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Carolina Carvajal Villalba

Colombia

Abstract : Upstream intervention for healthcare quality: Re-engineering nursing
curricula to address global disparities in patient safety.

Introduction: The public health imperative
Although patient safety is widely recognised as a fundamental aspect of the quality of healthcare,
preventable medical errors remain a leading cause of illness and death worldwide. Nurses form the
largest part of the global healthcare workforce and act as the primary defence against systemic
error. However, a critical “upstream” factor in hospital safety is often overlooked: the level of
education of the workforce. Current literature suggests an apparent paradox whereby undergraduate
nursing education treats patient safety as an implicit, fragmented or ancillary topic rather than a
core scientific competence. This study argues that failing to systematise safety education
perpetuates vulnerability in clinical systems and is not just a pedagogical issue, but also a public
health crisis.
Methodological approach
In order to map the global landscape of patient safety education (PSE) and identify scalable
solutions, we conducted a comprehensive integrative review and bibliometric analysis of peer
reviewed literature published between 2015 and 2024. Using the PRISMA 2020 guidelines, we
screened 6,889 records from four major databases: Scopus, PubMed, Web of Science and Springer
Link. Following a rigorous quality appraisal using the Johns Hopkins Nursing Evidence-Based
Practice (JHNEBP) model and the Mixed Methods Appraisal Tool (MMAT), we synthesised 20
high-impact empirical studies. Our analysis focused on competency acquisition, pedagogical
efficacy, and the geopolitical distribution of educational resources.
Results: Systemic failures and pedagogical successes
The Failure of “Osmosis”: The integrative review found that “implicit” curricula, in which students
are expected to learn safety procedures by observing clinical environments, are statistically
ineffective. Studies have shown that students often lack awareness of essential safety concepts (e.g.
error reporting and systems thinking) when learning is unstructured. Conversely, explicit
competency frameworks transform abstract principles such as 'vigilance' into measurable,
observable behaviours.
Efficacy of immersive learning: Active, constructivist learning strategies, specifically high-fidelity
simulation (HFS), have been shown to produce better results than traditional didactic methods. The
synthesis revealed substantial effect sizes (Cohen’s d > 0.8) for simulation-based training. Notably,
one longitudinal study documented a 40% reduction in medication errors among graduates who
utilised simulation. These methods succeed by creating 'episodic memories' — emotionally salient
experiences that link theoretical knowledge to psychomotor skills.
The Faculty capability gap: A major systemic barrier identified was the lack of faculty
preparedness. In 57% of the analysed studies, the main obstacle to safety education was not student
aptitude, but rather a lack of training in safety science among educators. This highlights the urgent
organisational need for mandatory faculty development: we cannot expect educators to teach
competencies they do not possess.
The "Pedagogical Paradox" (Global Health Equity): For public health policymakers, the most
critical finding is perhaps the geographic disparity in research and resources. The majority of
evidence-based models originate in high-income countries. This creates a paradox whereby regions
bearing the heaviest burden of preventable harm lack the resources for the 'gold standard' (high
fidelity simulation). It is ethically negligent to promote expensive technology as the only solution
in low-resource settings.
Discussion
The spiral curriculum & context-adaptive strategies
In order to bridge the gap between educational theory and patient outcomes, we propose shifting
to a competency-based spiral curriculum. This framework replaces the 'one-off' workshop model
with vertical integration, whereby safety science is introduced in the first year and revisited in
greater depth throughout the degree.
Furthermore, to address global inequities, the study advocates Context-Adaptive Pedagogical
Strategies. In settings with limited resources, there is evidence to support the effectiveness of low
fidelity simulations, peer-led micro-simulations and mobile-based learning tools. These
interventions prioritise pedagogical integrity over technological sophistication, ensuring that
effective safety training is accessible regardless of a nation's GDP.
Conclusion and policy recommendations
The evidence evaluated here demonstrates that patient safety cannot remain a peripheral or episodic
element of undergraduate nursing education. Fragmented, passive instruction fails to produce the
integrated knowledge, psychomotor skills, and safety-centred attitudes required by contemporary
clinical practice.
Immersive, longitudinal pedagogical approaches, particularly simulation coupled with mentored
clinical practice, interprofessional engagement and quality improvement projects, consistently
produce superior translation of learning into safer clinical behaviour. However, their impact is
constrained unless matched by deliberate, system-level support. To close this implementation gap,
educational institutions and accreditation bodies must recognise patient safety as a core
competency relevant to licensure and incorporate it into a competency-based spiral curriculum.
Licensure standards should therefore mandate explicit patient safety competencies rather than
deferring them to optional coursework. Similarly, governments, universities and funders must
invest in formal faculty certification and ongoing professional development in safety science and
allocate the necessary infrastructure and staffing resources to sustain high-impact pedagogies.
To make high-quality training equitable and scalable, programmes should adopt context
appropriate simulation technologies and low-resource pedagogical innovations, such as peer-led
micro-simulations and mobile learning. This will make treating education as a high-stakes,
upstream intervention feasible across diverse settings. Only by aligning accreditation, institutional
investment and context-sensitive delivery can we cultivate a nursing workforce that is technically
adept, ethically accountable and cognitively prepared to protect patients in complex clinical
environments.

Norrima Mokhtar

Malaysia

Nsabimana Mick

Burundi

Hosny Maher Sultan

United Arab Emirates

Abstract : Intergenerational Links between Parental Sleep Disorders
and Child Sleep Health and Mental Well-Being

Background: Sleep is a vital biological process essential for children’s physical, cognitive, and emotional development. Emerging evidence suggests that sleep disturbances may be transmitted across generations, with parental sleep disorders influencing children’s sleep health and mental well-being. However, limited research has explored these relationships in Arabic-speaking populations.

Objective: This study aimed to examine the associations between parental sleep disturbances and children’s sleep health and psychological well-being, and to evaluate the predictive role of parental sleep and mental health on child outcomes.

Methods: A cross-sectional study was conducted between January and March 2025 involving 200 parent–child dyads recruited from pediatric clinics, schools, and online platforms. Parents aged 25–55 years with sleep disturbances and children aged 6–17 years were included. Standardized instruments were used, including the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) for parental sleep, the Children’s Sleep Habits Questionnaire (CSHQ) for child sleep, and the Strengths and Difficulties Questionnaire (SDQ) and Revised Children’s Anxiety and Depression Scale (RCADS) for child mental well-being. Data were analyzed using descriptive statistics, Pearson correlations, and multiple regression analyses.

Results: Parents demonstrated poor sleep quality (mean PSQI=8.18±3.22) and subthreshold to moderate insomnia (mean ISI=12.23±5.35). Children exhibited clinically significant sleep disturbances (mean CSHQ=49.33±7.59). A substantial proportion of parents reported mental health issues (34%), and many families were single-parent households (58.5%). Preliminary findings indicate significant associations between parental sleep disturbances and children’s sleep problems and psychological difficulties. Parental sleep quality and mental health emerged as significant predictors of child emotional and behavioral outcomes.

Conclusion: The findings support the presence of intergenerational links between parental sleep disorders and children’s sleep and mental health. These results highlight the importance of addressing parental sleep and psychological well-being in interventions aimed at improving child health outcomes. Culturally tailored strategies are needed to promote healthy sleep practices and mental well-being in Arabic-speaking families.

Richard Sagacity Tugbeh

Liberia

Abstract : Spatial Distribution and Environmental-Climatic Determinants of Malaria Infection Among Children Under Five in Liberia
Background: Malaria remains a serious public health threat in Sub-Sahara Africa with
children under five years bearing the heaviest burden. However, Liberia is considered
hyperendemic for malaria and its tropical and a predominantly equatorial climate that is warm
and humid, provides ideal breeding conditions for Anopheles mosquitoes and year-round
transmission. The study aimed to examine the spatial pattern of malaria infection and assess
the influence of climatic and environmental factors on malaria risk among children under five
in Liberia.
Method: A quantitative secondary analysis was conducted using data from the 2022 Liberia
Malaria Indicator Survey and other sources containing the environmental and climatic
variables. The study focused on children under five years in the 150 LMIS 2022 clusters of all
the 15 counties in Liberia. Moran’s I was used to assessed the presence of spatial
autocorrelation, while the existence of local clustering was examined using Local Indicators of
Spatial Association (LISA). The Ordinary Least Squares (OLS) and the Spatial Lag analyses
(SLM) were performed to explore the relationship between malaria infection and
environmental and climatic drivers.
Result: The study revealed substantial spatial heterogeneity in under five malaria across
Liberia. Some survey clusters (0%) showed very low prevalence but the highest cluster (81%)
was in Sinoe county. Global Moran’s I (0.111, p =0.002) indicated weak but significant
clustering, and LISA maps highted significant hotspots in Southern and Southeastern counties
versus coldspots in Northwest. The regression results pinpointed rainfall (β=0.083, p<0.003),
vegetation (β= 0.055, p< 0.009), and water proximity (β= 0.701, p < 0.026). The SLM (AIC
=1184.01) outperformed OLS (AIC=1185.13) model.
Conclusion: The study demonstrated that malaria prevalence among children under five is
characterized by pronounced spatial heterogeneity driven by climate and geography. High
rainfall, dense vegetation, and proximity to water bodies create favorable conditions for
transmission, especially in the southern counties. It also revealed clusters of high risk that
extend beyond local environmental suitability, indicating spillover effects. These findings
underscore the need for geographically differentiated malaria control strategies in Liberia,
focusing intensified efforts on the identified hotspot counties/regions.

Laya Alphonse

Cameroon

Carla Calderón Figueroa

Chile

Abstract : Cancer Care Systems and Survival: Integrating Policy Contexts and Institutional Practices
The comparative analysis of cancer care systems in countries with high survival rates—Australia, Canada,
Belgium, Japan, and Costa Rica—demonstrates that outcomes in oncology cannot be explained solely by
biomedical advances. Rather, cancer survival emerges from the interaction between structural conditions, public
policies, and institutional practices operating across the entire disease trajectory. From this perspective, survival
should be understood as a multidimensional outcome shaped by both macro-level contexts and the organization
of care in practice.
At the structural level, these countries share key characteristics: high levels of socioeconomic development,
democratic political systems, and, critically, the presence of universal health coverage. These conditions enable
the implementation of public policies oriented toward equity, accessibility, and sustainability in cancer care (1).
In addition, the state plays a central role in regulating and financing health systems, while policy development
processes are typically participatory, incorporating the perspectives of patients, communities, and health
professionals. This combination of universalism and participation contributes to the development of policies that
are both socially responsive and territorially adapted.
However, structural and policy-level conditions alone are insufficient to explain high survival outcomes. A central
contribution of this analysis is the recognition that public policies must be translated into concrete institutional
practices that organize care along the cancer continuum—from screening and diagnosis to treatment, palliative
care, and survivorship. At this level, consistent patterns are observed across countries: the institutionalization of
population-based screening programs, the strengthening of diagnostic infrastructure, the use of multidisciplinary
teams, and the implementation of coordinated care pathways that ensure continuity of care (2).
Importantly, these systems also integrate non-biomedical dimensions into cancer care. Psychosocial support,
financial protection, legal frameworks, and community-based resources play a critical role in addressing the
broader needs of patients and their families (2). In this context, non-governmental organizations and patient
networks contribute significantly to counselling, navigation, and social reintegration, complementing formal
healthcare provision. As a result, cancer care is configured not only as a clinical process but as a comprehensive
socio-health practice that incorporates emotional, social, and economic dimensions.
Despite these strengths, persistent challenges remain. All countries face territorial inequalities in access to
services, gaps in effective screening coverage, and limitations in equitable access to innovative therapies.
Additionally, variability exists in the development of survivorship policies and labor reintegration strategies,
indicating that this dimension of care is still evolving. These findings highlight that even high-performing systems
must continuously address structural and organizational barriers to achieve full equity in cancer care.
In conclusion, high cancer survival rates are not the product of isolated interventions but of coherent and
integrated systems in which public policies, health system organization, and institutional practices are aligned.
The effectiveness of these systems lies in their ability to integrate biomedical, social, and cultural dimensions
into continuous, equitable, and person-centered care trajectories. Thus, cancer survival should be understood
as the outcome of a complex institutional ecosystem that extends beyond clinical treatment to encompass the
broader conditions that shape the experience and well-being of individuals living with cancer.

Agnieszka Jankowicz-Szymańska

poland

Abstract: Postural hygiene in children and adolescents within the public healthcare systems of selected European countries

Postural hygiene can be defined as maintaining proper posture while standing, walking, and performing daily activities. It also includes proper eating habits and regular physical activity to maintain a healthy body weight and fitness. Taking care of postural hygiene should be treated as one of the key elements determining the psychophysical well-being of people of all ages. This is particularly important in the case of children and adolescents because their developing skeleton is susceptible to deformations and the habits they form will remain with them until adulthood, largely determining their physical fitness and quality of life. Our research is conducted along three lines: (1) comparison of public health care focused on early detection and prevention of postural defects in children and adolescents in selected European countries in order to collect good practices and create a set of recommendations to improve this system; (2) creating a posture screening protocol for assessing posture – a simple, low-cost and widely accessible tool – which could be used by GPs, school nurses and physiotherapists to provide parents and children themselves with clear information about the quality of their body posture; (3) to develop a set of exercises designed to foster good posture, which could be used in nurseries and as in-lesson activities in primary schools to promote good posture. We compared systemic, state-guaranteed pediatric care interventions for the prevention of postural defects in Spain, Malta, Romagna, Turkey and Poland. In each of these countries are children and adolescents assessed on a regular basis for their weight status, proper musculoskeletal development and physical fitness. However, in none of these countries there is any formalized cooperation between GPs, schools and families, and paediatricians' practices are not equipped with even sipmle tools (such as a scoliometer or a podoscope), for assessing posture. There is also no standardized examination form that would provide parents with clear and comprehensive information about the results of the assessment. In none of these countries is a physiotherapist – although best qualified to assess posture – included in the system of free screening examinations. We have designed a simple protocol for screening body posture, validated it in pilot studies involving 64 children aged 5 and 6, and used it to assess approximately 800 pre-school children across Poland. The assessment using this protocol takes a few minutes and involves evaluating body posture in the habitual standing position from the front, back and side, as well as measuring trunk rotation using a scoliometer whilst the child is bent forwards. The protocol is graphical, easy to complete and received good feedback from parents. We are currently working with partners from Italy, Norway, Portugal and Turkey as part of the ‘Spine-friendly Teacher, Spine-friendly School’ project (Erasmus+ code: KA220-SCH) to develop sets of exercises that promote good posture, which will be made available free of charge to teachers and parents. We are also producing a handbook in which we explain, in a very accessible way, the anatomy and function of the spine and the importance of good posture for overall health.

Melissa Rivera Marano

USA

Abstract :Behavioral activation delivery by lay individuals in Latinx communities: a feasibility study

As the demand for mental health services increases, new models of care are necessary to address shortages of mental health professionals. Research in low- and middle-income countries has shown that lay individuals with limited formal education and no experience with mental health service delivery can be trained as providers; however, research in this model is limited in the United States. This study sought to assess the feasibility of training lay individuals to deliver Behavioral Activation (BA) to Spanish-speaking Latinos using the BA for Latinos Treatment Manual (i.e. the BA Manual). Design/methodology/approach Using a pilot feasibility trial, the authors trained four women who worked as receptionists at a community-based organization in Camden, New Jersey as community health workers (CHWs). CHWs attended three days of training and delivered BA sessions under supervision to Spanish-speaking Latinas with mild to moderate depression or anxiety. Delivery method included a telehealth platform with flexibility to integrate phone sessions. Findings Using the Pragmatic BA Fidelity tool, CHWs and their supervisors assessed high levels of fidelity in the delivery of the intervention. However, due to challenges with scheduling, CHWs completed only four of the planned six sessions. All participants expressed satisfaction with the intervention. Research limitations/implications This study suggests the feasibility of training lay individuals to deliver the BA intervention in community-based settings; however, modifications are necessary before moving to efficacy testing. The study was supported through pilot funding, which required us to focus on a limited number of outcomes. Based on the methods proposed by Teresi et al. (2022), the authors designed this study to focus specifically on fidelity to the intervention and acceptability of the intervention to diverse stakeholders. The authors were not able to address factors such as recruitment and retention of interventionists or more detailed assessment of recipients’ adherence to/engagement with the intervention. Further research will be necessary to address these components of intervention fidelity. Practical implications Given the small scale and exploratory nature of this study, the findings should not be interpreted as evidence of effectiveness but rather as an indication of whether the approach can be implemented and refined. The fact that both CHWs and their supervisors were confused about the number and timing of sessions, suggests that more time should be spent on training these participants on the BA model to enhance intervention fidelity. The next phase of this research will involve revising the training schedule, reviewing the translation of the intervention manual, and creating reporting templates to ensure consistency with the intervention’s aims. The authors expect these changes to significantly improve fidelity to the BA model, which the authors plan to test with a larger sample size. Social implications The fact that service recipients benefited from the program (i.e. decreased depression/anxiety symptoms and high satisfaction with the program) suggests that this approach may represent a promising direction for expanding access to culturally appropriate services, particularly in settings where traditional resources are limited. After further feasibility testing, the study team plans to conduct a pilot test with sufficient sample size to randomize recipients to service delivery either from a CHW or a mental health professional. Although the stakeholders in the present study identified few problems with either the training or service delivery, a larger pilot study that would train and compare these aspects of the intervention for lay individuals versus professional therapists is likely to identify more specific areas for improvement. Originality/value This study provides preliminary evidence of the feasibility of training lay individuals to deliver a BA intervention. The next phase of the research will incorporate findings from this study to test the model in a larger sample.

Marianne Vanderschuren

South Africa

Abstract : The accessibility of healthcare facilities in the South African context – a road transport analysis.

Background: Road Safety is a major cause of death around the world and in South Africa. Overall, over 12 000 people lose their lives in the country’s roads (RTMC, several years). While many measures in the healthcare and transportation field are implemented, analysis of the accessibility to medical facilities, including Emergency Medical Services (EMS) indicates that road fatality rates remain unacceptably high in South Africa. Method: This study consists of three different components. Firstly, it positions road fatalities in South Africa within the global context. This analysis is based on the latest World Health Organisation (WHO) database. The second part of the study utilises the South African National Household Travel Survey (NHTS) to analyse the accessibility of medical services. The analysis includes a gender and provincial comparison, amongst others. Finally, road fatality locations in rural areas in the Western Cape Province are analysed. The question that is answered in this part of the study is: can road crash victims reach EMS within the ‘Golden Hour’? The focus on rural areas stems from the fact that 50% of the world’s population lives in rural areas, where medical services are sparse. Analysis: In absolute numbers, global road fatalities dropped with 5% between 2010 and 2021 (WHO, 2023). However, this is nowhere near the aimed 50% reduction in road fatalities that was aimed during the first ‘Decade of Action for Road Safety 2011 to 2020’, proclaimed by the UN General Assembly in March 2010 (via General Assembly Resolution A/64/L.44). In line with the absolute fatalities, global road fatality rates have also reduced over the years. The global fatality rates have dropped to 15 fatalities per 100 000 population, while the African rate is 19 fatalities per 100 000 population. In South Africa the fatality rate has dropped during the first Decade of Action, to 17 fatalities per 100 000 population. According to the NHTS (2020; before Covid-19), trips to medical services make up 2.6% of all trips in South Africa. However, the differences per province are significant. While in Gauteng (1.5%), Mpumalanga (1.6%), Limpopo (1.8%) and the Free State (1.9%), record less than 2% of trips for medical reasons, in the Eastern Cape (5.6%) and the Northern Cape (6.0%), the percentage is 2.5 to 3 times as high. Travel times to healthcare services can be challenging in South African. Some 45% of trips to medical facilities take less than 15 minutes, while 35.4% of trips are between 16 - 30 minutes. A total of 13% of trips take between half an hour and one hour, while 6.6% of trips take more than an hour. In the database details it appears that some trips take over 5 hours. A Geographical Information System analysis revealed that 53% of the fatalities in the rural parts of the Western Cape Province occur outside the Golden Hour. In high-risk crash areas, the fatality risk is up to nine times higher than the province’s rural average. Conclusion: The road fatality burden in South Africa remains stubbornly high, in absolute and relative terms, The timeously accessibility of healthcare services is paramount and requires further healthcare and transportation improvements.