitis. Methods: A multidisciplinary panel convened for the Italian National Institute of Health formulated and prioritized clinical questions using the PICO framework and structured expert consensus. A systematic review of the literature from 2015 to 2026 informed the recommendations, with certainty of evidence assessed using GRADE methodology. Results: In food allergy, sensitization tests alone are insufficient for diagnosis, while oral food challenges remain central to diagnostic confirmation. Endoscopic biopsies are essential for diagnosing eosinophilic gastrointestinal diseases. In chronic urticaria, specialist consultation is recommended, whereas routine allergy testing should be avoided without a suggestive clinical history. In angioedema, distinguishing histaminergic from bradykinin-mediated forms is critical, with targeted laboratory testing for hereditary or acquired conditions. In atopic dermatitis, standardized severity assessment should guide management and consideration of biologic therapies, while patient and family education represent key components of care. Conclusions: These recommendations provide a framework for standardized pediatric allergy diagnostic pathways, aiming to improve quality and equity of care while reducing unnecessary investigations and optimizing healthcare resource use. Full article

Background: Community-based health insurance is an important strategy for extending healthcare access and financial protection to informal-sector populations. In Tanzania, the Improved Community Health Fund (iCHF) is implemented through region-specific models that differ in benefit packages, premium arrangements, and provider participation. However, evidence on how members experience these different implementation models remains limited. This study compared members’ experiences and perceptions of CHF implementation in Dodoma and Kilimanjaro, two regions operating different iCHF models. Methods: The study used data from a cross-sectional household survey conducted among 420 CHF-enrolled members in Dodoma and Kilimanjaro in January 2018. Data were collected using a structured, interviewer-administered household questionnaire covering socio-demographic characteristics, CHF enrolment history, registration and premium-payment experiences, benefit-package perceptions, trust in CHF management and community participation, perceived healthcare service quality, and perceived benefits of membership. Data were analyzed using descriptive statistics, cross-tabulations, and Pearson’s chi-square tests to assess regional differences. Results: Members generally reported positive experiences with CHF administration. Most had used their CHF cards, renewal intentions were high, premiums were considered affordable, payment arrangements were convenient, and local CHF management was generally perceived as trustworthy. Statistically significant regional differences were observed in renewal intention, satisfaction with CHF officers, perceived healthcare service quality, and perceived household benefit (p < 0.05). Dodoma respondents reported higher renewal intention and a higher proportion of households benefiting from CHF. The distribution of healthcare-quality ratings also differed significantly (p < 0.001): Kilimanjaro had a higher proportion rating care as excellent (16.1% vs. 2.9%), whereas Dodoma had a higher proportion rating care as good (44.6% vs. 38.9%). Challenges in both regions included limited benefit coverage, additional out-of-pocket payments, long waiting times, and limited perceived advantages of CHF membership. Conclusions: Regional differences were observed in members’ experiences; however, because the regional samples differed socioeconomically and the analysis was not adjusted for potential confounders, these differences should not be attributed to the iCHF models themselves. The findings describe members’ experiences during the 2018 pilot period and should not be interpreted as a direct description of current iCHF performance. The results nevertheless highlight the importance of benefit coverage, service responsiveness, financial protection, and healthcare quality alongside efficient administration. Full article

Globally, physical activity is increasingly acknowledged as an effective strategy for combating non-communicable diseases (NCDs). However, there is a significant global disparity in the integration of sport sciences graduates (SSGs) into national health systems. This study assessed the professional roles of SSGs within healthcare systems and their association with NCD mortality across (n = 34) countries that met the selection criteria, using a cross-national, ecological, and cross-sectional design. Principal component analysis was conducted to reduce the dimensions of the correlated structural indicators. A pre-specified generalized linear model (Gamma family, log link) with HC3 robust standard errors estimated the association between SSG integration and age-standardized NCD mortality, alongside a descriptive analysis of public funding (national or subnational) for SSG services. The findings indicate that integrating SSGs into primary care was associated with approximately 23% lower age-standardized NCD mortality (rate ratio 0.77, 95% CI 0.63–0.94, p = 0.011; approximately 16% to 23% across model specifications) after adjusting for demographic and economic factors, with near-universal public funding (100% of integrated versus 24% of other countries; Fisher’s exact p < 0.001). To our knowledge, this is the first cross-national analysis to link the functional integration of SSGs into primary care with population NCD mortality, and this relationship remained consistent across multiple robustness checks. The implications suggest that functional integration and its public funding may represent promising policy approaches for strengthening preventive health services. Given the ecological, cross-sectional design, longitudinal studies are warranted to establish causality. Full article