BACKGROUND: Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China.
METHODS: We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs\' characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation.
RESULTS: This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs\' heavy workload, and 12 enablers such as HCWs\' passion towards TCP planning.
CONCLUSIONS: With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed.

An integrated approach is lacking for the management of childbirth and newborn care, even though their codependence is critical for improving maternal and newborn outcomes. FIGO\'s Prep-for-Labor rapid triage methods for women arriving at a clinical facility are addressed in earlier papers in this Supplement, but do not include newborn care. Immediate postpartum rapid triage using established Apgar score helps determine whether standard of care can be followed on site with available staff/tools. If not, newborn transfer alone or with the mother to a higher-level center as soon as feasible may be required. Updated newborn management tools with special emphasis on pragmatic steps that are applicable for any clinical setting including low- and middle-income countries (LMICs) are presented in this article. Given that more than 80% of newborn care can be managed at the birthing facility, transfer to a higher-level center for care is required only in selected cases. Management steps for healthy newborns are described and the actions needed for those requiring resuscitation are summarized. The simple noninvasive kangaroo mother care approach-universally applicable for both term and preterm newborns-is associated with a significant reduction in morbidity and mortality. Kangaroo mother care involves continuous maternal skin-to skin contact from birth, exclusive breastfeeding, and home support after discharge. Hence, hypothermia, hypoglycemia, and acquired infections are frequently prevented. It is anticipated that implementing simple noninvasive management steps will have a substantial positive impact on improving maternal and newborn outcomes.

Background and Objectives: The aim of this article is to present a single-surgeon, open retroperitoneal lymph node dissection (RPLND) series for testicular cancer in a high-volume center. Materials and Methods: We reviewed data from patients who underwent RPLND performed by an experienced surgeon at our institution between 2000 and 2019. We evaluated surgical and perioperative outcomes, complications, Recurrence-Free Survival (RFS), Overall Survival (OS), and Cancer-Specific Survival (CSS). Results: RPLND was performed in primary and secondary settings in 21 (32%) and 44 (68%) patients, respectively. Median operative time was 180 min. Median hospital stay was 6 days. Complications occurred in 23 (35%) patients, with 9 (14%) events reported as Clavien grade ≥ 3. Patients in the primary RPLND group were significantly younger, more likely to have NSGCT, had higher clinical N0 and M0, and had higher nerve-sparing RPLND (all p ≤ 0.04) compared to those in the secondary RPLND group. In the median follow-up of 120 (56-180) months, 10 (15%) patients experienced recurrence. Finally, 20-year OS, CSS, and RFS were 89%, 92%, and 85%, respectively, with no significant difference in survival rates between primary vs. secondary RPLND subgroups (p = 0.64, p = 0.7, and p = 0.31, respectively). Conclusions: Open RPLND performed by an experienced high-volume surgeon achieves excellent oncological and functional outcomes supporting the centralization of these complex procedures.