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Mobile health clinics (MHCs) serve as an alternative HIV care delivery method for the HIV-burdened eThekwini district. This study aimed to describe and profile the HIV care services provided by the MHCs through process evaluation. A descriptive cross-sectional quantitative evaluation study was performed on 137 MHCs using total population sampling. An online data collection method using a validated 50-item researcher-developed instrument was administered to professional nurses who are MHC team leaders, following ethical approval from the local university and departments of health. Descriptive statistics were used to analyze the data. The results described that HIV care services are offered in open spaces (43%), community buildings (37%), solid built buildings called health posts (15%), vehicles (9%), and tents (2%) with no electricity (77%), water (55%), and sanitation (64%). Adults (97%) are the main recipients of HIV care in MHCs (90%) offering antiretroviral therapy (95%). Staff, monitoring, and retaining care challenges were noted, with good linkage (91%) and referral pathways (n = 123.90%). In conclusion, the standardization and prioritization of HIV care with specific contextual practice guidelines are vital.

Background Developing reflective capacity and critical thinking is one of the prerequisites of education in health professions, especially medicine. This study aimed to determine the reflective capacity of medical students and its role in their critical thinking disposition. Methods In this cross-sectional descriptive research, conducted in 2022, a total of 240 medical intern students were selected using the convenient sampling method. Data were collected using a reflective capacity questionnaire and critical thinking disposition questionnaire and analyzed with descriptive and inferential statistics using SPSS20. Results The mean reflective capacity was 4.53 ± 0.50, and mean critical thinking disposition was 127.52 ± 10.85. Among the dimensions of reflection, “active self-appraisal (SA)” and “reflective with others (RO)” had the highest and lowest means, respectively. The dimensions of critical thinking disposition with the highest and lowest means were related to innovation and intellectual maturity, respectively. Reflective capacity and its dimensions were found to have a direct and statistically significant relationship with critical thinking disposition and its dimensions. Regression analysis results showed that reflective capacity accounts for 28% of students’ critical thinking disposition. Conclusion The relationship between students’ reflective capacity and their critical thinking disposition has rendered reflection as one of the necessary components of medical education. Thus, determining the learning activities by considering the reflection process and models will be very effective in creating and strengthening critical thinking disposition.

Syrian people are the largest refugee population globally and are mainly hosted by the Turkish government. Due to the conflict-driven displacement and their insecure immigration status, many have limited access to basic human needs and develop further mental health issues due to forced displacement. The study aims to identify reasons for forensic evaluation in specific age groups and gender among Syrian refugees. For this descriptive study, the demographic and case information of 781 Syrian refugees, consisting of 74.6 % males and 25.4 % females who are referred to the Forensic Medicine Clinics due to five main reasons: psychoactive drug testing, age estimation, DNA analysis, injury assessment, and forensic-psychiatric evaluation were included. The patient information is collected from the patient files. The nominal data were categorized by gender and under 4 different age groups: pediatric (age 0–14), adolescent (age 15–24), young adult (age 25–34), and adult (age 35 and older). Drug tests were the most prevalent reason in males older than 14 years old (79.7 %), and age estimation, due to early marriages for the female refugees (53.3 %). DNA testing was the primary reason for female adults. The majority of the refugees’ injuries were untreatable with simple medical treatment (SMT) (89.2 % males, 58.8 % females). Pediatric injury assessments demonstrated head injuries (33.3 %), not treatable with SMT (100 %), and 33.3 % of those cases were life-threatening. Identifying vulnerable individuals among the Syrian refugee population based on demographics, gender, and age will further promote more effective approaches to improve the interventions. •There are gender-based differences in the reason for referrals of Syrian refugees.•The major reason for the referral of male refugees is psychoactive drug tests.•53.3 % of female refugees underwent age estimation due to early marriage suspicion.•Adult female refugees are mainly referred to examine family bonds via DNA tests.

Background To ensure the large number of school-based physical activity and nutrition programs have a lasting positive impact on the health and wellbeing of students, it is essential that such programs are sustained long-term. However, there is limited research assessing the duration of such programs and the determinants that are related to their sustainment. This study investigates the duration of, and determinants to the sustainment of physical activity and nutrition programs in Australian primary schools. Methods A cross-sectional study with 207 Principals (one from each school) from a nationally representative sample of randomly selected Australian primary schools. Principals completed a survey online or via telephone, which included items assessing the determinants of program sustainment categorised based on the domains of the Integrated Sustainability Framework (inner contextual factors; outer contextual factors; characteristics of the intervention; and processes). Schools were randomised to answer survey items relating to either physical activity or nutrition programs. We collected data on the number and type of programs, their duration, and factors influencing the sustainment of one selected program. Descriptive statistics were used to assess the duration and prevalence of programs. Regression analysis was used to assess the association between sustainment determinants and the duration of program delivery. Results Schools randomised to physical activity programs implemented on average, 5.4 of the nine physical activity programs assessed. Schools randomised to nutrition implemented on average, 2.8 of the seven nutrition programs assessed. Physical activity programs had a mean duration of 6.9 years and nutrition programs had 7.4 years. Nutrition programs had 3.27 times the odds of being sustained longer than physical activity programs (95% CI: 1.57, 6.83; p  = 0.002). The only domain from the Integrated Sustainability Framework that was statistically significantly associated with the sustainment for both physical activity and nutrition programs was outer contextual factors. This domain includes the alignment of the program with the priorities of the school, partnerships between the school and external organisations, and the existence of a governing body policy or guideline related to the program. The highest ranked determinant from this domain for both physical activity and nutrition programs was the alignment of the program with the priorities of the school. Conclusion This study highlights the need for targeted strategies to support the sustainment of health programs in schools, particularly focusing on outer contextual factors. Specifically, the alignment of the program with the priorities of the school. Policymakers and practitioners should prioritise targeting these outer contextual determinants to enhance the sustainment of physical activity and nutrition programs, ultimately promoting better long-term population health outcomes.

Background Nutrition-related health issues remain a significant public health challenge in Latin America and the Caribbean (LAC), where rapid transformations in food systems have contributed to increasing obesity and diet-related noncommunicable diseases. Government policies are key to shaping healthier food environments, but their implementation and evaluation vary widely across countries. This study aimed to identify national-level public policies that promote healthy food environments in the LAC region and to outline priority areas for research to strengthen their implementation, from the perspectives of researchers and advocates. Methods This cross-sectional study was conducted between July and December 2024, combining a bibliographic review and an online survey. The review compiled national laws, regulations, and policy documents from multiple databases, official government websites, and reports from international organizations. A structured, country-adapted questionnaire was administered to members of the Community of Practice in Nutrition and Health in Latin America and the Caribbean (COLANSA). Participants were asked to revise the list of policies in place in their countries, as identified by the review, and prioritize up to five policies requiring further research. They were also asked to specify the types of studies needed. Results The review identified 130 relevant documents. Seventy-three participants from 17 countries completed the survey, most of whom were affiliated with academic or civil society institutions. According to the review, all countries had legislation related to ingredient and nutrient declaration in labels, food-based dietary guidelines, and at least a regulation that influences school food environments. Measures such as fiscal incentives for sustainable agriculture, subsidies for healthy foods, and mechanisms to prevent industry interference were less commonly in place. The restriction of food advertising to children and adolescents, the policies to reduce inequalities and protect vulnerable populations, and the promotion of healthy foods were the most frequently identified priorities for further research. Study types that were more frequently suggested included analyses of implementation barriers, industry interference, policy impact evaluation, and stakeholder mapping. Conclusions This study identified food environment policies across LAC and research needs. The respondents emphasized the need for research to assess policy implementation, monitor impact, and address barriers such as industry interference. Strengthening regional collaboration and applied research capacities may contribute to generating actionable evidence for more effective and equitable food policies in the region.

Background The high availability and marketing of unhealthy foods has contributed to unhealthy diets. Unhealthy diets are a major risk factor for a range of non-communicable diseases (NCDs). However, the availability and marketing of pre-packaged foods haven’t been assessed in Senegal. Nutrient profiling models have been developed to identify less healthy foods that could be subject to marketing restrictions, particularly when targeted at children. The aim of this study was to assess the nutritional quality and on-pack promotion of pre-packaged food sold in major supermarkets in Senegal using the Nutrient Profile Model for the WHO African Region (NPM-WHO/AR), the Nutri-Score labelling system and the NOVA classification. Methods A cross-sectional survey was conducted in two major supermarkets in Dakar between August and September 2021. Data were collected for all pre-packaged foods, with the exception of the fresh food and alcoholic beverages categories. Pre-packaged foods were classified into fifteen food categories and five beverage categories according to the NPM-WHO/AR, with the exception of the categories “fresh and frozen meat, fish and sea food” and “fresh and frozen fruits and vegetables, legumes and tubers”. Nutritional information was extracted from product labels and products were evaluated using 3 classification systems: NPM-WHO/AR, Nova classification as an indicator of the degree of food processing and Nutri-Score, a nutritional labelling system based on a 5-colour scale from dark green to red, associated with letters ranging from A (high nutritional quality) to E (low nutritional quality), established according to nutritional value and fruits, vegetables and legumes content. Depending on the classification system used, foods were rated on the basis of the nutritional information declared as relevant for this rating. Thus, 5,542 products were evaluated for their nutritional composition, 5,280 products were evaluated according to the NPM-WHO/AR and 5,407 products were evaluated according to both the Nutri-Score and the Nova classification. A pre-packaged food was classified as “non-permitted” to be marketed to children if the content of defined nutrients exceeded the threshold set in the model for the corresponding product category. Data analysis was performed using RStudio. Results Ultra-processed foods (71.1%) and processed foods (18.8%) were the most common in Senegalese supermarkets. According to the Nutri-Score, pre-packaged foods were most frequently classified as Nutri-Score D (24.4%) and Nutri-Score E (22.1%). Almost 63.3% of the products were classified as non-permitted to be marketed to children according to the NPM-WHO/AR. Of these foods, 12.5% had on-pack promotions. Non-permitted foods to be marketed to children with the highest number of on-pack promotions were “breakfast cereals” (50.0%), “chocolate and sugar confectionery” (31.3%), “milk and dairy based drinks” (28.1%) and “cakes, sweet biscuits and pastries” (17.7%). However, the comparison between the NPM-WHO/AR and the Nutri-Score showed that some NPM-WHO/AR prohibited foods were classified into Nutri-Score A and B. Conclusions This study shows that pre-packaged foods available in major supermarkets in Senegal are predominantly non-permitted to be marketed to children. In the context of increasing levels of obesity and diet-related NCDs, effective policies should be established to regulate the promotion of these foods.

The purpose of this evaluation study was to identify strengths and opportunities for improvement in programme functioning and common aspects of patients' experiences at a hospital-based food pantry. Semi-structured, in-depth interviews with patients and a cross-sectional survey for providers were used. Interview transcripts were coded using both inductive and deductive approaches and assessed for inter-rater reliability. Descriptive statistics were produced from quantitative data. An academic urban safety-net hospital in the Northeastern US offering inpatient and outpatient services. Thirty patients and 89 providers. Patients expressed feeling comfortable, trusting the food, high satisfaction with food quality, convenience, and lack of stigma at the hospital-based pantry. Patients mentioned the pantry helped them eat more fruits and vegetables, but expressed concerns about the healthfulness of other foods distributed. Providers believed they should discuss food insecurity (FI) with patients (99 %) and that the pantry improves the health of patients (97 %), but faced barriers to consistently screening for FI and referring patients to the pantry, such as insufficient training on FI (53 %) and time constraints (35 %). Findings suggest hospital-based food pantries may have several advantages. Hospitals with onsite food pantries must work to eliminate barriers to FI screening and pantry referral. To optimize their impact, such pantries should develop nutritional guidelines for food donations and connect patients with nutrition education resources. Future research should examine health outcomes for patients using hospital-based food pantries.

Background Urbanization influences food culture, particularly in low- and middle-income countries where there is an increasing consumption of processed and pre-packaged foods. This shift is contributing to a rise in non-communicable diseases. Food labelling standards are crucial for regulating manufacturing practices and helping consumers make healthy food choices. We aimed to assess the compliance of local and imported pre-packaged snacks with Tanzanian and international labelling standards in Dar es Salaam, Tanzania. Methodology A cross-sectional study was conducted on 180 snack products. A checklist based on Tanzanian and Codex labelling standards was used to evaluate adherence. We also examined factors influencing adherence, such as product origin, price, category, purchase location, and package size. Results The majority of the snacks demonstrated partial adherence to Tanzania ( n  = 97; 54%) and International (Codex) ( n  = 120; 67%) labelling standards. Imported products showed significantly better adherence to both Tanzanian ( n  = 46; 53%) and international ( n  = 42; 48%) standards. Notably, more than half ( n  = 110; 66.7%) of the products used English for labelling, and infrequently ( n  = 74; 41.4%) used the recommended World Health Organization Front-of-Pack Nutrition Labelling. Product category, origin, and package size were significantly associated with higher levels of international standard adherence ( p  < 0.05). Conclusion The inadequate adherence to mandatory labelling standards and the scarce use of Swahili and FoPL highlight the need to strengthen labelling practices and potential challenges faced by consumers in understanding nutritional information. Thus, strengthening and emphasizing good labelling practices are urgently needed as we seek to address diet-related noncommunicable diseases.

Background Internationally, acute homelessness is commonly associated with complex health and social care needs. While homelessness can be understood as an outcome of structural housing exclusion requiring housing led solutions, the health care issues faced by homeless people equally require attention. A substantive evidence base on the health needs of homeless people exists, but relatively little is known about what influences the self-rated health of homeless people. This article presents new evidence on whether drug use (alcohol consumption, ever having used drugs), health variables (visiting a hospital once in the last year, visiting the doctor in the last month, having a health card, sleeping difficulties, and having a disabling impairment) and sociodemographic characteristics are significantly associated with Self-Rated Health (SRH) among Spanish homeless people. Method The approach applies secondary analysis to cross-sectional data from a sample of 2437 homeless adults in Spain (83.8% were male). Multinomial logistic regression modelling was used to analyse the relationships between drug use, other health variables and SRH. Results Being male, an abstainer, having a health card and being in the youngest age groups were significant factors associated with perceived good health. On the other hand, ever having used drugs, having been a night in hospital, having gone to the doctor in the last month, having sleeping difficulties, having a disabling impairment and being in the older age group were all significant risk factors associated with perceived poor health. Conclusions These results help to improve understanding of the key factors that influence the SRH among homeless people. The findings can contribute to development and delivery of preventive policies, suggesting that interventions to reduce drug consumption and ensure access to a health card/health services, as well as enhancing services for older, female and disabled homeless people are all measures which could improve health and well-being for those who face homelessness. Effective housing interventions (e.g. Housing First or Permanent Supported Housing programmes) are equally important to underpin the effectiveness of measures to improve the self-rated health of homeless people.

Background/Objectives: Nutrition literacy (NL) is an important determinant of healthy dietary behaviors, particularly among population groups at increased cardiovascular risk. This study aimed to describe NL and adherence to the Mediterranean diet (MD), and to describe their association, among women aged 45–70 years living in socioeconomically disadvantaged neighborhoods in Florence (Italy). Methods: A cross-sectional study was conducted within the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI). This study represents the second step of Phase 1 of the Optimising Health Literacy and Access (Ophelia) process. Women were recruited in a primary health care setting using a convenience sample. NL was assessed using the Italian-adapted version of the Nutrition Literacy Assessment Instrument (NLit-IT) and the adherence to the MD using MEDI-LITE. Results: Questionnaires filled in by 143 women were included in the analysis. Most participants (63.6%) had “possibility of poor NL”. Regarding the MD, 60.8% showed moderate and 9.1% low adherence. A positive correlation was observed between total NLit-IT and MEDI-LITE scores (rho = 0.214; p = 0.011). In logistic regression analysis, an increase in the NLit-IT total score was associated with a higher possibility of having a moderate/high adherence to the MD (OR 1.157). Only the subscale “Food Label and Numeracy” of NLit-IT emerged as an independent predictor of moderate/high adherence to the MD (OR 1.416). Conclusions: These preliminary findings suggest a possible association between NL and adherence to the MD. Further longitudinal and interventional studies are needed to confirm these results and inform tailored nutrition education interventions.