Public Health and Healthcare

Abstract: Healthy lifestyle behaviors established during childhood shape health trajectories across the lifespan. Although considerable evidence supports the benefits of physical activity, healthy eating, adequate sleep, and limited sedentary behavior, interventions targeting these behaviors often yield modest and short-term effects. This perspective argues that childhood health promotion should move beyond individual behavior change toward an ecological framework integrating family, school, community, healthcare, and digital environments. We discuss how social determinants of health, socioeconomic inequalities, mental well-being, and digital technologies interact to influence children’s lifestyle behaviors. We also highlight the growing role of artificial intelligence, wearable technologies, and personalized health promotion in supporting healthier lifestyles while emphasizing ethical and equity considerations. Finally, we propose priorities for future research, policy development, and multidisciplinary interventions that recognize children as active participants within interconnected social systems. This perspective aims to stimulate discussion on innovative strategies capable of generating sustainable improvements in child health.

Abstract: Background: Childhood obesity has been associated with musculoskeletal disorders and low back pain; however, evidence regarding the impact of body mass index (BMI) on upper-body postural alignment across different school-age groups in Saudi children remains limited. Objective: This study aimed to investigate the association between BMI and upper-body postural alignment in Saudi school-aged boys and determine if these relationships differ according to school level. Methods: This cross-sectional comparative study recruited 432 healthy Saudi boys aged 6–18 years from governmental and private schools in the Western Region of Saudi Arabia. Participants were categorized into three BMI groups (normal weight, overweight, and obese; n = 144 per group) and three school levels (primary, middle, and secondary; n = 144 per level). The upper-body postural alignment included forward head, shoulder protraction, shoulder slope, shoulder downward rotation, dorsal kyphosis, and trunk inclination angles was assessed using standardized digital photogrammetry. Results: Factorial MANOVA demonstrated a significant multivariate main effect of BMI category (p < 0.001), whereas neither school level (p = 0.893) nor the BMI × school level interaction (p = 0.132) was significant. Univariate analyses indicated that BMI significantly affected all postural variables (p < 0.001). Bonferroni-adjusted comparisons demonstrated that forward head and shoulder downward rotation angles decreased with increasing BMI, whereas shoulder protraction, shoulder slope, dorsal kyphosis, and trunk inclination angles increased (p < 0.001). These patterns were generally consistent across school levels, with Cohen's d values ranging from moderate to very large. Conclusion: Increasing BMI was consistently associated with progressive deterioration in upper-body postural alignment among Saudi school-aged boys, regardless of school level. Excess body weight exerted a substantially greater influence on postural alignment than school level, highlighting the importance of early postural screening combining weight management and postural rehabilitation to promote optimal musculoskeletal development.

Abstract: Background/Objectives: Family caregivers of people with schizophrenia frequently experience psychological stress due to long-term caregiving responsibilities, including symptom management, treatment supervision, and emotional support. Limited access to structured caregiver education remains a challenge, particularly in settings where mental health resources are constrained. This study aimed to evaluate the effectiveness of a web-based digital psychoeducation program in improving coping mechanisms among family caregivers of people with schizophrenia. Methods: A quasi-experimental study with a pretest–posttest control group design was conducted among family caregivers of people with schizophrenia receiving care at a mental health hospital in Indonesia. A total of 202 caregivers were recruited and allocated into an intervention group (n = 101) and a control group (n = 101). The intervention group received a 10-week web-based digital psychoeducation program consisting of structured modules addressing schizophrenia knowledge, caregiving skills, stress management, communication, relapse prevention, resilience, and emotional well-being. Coping mechanisms were assessed using the Brief COPE Inventory and categorized into problem-focused coping, emotion-focused coping, and avoidance coping. Data were analyzed using the Wilcoxon signed-rank test and Mann–Whitney U test. Results: The intervention group demonstrated significant improvements in problem-focused coping (p = 0.001) and emotion-focused coping (p = 0.011) after completing the digital psychoeducation program. Between-group comparisons showed significant differences in changes in problem-focused coping and emotion-focused coping compared with the control group (p < 0.001). Although avoidance coping increased within the intervention group (p = 0.018), the difference in change scores between groups was not statistically significant (p = 0.305). Conclusions: A web-based digital psychoeducation program was associated with improved problem-focused and emotion-focused coping among family caregivers of people with schizophrenia. Digital psychoeducation has potential as an accessible complementary approach to strengthen caregiver support services, particularly in healthcare settings with barriers to conventional face-to-face education.

Abstract: The objective of this study was to differentially analyze the predictors of compassion and fatigue/exhaustion dimensions of compassion fatigue (CF). Methods: Observational, analytical, and cross-sectional study in 374 nursing professionals from Peru, recruited through a virtual survey. Empathy, practice environment, life satisfaction, and CF were assessed. Two multiple linear regression models were conducted with variable selection based on the Akaike information criterion. Results: The sample was predominantly female (88.2%) and had a mean age of 39.77 years (SD = 9.11). In the compassion model, empathy (β = 0.45; p < 0.001) and female sex (β = 0.11; p = 0.025) maintained positive associations. The model accounted for 21% of the adjusted variance. In the fatigue/burnout model, professional experience of more than ten years (β = -0.18; p = 0.01) and a favorable practice environment (β = -0.12; p = 0.03) were associated with lower scores, while neutral life satisfaction (β = 0.15; p = 0.01) and working in health facilities (β = 0.12; p = 0.03) were associated with higher scores. This second model explained 8% of the adjusted variance. Conclusion: The dimensions of compassion and fatigue/exhaustion present different patterns of association. Empathy and sex predict the compassion dimension, while professional experience and practice environment predict the fatigue/burnout dimension.

Abstract: Background/Objectives: This study aimed to explore parents’ response processes and information-seeking patterns regarding early childhood sexuality education by integrating semantic network analysis of digital discourse with in-depth interviews. Methods: A qualitative multimethod design was employed. Semantic network analysis was conducted on 124 online posts from Korean parenting communities and Q&amp;A platforms, while in-depth interviews were conducted with 18 parents of young children. Online data were analyzed using semantic network analysis, and interview data were analyzed using inductive thematic analysis. Results: Four phases of the parental response process were identified: (1) recognizing sexuality in everyday contexts, (2) adopting initial coping strategies, (3) struggling with the role–action gap, and (4) seeking structured and collaborative support. Although parents recognized their role as primary sexuality educators, they experienced substantial uncertainty about how to respond and relied heavily on mediated resources, particularly storybooks and online information. Conclusions: Parents need practical, developmentally appropriate guidance to respond confidently to children’s sexuality-related questions and everyday situations. Family-centered support systems and accessible, evidence-based resources should be developed to strengthen parents’ capacity and bridge the gap between recognizing their educational responsibility and implementing sexuality education in daily life.

Abstract: Anxiety, sleep disturbance, and fatigue co-occur in adults with cardiovascular disease (CVD) and are associated with reduced quality of life (QOL), poor self-care, and increased healthcare use. The Theory of Unpleasant Symptoms (TOUS) organizes these symptoms well but treats psychological factors, including coping, as antecedents acting directly on symptom experience, leaving the mechanism connecting stress to symptom burden unspecified. This paper proposes the Coping-Mediated Symptom Model, an extension of TOUS that repositions appraisal-shaped coping from antecedent to mediator and incorporates the moderating structure that TOUS lacks. Drawing on Lazarus and Folkman's Stress-Appraisal-Coping framework and on empirical evidence from cardiovascular nursing, behavioral health, and psychophysiology, the model specifies perceived stress and anxiety as antecedents, coping quality as the mediator linking them to a latent sleep-fatigue symptom cluster, and perceived social support as a moderator of both the antecedent-to-coping and coping-to-symptom paths. Autonomic and hypothalamic-pituitary-adrenal pathways establish physiological plausibility. Six propositions state the model in a form estimable by structural equation modeling. Unlike prior TOUS extensions, which adapt the theory for new populations or perspectives while preserving its antecedent structure, this model modifies that structure, relocating the intervention target from symptom management to appraisal and coping.

Abstract: Background/Objectives: Loneliness among older adults is a public health concern associated with adverse health and well-being outcomes, yet evidence from eastern Croatia remains limited. This study examined social loneliness, family loneliness, and loneliness in romantic relationships among adults aged ≥65 years and their associations with sociodemographic, family, and social characteristics. Methods: This cross-sectional study included 431 community-dwelling older adults in Osijek-Baranja County from January to April 2025. Loneliness was assessed using the Croatian adaptation of the Social and Emotional Loneliness Scale. Group differences and correlations were examined using nonparametric methods, followed by separate multiple linear regression models with HC3 robust standard errors. Ordinal McDonald’s omega coefficients ranged from 0.863 to 0.919. Analyses were performed using R, version 4.6.1. Results: Median scores were 38 (29–47) for social loneliness, 20 (14–29) for family loneliness, and 41 (27–50) for loneliness in romantic relationships. Poorer perceived family-contact quality was associated with higher social and family loneliness in the adjusted models. Compared with good-quality contact, poor-quality contact was associated with social- and family-loneliness scores that were 19.66 and 25.52 points higher, respectively (both p < 0.001). Men and suburban residents had higher social loneliness in bivariate analyses, but sex and residence were not significant in the adjusted model. After adjustment for age, never-married, divorced, and widowed participants had romantic-loneliness scores 14.66, 21.55, and 15.58 points higher than married participants, respectively (all p < 0.001). Older age was weakly associated with social and romantic loneliness. Family-contact frequency was not significant overall in the adjusted social and family loneliness models. Conclusions: Perceived family-contact quality and marital status were associated with distinct loneliness dimensions. Assessments should consider older adults’ experience of close relationships alongside contact frequency and structural indicators.

Abstract: Background: Prospective bedside data collection for complex clinical syndromes such as postoperative delirium (POD) is labour-intensive and error-prone, and commercial electronic data capture (EDC) systems often carry substantial licensing and infrastructure costs. Methods: We deployed a low-cost, cloud-based data-capture and validation pipeline in a 10-bed cardiac surgical intensive care unit, combining four Google Forms modules with an open-source Python/Pandas validation backend, and retrospectively compared raw form exports against the validated dataset to quantify the pipeline’s real-world data-quality performance. Results: Over 11 months, the pipeline processed 7,146 raw form submissions (636 preoperative, 644 intraoperative, 2,517 ICU outcomes, 3,349 delirium-screening entries), contributing to a final cohort of 610 patients with required-field completeness of 99.2–100%. Scripted validation identified and resolved 156 discrete data-quality issues across seven categories, including duplicate submissions, a non-numeric identifier, date-typing errors, a spreadsheet auto-formatting artefact, required-field omissions, and manually flagged invalid entries. Direct comparison against REDCap, KoBoToolbox, and Epicollect5 showed this architecture matches the validation rigour of dedicated electronic data capture platforms without their server infrastructure or licensing cost. As an illustrative clinical application, postoperative delirium incidence was 19.7% (120/610). Conclusion: A zero-cost data-entry front end paired with a transparent, open-source validation backend can deliver auditable, high-completeness clinical datasets, offering a scalable, transferable model for data quality management in resource-constrained healthcare research.

Abstract: Background/Objectives: Falls among community-dwelling older adults are a major public health challenge and a leading cause of functional decline. Although multifactorial fall prevention strategies are recommended, evidence on comprehensive nurse-led preventive care models in primary health care remains limited. This study evaluated the clinical effects of the PM ACTIVAS nurse-led preventive care model and its potential to operationalize evidence-based fall prevention in routine primary health care. Methods: This article reports the quantitative component of a broader mixed-methods research programme. A two-arm randomized controlled trial included 220 community-dwelling adults aged 65–80 years randomly assigned to the PM ACTIVAS intervention (n = 110) or usual care (n = 110). The 12-month intervention combined multidimensional fall-risk assessment, individualized care planning, home environmental assessment, health education, a home safety kit, family involvement, and monthly telephone follow-up. The primary outcome was fall occurrence; secondary outcomes were modifiable fall-risk factors, recognition of environmental fall hazards, and fear of falling. Results: Primary outcome data were available for 145 participants. Falls occurred in 17 participants (23.3%) in the intervention group and 19 (26.4%) in the control group, with no significant between-group differences in fall occurrence (p = 0.666) or number of falls (p = 0.164). After adjustment for baseline scores, the intervention group showed significantly fewer fall-risk factors (p = 0.001; partial η² = 0.07) and greater recognition of environmental fall hazards (p = 0.044; partial η² = 0.02). No between-group differences were observed in fear of falling. Conclusions: Although the PM ACTIVAS nurse-led preventive care model did not significantly reduce fall occurrence over 12 months, it reduced modifiable fall-risk factors and improved recognition of environmental hazards. These findings suggest that coordinated nurse-led care can operationalize evidence-based fall prevention within routine primary health care and support further evaluation of this model in community settings.

Abstract: Background: Nurses routinely navigate high emotional demands and heavy workloads. Resilience is a critical competency for sustaining professional well-being and ensuring safe, person-centered care. Immersive technologies such as extended reality (XR) offer new possibilities for developing emotional and cognitive competencies within simulated, controllable, and clinically authentic environments. Objectives: To explore the experiences, needs, and expectations of nurses in Madrid regarding XR-based resilience training within the European XR2ESILIENCE project, with the aim of training mental health skills in virtual scenarios relevant to real-world practice. Methods: We conducted a qualitative study using a hybrid analytic approach. Four focus groups were held between February and March 2025 across three level-II hospitals and one out-of-hospital emergency service in Madrid, Spain. Twenty-six nurses were recruited through theoretical sampling. Data were analyzed through open and axial coding to identify emergent categories and their interrelationships. Standards for Reporting Qualitative Research (SRQR) guidelines were followed. Results: Three overarching categories were identified: (1) expectations surrounding XR, including the need for realistic and customizable training scenarios; (2) perceived barriers, such as workload pressures and digital skill gaps; and (3) facilitators and opportunities, including professional motivation and openness to innovation. The relational analysis showed how organizational conditions shaped nurses’ receptivity to XR and their capacity to cultivate resilience. Conclusions: Nurses viewed XR as a promising resource for strengthening resilience and managing work-related stress. Implementation will require participatory planning, adequate resources, and protected training time. These findings provide direction for developing XR-based educational programs.

Abstract: Background/Objectives: Prolonged working shifts may adversely affect healthcare workers’ health, wellbeing, cognitive performance, and patient safety. Nevertheless, 24-hour shifts remain widely used in Latvian healthcare. This study aimed to examine healthcare workers’ experiences of 24-hour shift work, their attitudes toward its revi-sion, and the main factors influencing their preferences. Methods: A nationwide cross-sectional survey was conducted in Latvia between October 2025 and February 2026. A structured 64-item questionnaire assessed sociodemographic and professional charac-teristics, workload, shift patterns, health and emotional wellbeing, patient-safety con-cerns, professional motivation, and attitudes toward alternative schedules. Of 1524 submitted questionnaires, 1318 were valid for analysis. Quantitative data were sum-marized using descriptive statistics, while open-ended responses were analyzed using inductive qualitative content analysis. Results: Most respondents regularly worked 24-hour shifts, and 40.5% worked at more than one institution. More than half reported health changes potentially related to 24-hour work, 61.1% experienced emotional ex-haustion, and 49.2% reported persistent fatigue. Fatigue had contributed to an error or perceived decline in care quality for 34.9% of respondents. Nevertheless, 59% opposed replacing 24-hour shifts at their workplace, and approximately half preferred retaining them. The main reasons were schedule convenience, consecutive days off, higher earn-ings, and the ability to combine workplaces. Open-ended responses supported a grad-ual transition toward flexible mixed schedules rather than immediate universal aboli-tion. Conclusions: Latvian healthcare workers perceive substantial health and safety risks associated with 24-hour shifts but also depend on their financial and practical benefits. Sustainable reform requires flexible scheduling, adequate staffing, financial neutrality, protected recovery time, and meaningful employee participation.

Abstract: The Family Management Measure (FaMM) is a theory-based instrument for assessing how families manage childhood chronic conditions; however, evidence supporting its cross-cultural structural validity remains limited, and no validated Thai version is available. This methodological study translated, cross-culturally adapted, and psychometrically evaluated the Thai FaMM among 350 primary family caregivers of children with chronic conditions. Translation followed the International Society for Pharmacoeconomics and Outcomes Research Task Force guidelines, and psychometric evaluation was guided by the Consensus-based Standards for the Selection of Health Measurement Instruments framework. Structural validity was examined using exploratory and confirmatory factor analyses with independent split-half samples, followed by second-order confirmatory factor analysis where appropriate. The Child’s Daily Life scale retained its original unidimensional structure, whereas Condition Management Ability, Family Life Difficulty, View of Condition Impact, and Parental (Caregiver) Mutuality were more accurately represented by multidimensional hierarchical measurement models. Five of the six scales demonstrated satisfactory structural validity, internal consistency, item discrimination, and excellent test–retest and interobserver reliability. In contrast, the Condition Management Effort scale demonstrated inadequate structural validity and internal consistency. The Thai FaMM is a culturally appropriate and psychometrically robust instrument that extends cross-cultural measurement of the Family Management Style Framework by demonstrating that several family management constructs are better represented as multidimensional hierarchical constructs within the Thai sociocultural context.

Abstract: Background/Objectives: Generative artificial intelligence (GenAI) presents immense potential to advance flipped learning approach. Yet, it is under-explored. This study presents the integration of GenAI into a nursing leadership course, guided by Bloom’s taxonomy, and explores the learning experiences of postgraduate nursing students in this GenAI-integrated flipped learning approach. Methods: A descriptive qualitative design was employed, and individual semi-structured interviews were conducted with 9 postgraduate nursing students who had completed a nursing leadership course delivered via a GenAI-integrated flipped-learning approach. Results: Three interconnected themes emerged: (1) GenAI supplements in-person learning, (2) Direct and Socratic questioning, and (3) Factors contributing to GenAI learning experience. Students appreciated that GenAI helped them summarize and understand the learning material, thereby promoting meaningful in-class activities. Students highlighted direct and Socratic questioning as the major approaches in using GenAI. Notably, Socratic questioning, AI-driven thought-provoking dialogue, helped develop higher-order thinking. However, suboptimal prompting techniques was the barrier, while channels for learning prompting and integrating it into the curriculum were facilitators. Conclusions: This study provides evidence on integrating GenAI into higher education. It also provides insights into the potential use of Socratic questioning to develop higher-order thinking in postgraduate nursing education.

Abstract: Background/Objectives: Despite recommendations that all hospitalized older adults receive tailored fall-prevention education, studies suggest that many patients at risk of falling do not receive such education. Furthermore, some patients may not recognize having received fall-prevention instructions, potentially limiting their effectiveness. This study examined the proportion of older patients who recognized that they had received fall-prevention instructions from nurses and examined the characteristics associated with this perception. Methods: A nationwide online survey was conducted among Japanese adults aged ≥ 60 years who were currently hospitalized or had been discharged within the previous year. Participants reported their fall-risk factors and whether they had received fall-prevention instructions from nurses. Latent class analysis identified two fall-risk profile groups, and logistic regression was used to examine factors associated with reported receipt of these instructions. Results: Among 3608 participants, more than 40% reported not receiving fall-prevention instructions. After excluding 395 participants without identified fall-risk factors, fall-risk profile and age were associated with reported receipt of instructions. Participants with mobility impairment and other risk factors more frequently reported receiving instructions than those with other risk factors but no mobility impairment (90.79% vs. 47.73%). Conclusions: Whether participants’ reports of not receiving instructions reflect a lack of provision or poor recall remains unclear. In either case, not recognizing or receiving fall-prevention instructions may increase fall risk by limiting patients’ ability to implement preventive behaviors. Enhancing nurses’ awareness of fall-risk profiles and providing consistent patient education may improve recognition of fall-prevention instructions and support fall prevention in hospital settings.

Abstract: Background/Objectives: Pediatric palliative care is a highly demanding field that requires nurses to possess a high level of professional competence and emotional resilience. Continuous exposure to suffering and death places these healthcare workers at an increased risk of psychological distress. The objective of this study was to examine the levels of occupational stress, burnout, secondary traumatic stress, and compassion satisfaction among nurses working in pediatric palliative and terminal care in Split-Dalmatia County, Croatia, and to identify organizational and emotional factors related to their professional quality of life. Methods: A descriptive cross-sectional study was conducted involving 36 female nurses employed in a pediatric hospice, pediatric hemato-oncology department, and neonatology department. Data were collected using the Professional Quality of Life (ProQOL) questionnaire and a custom questionnaire assessing organizational, educational, and emotional challenges. Results: Participants reported high levels of compassion satisfaction (M = 4.55, SD = 0.45), moderate levels of secondary traumatic stress (M = 3.02, SD = 0.68), and relatively low levels of burnout (M = 2.34, SD = 0.65). A significant negative correlation was found between compassion satisfaction and burnout (ρ = -0.542; p < 0.001). Favorable organizational conditions, such as sufficient time for rest (ρ = -0.567; p < 0.001) and emotional support from colleagues (ρ = -0.414; p = 0.012), were significantly associated with lower burnout levels. Although 63.9% of nurses lacked formal psychological support at the workplace, communication with families of terminally ill children remained a major emotional burden (M = 4.25, SD = 1.13), positively correlating with secondary traumatic stress (ρ = 0.460; p = 0.005). Conclusions: Despite the heavy emotional toll, nurses in pediatric palliative care maintain high compassion satisfaction. However, interventions emphasizing organizational improvements, collegial support, and formal psychological assistance are essential to prevent burnout and mitigate secondary traumatic stress.

Abstract: Background: The early postpartum period brings significant psychosocial changes. While breastfeeding difficulties can increase maternal emotional burden, social support may protect against postpartum distress. Objective: This study examined associations between breastfeeding difficulties, perceived social support, and baby blues symptoms among mothers in Croatia. Methods: A cross-sectional online survey was conducted among 1,378 women (≥18 years) who delivered within the previous year. The questionnaire assessed obstetric data, breastfeeding challenges, social support, and early postpartum emotional symptoms. Data were analyzed using descriptive and inferential statistics. Results: Breastfeeding difficulties within the first 14 days postpartum affected 79.3% of mothers, frequently involving sore nipples (25.7%) and latch problems (25.6%). Mothers experiencing breastfeeding difficulties reported significantly higher baby blues scores than those without (M = 3.28 vs. M = 2.72; p < 0.001). Furthermore, the emotional burden of breastfeeding positively correlated with baby blues intensity (r = 0.344, p < 0.001), whereas perceived social support had a protective, negative correlation (r = -0.263, p < 0.001). Regression analysis demonstrated that social support significantly mitigates the negative impact of breastfeeding difficulties on maternal emotional wellbeing (p = 0.033). Conclusions: Breastfeeding challenges exacerbate baby blues symptoms, but adequate social support buffers this negative effect. Early identification of feeding difficulties and proactive professional assistance are crucial for improving postpartum mental health.

Abstract: Introduction: Acute bronchiolitis is the most common cause of paediatric emergency department visits, with significant consequences for the child and considerable emotional stress for parents. Respiratory physiotherapy provided by a Rehabilitation Nursing Specialist not only improves the child's clinical condition but also offers a valuable opportunity to educate and empower parents. However, there is considerable heterogeneity and variability in the way these interventions are described and investigated in the literature. Objetive: To map the interventions of the Rehabilitation Nursing Specialist directed at children with acute bronchiolitis and their parents. Methods: Scoping review protocol based on the principles recommended by the Joanna Briggs Institute. A literature search will be conducted in the MEDLINE (via PubMed), CINAHL (via EBSCO), PEDro, Scopus, and the Cochrane Database of Systematic Reviews databases. Grey literature sources, including DART-Europe and the Portuguese Open Access Scientific Repositories (RCAAP), will also be searched. Results: Identifying the scientific evidence on this topic will enhance the understanding of the Rehabilitation Nursing Specialist's role in the management of children with acute bronchiolitis, with particular emphasis on parental empowerment, thereby contributing to the advancement of specialised clinical practice.

Abstract: Background: Inequalities in breast cancer care remain a major challenge in low- and middle-income countries. In Ghana, women continue to experience barriers that limit timely diagnosis, treatment, and continuity of care. This study explored the structural, health system, and policy factors influencing breast cancer care inequalities in Ghana. Methods: A focused ethnographic study was conducted across five healthcare facilities in Ghana between February 2023 and February 2024. Data were collected from 95 participants through in-depth interviews, observations, field notes, and document reviews and analysed thematically using Spradley’s ethnographic analytical framework. Results: Breast cancer care inequalities were driven by interconnected financial, health system, and governance barriers. Participants reported high out-of-pocket costs, inadequate financial protection, diagnostic and workforce shortages, centralised oncology services, fragmented referral pathways, and limited care coordination. Weak policy implementation, procurement challenges, and inconsistent availability of essential cancer medicines further constrained equitable access to care. Conclusions: Breast cancer care inequalities in Ghana are rooted in systemic weaknesses in financing, service delivery, and governance. Strengthening financial protection, decentralising oncology services, improving diagnostic capacity, enhancing care coordination, and ensuring reliable access to essential medicines are critical to achieving equitable breast cancer care.

Abstract: Background/Objectives: Thyroid disorders, particularly hypothyroidism and Hashimoto’s disease, are common among women of reproductive age and may influence lactation physiology. Evidence regarding their association with mature human milk composition remains limited. This cross-sectional study eval-uated macronutrient composition and thyroid-stimulating hormone (TSH) con-centration in 24-hour composite mature milk samples from women with diag-nosed and clinically managed hypothyroidism attending lactation counseling, compared with controls without thyroid disorders. Methods: Sixty-six lactating women attending the Human Milk Bank in Toruń, Poland, were enrolled (31 with hypothyroidism, including six with Hashimoto’s disease; 35 controls). Thyroid characterization was based on diagnoses and laboratory results documented dur-ing routine preconception or early-pregnancy/perinatal care; the study did not in-clude contemporaneous maternal serum TSH/FT4 testing at milk collection. Com-posite 24-hour milk samples were analyzed using the MIRIS Human Milk Analyz-er for fat, crude protein, true protein, carbohydrates, total solids, and energy. Milk TSH concentrations were measured using a third-generation ELFA assay; because the assay was not formally validated for the human milk matrix, these values should be interpreted as exploratory apparent milk TSH concentrations. Results: No statistically significant differences were observed in macronutrient composi-tion or milk TSH concentrations between groups in the analyses performed. Hy-perlactation was frequent in this selected counseling cohort and was more com-mon in controls (27/35; 77.1%) than in the hypothyroidism group (16/31; 51.6%). Exploratory analyses of pre-pregnancy BMI and Hashimoto’s disease were limited by small subgroup sizes. Conclusions: In this small selected cohort, diagnosed and clinically managed hypothyroidism was not associated with statistically signifi-cant differences in mature milk macronutrient composition or milk TSH concen-tration. These findings are exploratory and should not be interpreted as evidence of equivalence, confirmed euthyroidism at sampling, or absence of any possible biological effect.

Abstract: Background/Objectives: In Brazil, its rates remain persistently high and disproportionate, highlighting severe racial and social inequities that predominantly affect the Black population. The objective is to analyze racial inequalities in maternal mortality in Brazil (2000–2023), identifying sociodemographic, regional, clinical and temporal patterns, with an emphasis on the impact on Black women. Methods: A retrospective population-based cohort study was conducted using data from Brazil's Mortality Information System between 2000 and 2023. A total of 40,907 maternal deaths among women aged 10–49 years were included. Maternal mortality ratios were calculated, and adjusted Poisson regression models were used to examine associations between maternal mortality and race/skin colour, age, education level and region of residence. Results: Black and Brown women accounted for 59.2% of maternal deaths and experienced a significantly higher risk of maternal mortality than White women, while Indigenous women had more than twice the risk. Lower educational attainment, residence in the North and Northeast regions, and maternal age ≥40 years were also independently associated with increased mortality risk. Direct obstetric causes accounted for 65.9% of maternal deaths, with hypertensive disorders and childbirth-related complications among the most frequent causes. The immediate postpartum period represented the highest-risk period, accounting for 47% of deaths. More than half of women had no more than primary-level education, and 50.3% were single. Conclusions: Maternal mortality in Brazil remains characterised by substantial racial, educational and regional inequalities. Indigenous, Black and Brown women, women with lower educational attainment, and those residing in the North and Northeast regions experienced disproportionately higher mortality risks. These findings highlight the need for targeted public health and maternity care interventions to reduce preventable maternal deaths and improve equity in maternal health outcomes.