To explore nurses’ perceptions regarding their knowledge, degree of autonomy, and the difficulties encountered in managing diabetic foot in Primary Care.

Diabetes mellitus is a chronic condition with a high prevalence in Spain, predominantly type 2. One of its most serious complications is diabetic foot disease, affecting between 19% and 34% of patients and associated with considerable morbidity and amputation risk. Primary Care, particularly nursing professionals, plays a pivotal role in the prevention, assessment, and management of diabetic foot. However, institutional, methodological, and personal barriers continue to affect care quality.

A descriptive, cross-sectional observational study was conducted using quantitative and qualitative methods. A validated ad hoc questionnaire was administered to 176 nurses from the Murcian Health Service participating in a blended learning course on diabetic foot. Variables assessed included professional autonomy, knowledge, dressings use, clinical documentation, training, and perceived challenges. Qualitative analysis was based on open-ended responses using content analysis.

A total of 88.1% of nurses reported autonomy in performing foot examinations; however, only 45.5% managed wound care independently. Just 19.9% considered themselves sufficiently trained, while 42.6% felt confident in selecting dressings appropriate to the healing phase. Although 56.8% regularly completed specific clinical documentation forms, many still expressed uncertainty about dressing use. Qualitative analysis identified five key barriers: lack of knowledge, patient complexity, institutional constraints, issues of authority and communication, and professional insecurity. These findings provide a current picture of persistent barriers in diabetic foot care and reinforce the need for targeted training and institutional support.

In Brazil, decisions regarding the incorporation of health technologies, guided by health technology assessment (HTA), are made independently within the public and private health systems. There is ongoing discussion about establishing a unified HTA agency to address incorporation across both sectors. This study sought to compare the decision-making criteria for technology incorporation in Brazil’s public and private health systems.

A dataset of new medicines registered in Brazil between 2010 and 2020, along with their corresponding indications, was compiled to identify and assess medication-indication pairs. Case studies were developed for pairs that underwent coverage evaluations in both the public and private health systems. These HTA coverage decisions were systematically analyzed and compared using a published evidence-based methodological framework. This methodology requires that research questions from different HTA agencies be sufficiently alike to enable a meaningful comparison of decision-making criteria.

Twenty medicines across 10 indications were analyzed. Oncology related pairs (10 medicines, five indications) could not be compared due to differing research focuses: public evaluations covered entire treatment lines, whereas private assessments focused on specific medicine-indication pairs. Non-oncology cases (10 medicines, five indications) targeted eosinophilic asthma, ulcerative colitis, psoriasis, multiple sclerosis, and neuronal ceroid lipofuscinosis type 2. Public sector decisions prioritized unmet needs, disease impact, clinical benefits, and negotiated prices. In contrast, the private sector focused on expanding therapeutic options, with clinical uncertainties having limited influence. The private sector did not consider costs in decision-making, even when medicines lacked clinical superiority over comparators.

Decision-making in the public sector relies on HTA principles, while the private sector focuses on therapeutic expansion, ignoring efficiency and clinical uncertainties. A unified HTA agency in Brazil could negatively affect the public sector if private sector priorities dominate. Moreover, such an agency is unlikely to reduce the workload, as research questions differ significantly across sectors.

The world is facing an urgent environmental emergency that calls for ambitious, coordinated action by governments to improve humankind’s relationship with nature. Mitigation (reducing pollution) and adaptation (adjusting to pollution) are both necessary, and “NextGen” health technology assessment can play a key role in helping to guide health system decision-makers to achieve environmental sustainability.

In 2022, the International Network of Agencies for Health Technology Assessment (INAHTA) identified environmental impact assessment (EIA) as an important and urgent topic for a white paper. An international author group (n=10), formed of staff from INAHTA member agencies, wrote the paper. The author group met seven times over 2022 to 2024 to develop the paper, which is based on a literature review and expert opinion of INAHTA members. A second group of members formed an international advisory group (n=11), which reviewed the draft twice. The paper was approved by the INAHTA Board before release on the INAHTA website.

EIA can be useful to help achieve the “green” policy goals of health systems by identifying technologies that are comparatively harmful to the environment. However, health technology assessment (HTA) agencies are subject to the institutional structures and regulations of their local health system that can constrain their ability to independently adapt to incorporate EIA. Nevertheless, HTA agencies are starting to do this with some success, but difficult challenges remain, particularly around lack of data and methods. Looking ahead, raising awareness and working together across the HTA ecosystem will be key to achieving the shared goal of environmental sustainability.

The successful inclusion of EIA in priority setting, assessment, and appraisal, as well as knowledge sharing and dissemination activities of HTA, is a challenge since the operating principles, methods, and data in this area are not yet mature. The successful inclusion of environmental impacts in HTA will require some reconsideration of existing value frameworks and methods.

Aspects of the school food environment can influence food purchasing and consumption among adolescents, particularly those without access to a school meal programme. Our objective was to describe and compare food vendors of junior high schools (JHS) in Ghana.

We conducted structured observations of food vendors within a 0·25-km radius of eight JHSs. We compared foods sold and hygiene practices by vendor and community characteristics, such as on- v. off-campus location, urban v. rural, and predominant income-generating activity of the community. We also assessed the relationship between adolescent diet quality (food group diversity, all-5, NCD-protect and NCD-risk scores) and procurement method for foods consumed during the school day.

Cape Coast and Elmina, Ghana.

200 randomly selected students.

Of 265 identified vendors, 25·3 % sold foods on-campus. On-campus vendors were less likely to sell branded snacks (19·4 % v. 33·8 %, P = 0·001) and beverages (17·9 % v. 35·4 %, P = 0·008) and more likely to sell prepared dishes (53·7 % v. 31·8 %, P = 0·001) than off-campus vendors. Vendors practised an average of 38·8 % of applicable food hygiene practices, which did not differ by on- or off-campus location. In the previous month, 59·4 % of students most often purchased food on campus. There were no significant relationships between method of food procurement and diet quality.

Many adolescents purchased food at school, and there were differences in foods sold by on- and off-campus vendors. School policies may be a promising avenue to alter food environments for adolescents.

This study examined the temporal and seasonal distribution of sudden sensorineural hearing loss admissions and audiogram types from 2015 to 2024 using seasonal-trend decomposition with locally estimated scatterplot smoothing.

A retrospective analysis included sudden sensorineural hearing loss patients admitted to a tertiary otorhinolaryngology clinic between January 2015 and December 2024. Demographics, admission dates and audiogram types were evaluated.

Among 738 patients (mean age 45.7 ± 15.6 years; 58.4% male), admissions varied significantly across years, months and seasons, peaking from November to March. Winter admissions were highest, while autumn had the lowest. Seasonal-trend decomposition with locally estimated scatterplot smoothing confirmed recurring seasonal patterns. Although audiogram types showed no seasonal or pandemic association, their distribution differed significantly by month.

Sudden sensorineural hearing loss admissions demonstrate clear temporal and seasonal clustering, aligning with influenza-like illness peaks and suggesting a viral contribution. Monthly audiogram variations imply possible environmental influences.

The present study examined the association of body mass index (BMI), screen and sleep time, physical fitness and eating behaviour with Mediterranean diet (MD) adherence in a sample of pre-schoolers from Granada, Spain.

A cross-sectional, non-randomised design was employed. A multilinear regression model with backward elimination was used for analysis.

Variables included age, BMI, screen time, hours of nightly sleep, physical fitness, food approach and food avoidance. The developed model met assumptions of multiple regression in terms of linearity, homoscedasticity, normality, independence and non-multicollinearity.

Data were collected from 653 of the 2250 three-to-six-year-old children attending the 18 schools invited to take part in the present study.

Better sleep time and lower screen time and food avoidance were found to be predictive of MD adherence. These variables explained 15% of the variance in pre-schoolers MD adherence.

The present study suggests that sleep and screen time and food avoidance are important components to consider when targeting improvements in MD adherence in pre-schoolers. Future research should explore the way in which parental health behaviours influence their children’s health habits in order to better understand outcomes.

This study aims to examine the awareness, attitudes, and acceptability of medical aid in dying (MAiD) among healthcare professionals in Pakistan, a predominantly Muslim country where cultural and religious values heavily influence medical ethics and end-of-life decisions.

A cross-sectional survey was conducted online among 70 healthcare professionals, including physicians, nurses, and allied health workers in Pakistan. Data were collected via a structured, self-administered online questionnaire assessing knowledge, attitudes, and willingness to participate in MAiD-related actions. Descriptive and correlational analyses were conducted to identify patterns and associations.

Participants demonstrated moderate knowledge about MAiD (M = 17.13, SD = 3.42) and moderate support for its legalization (M = 18.89, SD = 4.99). However, levels of negative attitudes (M = 32.21, SD = 6.11) and legal and ethical concerns (M = 24.73, SD = 3.66) were high. Behavioral willingness to engage in MAiD-related actions remained low (M = 2.42, SD = 3.38), with limited intent to assist (M = 0.39), refer (M = 0.64), or approve physician-assisted MAID (M = 0.81). A significant negative correlation emerged between knowledge and support for legalization (r = − .25, p = .037), while no significant associations were observed between knowledge and willingness to participate in MAiD. Gender and profession did not significantly influence attitudes or willingness.

While Pakistani healthcare professionals display a conceptual understanding of MAiD, their readiness to participate remains low, primarily due to ethical, legal, and religious concerns. These findings highlight the need for creating awareness regarding MAiD and for providing culturally sensitive education, structured training in palliative care, and the development of clear legal frameworks to guide end-of-life decision-making in Muslim-majority contexts.

To explore the experiences of military medical first responders managing mass casualty incidents (MCIs) during the ongoing conflict in Ukraine to identify key challenges and insights.

This qualitative study employed in-depth, semi-structured interviews with medical first responders who managed MCIs in Ukraine. Thematic analysis was leveraged by our research team to identify recurring themes and patterns within the interview data.

Our results revealed crucial takeaways related to the (1) need for preparedness and training, (2) variability of triage, (3) importance of communication and teamwork, and (4) the resulting psychological strain.

These firsthand accounts offer valuable lessons for identifying challenges of first responders, developing areas of future research for MCI response strategies, and enhancing the readiness and well-being of medical first responders in current and future conflicts.

This study assessed iron-rich food consumption and its associated factors among children aged 6–23 months in South and Southeast Asia.

A cross-sectional study from the Standard Demographic and Health Survey (2015–2022).

South and Southeast Asian countries.

Data collected from 95 515 children aged 6–23 months, including information from their parents or caregivers.

The overall proportion of children, aged 6–23 months, consuming iron-rich foods in the region was 29·87 % (95 % CI: 29·58, 30·16). Higher odds of iron-rich food consumption were observed among children aged 12–23 months (adjusted OR (AOR) = 3·59; 95 % CI: 3·45, 3·76), had history of exclusive breast-feeding (AOR = 1·17; 95 % CI: 1·12, 1·23), born to teenage motherhood (AOR = 1·09; 95 % CI: 1·02, 1·17), born in health institution (AOR = 1·10; 95 % CI: 1·02, 1·19) and had pregnant mother at the time of the survey (AOR = 1·60; 95 % CI: 1·50, 1·72). Children of birth order 2–4 (AOR = 1·26; 95 % CI: 1·20, 1·32) and 5+ (AOR = 1·29; 95 % CI: 1·18, 1·43), from female-headed households (AOR = 1·06; 95 % CI: 1·01, 1·12) and those with household mass media exposure (AOR = 1·27; 95 % CI: 1·19, 1·36) also had significantly higher odds of iron-rich food consumption. Additionally, higher odds ratio (OR) (AOR > 1) of iron-rich food consumption were observed in Cambodia, Bangladesh, Indonesia, Myanmar, Maldives, Philippines, Pakistan and Timor-Leste.

Across countries, only about 30 % of children consumed iron-rich foods, with significant variation. Targeted public health efforts are essential to address maternal, child and household factors that influence intake.

This study aimed to evaluate adult women’s cooking (CS) and food preparation skills (FPS) and their nutrition literacy (NL) levels and to examine the relationship between these two concepts.

Data were collected via face-to-face interviews using a personal information form, the Cooking and Food Preparation Skills scale, and the Evaluation Instrument of Nutrition Literacy on Adults. Data were analysed with SPSS, with P < 0·05 considered significant.

Female adults aged 20–64 years who participated in family support courses in Tepebaşı, Eskişehir, Turkey.

The study sample consisted of 330 female individuals between the ages of 20 and 64 years who agreed to participate in the survey.

NL was generally adequate (91·8 %), though gaps were identified in portion knowledge (54·2 %) and food label reading (44·2 %, borderline). Higher literacy levels were associated with being younger, more educated and employed (P < 0·05). CS and FPS were higher among married women and those with children. Cooking frequency and enjoyment significantly influenced these skills (P < 0·05). Those who cooked more often had higher scores in food label reading and basic math (P < 0·001) and higher total scores (P = 0·049). Participants who enjoyed cooking had better reading comprehension (P = 0·030). A weak but significant correlation was found between FPS and general nutrition knowledge, but no strong relationship was observed between overall cooking skills (CS) and total NL.

Although no strong link was found between NL and CS, these skills appear to support healthier eating behaviours. Promoting cooking and food preparation through nutrition education may help improve public health.

In team science, invitation to writing groups can be subjective and secretive. Confronted with this challenge in the ISCHEMIA trial, with 320 participating sites, 4 coordinating centers, 6 core laboratories, and numerous committees, we adapted an existing model to develop a transparent, objective, and equitable method for determining authorship eligibility.

We developed a scoring system based on site performance of tasks critical to trial success that meet the ICJME criteria for authorship. Sites were ranked according to points earned, and points required for potential authorship were communicated to all sites. Site investigators were surveyed for their manuscript topic preferences for writing groups. Beyond the point-based system, authorship positions were also reserved for trial contributors who were not site investigators.

To date, 50 original, peer-reviewed ISCHEMIA trial manuscripts have been published. In total, 208 authors from 33 countries participated in at least one publication. Of the 87 sites that randomized at least 15 participants over a mean of 5 years, 72% had authorship positions across published manuscripts. Surveys were sent to 334 site investigators and 27% responded. Among respondents, 61% indicated that ISCHEMIA was the first trial they had worked on with performance-based criteria for authorship invitation. Respondents agreed the system was transparent (81%), objective (83%), and equitable for early career researchers (70%) and underrepresented minorities in research (57%).

ISCHEMIA employed a point-based authorship eligibility system that most authors found objective, merit-based, transparent, and equitable. Implementation of such a system should be considered for team science publications.

This study describes the management and outcomes of temporal bone fractures resulting from falls.

We retrospectively reviewed patients with traumatic temporal bone fractures from 2018 through 2022.

We analysed 171 patients with temporal bone fractures, 62 (36.3 per cent) of which occurred secondary to falls. Fall patients were significantly older than non-fall patients (mean age 46 vs. 38 years; p = 0.0079) and had higher Modified Frailty Index-5 scores (0.63 vs. 0.20; p = 0.0003). Fall patients had shorter hospital stays (10.1 vs. 15.8 days; p = 0.015), were more frequently discharged home (66.1 vs. 44.0 per cent; p = 0.007) and were less likely to experience non-resolving facial nerve weakness (6.5 vs. 21.1 per cent; p = 0.030).

Patients with temporal bone fractures from falls are older and frailer than non-fall patients and have unique preventative and rehabilitation needs.