اپیدمیولوژی
مقالهها، منابع و پژوهشهای تازه حوزه اپیدمیولوژی
ورود به زیرشاخهنقشه موضوعی
جستوجوی دقیقبهداشت و سلامت عمومی
سلامت جمعیت، پیشگیری، سیاستگذاری و عدالت سلامت
زیرشاخهها
برای رسیدن به فهرست متمرکزتر، یک مسیر تخصصی را انتخاب کنید.
آمار زیستی
مقالهها، منابع و پژوهشهای تازه حوزه آمار زیستی
ورود به زیرشاخهبهداشت محیط
مقالهها، منابع و پژوهشهای تازه حوزه بهداشت محیط
ورود به زیرشاخهبهداشت حرفهای
مقالهها، منابع و پژوهشهای تازه حوزه بهداشت حرفهای
ورود به زیرشاخهسیاستگذاری سلامت
مقالهها، منابع و پژوهشهای تازه حوزه سیاستگذاری سلامت
ورود به زیرشاخهاقتصاد سلامت
مقالهها، منابع و پژوهشهای تازه حوزه اقتصاد سلامت
ورود به زیرشاخهآموزش و ارتقای سلامت
مقالهها، منابع و پژوهشهای تازه حوزه آموزش و ارتقای سلامت
ورود به زیرشاخهسلامت جهانی
مقالهها، منابع و پژوهشهای تازه حوزه سلامت جهانی
ورود به زیرشاخهتعیینکنندههای اجتماعی سلامت
مقالهها، منابع و پژوهشهای تازه حوزه تعیینکنندههای اجتماعی سلامت
ورود به زیرشاخهکنترل بیماریهای واگیر
مقالهها، منابع و پژوهشهای تازه حوزه کنترل بیماریهای واگیر
ورود به زیرشاخهبیماریهای غیرواگیر
مقالهها، منابع و پژوهشهای تازه حوزه بیماریهای غیرواگیر
ورود به زیرشاخهتازهترین رکوردها
شواهد بهداشت و سلامت عمومی
PubMed2026
[THE HEALTH PRESERVATION OF FEMALE SAILORS CONCERNING ISSUES OF GENDER-CONDITIONED VIOLENCE. PART II. THE ROLE OF INTERNATIONAL ORGANIZATIONS].
The article summarizes results of analysis of the normative and institutional architecture of counteracting gender-conditioned violence in maritime industry. It is demonstrated that the Convention of International Labor Organization №190 and the Recommendation №206 shape ecosystemic standard of protection standard that extends to ship as workplace and covers wide range of situations and employment statuses. The mutual attachment with regimen of the International Maritime Organization and systems of security management enhances integration of psycho-social risks into corporate compliance and risk management. At the industry level, the principles of the International Chamber of Shipping (2024) codify zero-tolerance approach, mandatory training, secure communication channels and access to medical and psychological support. The support ecosystem (trade unions, charitable foundations and professional networks) decreases barriers of appealability and increases trust to procedures. The empirical data confirms high prevalence of undesirable behavior on ships with mixed-gender crew and demonstrates efficiency of combination of normative, organizational, technological and educational interventions. The conclusion is made that concordance with international standards, maturity of corporate systems and access to specialized care shift prevention from area of declarations to sustainable business practice, decreasing latency of violations, strengthening reliability of operations and improving staff retention.
PubMed2026
Co-Designing Physical Activity Programmes: A Participatory Research Study With Culturally Diverse Women and Local Government.
INTRODUCTION: Physical activity (PA) is essential for health and wellbeing, yet participation among women from culturally and linguistically diverse (CALD) backgrounds remains low due to complex, multi-level barriers. Co-design is increasingly recognised as a means of developing culturally relevant and sustainable interventions, but its application within local government-led PA programmes is limited. METHODS: Guided by the socioecological model (SEM), this study examined how co-design can be operationalised within a local government context to plan and deliver PA opportunities, alongside an exploratory analysis of short-term outcomes. A mixed-method participatory design was conducted across four phases: planning, co-creation, implementation and evaluation. SEM informed identification of barriers and enablers during workshops, while co-design principles guided collaborative strategy development. Data collection included co-design workshops (n = 76 women), pre- and post-intervention surveys (baseline n = 42; follow-up n = 21), a staff focus group and interviews with women (n = 3). Quantitative data were analysed using paired t-tests; qualitative data were thematically analysed to examine co-design processes and participant experiences. RESULTS: Co-design resulted in the development and implementation of culturally relevant programmes including group-based exercise, women's football, netball and water safety, incorporating features such as childcare, safety and opportunities for social connection. Quantitative findings indicated modest increases in PA (+34 min/week, p = 0.25), and improved physical health (p = 0.02). Qualitative findings highlighted outcomes associated with enhanced social connections and sense of empowerment, and the importance of iterative programme adaptation. CONCLUSION: Integrating SEM and co-design offers a robust framework for addressing multi-level barriers and supporting inclusive PA programmes within local government practice and strengthening community capacity and equity in health. SO WHAT?: These findings provide actionable evidence for local governments seeking to implement inclusive, culturally responsive PA initiatives, positioning co-design as a scalable approach to addressing participation inequities among women from CALD backgrounds.
PubMed2026
Improving allied health service use for type 2 diabetes management in Australia: a scoping review of barriers, enablers and policy opportunities.
OBJECTIVES AND IMPORTANCE OF STUDY: The aim of this scoping review was to: (1) consolidate the barriers and enablers to allied health service use for type 2 diabetes (T2D) management, and (2) identify knowledge gaps and priorities to inform future research and policy development. METHODS: This scoping review has been reported in accordance with the PRISMA for Scoping Reviews guidelines. Electronic databases, including Medline, Scopus, Web of Science, INFORMIT, and Cumulative Index to Nursing and Allied Health were searched from 1 January 2005 to 18 April 2025 for relevant articles. Peer-reviewed articles investigating barriers and enablers to allied health service use for T2D management in Australia were included. Barriers and enablers influencing: (1) patient utilisation of services, (2) General practictioner (GP) referral to services, and (3) allied health practitioners' delivery of services were extracted and categorised according to the Theoretical Domains Framework (TDF). RESULTS: A total of 44 articles (43 studies) were included. A total of 32 themes were identified across 11 TDF domains. Key barriers to service use included limited available services, workforce shortages, long wait lists, high out-of-pocket costs, a lack of GP referral, and limited patient and GP awareness of the role and value of allied health services. Enablers included person-centred care and culturally tailored service delivery. The Medicare Chronic Disease Management scheme was identified as both an enabler (facilitating use of and referral to services) and a barrier (limiting utilisation and delivery of services due to inadequate rebates and session caps). Few studies examined differences in barriers and enablers by age group or sex. CONCLUSIONS: This review identifies opportunities to strengthen multidisciplinary primary care management of T2D. Barriers and enablers to allied health service use are multifaceted, and addressing them will require targeted policy action, including workforce investment, a redesign of the Medicare Chronic Disease Management scheme, new integrated models of care and enhanced practitioner training. Future research should explore sociodemographic disparities in service use to inform equitable service delivery.
PubMed2026
Acceptability of an online theory-based intervention to support healthcare professionals' delivery of health behaviour change interventions: A theoretically framed qualitative study.
BACKGROUND: Healthcare professionals in the UK's National Health Service (NHS) are encouraged to deliver health behaviour change interventions during routine consultations. 'If-then' planning helps healthcare professionals to work with patients to identify and overcome barriers. However, in order to deploy such interventions, healthcare professionals must find them acceptable. AIMS: To use the Theoretical Framework of Acceptability (TFA) to understand the acceptability of interventions to support delivery of if-then planning interventions by: (a) exploring healthcare professionals' experiences of an online theory-based intervention which was designed to support them to deliver opportunistic health behaviour change interventions during routine clinical consultations, and (b) understanding the most prominent aspects of intervention acceptability to make recommendations for refinements and implementation. METHOD: Twenty-six NHS healthcare professionals (including nurses, physiotherapists, dieticians, doctors and midwives) participated in semi-structured interviews. The TFA informed both the design of the interview topic guide and the framework analysis, in which findings were mapped onto the TFA domains. RESULTS: Five TFA domains were prominent: affective attitude, burden, intervention coherence, perceived effectiveness, and ethicality. There were mixed attitudes, but HCPs were broadly positive (affective attitude), valued the brief format (burden), and felt it aligned with their professional values (ethicality). They understood the intervention (intervention coherence) and believed it addressed barriers to health behaviour change conversations (perceived effectiveness). CONCLUSIONS: The intervention was broadly acceptable to healthcare professionals, with key domains including affective attitude, burden, intervention coherence, perceived effectiveness and ethicality identified as important. These findings provide specific targets for refining the intervention and supporting its implementation in routine healthcare practice.
PubMed2026
Are YouTube Videos on Tarsal Tunnel Syndrome Reliable? An In-Depth Assessment of Educational Content, Source, and Audience Engagement.
BACKGROUND: Tarsal tunnel syndrome (TTS) is a relatively uncommon compressive neuropathy of the posterior tibial nerve that is often underdiagnosed due to variable presentation and overlap with other conditions. As patients increasingly turn to YouTube for health information, concerns have arisen about the reliability and comprehensibility of such content. METHODS: On December 23, 2024, YouTube was queried using the terms "tarsal tunnel syndrome," "tarsal tunnel release," and "tarsal tunnel injection." After excluding duplicates, unrelated, non-English, and short (< 30 seconds) videos, 88 were reviewed and the 50 most-viewed were analyzed. Each was evaluated using three tools: the Journal of the American Medical Association (JAMA) benchmark criteria (0-4) for reliability, a 4-point Likert scale for comprehensibility, and a 19-point Tarsal Tunnel Syndrome-Specific Score (TTS-SS) for educational content. Video source, content type, and video power index (VPI) were also recorded. The Shapiro-Wilk test assessed normality, and Kruskal-Wallis and Wilcoxon rank sum tests compared group with Holm adjustment. RESULTS: The median TTS-SS educational content score was 5.2 (IQR 3.0-8.0). Mean JAMA and comprehensibility scores were 2.0 and 2.6, respectively. Only 10% of videos met all four JAMA criteria, and fewer than 20% were rated as highly comprehensible. Disease-specific videos had the highest TTS-SS (mean = 6.8), while non-surgical management scored lowest (mean = 2.8, p = 0.025). Videos by trainers and physical therapists had higher VPI (mean = 338.4) than those by physicians (mean = 0.26, p < 0.001), despite lower educational value. Surgical technique videos were least comprehensible (mean = 1.4) compared with other types (p < 0.05). CONCLUSION: Among the most-viewed English-language YouTube videos sampled at a single time point, content related to TTS demonstrated generally low educational completeness, reliability, and comprehensibility. While healthcare professionals produce more accurate content, their videos attract less engagement than those by non-physicians. Improving visibility of evidence-based videos is necessary to ensure patients receive accurate information for this underrecognized condition.
PubMed2026
Nurses' Engagement in Healthcare Policy-Making: A Pragmatic Utility-Based Scoping Review.
AIM: This review aimed to map the available evidence on nurses' engagement in healthcare policy-making and to identify the foundational concepts that shape this engagement. BACKGROUND: Nurses represent the largest professional group in healthcare systems and hold a central position in responding to population health needs. However, they remain underrepresented in policy-making arenas. Their engagement is increasingly recognised as essential for building equitable, responsive and patient-centred healthcare systems, yet it is limited by insufficient policy education, restricted access to decision-making spaces, and the absence of a guiding conceptual framework. METHODS: This scoping review was conducted using established methodological guidance for evidence mapping. A Pragmatic utility approach informed the conceptual analysis, allowing the available literature to be examined in relation to the usefulness, clarity, and applicability of concepts describing nurses' policy engagement. SOURCES OF EVIDENCE: A systematic search of peer-reviewed databases was complemented by manual searches of reference lists. Eligible sources examined nurses' engagement, participation or influence in healthcare policy-making across clinical, organisational, professional, or governmental contexts. DISCUSSION AND CONCLUSION: Nurses' engagement in policy-making was described through interrelated antecedents, attributes, and outcomes. Individual factors and professionalism were important antecedents, but engagement was strongly shaped by contextual conditions, including organisational support, opportunities for collaboration, and access to policy spaces. The findings suggest that policy participation is relational and depends on the ability to translate nursing expertise into policy-relevant messages. Engagement was associated with enhanced advocacy, exposure to positive role models, and education and information seeking, which may reinforce further participation. IMPLICATIONS FOR NURSING PRACTICE: Nursing organisations, educators, and leaders should strengthen policy and advocacy education, mentorship, leadership development, and opportunities for nurses to participate in policy-related activities. IMPLICATIONS FOR HEALTH POLICY: Health systems should create organisational mechanisms that provide protected time, formal recognition, and access to policy forums, enabling nurses to contribute more effectively to policy decisions.
PubMed2026
Systematic Mental Health Care for Airline Pilots: Addressing Rare but Catastrophic Safety Outcomes.
Current understanding of mental health problems among aviation pilots remains limited. Pilots are exposed to distinctive occupational stressors, and when psychological distress occurs, they may be reluctant to disclose symptoms or seek timely assistance because of concerns about stigma, loss of income, licensing restrictions, or medical disqualification from flying. Pilot mental health is therefore not only an occupational health issue, but also a critical component of aviation safety governance. Although the vast majority of mental health conditions do not lead to flight safety events, in rare circumstances, severe psychological crises that remain unidentified or unsupported may result in catastrophic outcomes, including aircraft-assisted pilot suicide. These tragic events underscore the potential safety implications of pilot mental health and highlight the urgent need for greater attention to this critical issue. This article argues that prevention should be centered on system-level measures, including confidential peer support, carefully governed digital tools, destigmatized safety cultures, and harmonized data infrastructures.
PubMed2026
Optimising cancer support for rural residents from a refugee background: changing models of access and care.
BACKGROUND: Former refugee populations settling in regional Australia often experience low cancer literacy, delayed health-seeking and reduced engagement with cancer services. This study reports on the first phase of a community-led service improvement initiative designed to improve cancer literacy and access to culturally responsive cancer care for Karen and Afghan former refugees in Bendigo, Victoria. METHODS: A participatory, action-oriented service improvement approach was used, combining literature review, community consultation and health service engagement. Phase 1 involved a structured needs analysis including nine focus groups with Karen and Afghan community members (n = 128), alongside consultations with cancer service staff and health professionals. Findings informed the co-design of culturally responsive interventions and system-level improvements. A theory of change framework was developed to guide implementation and evaluation. RESULTS: The needs analysis identified limited cancer knowledge, fatalistic beliefs, mistrust of Western health systems and significant language and navigation barriers. System-level challenges included interpreter limitations, complex service pathways and limited culturally appropriate resources. In response, a cross-sectoral partnership implemented bicultural workforce development, in-language education programs, co-designed resources, navigation support and service system improvements. Early outcomes from 39 community education sessions (n = 412 participants) showed high reported uptake of knowledge (99%) and intention to use knowledge (92%). CONCLUSION: Early findings suggest that integrating community-led needs analysis with system-level service redesign shows promise for improving culturally responsive cancer care in regional settings. With former refugees increasingly settling in regional Australia, this place-based model provides a potential framework for strengthening equitable access to cancer prevention, screening and care for refugee populations.
PubMed2026
A Service Evaluation of a Specialist Multi-Disciplinary Weight Management Service Based in Primary Care Including Long-Term Follow-Up Data.
This service evaluation of a primary care-based specialist weight management service reports data from 1094 patients over 5 years (2014-2019), including weight data at 1-year post-discharge. The results show clinically and statistically significant improvements in weight, diet, physical activity, quality of life, blood pressure and blood glucose control (in people living with type 2 diabetes). Change in weight was statistically significant for all timepoints in all subgroups. At 1-year completers (n = 560) had lost a mean of 8.3 kg (SD 0.3) and 133 patients (23.8%) had lost ≥ 10% of their starting weight. Using baseline observation carried forward analysis on the whole cohort (n = 1094) the mean weight loss at the end of the 1-year programme was 4.5 kg (SD 0.2) and 144 (13.2%) had lost ≥ 10% of their starting weight. A year after discharge completers demonstrated a mean weight loss of 8.3% (SD 10.3 n = 303) and 35.6% (n = 108) of completers had maintained ≥ 10% change in body weight. Analysis showed a mean weight loss of 2.5% (SD 6.8 n = 1094) in the whole cohort using baseline observation carried forward, demonstrating maintenance of weight loss and suggesting that specialist weight management services in primary care may be effective in the longer-term.
PubMed2026
Active Learning With Peer-to-Peer Health Communication in School Health Education and Student Behavior Change: A Scoping Review.
BACKGROUND: This scoping review mapped evidence on whether school health education using active learning with peer-to-peer health communication is associated with behavior change among elementary and junior high school students and identified challenges to sustaining change. METHODS: Following PRISMA-ScR, we searched Ichushi Web, PubMed, and ERIC (February 14, 2024) for studies (2014-2024) evaluating peer-communication-based active learning in school health education with behavioral outcomes. FINDINGS: Seventeen studies were included; 14 reported behavioral change, 2 partial change, and 1 emotional change without clear behavioral outcomes. Nine studies used behavioral or learning theories, and in this small set of studies, theory-informed interventions were reported to show overall or partial behavioral change, most often with Social Cognitive Theory (5 studies). These findings should be interpreted cautiously given the heterogeneity of study designs and outcome measures. Key limitations were limited long-term follow-up assessing sustainability of behavior change (5 studies) and concerns about measurement reliability (4 studies). The included studies were heterogeneous in terms of interventions and outcome measures, and many relied on self-reported behavioral indicators. As this was a scoping review, no formal risk-of-bias assessment was conducted. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools may strengthen primary prevention by embedding structured peer interaction and theory-informed techniques, while ensuring inclusive participation and supports that do not depend on family resources. CONCLUSIONS: Peer-to-peer health communication-based active learning may support short-term behavior change, but sustainability and measurement quality remain major evidence gaps.
PubMed2026
Alignment of Australian Hospital Nutrition Standards With National and International Evidence-Based Guidelines: A Scoping Review.
Hospital malnutrition remains highly prevalent in Australia and contributes to poorer clinical outcomes and increased healthcare costs. Hospital nutrition standards play a critical role in ensuring nutritionally adequate menus and supporting patient intake. While Australian jurisdictions have developed hospital nutrition standards, the extent of their consistency and alignment with national and international evidence-based guidelines has not been systematically examined. This scoping review aimed to identify and compare existing hospital nutrition standards across Australia and assess their alignment with the Australian Dietary Guidelines (ADG) and European Society for Clinical Nutrition and Metabolism (ESPEN) hospital nutrition guidelines. Guided by JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, grey literature searches were conducted across government websites, national repositories, and targeted Google searches. Twelve documents met inclusion criteria, including six nutrition standards and six supporting documents. Directed content analysis guided by ADG and ESPEN deductive frameworks was used to extract and compare data across jurisdictions. Findings showed strong alignment with the ADG, particularly in five food group provision and macronutrient targets. Alignment with ESPEN guidelines was more variable. All jurisdictions met minimum energy and protein targets and offered patient menu choices; however, inconsistencies were observed in therapeutic diet provisions, macronutrient distribution, food service considerations, adaptations for diverse patient groups and monitoring practices. Hospital nutrition standards in Australia are fragmented. Developing a unified evidence-based standard integrating ADG principles with ESPEN hospital nutrition recommendations could enhance consistency, quality, and equity in hospital nutrition care.
PubMed2026
Awareness and Information Seeking About Bowel Cancer and Screening in a Remote Australian Community: A Qualitative Study.
INTRODUCTION: Understanding how individuals find bowel cancer and screening information and what influences awareness may support targeted interventions and encourage informed participation in screening programmes and support early detection. This study aimed to identify factors that influence remote community members information-seeking behaviours and awareness of bowel cancer and screening. METHODS: A qualitative study was conducted with 16 community members aged 50-years and over living in a remote Tasmanian community in Australia. Semi-structured interviews were informed by the Theoretical Domains Framework and Behaviour Change Wheel. Interview questions were reviewed by three consumers with lived experience of bowel cancer and screening to improve clarity and accessibility. Interviews were analysed using qualitative content analysis with inductive and deductive coding. RESULTS: Information‑seeking was shaped by self‑efficacy, health literacy, personal relevance, and social influences, with trusted healthcare providers playing a central role. Awareness influenced screening decisions, while screening experiences also built awareness across the screening pathway to diagnosis. Some participants screened with an understanding of the risks and benefits, while others complied without understanding why, and some with low awareness chose not to screen. Awareness most often developed through passive information exposure, including environmental cues, screening material prompts, and social influences of routine healthcare encounters, and conversations with family, friends, and healthcare providers, rather than through active information‑seeking. CONCLUSION: In this remote community, bowel cancer awareness was commonly shaped through passive exposure rather than deliberate searching and influenced the quality of screening decision‑making. Health promotion strategies that embed accessible, plain‑language information within everyday community and healthcare settings, and leverage trusted relationships, may better support informed and equitable participation in bowel cancer screening than approaches that rely on active information‑seeking. PATIENT OR PUBLIC CONTRIBUTION: Consumers with a lived experience of bowel cancer and screening contributed to this study by reviewing the interview guide structure and questions prior to the researchers undertaking the interviews. This improved the plain language and the participants understanding of the questions, with the addition of an introductory script outlining the study aims and process of the interview. The final interview guide was sent to the consumers for approval prior to the first interview being conducted. These consumers did not participate in this study. Remote Tasmanian community members who were eligible or previously eligible to participate in the National Bowel Cancer Screening Program contributed to this study as participants who shared their experiences and insights into bowel cancer and screening information-seeking behaviours and awareness.
PubMed2026
Being Heard, Being Valued, Being Understood-Aboriginal Community Perspectives on Adapting a Healthy Lifestyle Program for Boorloo/Perth, Western Australia: A Qualitative Study.
BACKGROUND: Childhood obesity prevalence is increasing globally, with Aboriginal and Torres Strait Islander children over-represented in Australian data. Evidence-based, community healthy lifestyle programs require culturally safe adaptation when implemented in new First Nations contexts, where prioritising access and engagement of First Nations groups is critical. This study aimed to identify Aboriginal community representatives' perspectives on potential barriers and enablers to recipient engagement and program implementation, and to identify cultural and place-based considerations to inform culturally safe adaptation of Whānau Pakari from Aotearoa/New Zealand for delivery as the Healthy Lifestyle Program in Boorloo/Perth, Western Australia. METHODS: A 3-h workshop was conducted with 29 Aboriginal advisors, with whole-group discussions and 5 facilitated breakout groups, to obtain Aboriginal community guidance on cultural and place-based considerations needed to adapt the program locally. Data were analysed by Framework Analysis using the updated Consolidated Framework for Implementation Research (CFIR) to identify barriers and enablers (determinants) of program engagement and implementation. Determinants were then reclassified inductively into themes to enhance participant relatability, supporting communication and feedback. RESULTS: A total of 44 potential determinants (16 barriers and 28 enablers) were mapped to 18 CFIR constructs across all five domains of innovation, outer setting, inner setting, individuals and implementation process. Three themes were identified from these determinants: acknowledging cultural context encompassed healing and self-determination, reclaiming knowledge and culture, and addressing limited access to health-promoting environments; guiding values included mutual respect, building and earning trust, and intergenerational learning; and program considerations included culturally secure practice, specific ways of working, and keeping families engaged. CONCLUSIONS: Aboriginal community guidance highlighted cultural and place-based priorities for program adaptation, and potential determinants of successful implementation within a prevailing healthcare service, iteratively informing program adaptation. This study used a unique methodological approach, prioritising participant voice alongside CFIR terminology, to provide rare evidence of pre-implementation First Nations engagement outcomes when adapting a program to integrate into the prevailing healthcare service. Partnership with First Nations communities is essential to implementing accessible, culturally safe models of care, thereby addressing health inequities. LIVED EXPERIENCE OR PUBLIC CONTRIBUTION: An established Cultural Advisory Group of 12 Aboriginal Elders worked in partnership with the Healthy Lifestyle Program, 10 of whom reviewed the identified themes and sub-themes throughout the analysis process. Two members were nominated by the group and reviewed the final draft manuscript. Identified determinants iteratively informed program adaptation, guided by the Cultural Advisory Group. This work was also supported and guided by a representative consumer body, Health Consumers' Council WA.
PubMed2026
Challenges and Contextual Dynamics in Implementing Smoke-Free School Policies in Thailand: A Qualitative Study.
BACKGROUND: Thailand has one of the strongest tobacco control frameworks in Southeast Asia, including comprehensive smoke-free laws and a ban on e-cigarettes. However, implementation of smoke-free school policies remains uneven across diverse educational settings. This study examined the contextual and governance dynamics shaping implementation and sustainability across school types. METHODS: A qualitative study was conducted using 14 focus group discussions (FGDs) across 14 provinces. Participants (n = 122) included school administrators, teachers, and provincial tobacco control stakeholders. Data were analyzed using reflexive thematic analysis to identify key governance conditions influencing implementation. RESULTS: Six interrelated themes emerged: institutional diversity, structural constraints, enforcement gaps, multi-level enablers, sustainability challenges, and field-driven recommendations. Implementation gaps were driven less by policy absence than by differentiated governance conditions. Hybrid authority structures, leadership turnover, digital diffusion of e-cigarettes, and geographic monitoring disparities constrained enforcement capacity. While teacher networks and provincial endorsement enhanced legitimacy, sustainability depended on institutional embedding rather than individual leadership. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Uniform national standards require context-sensitive implementation strategies. Embedding smoke-free criteria within evaluation systems, institutionalizing peer networks, and addressing geographic inequities are critical to strengthening sustainability and equity. CONCLUSIONS: Strong legislation alone is insufficient; tailored governance approaches are essential to achieve equitable and durable implementation.
PubMed2026
Development of a Theoretical Framework for Program Evaluation of the Impact of Policy, Systems, and Environmental Interventions on Individual-Level Behavior.
BACKGROUND: As community nutrition education programs have expanded to include policy, systems, and environmental (PSE) initiatives to increase access to nutritious food and safe physical activity, the impact of these efforts on the consumption of healthier foods and physical activity levels is not clear. Research shows the effectiveness of PSE changes on individual-level behavior in controlled environments and in other public health disciplines. However, more evidence and guidance is needed to show the impact of PSE interventions in practice on individual-level nutrition and physical activity behaviors. The PSE Intervention and Evaluation Framework (PSE-IEF) was developed to explain the process by which implemented PSE activities may result in behavior changes within the priority audience. METHODS: Framework development involved a review and Theory of Change mapping process of a list of PSE changes used in the Supplemental Nutrition Assistance Program- Education (SNAP-Ed) Program, an environmental literature scan to identify relevant theories and related factors, and an expert review. The environmental scan examined how PSE changes are conceptualized as drivers of behavior change and how their impacts are measured at the individual level. Sources were identified through database searches, grey literature review, and citation tracking, with inclusion limited to U.S.-based, English-language documents published in the past 10 years. Twelve frameworks or theories were reviewed for their focus on individual behavior, ability to capture behavior change over time, and recognition of individual choice in when or whether change occurs. The PSE changes theory of change mapping results were reviewed for alignment with the selected framework and applied to a logic model for PSE implementers. Forty-five practitioners reviewed the framework for relevance, comprehensiveness, and comprehensibility, with revisions made iteratively until no substantial changes to structure or content were received. RESULTS: The final PSE-IEF describes how PSE programs are implemented at the organizational level and how they might impact the target audience at the individual level. To see outcomes at the individual level, organizational level activities must be completed, including staff awareness, engagement, action and maintenance activities to produce PSE outputs available for target audience use. Precaution Adoption Process Model stages of awareness, engagement, decision, action, and maintenance describe the responses at both the organizational and individual level over time. CONCLUSIONS: The resultant framework can be used to guide PSE intervention and evaluation in community-based programs and to increase the evidence base illustrating the impact of PSE interventions on individual behavior and health.
PubMed2026
Effects of a Mobile Application for Patients With Type 2 Diabetes Initiating Insulin Therapy: Randomized Controlled Trial.
AIM: The aim of this study was to develop a mobile application for patients with Type 2 diabetes initiating insulin therapy for the first time and to evaluate its effects on insulin knowledge, insulin injection skills, self-management of insulin therapy and attitudes towards insulin use. METHODS: This randomized controlled study included 88 participants assigned by block randomization to intervention (mobile application, n = 44) and control (standard care, n = 44) groups. The intervention group received insulin training via the mobile app, whereas the control group received standard care. Data were collected at baseline (T1), on the 14th day (T2) and on the 28th day (T3) using the Patient Information Form, Insulin Knowledge Form, Insulin Treatment Assessment Scale, Insulin Treatment Self-Management Scale and Insulin Injection Skill Observation Form. RESULTS: In the intervention group using the mobile application, a statistically significant increase over time was observed in the levels of insulin-related knowledge, self-management of insulin treatment and insulin injection skills, whereas negative attitudes and perceptions regarding insulin treatment decreased (p < 0.05). No statistically significant change was observed in the control group (p > 0.05). CONCLUSION: The results obtained in the present study indicated that the mobile application developed for patients with Type 2 diabetes using insulin for the first time is effective in disease self-management, fosters positive behavioural changes and serves as a viable educational tool for individuals with Type 2 diabetes. The application can be integrated into routine nursing-led diabetes education programmes to enhance continuity of care and support patients during insulin initiation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06060743.
PubMed2026
Long-term follow-up for mothers of children with disability after healthy mothers healthy families e-workshops.
UNLABELLED: Health disparities experienced by mothers of children with disability highlight the need for mental health and wellbeing interventions. This study investigated the health behaviour, health-seeking, mental health, wellbeing and longitudinal outcomes for participating mothers in the Healthy Mothers Healthy Families (HMHF) e-workshop package. METHODS: Data were collected at baseline (T1), post-intervention (T2), 6 weeks post-workshop (T3), and 12 weeks post-workshop (T4). The HMHF package included: three, 2-hour HMHF e-workshops facilitated by trained peer facilitators, messaging group support, electronic workbook, and online modules. Outcome measures included the Health Promoting Activities Scale (HPAS); Depression Anxiety Stress Scale (DASS-21); Psychological General Wellbeing Index - subscales wellbeing (PGWBI-PWB), vitality (PGWBI-VT) and general health (PGWBI-GH); Family Empowerment Scale - Cohesion (FES-C); Family Environment Scale - Family (FES-Family); and My Families Accessibilities and Community Engagement (MyFACE). CONSUMER/COMMUNITY INVOLVEMENT: This project is about a co-designed intervention that is delivered by trained consumers. RESULTS: Outcomes for mothers (N = 56) from T1-T4: HPAS increased (Δ = 8.90, 95% CI 6.70-11.10, P < 0.001); Psychological distress decreased, with lower DASS Depression (Δ = -3.16, 95% CI - 4.84 to -1.47, P < 0.001), Stress (Δ = -6.45, 95% CI - 8.67 to -4.24, P < 0.001), and Anxiety (Δ = -2.26, 95% CI - 3.88 to -0.65, P = 0.006). Improvements were observed for psychological wellbeing and vitality, and for family environment, while no significant changes were found for general health or attitudes to community accessibility (MyFACE). Mothers reported improved stress management, diet, physical activity, participation in leisure, and self-concept. CONCLUSION: The HMHF package was effective in promoting positive and sustained mental health and wellbeing at 12-week follow-up. Increased engagement in health-promoting activities is indicative of effective inclusion of healthy habits in the daily routines of mothers who participated in the workshops. This online, group-based programme with occupational therapy foundations supported the health and empowerment of mothers who participated. Future development of similar programmes is recommended.
PubMed2026
Pilot Study and Evaluation of a Sleep Health Education Program for Early High School.
BACKGROUND: Sleep education remains largely absent from high school health curricula, despite widespread insufficient sleep in adolescents. This pilot study evaluated Sleep Ninja for the Classroom, a curriculum-aligned sleep health education program for Australian high schools. METHODS: Participants were teachers (N = 12) and students in Year 7-8 (N = 428). Using a single-arm pre-post design, all students received the three-lesson program during regular health classes. Student sleep knowledge and behaviors were assessed, and a program evaluation examined student- and teacher-rated acceptability, appropriateness, and feasibility. RESULTS: Improvements were observed in students' sleep knowledge, satisfaction with current sleep pattern, frequency of daytime napping, earlier weekend rise time (mean = 25-min), and weeknight bedtime (mean = 6-min). No changes were found in other sleep behaviors. Students spending < 8 h in bed at program commencement showed the most significant changes in bedtimes (mean = 54-min earlier on weeknights and 39-min earlier on weekends). Acceptability was high, with most students reporting the program was relevant and engaging, and all teachers rating the program as appropriate and feasible to implement. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Sleep Ninja for the Classroom is a brief, acceptable sleep education program that could be considered for inclusion in high school health curricula. CONCLUSIONS: This study provides preliminary evidence for an Australian curriculum-aligned sleep education program. Controlled studies are needed to evaluate longer-term outcomes and sustainable implementation.
PubMed2026
Pilot Test of a Diet Cost Calculation Process for Use in Economic Evaluations of Dietary Interventions.
BACKGROUND: Nutrition is a significant modifiable risk factor for many illnesses. One often-cited barrier to diet change is the perceived cost of healthy food. While many diet diary templates exist, none have been developed to capture the data needed for calculating the cost of a diet consumed during a diet intervention study. METHODS: The objective of the present project was to develop and pilot test (1) a tailored diet diary template with instructions, and (2) alternative approaches for calculating diet cost. We created a draft diet diary and instructions which were used by participants. We used those data to test the feasibility of calculating weekly diet cost. Two methods were used: calculation of the cost of the actual price of the items purchased, and standardised prices. Acceptability was assessed by conducting participant interviews and the feedback that was provided was used to revise them. The methods to calculate costs were compared in terms of feasibility and researcher time needed. RESULTS: Of the 15 participants enrolled, 14 completed the interview. All participants reported that the process was acceptable or highly acceptable. Participant feedback was used to guide changes to the diet diary and instructions. Costs were calculated for 85.3% to 96.3% of food items. The researcher time needed to complete each method per participant, per week was 5 to 6.5 h. Participants who gave feedback confirmed that the edits addressed their previous concerns. CONCLUSIONS: Overall, the diet diary and instructions were acceptable to participants who are women and feasible for the collection and costing of diet data in Canada.
PubMed2026
Supporting Nutritional Health of the UK Food Manufacturing Workforce: A Qualitative Study Exploring Insights From Employees.
INTRODUCTION: Engagement of underserved groups, including low-paid, shift workers, men, and ethnic minorities, is a priority for workplace health and wellbeing practitioners. The aims of the study were to explore experiences and perceptions around nutritional health and wellbeing in UK food manufacturing shift work employees and identify priorities to take forward for research, policy and practice. METHODS: Online semi-structured interviews with shift work food manufacturing workers were conducted between May and July 2025. Interview guides were developed using the Theoretical Domains Framework, aiming to explore factors influencing healthy nutrition choices when at work (the target behaviour) and to understand perceptions of worksite nutritional health and wellbeing provision. Data were analysed using a combined deductive framework and inductive thematic analysis approach; emergent themes were mapped to the COM-B model and linked to potential Behaviour Change Techniques. Findings were externally validated with food and beverage industry stakeholders. RESULTS: Interviews were conducted with 11 participants, 91% male, with a mean of 14 years of day and night shift work experience. Eight themes were identified including: (1) Having knowledge of healthy dietary choices for working on shift, (2) Physical consequences of dietary choices, (3) Intentions to make healthier dietary choices, (4) Influence of convenience on dietary choices, (5) Ability to access healthy dietary choices, (6) Social influence on dietary choices, (7) Emotional influence on dietary choices, (8) Ability to plan or monitor dietary intake. CONCLUSIONS: In addition to previously reported barriers around healthy food access while working atypical hours, UK food manufacturing staff face role-specific challenges, including inadequate breaks, health and safety regulations and exposure to food production. Workplace policies to improve access to healthy nutrition and protected breaks may be prerequisites for individual-level support for UK food manufacturing staff.
PubMed2026
Systems-Based Dialogue With Secondary School Students to Explore School Food Environments That Promote Healthy People and Planet.
BACKGROUND: The quality of food environments in secondary schools in the Republic of Ireland (ROI) varies depending on local practices. Funding for free hot school meals recently increased significantly with phased implementation and priority for universal access in primary schools and among 'disadvantaged' status schools at the secondary level. Engagement with students, in the context of rapidly changing school food policies, is lacking. This study explored students' views about the food environment in secondary schools using a system-based approach and identified student priorities for actions and policies to support school food environments that are healthy for people and planet. METHODS: A cross-sectional qualitative study design using participatory methods was used. Public secondary schools were recruited in 2023 and 2024. Fourth year students volunteered to participate in one CO-CREATE Dialogue Forum per school on the idea: How to make our school food environment better for our health and the planet? Data were analysed using content analysis. The systems-based action scales model was applied to categorise students' recommendations for a desired system. RESULTS: Sixty-two students (55% female) aged 15-17 years in eight schools (including four schools designated 'disadvantaged' status) participated in dialogue forums. Issues with time, space and mealtime infrastructure were reported by students. Dissatisfaction with food quality and lack of variety were reported by some. Practices that identify students accessing free school meals risk perpetuating stigma. Food and packaging waste and catering for diverse food cultures and health needs were students' primary concerns from a planetary health perspective, with a small minority suggesting more plant-based food options. Limited opportunities to influence school food were reported. In the desired system, food choice, taste and quality, food and packaging waste, adequate spaces to eat and socialise, improved break-time logistics (e.g., food ordering system, time available, queue systems), and structures for participation and influence were priorities for students. CONCLUSION: The CO-CREATE Dialogue Forum was an effective method for exploring school food, with students demonstrating systems thinking ability in considering a range of factors shaping their environments. Their ideas and solutions are important to inform policy and practice at local school, public health and government levels.
PubMed2026
Using Patient and Public Involvement to Develop a Survey for Economic Evaluation in Dementia Research.
BACKGROUND: This methodological paper reflects on how people with lived experience of dementia contributed to the development and refinement of a survey intended to identify priorities for future economic evaluation in dementia research. Although Patient and Public Involvement (PPI) is increasingly recognised as essential for producing relevant and ethical health research, people living with dementia are rarely included in PPI activities related to health economics, where outcomes are often predetermined by decision-making bodies. METHOD: To support the development and refinement of the survey, a small bespoke PPI group comprising four individuals with lived experience in England reviewed draft survey materials through online meetings and helped ensure the survey was accessible and meaningful through feedback on survey clarity, accessibility, and response options. RESULTS: PPI contributions led to important refinements, including simplifying terminology, removing ambiguous or burdensome items, and enhancing overall usability. DISCUSSION: The findings demonstrated the significant value of involving PPI contributors early and collaboratively, showing that co-design approaches enrich the relevance and sensitivity of research tools. The experience also highlighted the need for tailored support and an accessible introduction to health economic concepts for PPI contributors, alongside broader participation across study stages and engagement in dissemination activities.
PubMed2026
Planetary Health in Otolaryngology: A Call to Depollute Care.
Planetary health is a framework that emphasizes the interdependence between human and environmental health. Principles of planetary health are increasingly relevant to Otolaryngologists, who both contribute to climate change and face its consequences for their patients' health. This commentary applies these principles to Otolaryngology-Head and Neck Surgery, offering recommendations at 3 levels of change: the individual Otolaryngologist, the institution, and the broader system. These recommendations are grounded in 3 principles: reducing demand for care through health promotion and disease prevention, ensuring appropriateness of care by addressing overuse and underuse, and reducing healthcare pollution through adoption of circular economy principles. By embracing planetary health as a guiding principle, Otolaryngologists can reduce their footprint while advancing patient and community health.
PubMed2026
Applying Brazilian front-of-pack nutrition labeling and PAHO nutritional criteria to digital food advertising: regulatory implications for protecting children and adolescents.
Front-of-pack nutrition labeling (FoPNL) and restrictions on food advertising are regulatory strategies to support informed dietary choices and reduce exposure to unhealthy food. These measures are often integrated through a policy package, that employs a Nutrient Profile Model (NPM) for the classification of food. In Brazil, however, these policies remain fragmented, and current food advertising regulations do not fully cover all channels, particularly digital media. This study applied the NPM adopted in Brazil's FoPNL (RDC No. 429/2020 in conjunction with IN No. 75/2020, hereafter RDC 429) and those proposed by the Pan American Health Organization (PAHO) for identifying foods subject to advertising restrictions on social media posts directed at children and adolescents. The sample included posts from ultra-processed food brands/products on Instagram (n = 623), TikTok (n = 257), and YouTube (n = 114). Both NPM were applied to assess non-compliance at the food-item level and at the advertisement level (considering posts containing at least one non-compliant food). At the food-item level, 61.28% of products exceeded at least one item of RDC 429, with the highest prevalence on TikTok (72.63%), while 93.86% were non-compliant according to PAHO, reaching 100% on TikTok and 98.5% on YouTube. At the advertisement level, 49.53% of posts contained at least one non-compliant food under RDC 429, and 74.13% under PAHO, with YouTube showing the greatest potential for restriction (62.16% RDC; 99.10% PAHO). Both models are feasible for regulating digital food advertising: the PAHO provides a robust framework, while RDC 429 offers a strategic starting point given its current implementation in Brazil.
PubMed2026
Community-based health literacy programs: a comparative narrative review of policy and implementation approaches.
Despise the existence of numerous community-based health literacy interventions worldwide, our understanding of their impact on equity and the influence of national policy frameworks and implementation considerations remains limited. This narrative review aims to conduct a comparative analysis of community-based health literacy programs and national policy frameworks post-2020, with a focus on implementation characteristics, system-level integration, and implications for equitable public health initiatives. Effective interventions across various countries exhibited three key action-relevant features: integration into national prevention and broader primary care strategies; utilization of hybrid delivery models combining digital technology with in-person contact; and active targeting of socioeconomically disadvantaged groups. Government-led models demonstrated superior scalability and sustainability, whereas community-based models enhanced outreach to marginalized populations. However, the majority of programs rely on short-term or output-based indicators to assess success, with insufficient evidence regarding their long-term impact on equity. Although digitalization increased accessibility on a large scale, there is a risk of reinforcing existing inequalities in the absence of inclusive design and digital support. This study provides a policy-focused synthesis that positions community-based health literacy as a viable public health intervention rather than merely an educational endeavor. This review provides practical guidance for integrating health literacy into national preventive efforts by identifying transferable implementation characteristics and governance requirements.
PubMed2026
Informing food safety trainings in low- and middle-income countries: a novel evaluation of training materials and design.
BACKGROUND: Over the past two decades, food safety training interventions in LMICs have increased significantly, yet improvements in food hygiene and safety outcomes remain inconsistent. This limited effectiveness may reflect a lack of contextual adaptation and a failure to align training materials with the socio-economic constraints of participants. OBJECTIVE: To evaluate LMIC food safety training interventions and their educational materials on a novel framework, and to propose a checklist for the efficacy of future programs. METHODS: Relevant literature on training interventions was systematically identified, and only studies with accessible training materials were included. Interventions were evaluated using a novel qualitative framework, encompassing image-text ratios, readability grade, training design, incentives, and outcome parameters. Novel concepts, 'Engagement features' and 'Contextual-fit factors' were also developed, and the correlations between them were tested. RESULTS: A total of 28 studies met the inclusion criteria with available training materials. Infographics from 13 studies demonstrated a satisfactory balance of images and text. The readability assessment revealed an average result comparable to the US grade 6 level (5.90 ± 1.74), potentially hindering comprehension for low-literacy populations. Incentives were commonly used (n = 18), most frequently as non-cash economic incentives. Change in knowledge was the most measured outcome, and studies reporting null or negative results lacked several engagement and contextual-fit elements. CONCLUSIONS: This study uses innovative methods to identify and shed light on the existing gaps in food safety trainings. Based on these findings, it proposes a 35-point checklist to support the development of more engaging, comprehensible, and contextually appropriate programs.
PubMed2026
Local governance and health equity: Practical reflections from Chinese crisis governance.
This study examines mass testing in three Chinese cities since 2020 as a 'stress test' for local governance. It analyses the governance performance of Shenzhen, Nanjing and Wuxi in terms of efficiency, equity and community resilience. Using Melbourne's pandemic lockdown as a reference case, it discusses the underlying mechanisms linking different governance approaches to health equity outcomes. The study adopts a nested governance framework to examine how governance capacities and policy logics operate across different local contexts. The results indicate that Chinese cities can efficiently complete mass testing within a few days, but face pressures related to health equity and community resilience. Melbourne's lockdown governance emphasised participation and institutional transparency, but advanced policies at a relatively slower pace. This study recommends building a dynamic governance mechanism that better balances efficiency and equity.
PubMed2026
The Effectiveness and Exploratory Cost-Effectiveness of Regular Meditation for Improving Quality of Life: Protocol for a Prospective Longitudinal Cohort Study.
BACKGROUND: In recent decades, millions of people globally have taken up Buddhist spiritual and secularized meditation practices, such as mindfulness, with the aim of improving their quality of life and well-being. Practitioners are recommended to continue meditating regularly for the long term; however, the effects of regular meditation practice after introductory instruction remain scientifically underexplored. OBJECTIVE: This protocol aims to investigate whether regular meditation practice improves quality of life and mental well-being and whether its effects vary between secular and spiritual practitioners. We will also explore the cost-effectiveness of meditation in terms of quality of life and the incidence and functional impact of any adverse effects associated with the practice. METHODS: We will conduct a prospective longitudinal cohort study of 600 beginner meditators in Australia, New Zealand, the United States, and the United Kingdom over a 1-year period. Meditation practice frequency and duration will be reported weekly through the ambulatory assessment app Fabla (Emory University), with sampling of the primary outcome of quality of life and secondary outcome of mental well-being at monthly intervals. Practice characteristics, including secular versus spiritual practice, will also be reported monthly, as will the costs of meditation and mental health care and the incidence, severity, and duration of any adverse effects. Potential confounders, including baseline mental health symptoms, social support, and sociodemographics, will be controlled for in linear mixed models. An incremental cost-effectiveness ratio will be calculated, and sensitivity analyses will be conducted. RESULTS: Data collection began on October 28, 2025, after this study was first submitted on October 1, 2025. As of May 14, 2026, 341 participants have completed baseline measures. We expect results to be published in January 2028. CONCLUSIONS: Results of this investigation will illuminate the impact of meditation as it is currently practiced in natural contexts, and inform clinicians about whether and how regular meditation may be an effective tool for improving quality of life.
PubMed2026
The influence of implant survival on cost-effectiveness in total knee arthroplasty: a patient-level discrete-event simulation study.
BACKGROUND: Although several studies have evaluated the cost-effectiveness of total knee arthroplasty (TKA) compared with conservative treatment, few have explored how implant revision rates may influence its long-term cost-effectiveness. The objective of this study was to evaluate the impact of implant revision rates on quality of life and cost-effectiveness in patients undergoing TKA. METHODS: A cost-utility analysis from a healthcare system perspective was conducted using an individualized discrete-event simulation model parameterized with data from a Spanish cohort of patients undergoing TKA. Quality-adjusted life years were calculated with the SF-6D index, and implant alternatives were compared by assigning age- and sex-specific revision rates to each simulated patient while projecting long-term quality of life and life expectancy according to general population standards. The prosthetic models compared were those associated with the highest (WorstKnee) and lowest (BestKnee) revision rates in the UK National Joint Registry. The primary outcome was the incremental cost-effectiveness ratio. Secondary analyses included budget impact and deterministic sensitivity analyses. RESULTS: The projected quality-adjusted life expectancy over 15 years was 9.767 QALYs for WorstKnee, compared with 10.004 QALYs for BestKnee. The incremental cost-effectiveness ratio was €6,219/QALY, which remained below the cost-effectiveness thresholds commonly used in Spain. Use of BestKnee was associated with an additional cost of €332.3 M over 15 years; however, it also led to a substantial reduction in revision surgeries, with 27,878 fewer procedures performed, resulting in gradual cost savings over time. CONCLUSION: Within the price ranges currently observed in the Spanish National Health System, total knee prostheses associated with lower revision rates provide a favorable long-term cost-effectiveness profile and may reduce future revision burden despite their higher acquisition cost.
PubMed2026
Cost-effectiveness of ferumoxtran-enhanced macrophage-specific-MRI and PSMA-PET/CT versus ePLND for nodal staging in primary prostate cancer: a decision analysis based on updated phase-3 trial data.
BACKGROUND AND OBJECTIVE: Accurate nodal staging in intermediate- to high-risk prostate cancer (PCa) is crucial for treatment decisions. While extended pelvic lymph node dissection (ePLND) is the standard, it is invasive and has a low diagnostic yield. A 2019 analysis suggested that non-invasive imaging such as PSMA-PET/CT and ferumoxtran-enhanced macrophage-MRI (m-MRI) is cost-effective, but at the possible expense of a small QALY loss compared to ePLND, based on limited evidence. Recent Phase 3 trials have provided new data, prompting a reevaluation. Therefore, the aim of this article is to update a model with recent trial data to assess the cost-effectiveness of m-MRI and PSMA-PET/CT versus ePLND in Germany. MATERIAL AND METHODS: We adapted a Markov model to simulate lifetime outcomes for men with intermediate- to high-risk PCa from a German insurer's perspective, with costs updated to 2025 level. Diagnostic accuracy data were derived from recent multicenter trials. Costs and QALYs were calculated using a 3% discount rate. Sensitivity analyses tested uncertainties. A practical interactive online-tool is provided for clinical decision-making and research purposes, which can incorporate various input data (https://macrophage-mri.app). RESULTS: Both imaging options were dominant over ePLND (€37,855; 18.11 QALYs). PSMA-PET/CT was €7,869 cheaper and gained 0.800 QALYs; m-MRI was €9,985 cheaper and gained 0.990 QALYs. m-MRI was superior, saving €2,116 and gaining 0.19 QALYs over PSMA-PET/CT. The probabilistic analysis showed that m-MRI was optimal over 95% of the time at an €80,000/QALY threshold; the probability of PSMA-PET/CT being optimal was less than 5%. CONCLUSIONS: An imaging-first approach outperforms routine ePLND, with m-MRI as a cost-effective option. PSMA-PET/CT's low sensitivity limits its usefulness, though it is still cheaper than ePLND. These results support including m-MRI in guidelines for initial staging.