Frontiers in health services最新文献

{"title":"Building and evaluating a social prescribing program for carer-employees: an intervention study.","authors":"Allison M Williams, Brooke Chmiel, Kate Mulligan, Sarah Neil-Sztramko, Winny Fung, Srija Biswas","doi":"10.3389/frhs.2026.1918717","DOIUrl":"10.3389/frhs.2026.1918717","url":null,"abstract":"<p><strong>Background: </strong>Within a 12-month time window, and in partnership with the Canadian Institute for Social Prescribing (CISP), an extension of the Canadian Red Cross (CRC), we will develop and test a social prescribing (SP) program intervention in Hamilton, Ontario, Canada for Carer-Employees (CEs) - those who balance unpaid care of an adult dependent with paid employment. Given the emergence of SP programs geared towards unpaid carers more broadly, the development of an SP program specific to CEs will provide coordinated access to social and community supports that are unique to the needs of CEs in balancing their dual role.</p><p><strong>Methods: </strong>OBJECTIVE 1: Informed by a recently completed scoping review of SP programs for CEs, the team will work closely with partner organizations, CISP and the CRC, and a Project Advisory Committee (PAC), including CEs with lived experience, to develop an SP program intervention via a co-design approach drawing on design thinking techniques and collective impact initiative backboned by CISP's SP pathway. The SP program will then be used as an intervention to be tested in the province of Ontario, Canada, via OBJECTIVE 2. OBJECTIVE 2: Using a sequential exploratory mixed-methods design, four Plan-Do-Study-Act (PDSA) cycles (a problem-solving model for improving the SP intervention program) will refine the implementation characteristics of the developed SP program and explore its impacts on CE health. The intervention(s) will operate as a quasi-experiment, where a quasi-experimental pre-post design will be conducted within each PDSA cycle, allowing the SP intervention to be tested and refined with respect to potential adoption by CEs. Impacts on CEs' health will be determined within each PDSA cycle, specifically on CEs' mental, psychosocial, and physical health. Quantitative and qualitative data will be generated within each cycle to inform refinements to implementation. A wait-list control group will be randomly assigned to ensure that the observed improvements can be attributed to the intervention.</p><p><strong>Discussion: </strong>Given the national reach and scope of CISP and the CRC, their commitment to the present initiative provides the project team with the resources necessary to build an effective SP program for CEs in Ontario, while also establishing sustainability through the expansion of this SP program across Canada. The final SP program will be scaled up to the national level.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1918717"},"PeriodicalIF":2.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causes of medical disputes in China and Japan from physicians' perspectives: a qualitative study.","authors":"Hua Xu, Atsushi Asai, Masao Tabata, Yasuhiro Kadooka","doi":"10.3389/frhs.2026.1826004","DOIUrl":"10.3389/frhs.2026.1826004","url":null,"abstract":"<p><strong>Background: </strong>Medical disputes and strained doctor-patient relationships (DPRs) remain pressing challenges in China. This comparative qualitative study examined Chinese and Japanese doctors' perspectives on the causes of medical disputes to identify context-specific factors, elucidate causal mechanisms, and inform strategies for improvement.</p><p><strong>Method: </strong>Using purposive sampling, 20 practicing physicians from each country were recruited primarily through the authors' personal networks. Semi-structured interviews were conducted, and qualitative descriptive analysis was used to identify categories and subcategories of perceived contributors to medical disputes.</p><p><strong>Result: </strong>Five categories and seventeen subcategories emerged. While both countries' doctors identified similar negative factors affecting DPRs, their manifestations differed, explaining divergence in dispute prevalence. In China, disputes were additionally influenced by inefficiencies in medical insurance and the medical dispute resolution system, poverty, healthcare consumerism, distrust, low social morality, and a \"vicious cycle of disputes.\" In Japan, disputes largely reflected poor communication and mutual distrust rather than broader systemic issues.</p><p><strong>Discussion: </strong>The findings underscore that medical disputes arise from broader social, medical, legal, economic, cultural, and ethical structures. In China, resolving disputes and improving DPRs requires systemic reforms, including strengthened social security, refined healthcare and legal systems, and enhanced ethics and public education. Sustainable trust-building is thus a long-term, structural endeavor rather than a matter of isolated interactions.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1826004"},"PeriodicalIF":2.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses' knowledge and attitudes toward pediatric pain assessment and management: a scoping systematic review from 2015 to 2025.","authors":"Haytham Al-Oran, Yousef Rubbai","doi":"10.3389/frhs.2026.1918667","DOIUrl":"10.3389/frhs.2026.1918667","url":null,"abstract":"<p><strong>Introduction: </strong>Nurses play an essential role in providing care to patients, and having the necessary skills, knowledge, and attitudes for effective pain assessment and treatment is crucial for ensuring best patient outcomes. The purpose of this paper is to review recent research about current nurses' knowledge and attitude toward pediatric pain assessment and management in pediatric settings.</p><p><strong>Method: </strong>The methodological approach taken in this paper is a scoping review using Arksey and O'Malley's five-step framework (2005). Databases including EBSCO host, PubMed, CINAHL, Springer, Cochrane, Science Direct, Ovid, and Google Scholar were searched to collect full-text articles available in English between 2015 and 2026. 20 out of 235 full-text papers met the inclusion criteria in the current scoping review.</p><p><strong>Results: </strong>The synthesis of the results of the 20 included research studies revealed that nurses worldwide had poor knowledge and attitudes concerning pediatric pain assessment and management. Various tools were utilized to assess nurses' knowledge and attitudes. The majority of research adopted the use of true/false or multiple-choice questions, as well as Likert scales with acceptable validity and reliability. The most extensively utilized tool was the Knowledge and Attitudes Survey Regarding Pain.</p><p><strong>Conclusion: </strong>This review's findings imply that pain education programs should be refined to enhance nurses' knowledge and attitudes toward pediatric pain assessment and management. Studies in the future should focus on recognizing individual and environmental features that influence nurses' level of knowledge and attitudes to improve the development of educational programs and the quality of care provided.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1918667"},"PeriodicalIF":2.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of implementing collaborative decision skills training among veterans with psychosis: a qualitative study guided by the practical, robust implementation and sustainability model.","authors":"Emily B H Treichler, Jennisa Bangal, Lauren McBride, Elissa Gomez, Sydney Seaton, Joanna Jain, Han Trieu, Eric Granholm, Gregory A Light, Borsika A Rabin","doi":"10.3389/frhs.2026.1837307","DOIUrl":"10.3389/frhs.2026.1837307","url":null,"abstract":"<p><strong>Background: </strong>Collaborative Decision Skills Training (CDST) is a promising group intervention for adults with serious mental illness (SMI) intended to increase collaborative decision-making (CDM) at the patient-clinician level. CDST previously underwent a systematic, community-engaged mixed methods adaptation to increase fit and feasibility for Veterans with psychosis at VA Psychosocial Rehabilitation and Recovery Centers (PRRCs). This qualitative study applies the Practical, Robust Implementation and Sustainability Model (PRISM) framework to identify the fit and feasibility of the adapted version of CDST within VA PRRCs for Veterans with psychosis.</p><p><strong>Methods: </strong>Nine Veterans with psychosis and two clinicians who participated in a CDST pilot trial at a VA PRRC provided feedback about CDST in qualitative interviews. PRISM-mapped guides were used to administer semi-structured interviews and develop qualitative codes. Following the initial coding of interviews, four analysts applied a systematic thematic approach to identify themes within each PRISM domain, inclusive of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework housed within PRISM. Identified themes were then reviewed by three analysts who reached consensus on the final themes to be presented in this paper.</p><p><strong>Results: </strong>Five cross-cutting themes were identified across PRISM domains, capturing CDST's conceptual alignment with PRRCs and the recovery model; variability of Veteran and clinician interest despite fit or effectiveness; the need for structural integration for sustainability; mixed perceptions of CDST's virtual format; and challenges with at-home practice completion. Additional themes were identified under PRISM Intervention Characteristics, Implementation and Sustainability Infrastructure, Recipients, and all RE-AIM outcomes which inform Veterans' and clinicians' implementation viability and sustainability.</p><p><strong>Conclusions: </strong>Application of the PRISM framework facilitated identification of multilevel determinants for CDST feasibility. CDST shows promising alignment with the recovery model and the structural approach to care at PRRCs, but delivery mode and auxiliary practice group require adjustment to support CDST's sustainability.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1837307"},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognising and responding to clinical deterioration in acute hospitals. Recording patient-reported wellness after Martha's rule.","authors":"Christian Peter Subbe, Lorelei Jones, Aimee Banfield, Sahla Siji, Lakshmipriya Munduchirayil Ajimon, Catherine Phythian, Adama Kaba","doi":"10.3389/frhs.2026.1854717","DOIUrl":"10.3389/frhs.2026.1854717","url":null,"abstract":"<p><strong>Background: </strong>Early recognition of clinical deterioration is central to patient safety, yet preventable harm still occurs. UK policy emphasizes listening to patients and systematically capturing patient-reported wellness.</p><p><strong>Aims: </strong>The aim of this study was to understand current practice for including patient and family voices in recognising and responding to deterioration, and to assess the feasibility of a structured approach to including patient-reported wellness as part of routine clinical monitoring.</p><p><strong>Methods: </strong>A mixed-methods feasibility study of a structured approach to capturing patient assessments of wellness (the Patient Wellness Scale) across four medical wards in an acute hospital in Wales.</p><p><strong>Findings: </strong>Healthcare staff routinely ask patients how they are feeling but documentation is inconsistent and fragmented. Testing the Patient Wellness Scale in a real-world clinical setting found it was not accessible to patients with speech and language difficulties, cognitive impairments, dementia and those who were critically unwell. In the context of staff shortages, temporary staffing and a task-based approach to care there is a risk that the Patient Wellness Scale could be implemented mechanistically.</p><p><strong>Conclusions: </strong>How patients are feeling is widely recognised as clinically meaningful but remains poorly formalised as a safety signal. A brief, structured Patient Wellness Scale embedded within routine observations could externalise tacit knowledge, support escalation across hierarchies, and align practice with national policy. However, there are potential unintended consequences. Our research identifies important considerations for policy makers and organisations implementing national policy requirements for patient-reported wellness.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1854717"},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A program theory for a continuing professional development program to enhance primary care nurses' mental health assessment practices.","authors":"Ariane Girard, Marie-Hélène Lemée, Sarah Lafontaine, Jean-Daniel Carrier, Marie-France Langlois, Hélène Clabault, Luz Piedad Arroyave, Johanie Gagné","doi":"10.3389/frhs.2026.1887809","DOIUrl":"10.3389/frhs.2026.1887809","url":null,"abstract":"<p><strong>Aim: </strong>To develop and test the relevance of a program theory underpinning a continuing professional development (CPD) program designed to support primary care nurses in adopting evidence-based mental health assessment practices.</p><p><strong>Background: </strong>Primary care nurses play a key role in identifying and responding to mental health needs, yet often report limited confidence and support in conducting assessments. A CPD program grounded in reflective practice and clinical supervision was co-created to address these gaps. Program design included a program theory representing the selected training processes and their expected outcomes.</p><p><strong>Design: </strong>Theory-driven evaluation using relevancy testing with a mixed-methods approach.</p><p><strong>Methods: </strong>Data collection included questionnaires based on the Ability, Motivation and Opportunity (AMO) framework at baseline, post-training, and 4-6 months follow-up; semi-structured interviews; observational field notes; and a logbook. Research team members analyzed qualitative data thematically and quantitative data descriptively.</p><p><strong>Results: </strong>Fourteen primary care nurses from two healthcare centres in Quebec participated (<i>n</i> = 13 completed). The program enhanced nurses' ability (knowledge, skills), motivation (confidence and professional engagement), and perceived opportunities at the individual level. Participants reported integrating new practices, including systematic screening, goal-setting, and follow-up, indicating behavioural change. Results suggest reflective and clinical supervision mechanisms that may have explained these outcomes and that enrich the initial CPD program theory.</p><p><strong>Conclusions: </strong>A CPD program integrating reflective practice and clinical supervision can strengthen conditions for evidence-based mental health assessment in primary care. Sustained practice change, however, requires alignment with organizational support processes.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1887809"},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building an integrated cardiogeriatric heart failure pathway for very old adults: a four-year community case study from Hôpital La Porte Verte.","authors":"Rémi Esser, Olivier Maurou, Marine Larbaneix, Alejandro Mondragon, Sophie Balesdent, Maureen Assayag, Marlène Esteban, Christine Farges, Vincenzo Palermo, Sophie Nisse Durgeat, Marc Harboun","doi":"10.3389/frhs.2026.1877754","DOIUrl":"10.3389/frhs.2026.1877754","url":null,"abstract":"<p><p>Heart failure pathways are often poorly adapted to very old adults, whose clinical trajectories are shaped by frailty, multimorbidity, cognitive impairment, functional decline, polypharmacy, caregiver dependence, and fragmented transitions between hospital, home, and long-term care settings. This Community Case Study describes the progressive construction, over nearly four years, of an integrated cardiogeriatric heart failure pathway at Hôpital La Porte Verte, Versailles, France. The pathway was developed iteratively through the phased implementation of complementary services, progressive clarification of professional roles, and repeated adaptation of coordination and escalation processes across inpatient, outpatient, home-based, and long-term care settings. Developed within a dedicated cardiogeriatrics department, the pathway connects acute inpatient care with structured post-discharge follow-up, remote monitoring, rapid-access day hospitals, advanced practice nurse-led coordination, hospital-at-home collaboration, long-term care facility outreach, pre-interventional geriatric evaluation, and palliative-oriented decision-making when appropriate. The central lesson is that integrated cardiogeriatric heart failure care should not be viewed as a single intervention, but as a responsive care architecture linking early detection, human triage, timely clinical response, reassessment, and continuity across settings. Remote monitoring is clinically meaningful only when connected to a trained response team and rapid-access care capacity; day hospitals function as reassessment platforms rather than simple alternatives to admission; and advanced practice nurses are key to operational continuity. The conceptual contribution of this report is to make visible the architecture linking these components, rather than to evaluate another isolated intervention. This single-centre experience provides a practice-based implementation framework for ageing health systems by identifying the organisational links, workforce roles, response capacities, and governance conditions required to connect otherwise isolated care components. Prospective multicentre and health economic studies are needed to assess clinical impact, scalability, cost-effectiveness, and transferability.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1877754"},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory segmentation of selected cardiovascular hospital services in Chile using DRG-based normalized indicators.","authors":"José Rodríguez, Manuel Vargas, Pilar Cos, Andrés Viveros","doi":"10.3389/frhs.2026.1859518","DOIUrl":"10.3389/frhs.2026.1859518","url":null,"abstract":"<p><strong>Objective: </strong>To assess the use of DRG-based normalized indicators in supporting an exploratory analysis of inter-hospital variation in specific cardiovascular services within the Chilean public system from 2019 to 2023, employing routinely collected administrative data and confining interpretation to descriptive comparisons within the examined sample. The study was designed as descriptive and hypothesis-generating, not to validate hospital performance measures.</p><p><strong>Methods: </strong>An analysis was conducted of 141,893 adult discharges from the departments of Cardiology, Cardiovascular Surgery, and Peripheral Vascular Surgery in 54 hospitals within the Chilean public system. Relative throughput, severity, and mortality were summarized into three DRG-based normalized indicators as a function of coded complexity. The hospital-level means were standardized to z-scores prior to principal component analysis. Sampling adequacy for PCA was assessed using the Kaiser-Meyer-Olkin statistic (KMO = 0.6251) and Bartlett's test of sphericity (<i>p</i> = 1.00 × 10^-10), which suggested performing exploratory analysis with caution. K-means clustering was then performed on the first two principal components with k = 4, n_init=50, and random_state=42 for reproducibility. Differences (specialty, sex, cluster) in the relative throughput proxy were assessed using the Kruskal-Wallis test and Dunn's <i>post hoc</i> tests.</p><p><strong>Results: </strong>The first two principal components accounted for 86.26% of the variability in the hospital-indicator matrix. K-means clustering resulted in four hospital clusters: cluster 0 (8 hospitals, 14.8%), cluster 1 (8 hospitals, 14.8%), cluster 2 (26 hospitals, 48.1%), and cluster 3 (12 hospitals, 22.2%). Distinct combinations of indicators emerged from the cluster means: cluster 1 had the highest ER (0.9633) and the lowest MR (0.0016), while cluster 3 had low ER (0.2465), high SR (2.3286), and the highest MR (0.0375). Kruskal-Wallis tests indicated significant differences in ER by specialty, sex, and cluster (all <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The analysis suggests that DRG-based normalized indicators can be used to explore the segmentation of hospitals providing selected cardiovascular services within the Chilean public system. Their outputs should be interpreted as descriptive and hypothesis-generating rather than as validated measures of hospital efficiency or stand-alone evidence for resource-allocation decisions.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1859518"},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare workers hydration status and performance: a scoping review.","authors":"Omar B Da'ar, Razan Alhabeeb, Farah Kalmey","doi":"10.3389/frhs.2026.1778164","DOIUrl":"10.3389/frhs.2026.1778164","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers play a crucial role in providing life-saving care in high-pressure fast paced settings, where sustained alertness is critical. Adequate hydration is essential for their decision-making and timely delivery of treatment. Water intake is crucial for optimal cognitive, digestive, and cardiovascular function. The World Health Organization (WHO) emphasizes the importance of hydration in delivering quality healthcare. Therefore, this review aims to map the existing literature on healthcare workers' hydration status and its relationship with their work performance.</p><p><strong>Methods: </strong>In this scoping review, we conducted an electronic search in three databases- PubMed/PubMed Central, ScienceDirect and Google Scholar. The search was carried out between March 2023 through September 2023.</p><p><strong>Result: </strong>The scoping search identified 17,799 records, of which 15 met the inclusion and exclusion criteria, and were fully reviewed (<i>N</i> = 15). The result shows that dehydration affects healthcare workers significantly, with 60% reporting reduced physical performance when dehydrated during shifts. Nearly half (53%) of studies document declines in cognitive pFerformance and mood. This mental strain increased with longer shift lengths, particularly among nurses on 12-h shifts and medical residents working more than 24 h.</p><p><strong>Conclusion: </strong>There is a lack of adequate studies on healthcare workers' hydration health and its impact on performance, cognition, and mental well-being. Future research should be conducted in both cross-sectional and experimental methodologies, incorporating quantifiable measures to evaluate hydration and interventions. Countries with hot climate, such as, Saudi Arabia, should lead this research agenda, given that high temperatures could amplify the effects of inadequate hydration.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1778164"},"PeriodicalIF":2.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and determinants of academic bullying among medical and dental students in Jordan.","authors":"Hana Taha, Omar Alshadaidah, Salwa Samhouri, Malek Awamleh, Hana Hadidi, Suhib Awamleh, Martin Söderberg, Vanja Berggren, Linus Jönsson","doi":"10.3389/frhs.2026.1932348","DOIUrl":"10.3389/frhs.2026.1932348","url":null,"abstract":"<p><strong>Background: </strong>Academic bullying is a well-recognized issue in medical education, carrying considerable consequences for mental health, academic performance, and even patient care. The issue remains understated, as most victims refrain from reporting due to fear of repercussions. This is especially relevant in the MENA region, where data on the topic is already sparse. This study aims to report the prevalence, types, associated factors, and perceived effects of academic bullying among medical and dental students at a Jordanian university.</p><p><strong>Methods: </strong>A cross-sectional study collected the data from 383 medical and dental students at a public Jordanian university, using a self-administered questionnaire assessing sociodemographic, bullying involvement, types, determinants and responses. Depressive and anxiety symptoms were measured using the PHQ-9 and GAD-7. Victims and non-victims were compared using the Mann-Whitney U and chi-square tests; binary logistic regression identified independent predictors of victimization.</p><p><strong>Results: </strong>Of the 383 participants, 38.6% reported some involvement in bullying: 27.7% as witnesses only, 4.2% as victims only, and 6.8% as both victims and witnesses. Verbal bullying was the most prevalent form in both the witnessed and victimized groups (69.7% and 73.8%, respectively), with fellow students being the most commonly reported perpetrators. Independent predictors of victimization included a history of childhood bullying (OR = 12.05, 95% CI: 4.88-37.0) and lower GPA (OR = 0.38, 95% CI: 0.18-0.79).</p><p><strong>Conclusion: </strong>Academic bullying remains prevalent yet underreported among Jordanian medical and dental students, with measurable consequences for mental health and academic life. Certain groups - particularly those with a childhood bullying history -appear more vulnerable to victimization. These findings support the need for accessible, confidential reporting systems, routine mental health screening, and peer-support programs in medical education.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1932348"},"PeriodicalIF":2.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}