Introduction:The yearly observance of Ramadan, which includes prolonged daily fasting, presents a challenging scenario for patients with chronic illnesses, with existing studies presenting inconsistent findings on its metabolic implications.Objective:This study aimed to objectively measure the immediate and sustained impacts of Ramadan fasting on monthly mean Hemoglobin A1c (HbA1c), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) in a large, real-world cohort of Saudi Arabian patients with concomitant T2DM and HTN.Methods:A retrospective longitudinal study was carried out using electronic health record (EHR) data from a Saudi multi-facility healthcare system from December 2023 to May 2024. The analysis used a segmented regression for Interrupted Time Series (ITS) to estimate changes in outcomes, with Ramadan (March 2024) serving as the intervention point.Results:The final cohort comprised 15 289 patients. The ITS analysis showed that Ramadan resulted in a substantial reduction in mean HbA1c by −0.25% (P < .001) and mean SBP by −4.12 mmHg (P < .001). However, the post-Ramadan trend for HbA1c demonstrated a significant monthly increase of 0.15% (P = .002), indicating a rebound impact. The reduction in SBP was not sustained, as it returned to pre-Ramadan levels in the months that followed.Conclusions:In this large Saudi cohort, Ramadan fasting was linked to transitory improvements in glycemic and blood pressure control. The ensuing rebound implies that, while fasting can be metabolically advantageous, the effects do not last without ongoing intervention. These results highlight the important necessity for rigorous post-Ramadan clinical follow-up to consolidate any gains made during the fasting period. These findings position Ramadan as a novel window for metabolic reset and a potential preventive opportunity against cardiorenal metabolic syndrome progression in high-risk populations.

Adolescents and youth from socially and culturally underserved communities face a disproportionate burden of depression, exacerbated by systemic barriers to accessing timely and culturally appropriate mental health care. In contexts where health systems are under-resourced, community-based initiatives may offer promising strategies for promoting youth mental well-being. This study explores how adolescents and youth from underserved communities in Mexico perceive and cope with depressive symptoms, with the aim of identifying community-informed strategies that can inform culturally relevant mental health promotion and prevention initiatives. Using an exploratory qualitative design, the study combined participant observation with focus group discussions involving people aged 15 to 25. A thematic analysis guided by resilience and participatory frameworks was conducted to examine youths' emotional experiences, stressors, and coping mechanisms within their family, school, and social environments. Participants reported depressive symptoms such as sadness, social withdrawal, fatigue, and hopelessness. Key stressors included family conflict, exposure to violence, and school-based pressures like bullying and academic demands. Although many youth used positive coping strategies-such as seeking social support and participating in recreational activities-some also exhibited maladaptive responses, including avoidance and silence. Focus groups emerged as empowering spaces for youth to articulate emotions and co-develop potential solutions. Findings highlight the urgent need for holistic interventions that integrate family and school-based programs with youth-centered, community-led mental health initiatives. Participatory methods are proposed as culturally sensitive, scalable approaches to address service gaps in under-resourced settings. These community-driven responses not only support individual coping but also contribute to the resilience of local health systems by aligning services with the lived realities of underserved populations.

Background:Unsafe abortion is a major contributor to maternal mortality in low- and middle-income countries. Despite the legalization of abortion and expanded access to services in Nepal, data on abortion practices and patient satisfaction remain limited.Objective:This study aimed to assess abortion methods, their management, and patient satisfaction among women seeking safe abortion services at a tertiary care hospital in Kathmandu, Nepal.Design:A hospital-based cross-sectional study.Methods:The study was conducted from December 2023 to May 2024 among 285 women aged ⩾18 years with gestational age of up to 12 weeks. Data were collected through face-to-face interviews and clinical records, followed by 7-day post-abortion assessment via in-person visits or phone calls. Pearson’s chi-square test and binary logistic regression were performed at a 5% level of significance to identify factor associated with patient satisfaction.Result:Among 285 women, 76.8% underwent medical abortion with oral mifepristone followed by misoprostol via sublingual, buccal, or vaginal routes, while 23.2% received surgical abortion through vacuum aspiration after misoprostol pre-treatment and local anesthesia. Discharge medications commonly included analgesics (paracetamol and ibuprofen) and antibiotics (ciprofloxacin, and metronidazole). Post-abortion contraceptive uptake was 79.3%, with implants (28.8%) and condoms (28.4%) being the most chosen methods. Overall, 50.2% of women reported satisfaction with the abortion services received. Logistic regression analysis showed that higher education (AOR: 5.63; 95% CI: 2.40-13.16), extended family structure (AOR: 7.25; 95% CI: 3.11-16.91), and no history of live birth (AOR: 4.20; 95% CI: 1.48-11.93) were significantly associated with higher satisfaction, while age ⩾35 years was negatively associated (AOR: 0.52; 95% CI: 0.28-0.95).Conclusion:Medical abortion was the preferred method, and overall management was aligned with WHO guidelines. However, patient satisfaction was moderate. Improving infrastructure, ensuring privacy, reducing waiting times, enhancing post-abortion counseling, and providing tailored health education with regular service evaluations are needed to improve the quality of abortion care and patient satisfaction.

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.

Background:Mental illness is a widespread issue that affects millions of people worldwide. Its impact is not only limited to the individuals suffering from it but also extends to their families and communities. Caregivers suffer physically, psychologically, and socially twice than general population related to care giving process.Methods:An institutional-based cross-sectional study design was employed from January 21 to February 21, 2024, at public hospitals in Harari Regional State and Dire Dawa City Administrative; 437 primary caregivers were selected via a systematic sampling technique. Data were collected using interview-administered questionnaires. Simple and multiple linear regression analysis were used to assess the contributing factors of quality of life domains among the participants, and the ꞵ-coefficient with a 95% confidence interval was used. Statistical significance was accepted at a P-value < .05.Results:A total of 421 respondents participated, for a response rate of 96.3%. The results found that the mean quality of life scores of caregivers of people living with mental illness for each domain (mean ± SD) were 58.05 ± 18.81, 57.29 ± 16.28, 51.19 ± 23.12, and 53.04 ± 16.13, for physical, psychological, social and environmental factors, respectively. Multiple regression analysis revealed that the caregiver’s educational status, depression, perceived stigma, perceived burden and patient’s diagnosis were negatively associated with all domains of quality of life, whereas the caregiver’s resilience and social support were strongly positively associated with all domains of quality of life.Conclusion:Caregivers’ quality of life found to be low across the four domains of quality of life, with the lowest score in the social domain. Resilience and social support found to plays a positive role in the quality of life of caregivers. Regular evaluation of risky caregivers, and psycho-support are crucial to address these challenges and improve caregivers’ well-being.

Background: This exploratory study investigates the code of silence in healthcare, exploring its origins and outlining its negative impact on healthcare quality and patient safety. Drawing parallels with other professions where similar codes exist, the research delves into the reasons healthcare professionals may choose not to report inappropriate practices. Objective: This article outlines the reasons for the existence of the code of silence in healthcare, assesses its prevalence, and suggests strategies to address it. Design and methods: This is a qualitative study which uses in-depth interviews with 88 licensed healthcare providers (physicians, nurses, administrators, and pharmacists) to identify common types of inappropriate practices, the actions taken to address them, and the reasons why observers chose to remain silent. Results: We find that the majority of healthcare providers in the sample (nearly 70%) either witnessed or were made aware of incidents of inappropriate practices. In a substantial proportion (about 40%) of the cases, no action was taken after reporting the inappropriate practice. The findings are discussed in the context of existing codes of professional ethics and the organizational cultures that either encourage or discourage transparency. The study highlights the tension healthcare professionals face between their personal values, institutional goals, and fear of retribution. Conclusion: Breaking the code of silence is both a personal and organizational responsibility. The paper concludes with actionable recommendations to break the code of silence, such as fostering a supportive reporting culture, improving anonymous reporting mechanisms, and encouraging leadership to prioritize accountability.

Background:Scaling community-based health programs can contribute to efforts to achieve universal health coverage. Implementers of community-based health programs, such as community health workers (CHWs), hold valuable insights and experiences that can inform how these programs scale up and out.Objectives:(1) To assess implementer experiences and perceptions of a community-based health program delivered by CHWs that underwent recent changes to broaden its programing and reach (ie, scaling up); and (2) to describe facilitators and barriers to the implementation of this community-based health program to inform subsequent scaling out.Methods:In April 2023, an evaluation of an NGO-led CHW program was conducted with program implementers across 6 geographic regions in Negros Oriental, Philippines (n = 64 semi-structured interviews). Data were analyzed using a hybrid inductive-deductive analysis, informed by the Medical Research Council’s framework for process evaluation of complex interventions. Ethics approval was provided by the University of Waterloo Research Ethics Board (Certificate #: 44828).Results:CHWs perceived that the scaled up version of the program was more useful and impactful, given its expanded reach and provision of basic treatment; however, new program components also required significant time, effort, and strategy to implement which created new opportunity costs for CHWs. Implementation of the scaled up version of the program was facilitated via clear communication structures and supportive group training spaces. Pre-existing roles and social networks held by CHWs further facilitated the implementation of the scaled up version of the program. Overall, new individual-level and community-based strategies were leveraged by CHWs to implement the scaled up program, and participants described facilitators (eg, expanded reach) and barriers (eg, increased time and effort) that influenced program implementation.Conclusion:This study contributes insights into how individuals involved in the scaling of a community-based health program may experience this process.

Background:Addressing social determinants of health in patient care helps hospitals better understand the non-medical factors influencing patients’ health outcomes.Objectives:The objective of this study was to evaluate the correlation between hospital characteristics, county determinants, and the systematic recording of health-related social needs among general and surgical acute care hospitals in the United States. It focused on the hospital’s routine collection of data on patients’ health-related social needs, such as transportation, housing, and food insecurity.Design:A cross-sectional retrospective study design was utilized.Methods:All hospitals that completed the American Hospital Association Annual survey (n = 2254) were included in the study. A series of multinomial logistic analyses were conducted.Results:The relative risk of hospitals routinely collecting health-related social needs data is 67% lower in for-profit hospitals and 90% higher in not-for-profit hospitals compared to government hospitals. Hospitals that are part of a system are 1.5 times more likely to routinely collect data on social needs. In addition, counties with higher household income have a statistically significant higher relative risk of hospitals collecting data on social needs, though the magnitude of the difference is small. The relative risk of hospitals collecting social needs data, but not routinely, is 2 times higher in teaching hospitals and 3 times higher among system hospitals.Conclusion:Our research strongly indicates that understanding and addressing these inherent hospital-related factors are essential for effectively integrating social determinants of health into routine healthcare data collection practices. Establishing more robust guidelines and standardization in these practices may enhance hospitals’ ability to document and utilize health-related social needs information, ultimately driving improved patient outcomes and supporting more equitable care.

This research aims to enhance the quality of hospital services by utilizing Quality Function Deployment (QFD) with a novel Multi-Dimensional House of Quality (MD-HOQ) approach. This method integrates Service Quality (SERVQUAL) analysis and considers resource constraints, such as financial and workforce limitations, to select and prioritize technical requirements effectively. The proposed MD-HOQ approach was applied to a private hospital in Tehran, Iran. Data were gathered from a sample of 8 experts and a sample of 386 patients, using 2 in-depth interviews and 4 questionnaires. The process included identifying hospital sections and determining their importance using the Analytic Hierarchy Process. Patients' needs in each section were then identified and weighted through SERVQUAL analysis. Subsequently, technical requirements to meet these needs were listed and weighted using MD-HOQ. A mathematical model was employed to determine the optimal set of technical requirements under resource constraints. Application of the MD-HOQ approach resulted in the identification of 50 patient needs across 5 hospital sections. Additionally, 40 technical requirements were identified. The highest implementation priorities were assigned to "training practitioners and nurses," "improving the staff's sense of responsibility," and "using experienced specialists, physicians, and surgeons." The integrated QFD approach, utilizing MD-HOQ and SERVQUAL analysis, provides a comprehensive framework for hospital managers to prioritize technical requirements effectively. By considering resource constraints and the gap between patient expectations and perceptions, this method ensures that resources are allocated to the most impactful technical requirements, leading to improved patient satisfaction and better overall hospital service quality. This approach not only enhances the quality of hospital services but also ensures efficient utilization of resources, ultimately benefiting patient satisfaction.