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Background: In Rwanda, nurses manage all primary care at health centres, and therefore are their clinical reasoning skills important. In this study, a web-based software that allows the creation of virtual patient cases (VP cases) has been used for studying the possibility of using VP cases for the continuous professional development of nurses in primary health care in Rwanda. Previous studies in pre-service education have linked VP cases with the enhancement of clinical reasoning, a critical competence for nurses. This study investigated the feasibility of continuous professional development through VP cases to further train in-service nurses in clinical reasoning. Method: The study used a pre-post test design. Initially, seventy-six participants completed a questionnaire as part of the pre-test phase, subsequently invited to engage with all four VP cases, and finally responded to the post-test questionnaire evaluating clinical reasoning skills. Fifty-six participants successfully completed the entire study process and were considered in the analysis. The primary outcomes of this study were evaluated using a paired t-test for the statistical analysis. Results: The results show that the mean score of clinical reasoning increased significantly from the pre-test to the post-test for all four illness areas (p < 0.001). The study findings showed no statistically significant difference in participants’ scores based on demographic factors, including whether they worked in urban or rural areas. Conclusion and recommendation: Utilizing VP cases appears to significantly enhance the continuous professional development of nurses, fostering a deliberate learning process that enables them to reflect on how they manage cases and, in turn, refine their clinical reasoning skills. This study strongly recommends incorporating VP cases in the continuous professional development of nurses at the primary health level (health centers). This is especially pertinent in a context where n, Funding: Open access funding provided by Stockholm University. The study was funded by the Swedish International Development Cooperation Agency (SIDA) in the University of Rwanda-Sweden Research Partnership 2019–2024 grant (No 11277).

The management of hospitalized patients with dementia is more complicated compared to patients without dementia, specifically in the surgery ward. The aim of the current study was to explore the experiences of operating room health care providers in the management of patients with dementia. A descriptive qualitative study was designed. Twenty semi-structured interviews were conducted with surgical professionals. Content analysis was performed. Four main themes emerged: Communication Issues, Experience-Based Protocol, Emotions, and Perceived Needs. Health care providers in a surgical ward face numerous challenges when attending to patients with dementia and tend to use strategies based on their own experience due to lack of specific action protocols. Therefore, specific training of the surgical team and protocols are needed to ensure quality care.

Bakgrund: Endometrios är en kronisk inflammatorisk sjukdom som drabbar en av tio kvinnor i fertil ålder. Vanliga symtom är intensiv smärta i samband med menstruation, kraftiga och oregelbundna blödningar, samlagssmärta och infertilitet. Det tar ofta flera år innan kvinnor får en diagnos vilket medför ett stort lidande. Forskning om endometrios går framåt men det finns fortfarande okunskap inom vården och vårdpersonalen behöver fortbildning för att kunna ge stöd och råd. Den teoretiska referensram som användes var Joyce Travelbees omvårdnadsteori samt personcentrerad omvårdnad. Syfte: Att belysa hur kvinnor med endometrios upplever bemötandet i vården. Metod: Litteraturstudien genomfördes med en kvalitativ ansats. Efter kvalitetsgranskningen återstod tio artiklar som användes i litteraturstudien. Resultat: De tio artiklar som ligger till grund för resultatet kommer från Sverige, Ungern, Australien, Storbritannien och Nederländerna. Dataanalysen genererade i tre kategorier: Vårdpersonalens förminskande attityd, Kunskap och information samt Fertilitet, med sex subkategorier som representerade olika aspekter av upplevelsen av bemötandet i vården. Kvinnorna upplevde att de fört en kamp under flera år för att få en diagnos, vårdpersonalen tog dem inte på allvar samt normaliserade deras symtom. Kvinnorna upplevde även att vårdpersonalen hade bristande kunskaper om sjukdomen samt fokuserade för mycket på fertiliteten. Positiva upplevelser var när vårdpersonalen lyssnade och bekräftade dem. Konklusion: Kvinnorna hade övervägande negativa upplevelser av bemötandet i vården och saknade stöd från vårdpersonalen. Det är viktigt att höja kunskapsnivån för att minska det långdragna lidandet. Sjuksköterskan behöver arbeta empatiskt och personcentrerat för att kunna tillgodose kvinnornas behov., Background: Endometriosis is a chronic inflammatory disease that affects one in ten women in their fertile age. Typical symptoms of endometriosis are dysmenorrhea, heavy irregular bleedings, dyspareunia and infertility. The diagnostic delay is often many years, which could cause suffering. Research of endometriosis is progressing, yet there still exists ignorance in health care and health care staff need training to be able to provide support. The theoretical frameworks used were the nursing theory by Joyce Travelbee and person-centered nursing. Aim: To illustrate how women with endometriosis experience health care encounters. Method: The literature review was performed with a qualitative approach. After the quality review ten articles remained that were included in the literature review. Results: The ten articles used in the literature review came from Sweden, Hungary, Australia, United Kingdom and the Netherlands. The data analysis generated three categories: Health care provider ́s diminishing attitude, Knowledge and information and Fertility, with six subcategories that represented different aspects of the experience in the health care encounter. The women fought several years to get a diagnosis, health care providers did not take them seriously and normalized their symptoms. The women also felt that the health care providers lacked knowledge about the disease and focused too much on fertility. Positive health care encounters were when the health care providers listened and confirmed them. Conclusion: Women mostly had negative experiences of health care encounters and lacked support from the health care staff. It is significant to raise the level of knowledge in order to reduce women’s suffering from the disease. The nurse needs to work empathically with a person-centered approach to be able to meet the women’s needs.

This research work targets to analyze and ascertain the epidemiological profile of medication errors occurred at a tertiary care hospital in South India. A retrospective cross-sectional investigation of medication errors by chart review method. The process involved assessment and interpretation of medication errors reported to and by the Department of Clinical Pharmacology from April 2016 to March 2020. Data was later analyzed employing descriptive statistics. A total of 11,314 medication errors [8,835 prescription errors and 2,479 non-prescription errors] were reported among 1,01,981 hospitalized patients, with an average incidence of 26.56 per 1000 patient days. More than a quarter of prescription errors were within the drug dosage modification subclass, whereas transcription errors were the most common non-prescription errors, around 70%. An appreciable portion of the total medication errors constituted by potential errors were prevented before reaching patients [9681, 85.56%] with timely interventions by health care professionals, remarkably by clinical pharmacists, over 96%. The study benchmarks how a well-designed voluntary reporting system provides a good way for identifying the emerging medication errors before they result in harm to the patients.  Ward-based clinical pharmacists in close liaison with health care professionals are effective in reporting and implementing interventions to prevent such unfortunate events, ensuring patient safety.

Background and objectives: Health care professionals (HCPs) are well-positioned to discuss healthy behaviors during pregnancy, but the published research of prenatal healthcare providers’ knowledge about the significance of nutrition during pregnancy in Lebanon is scarce. The purpose of this study was to explore the knowledge, attitudes, and practices of Lebanese prenatal healthcare providers towards nutrition during pregnancy. Materials and Methods: A cross-sectional study using an online questionnaire was conducted. Health care providers were contacted by phone and email to participate in the online survey. A list of all clinics providing antenatal health services was obtained from the Order of Physicians and the Order of Midwives. A multistage random sample was selected. In the first stage, it was stratified per region (Beirut center or suburbs, and the southern region). In the second phase, it was stratified per clinic type (private, primary healthcare center, or hospital). Gynecologists and midwives who are members of the Order of Physicians and the Order of Midwives (n = 1333), were included. Results: Two-hundred and six responses (55% males) were obtained. Approximately 44% of the HCP were aged 50 and older, and 68.4% had more than 10 years of work experience. HCPs from Beirut represented 41.3% of the respondents. Eighty-eight percent of the HCPs were physicians, and 11% were midwives. The majority of the participants considered nutrition during pregnancy to be very important. Furthermore, half of these participants considered their position in delivering nutrition information as very significant. Most of the respondents reported that they provide nutrition advice to pregnant women, and they also received nutrition education during their profession. However, they perceived their nutrition knowledge as inadequate. Conclusion: Health care providers’ attitude towards the importance of maternal nutrition and their confidence in talking about nutrition-related top

Background: The Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling was monumental for sexual and reproductive health and rights in the United States. This shifted the legislative power over the right to an abortion from federal to state government. Missouri’s post- Roe legislation banned abortion statewide. Health care providers (HCPs) are facing unique facilitators and barriers that influence their capabilities to engage with abortion related care. Aim: To understand how HCPs experience and perceive Missouri’s post-Roe abortion law and context and discuss the potential implications on occupational agency in abortion related care. Methods: Utilizing a constructivist grounded theory methodology, seven interviews were conducted to explore HCPs experiences and perceptions of navigating Missouri’s post-Roe abortion law and context. Findings: Three theoretical themes emerged from the constant comparative analysis (1) learning the law’s limits and extents; foundational and configuring elements of Missouri’s abortion law that directly impact HCPs occupational capabilities (2) balancing the breaking branches; choices and situations HCPs actively balance in the clinical setting concerning abortion related care and (3) professional pushes and pulls; profession-related factors that influence HCPs involvement in the abortion discourse beyond their occupational duties. These aspects contribute to the emerging main concept of curating occupational agency, the process of HCPs actively navigating Missouri’s post-Roe abortion law and context to curate their occupational agency, both individually and collectively. Conclusion: HCPs curate their occupational agency by navigating through the post-Roe landscape. As HCPs comprehend, integrate, and organize their individual and shared reality, they are curating their occupational agency, which in turn impacts how they engage with abortion related care and the abortion discourse at large. Thus, their engagement with abortio, The United States’ Supreme Court overturned the precedence set by Roe v. Wade, which shifted the legislative power over the right to an abortion from federal to state government. The right to abortion is an extensively controversial and sensitive public health issue, and significantly influences the landscape of sexual and reproductive health and rights in the United States. Missouri state’s law bans all abortion except in the case of a medical emergency. This directly impacts the clinical interventions of sexual and reproductive health care providers; thus, influencing the access and quality of abortion related care. The aim of this study was to understand how health care providers experience and perceive Missouri’s post-Roe abortion law and context and discuss the potential occupational implications. The study wanted to determine what factors are influential to occupational agency and how this impacts the abortion discourse and health care landscape in Missouri. Seven interviews were conducted and analyzed through a constant comparison analysis. The findings showed that health care providers’ realities in Missouri’s post-Roe world involve learning the law’s limits and extents, balancing the breaking branches, and professional pushes and pulls. As health care providers navigate through these elements, they are curating occupation agency, which encourages them to enhance engagement with abortion related care in post-Roe Missouri. Comprehensively understanding the factors that influence occupational agency can significantly impact the abortion discourse and health care landscape. Despite the unavoidable ambiguity of abortion legislation, health care providers can still prevail in providing and protecting the publics sexual and reproductive health.

Purpose: Exercise has been underutilized in people with advanced or incurable cancer despite the potential to improve physical function and reduce psychosocial morbidity, especially for people with bone metastases because of concerns over skeletal complications. The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations for exercise programming for people with bone metastases on the basis of published research, clinical experience, and expert opinion. Methods: The IBMEWG undertook sequential steps to inform the recommendations: (1) modified Delphi survey, (2) systematic review, (3) cross-sectional survey to physicians and nurse practitioners, (4) in-person meeting of IBMEWG to review evidence from steps 1-3 to develop draft recommendations, and (5) stakeholder engagement. Results: Recommendations emerged from the contributing evidence and IBMEWG discussion for pre-exercise screening, exercise testing, exercise prescription, and monitoring of exercise response. Identification of individuals who are potentially at higher risk of exercise-related skeletal complication is a complex interplay of these factors: (1) lesion-related, (2) cancer and cancer treatment–related, and (3) the person-related. Exercise assessment and prescription requires consideration of the location and presentation of bone lesion(s) and should be delivered by qualified exercise professionals with oncology education and exercise prescription experience. Emphasis on postural alignment, controlled movement, and proper technique is essential. Conclusion: Ultimately, the perceived risk of skeletal complications should be weighed against potential health benefits on the basis of consultation between the person, health care team, and exercise professionals. These recommendations provide an initial framework to improve the integration of exercise programming into clinical care for people with bone metastases.

Health care providers have difficulties responding to elder abuse. This study aimed to investigate factors associated with health care providers speaking with older patients about being subjected to abuse, and what facilitating measures staff preferred to help them achieve this. A cross-sectional questionnaire survey was conducted among hospital health care providers (n = 154) in Sweden. Half of the respondents had experience of speaking about elder abuse. A high sense of professional responsibility (OR 3.23) and being less concerned about inflicting damage to the therapeutic relationship (OR 3.97) were associated with having spoken with older patients about being subjected to abuse. Written guidelines about elder abuse and a patient information sheet were the most preferred facilitating measures. Our findings indicate that increasing care providers’ sense of responsibility and addressing concerns about damaging the therapeutic relationship might be important factors to target in future interventions to improve health care response to elder abuse.

Bakgrund: Kunskapen om compassion fatigue behöver belysas i den palliativa vårdens kliniska vardag. Att arbeta med palliativ vård innebär komplexa relationer med patienter och närstående samt dagliga möten med lidande, död och sorg. Vårdpersonal inom vårdgivande yrken har stor risk att drabbas av compassion fatigue. Syfte: Syftet var att beskriva upplevelsen av compassion fatigue hos vårdpersonal som utför palliativ vård. Metod: En systematisk litteraturöversikt har genomförts av vetenskapliga forskningsresultat genom användandet av reflexiv tematisk analys. Fynden i resultatet har relaterats till det vårdvetenskapliga teoretiska ramverket Compassion Fatigue Model. Resultat: Fyra teman framkom: upplevelser av bristande resurser, upplevelser av svåra relationer i vårdandet, upplevelser av existentiell stress och bristande palliativt sammanhang samt upplevelser av otillräcklig coping och egenvård. Vårdpersonalens upplevelser av compassion fatigue grundades i de känslor som blev ohanterliga i samband med vårdandet av svårt sjuka patienter och närstående. Hög arbetsbelastning och bristen på återhämtning bidrog till att dränera vårdpersonalen på energi, vilket gav dem obalans mellan deras professionella och privata liv. För att minska risken att drabbas av compassion fatigue blev det palliativa sammanhanget, coping och egenvård betydelsefullt. Slutsats: Compassion fatigue kunde påverka vårdpersonalens hela livsvärld. Vårdpersonal är självmedvetna, men behöver bli bättre på att förstå hur betydelsefullt egenvård och positiv coping är för att bibehålla sin hälsa. Arbetsmiljöns betydelse för vårdpersonalens upplevelser av compassion fatigue är väsentlig. Arbetsgivare behöver uppmärksamma och prioritera resurser som förstärker vårdpersonalens hälsa. Palliativ vård är en vårdform som är resurskrävande och det behövs empatisk vårdpersonal som orkar vara närvarande i den vårdande relationen., Background: Compassion fatigue is a concept that needs to be further established in the line of palliative care praxis. The concept compassion fatigue is well studied within scientific research. Compassion fatigue occurs as physical, mental, and emotional damage through work-related stress. Healthcare professionals are at high risk of suffering from compassion fatigue. Working in palliative care involves daily encounters with suffering, death, and grief through relationships with patients and relatives. Awareness of compassion fatigue needs to be highlighted and studied within the work field of palliative care. Aim: The purpose of this study was to describe experiences of compassion fatigue in healthcare professionals who work within palliative care settings. Method: A systematic literature review has been conducted on scientific research papers using reflexive thematic analysis. The findings in the results have been related to the theoretical framework Compassion Fatigue Model. Results: Four themes were identified: experience with lack of resources, experiences of difficult relationships in care, experience of existential stress and lack of palliative context, as well as the experience of insufficient self-care and coping. The care staff's experiences of compassion fatigue were based on the emotions that became unmanageable in connection with the care of seriously ill patients and relatives. High workload and lack of recovery contributed to draining healthcare staff of energy, giving them an imbalance between professional and private life. To reduce the risk of suffering from compassion fatigue, the palliative context, coping and self-care became important. Conclusion: Compassion fatigue could affect the entire lifeworld of healthcare professionals. Healthcare professionals do have self-awareness but need to improve their knowledge about the importance of self-care and positive coping strategies to maintain their health. A healthy work environment is essential for

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in the U.S. experience numerous sexual health and sexual health care inequities compared to cisgender, heterosexual people. However, LGBTQ+ sexual health research has overwhelmingly focused on HIV/AIDS, while comparatively little research documents LGBTQ+ individuals’ experiences navigating sexual health care. Further, existing studies overwhelmingly represent the experiences of White LGBTQ+ individuals, limiting understanding of the experiences of LGBTQ+ people of color who, theoretical literature suggests and limited empirical studies have shown, experience particularly pronounced sexual health inequities due to their location at the intersections of multiple systems of oppression and inequality. Informed by theoretical frameworks of intersectionality, stigma, and socio-structural determinants of health, this multiple methods dissertation examines how stigma impacts the sexual health and gender affirming care experiences of LGBTQ+ people assigned female at birth (AFAB). The project combines nationally representative data from the National Survey of Family Growth with data from 76 in-depth interviews conducted between 2019 and 2021 with a racially/ethnically diverse sample of 64 LGBTQ+ individuals AFAB recruited from the San Francisco Bay Area. Three empirical chapters comprise this dissertation. Chapter 3, which draws on U.S. survey data from the National Survey of Family Growth, finds that White, Black, and Latina bisexual women and Black or Latina lesbian women aged 15-44 years have higher odds of a medical provider having asked them questions about their sexual behavior compared to White heterosexual women. Notably, Black bisexual women have the highest predicted probability of having been asked these questions in the past year, which may be a reflection of assumptions of promiscuity rooted in both racism and biphobia. The first and third empirical chapters use constructivist grounded theory methods

Objective This cross-sectional questionnaire study investigates if there a difference in the extent to which health care providers in prenatal Shared Medical Appointments (CenteringPregnancy©) and in prenatal individual appointments support self-management in patient education. It also investigates if there is a difference in the extent to which health care providers in CenteringPregnancy@ and in individual appointments pay attention to the factors of the Integrated Model for Behavioral Change (I-Change) in supporting self-management. Methods Dutch health care providers in prenatal care were invited to fill out a questionnaire. Respondents who provided care in CenteringPregnancy© formed the CenteringPregnancy© group, the others were categorized in the individual appointments’ group. After a definition of self-management and an introduction of the I-Change model, respondents were asked if they supported self-management and if they paid attention to the I-Change model for each of 17 themes of prenatal patient education. Pearson’s chi-squared tests and Fisher’s Exact tests were performed to compare both groups. Results We included 133 respondents. Health care providers in the CenteringPregnancy@ group supported self-management to a higher extent compared to the individual appointments group. This difference was statistically significant for eight themes (body position and exercises, oral health, domestic violence, birth mechanism and premature birth, postnatal period, transition from pregnancy to parenthood, taking care of the baby and newborn’s safety). In both groups, health care providers paid most attention to information or to awareness factors instead of motivation factors. Conclusion We found a first prove that health care providers in CenteringPregnancy@ support self-management to a higher extent than health care providers in individual appointments. This could be explained by factors as time, feelings of safety and bonding, continuity of care and emphasis on f

Background: Corona virus disease (COVID-19) is a health concern that produced considerable psychological and physical health challenges to Health care providers (HCPs) internationally. Aims: This study aims to determine the level of depression, anxiety, and stress after receiving the COVID-19 vaccine among HCPs in Iraq. Methods: A retrospective cross-sectional study design was used in this study. The participants involved were 700 Iraqi HCPs who received one or two doses from COVID-19 vaccines. The questionnaire was designed and brought to them electronically using Google form and distributed by social media. Then mental health status was measured using a specific depression, anxiety and stress scale named DASS-21. Each domain of the DASS scale was calculated for each subject and DASS-21 scores were compared between different demographic groups. Results: Females represented a large percentage of participants (80%). The majority of participants had a normal level of DASS-21 after receiving the vaccine. Higher scores were obtained among graduated young age groups also among individuals who have side effects associated with the vaccine. Conclusions: To the best of our knowledge, this is the first study that assesses mental health after receiving the COVID-19 vaccine in the middle east. The study concluded that HCPs have low DASS-21 scores and this gives us promising results for the use of the COVID-19 vaccine in future.

Objective: To identify the existing barriers to the care of suicidal behavior from the perspective of mental health professionals at the first level of care in Mexico City. Methodology: Qualitative exploratory study based on 35 semi-structured interviews conducted on health personnel from two national reference mental health facilities. The data were analyzed with Framework Analysis. Results: The participants considered that suicidal behavior has not been prioritized among mental health disorders. The absence of public policies, work overload, lack of patient follow-up, among others, were identified as barriers to adequate and timely care. Conclusions: Suicidal behavior prevention programs should consider the socioeconomic context of the population, the characteristics of health services, and the needs of health care providers. Professional training should be enhanced, and the referral and counter-referral system across levels of care should be improved., Objetivo: Identificar as barreiras existentes para a atenção das condutas suicidas, desde a perspectiva dos profissionais de saúde mental de atenção básica da Cidade do México. Metodologia: Estudo qualitativo exploratório, baseado em 35 entrevistas semiestruturadas, dirigidas a profissionais de saúde de duas unidades de saúde mental de referência nacional. A análise da informação foi feita através do Framework Analysis. Resultados: Os participantes consideraram que as condutas suicidas não têm sido definidas como uma prioridade dentro dos transtornos de saúde mental. A ausência de políticas públicas, a sobrecarga de trabalho, a falta de seguimento aos pacientes, entre outras, foram identificadas como barreiras para uma atenção adequada e oportuna. Conclusões: Os programas de prevenção das condutas suicidas devem considerar o contexto socioeconômico da população e as características dos serviços de saúde, além das necessidades dos profissionais de saúde. É necessário ampliar o treinamento profissional e melhorar o sistema de referência e contrarreferência entre os diferentes níveis de atenção., Objetivo: Identificar las barreras que existen para la atención de las conductas suicidas, desde la perspectiva de las/los profesionales de la salud mental del primer nivel de atención de la Ciudad de México. Metodología: Estudio cualitativo exploratorio, basado en 35 entrevistas semiestructuradas, dirigidas a personal de salud de dos unidades de salud mental de referencia nacional. El análisis de la información se hizo mediante el Framework Analysis. Resultados: Las/los participantes consideraron que las conductas suicidas no han sido definidas como una prioridad dentro de los trastornos de salud mental. La ausencia de políticas públicas, la sobrecarga de trabajo, la falta de seguimiento a las/los pacientes, entre otras, fueron identificadas como barreras para una atención adecuada y oportuna. Conclusiones: Los programas de prevención de las conductas suicidas deben tomar en cuenta el contexto socioeconómico de la población y las características de los servicios de salud, así como las necesidades de las personas prestadoras de servicios de salud. Se requiere ampliar el entrenamiento profesional y mejorar el sistema de referencia y contrarreferencia entre los distintos niveles de atención.

Introduction: The objective of this article was to explore, from an anthropological perspective, the social representations that doctors who treat covid-19 in specialized hospitals in Mexico City have, regarding the relationship between their professional performance and the deterioration of their mental health; as well as their social representations of the existing institutional resources to provide them mental health attention and their care-seeking and self-care strategies. Materials and Methods: For this, a qualitative investigation was carried out with semistructured interviews with 35 doctors who treat covid-19. Results: From the points of view of the doctors, various sociocultural and structural causes of mental illness related to their professional performance are documented and analyzed, as well as their representations about the inadequacy and/or ineffectiveness of the institution, group, or individual resources to provide them mental health attention; and some allopathic and non-biomedical forms of careseeking and self-care. Conclusions: Recommendations are made to address the etiologies of the disease analyzed in a culturally and structurally appropriate way to the context of the pandemic., Introdução: O objetivo deste artigo é explorar, a partir de uma perspectiva antropológica, as representações sociais que os médicos que tratam a covid-19 em hospitais especializados na Cidade do México, têm sobre a relação entre seu desempenho profissional e a deterioração de sua saúde mental; bem como os recursos institucionais existentes para cuidar da saúde mental e as estratégias de busca de cuidado e autocuidado. Materiais e métodos: Para isso, foi realizada uma pesquisa qualitativa com entrevistas semiestruturadas com 35 médicos que tratam da covid-19. Resultados: Do ponto de vista dos médicos, são documentadas e analisadas diversas causas socioculturais e estruturais do adoecimento mental relacionadas à sua atuação profissional, bem como suas representações sobre a inadequação e/ou ineficiência dos recursos institucionais, grupais ou individuais, disponíveis para atendê-los e algumas modalidades de busca de cuidado e autocuidado alopáticos e não biomédicos. Conclusões: São feitas recomendações para abordar institucionalmente as etiologias da doença relatadas pelos entrevistados de forma cultural e estruturalmente adequada no contexto da pandemia., Introduction: The objective of this article was to explore, from an anthropological perspective, the social representations that doctors who treat covid-19 in specialized hospitals in Mexico City have, regarding the relationship between their professional performance and the deterioration of their mental health; as well as their social representations of the existing institutional resources to provide them mental health attention and their care-seeking and self-care strategies. Materials and Methods: For this, a qualitative investigation was carried out with semi-structured interviews with 35 doctors who treat covid-19. Results: From the points of view of the doctors, various sociocultural and structural causes of mental illness related to their professional performance are documented and analyzed, as well as their representations about the inadequacy and/or ineffectiveness of the institution, group, or individual resources to provide them mental health attention; and some allopathic and non-biomedical forms of care-seeking and self-care. Conclusions: Recommendations are made to address the etiologies of the disease analyzed in a culturally and structurally appropriate way to the context of the pandemic.

Simulated standardized patients (SSP) have emerged as close to a gold standard for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patients. How, then, should data from SSPs be considered relative to clinical observations with real patients in a given health system? Here, we reject the proposition that SSPs are direct substitutes for real patients and that the validity of SSP studies therefore relies on their ability to imitate real patients. Instead, we argue that the success of the SSP methodology lies in its counterfactual manipulations of the possibilities available to real careseekers - especially those paths not taken up by them - through which real responses can be elicited from real providers. Using results from a unique pilot study where SSPs returned to providers for follow-ups when asked, we demonstrate that the SSP method works well to elicit responses from the provider through conditional manipulations of SSP behavior. At the same time, observational methods are better suited to understand what choices real people make, and how these can affect the direction of diagnosis and treatment. A combination of SSP and observational methods can thus help parse out how quality of care emerges for the patient as a shared history between care-seeking individuals and care providers.

The COVID-19 infection is a new disease which has spread to all countries of the world. People are worried and concerned about this disease. Thai people regularly send news or messages to their relatives and other people by social media, especially the Line application. Health care providers also influence their patients’ behavior through such messaging. To evaluate the reliability of the COVID-19 messages from health care providers via the Line application and assess the factors that influence the reliability of the messages. A quantitative cross-sectional study was conducted on 99 health care providers in a Thai government hospital. Data were collected using face-to-face interviews. Each interviewee was asked to evaluate 3 COVID-19 messages which they had sent to other people on the Line application. Each message was evaluated for reliability which was assessed based on the criteria of existing web-based evaluation services. Descriptive and logistic regression analysis were performed using the R Program. The prevalence of the participants with 3 high reliability messages was 15.15%. In total there were 297 messages of which only 122 met the criteria for reliable messages (41%). The participants with reliable messages had a significantly higher rate of sending messages from news updates than the other groups. There are many messages on social media, and health care providers need to learn about the reliable messages and consider their impact on others before they make the decision to send messages to others or believe these messages.

Background: Humanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions. Humanitarian actors and health care providers can play important roles in ensuring the availability and accessibility of abortion-related care. This study explores health care providers' perceptions and experiences of providing comprehensive abortion care in a humanitarian setting in Cox's Bazar, Bangladesh and identifies barriers and facilitators in service provision. Method: In-depth interviews (n = 24) were conducted with health care providers (n = 19) providing comprehensive abortion care to Rohingya refugee women and with key informants (n = 5), who were employed by an organisation involved in the humanitarian response. Data were analysed using an inductive content analysis approach. Results: The national menstrual regulation policy provided a favourable legal environment and facilitated the provision of comprehensive abortion care, while the Mexico City policy created organisational barriers since it made organisations unable or unwilling to provide the full comprehensive abortion care package. Supplies were available, but a lack of space created a barrier to service provision. Although training from organisations had made the health care providers confident and competent and had facilitated the provision of services, their knowledge of the national abortion law and menstrual regulation policy was limited and created a barrier to comprehensive abortion services. Even though the health care providers were willing to provide comprehensive abortion care and had acquired skills and applied strategies to communicate with and provide care to Rohingya women, their personal beliefs and their perceptions of Rohingya women influenced their provision of care. Conclusion: The availability and accessibility of comprehensive abortion care

Tissue donation is essential for many individuals to improve their quality of life, and unfortunately, the need exceeds the supply. Although the Province of Alberta (2013) enacted legislation that requires all deaths be considered for donation potential, a knowledge gap still exists. The ongoing problem of missed tissue referral inspired the development of a clinical pathway that would provide health care providers the necessary tools to assess individuals for donation potential. The clinical pathway underwent a two-phased evaluation, first from subject matter experts within the donation program and finally through the Chinook Health Region ICU leadership team. This two-phased approach provided constructive feedback, resulting in a clinical pathway ready to be implemented at rural hospitals.

Aims: The overall aim of this thesis was to explore decision makers’ and professionals’ perceptions, utilisation, and decision-making about assistive technology (AT) and welfare technology (WT) within the interprofessional field of care for older adults. Methods: A literature review was conducted, including nine peer-reviewed scientific articles (I), analysed with a qualitative descriptive method. A web-based questionnaire, answered by 393 officials and health care providers in municipal eldercare (II and III), was analysed using content analysis of the open-ended answers (II) and descriptive and inferential statistics of the closed-ended answers (III). A semi-structured interview with 24 decision makers was also conducted and analysed with thematic reflexive analysis. Results: The studies revealed a lack of evidence-based decision models to support assistive and welfare technology decisions, partly due to the context being complex and multifaceted. The technology was perceived as progressive and cutting-edge, while organizational structure and culture were perceived as regressive and resistant to change. The results revealed personnel working with WT were generally very positive toward new technology, although there were age, gender, participation, and professional differences. Study IV results revealed that supportive aspects, technology aspects, patient aspects, and knowledge aspects influence AT-organizations' decision-making. Although AT/WT has been portrayed to have the potential to solve the challenges of an aging population, the decision-making regarding AT/WT is complex and evolving. Increased communication between government, regions, and municipalities to support the development of guidelines would enhance the goal of a person-centred care. Conclusion: This thesis contributes to knowledge of decision-making models, focusing on GATE´s model (Khasnabis et al., 2015) applicable in AT/WT. Further development and deepen knowledge in the area of AT/WT appears a, HV3D

Purpose: The World Health Organization advocates that all pregnant women in areas where anemia is prevalent receive supplements of iron and folic acid. However, owing to a myriad of factors, the uptake of iron and folic acid supplementation (IFAS) is still low in many countries. Therefore, this study was conducted to assess the prevalence of IFAS and its associated factors among pregnant women. Patients and Methods: A cross-sectional study was conducted at a hospital in Muntinlupa, Philippines, between March and August 2019 among 280 pregnant women. A systematic random sampling technique was used to select participants. Data were collected using interviewer-administered questionnaires. Multivariable logistic regression analyses were employed to identify factors associated with the prevalence of IFAS among pregnant women. Results: Among 280 pregnant women, a majority (85.6%, n= 238) took IFAS during pregnancy. Among the respondents, 128 (45.9%) women had knowledge about signs and symptoms of anemia, 126 (45.3%) had knowledge of the benefits associated with IFAS, and 42 (15.4%) had knowledge about side effects associated with IFAS. The main sources of information about IFAS were health care providers (41.8%), followed by community health workers (CHWs) (14.6%). Maternal knowledge concerning IFAS benefits (OR = 2.50, CI = 1.04– 5.97, p=0.04) was positively associated with the prevalence of IFAS. Conclusion: Maternal knowledge about the benefits of taking IFAS was significantly associated with the prevalence of IFAS among pregnant women in Muntinlupa, Philippines. There is a pressing need to improve health education on the benefits of IFAS among pregnant women to increase its prevalence. This emphasizes the necessity of increased involvement of health care providers and CHWs to increase women’s knowledge of IFAS benefits and support them through pregnancy.

Duty of care is a critical component of any negligence claim necessary to establish liability. It is well recognized at common law that a physician owes a duty to advise a patient but is not mandated to take affirmative measures outside the physician-patient relationship to protect a third-party. Health care providers may also be responsible for oversight, or the failure to safeguard a patient, due to a special relationship they undertake, such as failing to properly diagnose or recommend an appropriate treatment plan. Recently, the courts have struggled over whether public policy and fairness require the expansion of the law to impose liability upon health care providers for injuries sustained by third parties caused by patients in motor vehicle accidents. Various theories are advanced to establish liability, such as the physician being negligent by violating a statute created to protect the public through negligence per se, establishing prima facie negligence, or offering evidence of carelessness. A clear court consensus has failed to emerge whether the common law should be expanded in favor of responsibility. This article will provide a brief history of the efforts to enlarge physician liability to third parties. It will then focus on the cases that have arisen against physicians by a third party injured in a motor vehicle accident related to a patient’s medical condition or medication side-effects. This is a dilemma confronting the courts on a regular basis.

Remote health monitoring and medication systems are becoming prevalent owing to the advances in sensing and connectivity technologies as well as the social and economical demands due to high health care costs as well as low availability of skilled health care providers. The significance of such devices and coordination are also highlighted in the context of recent pandemic outbreaks underlying the need for physical distancing as well as even lock-downs globally. Though such devices bring forth large scale benefits, being the safety critical nature of such applications, one has to be vigilant regarding the potential risk factors. Apart from the device and application level faults, ensuring the secure operation becomes paramount due to increased network connectivity of these systems and services. In this paper, we present a systematic approach for identification of cyber threats and vulnerabilities and how to mitigate them in the context of remote medication and monitoring devices. We specifically elaborate our approach and present the results using a case study of an electronic medication device.

This research is at the intersection of artistic, Indigenous and nursing knowledge. The objectives of this research were to explore several priorities of the Manitoba Collaborative Indigenous Education Blueprint with health care providers, nursing educators and nursing students through Theatre of the Oppressed and forum theatre; to offer possibilities for integrating the priorities within nursing education; and to determine the receptivity of health care providers, nurse educators and students to Theatre of the Oppressed and forum theatre as pedagogical methods. Using an arts-based methodology and a Two-Eyed Seeing lens, a Theatre of the Oppressed workshop infused with Indigenous approaches was developed. The workshop was facilitated by a workshop team (including a forum theatre facilitator and an Indigenous nurse-Elder) and included eight health care providers who dialogued, shared stories and generated knowledge and vignettes performed to an audience of students and educators (n=7). The discussions, dialogue and stories shared during the workshop supported the dramatic exploration of the priorities of the Manitoba Collaborative Indigenous Education Blueprint and the creation of the vignettes. The data (including theatre games, exercises, image theatre, forum theatre, sharing circles, photographs and vignettes) were analyzed using thematic analysis. The themes emerging from the exploration of research objective #1 were: 1) colonialism is ongoing; 2) the multiple faces of racism; 3) challenges in negotiating identity; 4) struggles in finding safe spaces and people. This inquiry also included the development of a framework for nursing education that engendered an anti-racist praxis and transformative learning opportunities. The framework also serves as one example of how Indigenous methods, models and approaches can be employed in nursing education, thus connecting to research objective #2 of this study. Other suggestions proposed for integrating the priorities of th

Objective Delayed childbearing has gradually started to become the norm for higher educational students, with possible increased future fertility risks and psychological distress as a consequence. What do female students expect from their general practitioners (GP) and other health care providers (HCPs) with regard to delaying childbearing? We also looked into indicators that can be used by HCPs to detect female university students who have issues regarding delayed childbearing. Methods Cross sectional study: A total of 398 female students (mean age 21.83; SD = 2.4) from at least three different universities completed the questionnaire (distributed through the Internet and at a students' health service). Potential predictors for having an issue regarding delayed childbearing were assessed with multivariate logistic regression. Results Thirteen percent of 398 female students experienced being childless as more or less problematic. Forty-nine percent thinks having children deserves more attention and 33% of the students expect attention from their GP regarding a possible desire to have children during contraceptive consultations. Four factors demonstrated significant associations with having an issue concerning delayed childbearing: age (these issues also occur in younger students), worrying about fertility, not opting for an abortion if pregnant and dissatisfaction with current contraceptive use. Conclusion HCPs should discuss delayed childbearing with female students, addressing both the decrease of fertility after a certain age (30), the limited range of fertility methods, and the possible negative physical and psychological consequences of postponement. These elements could be included into programmes of sexual and reproductive health training and into pre-conception care and pre-conception education.

Background: Sexual and reproductive health and rights (SRHR) have historically been regarded as a woman's issue. It is likely that these gender norms also hinder health care providers from perceiving boys and men as health care recipients, especially within the area of SRHR. The aim of this study was to explore midwives' thoughts and experiences regarding preventive work for men's sexual and reproductive health and rights in the primary care setting. Methods: An exploratory qualitative study. Five focus group interviews, including 4-5 participants in each group, were conducted with 22 midwives aged 31-64, who worked with reproductive, perinatal and sexual health within primary care. Data were analysed by latent content analysis. Results: One overall theme emerged, in everybody's interest, but no one's assigned responsibility, and three sub-themes: (i) organisational aspects create obstacles, (ii) mixed views on the midwife's role and responsibility, and (iii) beliefs about men and women: same, but different. Conclusions: Midwives believed that preventive work for men's sexual and reproductive health and rights was in everybody's interest, but no one's assigned responsibility. To improve men's access to sexual and reproductive health care, actions are needed from the state, the health care system and health care providers.

Background: Malawi has one of the highest maternal mortality rates in the world, with unsafe abortion as a major contributor. Curettage is most frequently used as the surgical method for treating incomplete abortions, even though it is costly for an impoverished health system and the less expensive and safe manual vacuum aspiration (MVA) method is recommended. Methods: The aim of this 2016-17 study is to explore health worker's perception of doing MVA 1 year after an educational intervention. Focus group discussions were recorded, transcribed verbatim, and analyzed using content analysis for interpreting the findings. A knowledge, attitude and practice survey was administered to health professionals to obtain background information before the MVA training program was introduced. Results: Prior to the training sessions, the participants demonstrated knowledge on abortion practices and had positive attitudes about participating in the service, but preferred curettage over MVA. The training was well received, and participants felt more confident in doing MVA after the intervention. However, focus group discussions revealed obstacles to perform MVA such as broken equipment and lack of support. Additionally, the training could have been more comprehensive. Still, the participants appreciated task-sharing and team work. Conclusion: Training sessions are considered useful in increasing the use of MVA. This study provides important insight on how to proceed in improving post-abortion care in a country where complications of unsafe abortion are common and the health system is low on resources.

This doctoral thesis investigates and analyzes the legal conditions under which the Swedish Social Insurance Agency may engage in cooperation with the Swedish Public Employment Service and Swedish Health Care Providers (both public and private), regarding rehabilitation, information exchange and investigation measures in individual sick leave insurance cases. It also presents an analysis of whether these legal conditions contribute to safeguarding legality and legal certainty when the Social Insurance Agency is involved in cooperation. Overall the thesis concludes that the legal conditions for such cooperation are good in terms of assistance regarding rehabilitation, information exchange and investigation measures. The designated assignment of the Social Insurance Agency relating to the distribution of sickness benefits is also such that any cooperation that helps the individual's rehabilitation or the investigation and assessment of entitlement to such benefits is encouraged. The legality and legal certainty in such cooperation is also found to be fundamentally safeguarded, since it follows from the principle of legality in Swedish administrative law that any measures taken by the Social Insurance Agency in cooperation with other bodies must be founded in the constitutional legal order. However, since the Social Insurance Agency's assignment pertains to the distribution of positive rights and benefits, the requirements governing how clearly stated and distinct such legal support must be are generally less stringent. This is reflected in the rules and principles identified as supporting or limiting the legal conditions for cooperation, as in many cases they lack detailed prerequisites for when they may be used or what should be done. Many of the legal rules or legal principles that limit the authority and power to freely design the possible content, aims and process practice of cooperation are also not specifically aimed at regulating such situations. Moreover, in m

Introduction: The growth of type 2 diabetes is considered an alarming epidemic in Oman. The efficient team-based approach to diabetes management in primary health care is an essential component for providing ideal diabetic care. This thesis aimed to explore the current situation related to team-based management of type 2 diabetes in public Primary Health Care Centres (PHCCs) under the Ministry of Health (MOH) in Oman, including the various challenges associated with diabetes management and the most preferable Human Resources for Health (HRH) management mechanism, and to examine how this could be optimized from provider and patient perspectives. Materials and methods: The entire project was conducted in Muscat Governorate and was based on one quantitative and three qualitative studies. In the quantitative study, 26 public PHCCs were approached through cross-sectional study. The core diabetes management team recommended by the MOH for PHCCs in Oman was explored in terms of their competencies, values, skills, and resources related to the team-based approach to diabetes management. For the qualitative studies, five public purposely-selected PHCCs were approached. The diabetes consultations conducted by the core members and other supportive members involved in diabetes management were observed and later the Primary Health Care Providers (PHCPs) were interviewed. The different approaches explored challenges related to diabetes management and the most preferable HRH mechanism by PHCPs. Seven type 2 diabetes patients with different gender, employment status, and education were consequently interviewed to explore their perceptions towards the current diabetes management service and their opinions towards nurse-led clinics. Results: The survey provided significant and diverse perceptions of PHCPs towards their competencies, values, skills, and resources related to diabetes management. Physicians considered themselves to have better competencies than nurses and dieticians. Phy

BackgroundThe literature has described several challenges related to the quality of diabetes management clinics in public primary health care centres in Oman. These clinics continue to face challenges due to the continuous growth of individuals diagnosed with type 2 diabetes. We sought to explore the challenges faced in these clinics and discuss opportunities for improvement in Oman.MethodsThis qualitative study was designed to include non-participant observations of diabetic patients and care providers during service provision at diabetes management clinics, as well as semi-structured interviews with care providers, at five purposively selected public primary health care centres. Care providers included physicians, nurses, dieticians, health educators, pharmacists, an assistant pharmacist, a psychologist, and a medical orderly. The data were analysed using qualitative content analysis.ResultsThe study disclosed three different models of service delivery at diabetes management clinics, which, to varying degrees, face challenges related to health centre infrastructure, technical and pharmaceutical support, and care providers' interests, knowledge, and skills. Challenges related to the community were also found in terms of cultural beliefs, traditions, health awareness, and public transportation.ConclusionThe challenges encountered in diabetes management clinics fall within two contexts: health care centres and community. Although many challenges exist, opportunities for improvement are available. However, improvements in the quality of diabetic clinics in primary health care centres might take time and require extensive involvement, shared responsibilities, and implications from the government, health care centres, and community.

Bakgrund: Kvinnor som utsätts för våld i nära relation söker oftare vård, men alla får inte den hjälp som behövs. Vårdpersonal kan sakna beredskap och kunskap för att identifiera våldsutsatta kvinnor. Oupptäckt våld i nära relation medför negativa konsekvenser för kvinnan och samhället. Syfte: Undersöka hur kvinnliga patienter upplever att få frågan om våld i nära relation, hur de vill bli tillfrågade och hur de upplever det att inte bli tillfrågad. Metod: En integrativ litteraturöversikt baserad på 10 kvalitativa artiklar från databaserna PubMed och CINAHL. Resultat: Kategorier som framkom ur resultatet var upplevelser av att bli tillfrågad, upplevelser av olika tillvägagångssätt och upplevelser av att inte bli tillfrågad. Från dessa kategorier bildades underkategorier som samlade patienters tankar och känslor. De flesta kvinnor uppskattade att bli tillfrågade om våld i nära relation, för andra uppstod det en rädsla inför frågan. Kvinnor som inte blev tillfrågade kände att de inte var prioriterade Vårdpersonalen behöver definiera våld, eftersom våldet kan ha normaliserats och deras bemötande vid tillfrågandet samt miljön har betydelse om kvinnan väljer att erkänna sin våldsutsatthet. Frågan bör ställas vid olika tillfällen. Slutsats: Frågan om våld i nära relation är uppskattad, kvinnor kan dock uppleva rädsla av att svara på frågan. Det är viktigt att sjuksköterskan vågar fråga om våldsutsatthet vid olika tillfällen och ger ett bra bemötande i en trygg miljö. Kvinnor kan känna sig mindre prioriterade om inte frågan ställs., Background: Women that are victims of intimate partner violence seek care more often, but not all of them receive the care that they need. Caregivers can lack knowledge and preparedness to identify abused women. Undetected intimate partner violence can result in negative consequences for both the woman and society. Aim: To describe women’s experiences of being asked about violence in intimate partnership, how they want to be questioned and how they felt when they did not get the question. Method: An integrative literature review based on 10 qualitative articles from the databases PubMed and CINAHL. Results: The categories that emerged was; experiences of being questioned, experiences of different approaches, and experiences of not being asked. From these categories, subcategories were built that gathered patients’ thoughts and feelings. Most of the women appreciated being asked about intimate partner violence, but some felt scared when they got the question. Women who were not asked felt that they were not prioritized. Caregivers should define abuse, because the abuse could have been normalized. The caregivers’approach when questioning and the environment are significant if the women choose to admit they are exposed to violence. The question should be asked at different occasions. Conclusion: The question about intimate partner violence is appreciated, but it can also lead to a feeling of fear when answering the question. It is important that nurses dare to ask about violence exposure at different occasions and that the women are well treated in a safe environment. Women can experience that they are not prioritized if no one asks the question.

Breast cancer cases are on the increase globally. Studies have shown that breast cancer awareness is generally low in African women, thus most cases are detected late, indicating a low level of screening uptake. In 2011 there were a total of 291 breast cancer cases among Namibian women. In Zambezi region only 28% of women have ever been screened for breast cancer by a health care provider. Health care providers are key role players in awareness of breast cancer screening, as they have access to the public in a conducive environment fit for creating awareness and performing breast cancer screening. The study assessed breast cancer and screening knowledge, attitudes and practices of health care providers, the knowledge of women accessing ante-natal care and family planning services, and the source of information for the women with regards to breast cancer and screening in Zambezi region. A cross sectional study was conducted on 196 participants (98 health care providers and 98 women accessing ante-natal care and family planning services). Data was collected using structured questionnaires and was entered into micro soft Excel and analysed using EPI info 7.2 software. Frequencies and proportions were generated and bivariate analysis were performed to determine association. Most (39.8%) of the health care providers were in the age group of 40 years and above, the majority (62.2%) were females. Health care providers had adequate knowledge (94.9%), positive attitudes (67.3%) and poor practices towards breast cancer and screening. Women accessing ante-natal care and family planning services showed inadequate knowledge on breast cancer screening (76.5%), and only 2.04% of them had ever been screened for breast cancer by a health care provider. Generally health care providers had adequate knowledge and positive attitudes towards breast cancer screening, however their level of practices were poor, they rarely educated women accessing routine services at health facilities on b

The purpose of this study was to define a business case for an eHealth platform to provide remote monitoring and coaching services for elderly with mild cognitive impairment and mild dementia in the Italian context. 107 patients with mild cognitive impairment and mild dementia were divided into the intervention and control groups. The data was collected using standardized instruments Clinical Dementia Rating Scale (CDR) and EuroQoL-5D-5L, and tailor-made instruments, such as surveys to technology and healthcare providers, and semi-structured interviews to patients and healthcare professionals. The data that was not collected in the study, was obtained from the scientific literature. Benefit/cost ratio was calculated for three years. The study shows that a digital platform to provide remote monitoring and coaching services for elderly with mild cognitive impairment and mild dementia can be cost-effective from the first year, and can improve care without monetary loss for the healthcare provider. The key benefits show that the deterioration of the illness is postponed, and that the satisfaction of the patients and the healthcare professionals increases. Therefore, such an eHealth platform can be a worthy investment in Italy, and could be considered for wider nation-wide adoption.

Background: While there has been a steady decline in adolescent pregnancies worldwide and in Australia over the last three decades, Australian rates still lank third highest among developed countnes. Adolescent pregnancies are defined as those that occur to girls between the ages of 15 and 19. The current pregnancy rate of 15 to 19 year old females rural Victoria is 21.19%, this is more than double the Victorian state rate of 8.2% and almost double the national Australian rate at 13.1% The aim of this study was to explore Health Care Professionals and Educator perspectives on these high adolescent pregnancy rates, with particular focus on the role of adolescent males, in a rural region in Victoria, Australia. Methods: A qualitative descriptive study using focus group discussion was undertaken with Health Care Providers and Educators (N = 8) in 2016. Data was analysed using thematic analysis. Results: Four themes emerged from analysis. The first, 'Gender Stereotyping' focused on the acceptance of traditional masculinities; the second 'Adolescent males as health consumers' was based on the consensus that adolescent males are poor consumers of health and 'invisible'; the third 'Complexity of Issues' identified that, particularly in a rural region, contributing issues are varied and complex; and the fourth 'Focus on Fatherhood', saw the participants diverge from the discussion about pregnancy prevention and the adolescent males' role in unintended pregnancy, and focus on the role adolescent males may have as unintended fathers. Conclusions: Participants did not consider young males to be of importance in the prevention of adolescent pregnancy. There is a need to further explore the role of young males in pregnancy prevention, including what role traditional gender stereotyping, from health professionals' and young males' perspectives, plays in provision of adolescent sexual health services.

PurposeHypertension (HT) is considered to be the most common disorder in the general population. Demographic data indicate that older adults commonly suffer from HT. Older age is one of the key factors affecting the adherence of patients with HT. The main purpose was to identify demographic, socioeconomic, and clinical factors that affect adherence in older adults with HT.Materials and methodsThis cross-sectional study included 150 patients (84 women and 66 men) with mean age of 72.1 years. The Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone CHBPTS) was used to evaluate the adherence to therapeutic recommendations for HT.ResultsThe mean score obtained by the patients in the Hill-Bone CHBPTS was 20.19 (SD±4.05). The linear regression model showed the independent predictors of the total score (P<0.05): 1) age, each subsequent year of life raises the total score by an average of 0.2 points; 2) gender, males raise it by an average of 1.34 points compared to females; 3) education, a secondary, higher, or higher professional education lowers it by an average of 1.75 points compared to a primary education or no education; and 4) living with the family, having familial support lowers it by an average of 1.91 points compared to living alone or in an organized institution.ConclusionOur study has shown that the variables of age, education level, and living with the family were statistically significant in explaining the adherence rates. Health care professionals should pay more attention to older HT patients who have a low level of education and who experience the lack of social support. There is a need for a tailored education among this group of patients to better understand and adhere to medication treatment.

Background:Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Lack of knowledge and willingness of health care providers (HCPs) to prescribe PrEP is an important barrier to implementation. Objective:The objective of this study was to describe and examine the feasibility and acceptability of a PrEP Optimization Intervention (PrEP-OI) targeted at HCPs. The ultimate purpose of this intervention was to increase PrEP uptake, adherence, and persistence among those at risk for HIV acquisition. Methods:This intervention included the following: (1) a Web-based panel management tool called PrEP-Rx, which provides comprehensive HIV risk assessment, automates reminders for follow-up, and reports patients' history of PrEP use; and (2) centralized PrEP coordination by a clinical support staff member (ie, the PrEP coordinator) who can identify individuals at risk for HIV, provide medical insurance navigation, and support multiple HCPs. Feasibility was evaluated based on HCPs' ability to log in to PrEP-Rx and use it as needed. Acceptability was assessed via individual formative qualitative interviews with HCPs after 1 month of the intervention. Results:The intervention was feasible and acceptable among HCPs (N=6). HCPs identified system-level barriers to PrEP provision, many of which can be addressed by this intervention. HCPs noted that the intervention improved their PrEP knowledge; increased ease of PrEP prescription; and was likely to improve patient engagement and retention in care, enhance communication with patients, and improve patient monitoring and follow-up. Conclusions:Given the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact the P

Purpose Empowerment in patients can lead to a higher participation in care and self-management skills. However, there are a limited number of high-quality instruments to assess empowerment and its various dimensions in young persons. The aim was to develop and assess the psychometric properties of the Gothenburg Young Persons Empowerment Scale (GYPES). Methods The GYPES is a 15-item questionnaire designed to measure patient empowerment in young persons with chronic conditions. Three studies were conducted to evaluate the psychometric properties of the scale. Studies I and II assessed face, content and factorial validity, as well as responsiveness and reliability in young persons with congenital heart disease and diabetes. After these studies problematic items were identified and reworded and the final version of the GYPES was tested in young persons with diabetes in study III. Results The content and face validity of the scale was confirmed in study I. Confirmatory factor analyses (CFA) in study II supported the five-factor structure of the GYPES. However, one item had a low factor loading. The scale was revised and evaluated in study III. CFA of this version supported adequate model fit with factor loadings ranging from 0.385–0.941. A second-order model had an adequate fit to the data. Cronbach’s alpha for the overall scale was 0.858 and for each subscale, alphas range from 0.609–0.858. Conclusions GYPES was developed to measure patient empowerment in young persons with chronic conditions. Preliminary evidence supports that the GYPES may be a valid and reliable tool for assessing young persons’ empowerment.

BACKGROUND: Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Lack of knowledge and willingness of health care providers (HCPs) to prescribe PrEP is an important barrier to implementation. OBJECTIVE: The objective of this study was to describe and examine the feasibility and acceptability of a PrEP Optimization Intervention (PrEP-OI) targeted at HCPs. The ultimate purpose of this intervention was to increase PrEP uptake, adherence, and persistence among those at risk for HIV acquisition. METHODS: This intervention included the following: (1) a Web-based panel management tool called PrEP-Rx, which provides comprehensive HIV risk assessment, automates reminders for follow-up, and reports patients history of PrEP use; and (2) centralized PrEP coordination by a clinical support staff member (ie, the PrEP coordinator) who can identify individuals at risk for HIV, provide medical insurance navigation, and support multiple HCPs. Feasibility was evaluated based on HCPs ability to log in to PrEP-Rx and use it as needed. Acceptability was assessed via individual formative qualitative interviews with HCPs after 1 month of the intervention. RESULTS: The intervention was feasible and acceptable among HCPs (N=6). HCPs identified system-level barriers to PrEP provision, many of which can be addressed by this intervention. HCPs noted that the intervention improved their PrEP knowledge; increased ease of PrEP prescription; and was likely to improve patient engagement and retention in care, enhance communication with patients, and improve patient monitoring and follow-up. CONCLUSIONS: Given the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact th

Bakgrund: Personer med ADHD har ofta nedsatta exekutiva funktioner, vilket kan försvåra social interaktion. Även vid autismspektrumtillstånd förekommer exekutiv dysfunktion, och där har tidigare studier visat ett behov av att ta hänsyn till detta vid vårdrelaterat bemötande. Det finns begränsad kunskap om hur personer med ADHD upplever bemötande inom hälso- och sjukvården. Syfte: Syftet var att utforska hur personer med ADHD upplever bemötande inom hälso- och sjukvården. Metod: I studien tillämpas en kvalitativ design med deskriptiv ansats. Semistrukturerade intervjuer genomfördes med åtta personer med ADHD-diagnos. Resultat: Tre huvudkategorier kunde formuleras utifrån intervjumaterialet: Brist på tydlighet, bristande respekt för individ och autonomi samt begränsad kunskap om ADHD hos vårdpersonal. Informanter upplevde otydlighet i kommunikation och struktur och en känsla av att vårdpersonalen inte hade respekterat deras person eller autonomi. De beskriver också hur tidsaspekten blir ett problem: att behöva vänta på olika moment och inte veta hur länge de behöver vänta. Okunskapen om ADHD kändes besvärande. Informanter upplevde att vårdpersonalen hade låst sig vid en begränsad kunskap om ADHD istället för att se personen de hade framför sig. Studiens teoretiska referensram, Joyce Travelbees interaktionsteori, understryker betydelsen av kommunikation och interaktion i omvårdnadssituationen för att adekvat vård ska kunna ges till den unika patienten, och att en förutsättning är att sjuksköterskan vill hjälpa men också har förmågan att göra det. Slutsats: Informanter i studien upplevde brister inom i huvudsak tre områden: tydlighet i kommunikation och struktur, respekt för deras person och autonomi samt vårdpersonalens kunskapsnivå gällande ADHD. Det är viktigt att patienter bemöts efter sina särskilda förutsättningar. Patienter med ADHD är inte en homogen grupp: graden och omfattningen av svårigheter kan skilja mycket, även mellan individer som uppfyller samma subd, Background: People with ADHD often have impaired executive functions, which can hamper social interaction. Also in autism spectrum disorders executive dysfunction occurs, and here previous studies have demonstrated a need to take that into account in health-related personal treatment. There is limited knowledge about how people with ADHD are experiencing personal treatment in health care. Aim: The aim was to explore how people with ADHD are experiencing personal treatment in health care. Method: The study applied a qualitative design with descriptive approach. Semi-structured interviews were conducted with eight people with ADHD diagnosis. Results: Three main categories could be formulated on the basis of the interview material: Lack of clarity, lack of respect for individual and autonomy, and healthcare professional’s limited knowledge about ADHD. The informants experienced a lack of clarity in communication and structure and a feeling that the staff had not respected their person or autonomy. They also describe how the time factor becomes a problem: having to wait for different moments and not knowing how long they will have to wait. Ignorance of ADHD was perceived troublesome. Informants felt that caregivers often stuck to limited understanding of ADHD instead of seeing the person they had in front of them. The study's theoretical framework, Joyce Travelbee’s interaction theory, emphasizes the importance of communication and interaction in the nursing situation to care adequately for the unique patient, and that a prerequisite is that the nurse wants to help but also has the ability to do so. Conclusion: Informants in the study experienced shortcomings in mainly three areas: clarity in communication and structure, respect for their person and autonomy, as well as the healthcare professionals' level of knowledge regarding ADHD. It is important that patients are treated according to their particular conditions. Patients with ADHD are not a homogeneous group: the se

Rapid proliferation of smartphone ownership and use among Latinos offers a unique opportunity to employ innovative visually enhanced low-text (VELT) mobile health applications (mHealth app) to promote health behavior change for Latinos at risk for lifestyle-related diseases. Using focus groups and in-depth interviews with 16 promotores and 5 health care providers recruited from California clinics, this qualitative study explored perceptions of visuals for a VELT mHealth app promoting physical activity (PA) and limiting sedentary behavior (SB) for Latinos. In this Phase 1 study, participants endorsed visuals portraying PA guidelines and recommended visuals depicting family and socially oriented PA. Overall, participants supported a VELT mHealth app as an alternative to text-based education. Findings will inform the future Phase 2 study development of a culturally appropriate VELT mHealth app to promote PA for Latinos, improve health literacy, and provide an alternative to traditional clinic text-based health education materials.

Social media represent specific types of technologies that are end-user driven and end-users are able to drive disruptive change giving little time to organizations to react. With rapid and powerful emergence of social media communities in healthcare, this sector is faced with new and alternative avenues to the traditional healthcare provision. These are offered from both firm-hosted and patient-hosted social media health communities. But, what are the effects of these developments on the healthcare providers and how do they react to different social media disruptive changes? To address these important questions, we draw on the disruptive innovation and information processing perspectives to explore the effects of social media disruptive change on business models, strategic responses and social media strategies of healthcare providers. We conceptualize social media as disruptive innovation and explore yet unknown differences in effects from firm-hosted and patient-hosted social media health communities. In this way, we address recent calls for research on social media and business models as well as go beyond traditional topics in healthcare information systems (IS) research, which were focused on privacy, interoperability and resistance to change. We plan to conduct our research through survey of healthcare providers in different healthcare systems. Garanti; Palgrave Macmillan; Turkish Electro Technology (TET)

Introduction: Sexually Transmitted Infections (STIs) and Reproductive Tract Infections (RTIs) have been a major public health problem in all the developing countries. STDs and their complications are amongst the top five disease categories for which adults seek health care. The health-seeking behaviour among the general population in India shows that for STI/RTI treatment people prefer non-modern medicine private practitioners. Aims and objectives: 1) To determine awareness and opinion regarding syndromic approach towards STI / RTI case management among the practitioners in private sector. 2) To compare the results with the previous large scale studies and to provide suitable recommendations. Material and methods: This cross sectional study was carried out in urban Patiala in 2012-13 among 100 randomly selected private practioners by personal visiting and getting responses to a set questionnaire. Group A constitutes allopathic and group B constitutes non allopathic practioners. Results and observations: 60% in Group A and 38% in Group B admit to be aware of syndromic approach but only 16 in Group A and 4 in Group B had correctly replied about no. of kits available in syndromic approach. 70% in both the groups were of the opinion that it will generate better follow up while 35-40% believe there is a risk of over treatment with this approach. Discussion: Since, practice of syndromic case management of STIs is presumed to be dependent on the practioners individual opinion and attitude hence it is beneficial to know about their opinion. To raise the rates of treatment as per WHO advised strategy of Syndromic management, confidence building and appropriate knowledge to the health care providers is a must. Conclusion: Apparent need is there for regular educational activities for licensed private practioners as short trainings, CME, seminars on standard treatment protocols.

Family-centered care (FCC) purports that unlimited presence and involvement of the family in the care of the hospitalized child will optimize the best outcome for the child, family, and institution. A systematic appraisal was conducted of peer-reviewed, English-language, primary quantitative research conducted within a pediatric critical care setting reported from 1998 to 2014. The aim of this review was to explore the parents’, hospitalized child’s, and health care providers’ perception of FCC within pediatric critical care. Fifty-nine articles met the criteria that generated themes of stress, communication, and parents’ and children’s needs. This review highlighted that communication tailored to meet the parents’ and child’s needs is the key to facilitating FCC and positive health outcomes. Health care providers need to be available to provide clinical expertise and support throughout the health care journey. Future initiatives, education, and research are needed to evaluate the benefits of parent- and child-led FCC practice.

Objective: To develop an instrument to measure variables that influence health care professionals' behavior with regard to the protection, promotion, and support of breastfeeding, especially one that related to the Baby-Friendly Hospital Initiative (BFHI), and to conduct a psychometric assessment. Design: Cross-sectional study. Setting: Two public health departments in eastern Spain. Participants: A convenience sample of 201 maternity and primary care professionals. Methods: The Questionnaire of Professional Breastfeeding Support of the Healthcare Quality Management Program of the Spanish Region of Murcia (QPBS-EMCA) was developed using the theory of reasoned action as a conceptual framework and the Global Criteria for evaluating implementation of the BFHI. It comprises 4 scales on beliefs, attitudes, subjective norms, and behavioral intention. The development process included item assessment and selection based on expert judgment and statistical criteria. The QPBS-EMCA scales were assessed for reliability and validity, including internal consistency, principal components factor analysis, criterion-related validity, and comparison of contrasted groups. Results: The Beliefs, Attitudes, and Subjective Norms Scales were multidimensional, whereas the Behavioral Intention Scale was unidimensional. Cronbach's alpha coefficients ranged from .65 to .81. Total scores for the Beliefs, Attitudes, and Subjective Norms Scales predicted scores for the Behavioral Intention Scale. Scores for the different QPBS-EMCA scales were related to professionals' previous breastfeeding training, interest in new training, and appraisal of breastfeeding policy in the workplace. Conclusion: The psychometric characteristics of the QPBS-EMCA render it suitable for evaluation of professionals' beliefs, attitudes, subjective norms, and behavioral intention in relation to breastfeeding and could be useful in health care facilities implementing quality improvement processes based on the BFHI.

Background Context: Low back pain (LBP) is one of the leading causes of disability worldwide and among the most common reasons for seeking primary sector care. Chiropractors, physical therapists and general practitioners are among those providers that treat LBP patients, but there is only limited evidence regarding the effectiveness and economic evaluation of care offered by these provider groups. Purpose: To estimate the clinical effectiveness and to systematically review the literature of full economic evaluation of chiropractic care compared to other commonly used care approaches among adult patients with non-specific LBP. Study Design: Systematic reviews of interventions and economic evaluations. Methods: A comprehensive search strategy was conducted to identify 1) pragmatic randomized controlled trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared to standard care delivered by other healthcare providers. Studies published between 1990 and 4th June 2015 were considered. Primary outcomes included pain, functional status and global improvement. Study selection, critical quality appraisal and data extraction were conducted by two independent reviewers. Data from RCTs with low risk of bias were included in a meta-analysis to determine effect estimates. Cost estimates of full economic evaluations were converted to 2015 USD and results summarized using Slavin’s qualitative best-evidence synthesis. Results: Six RCTs and three full economic evaluations were scientifically admissible. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1), physical therapy (n = 3) and medical care (n = 1). Overall, we found similar effects for chiropractic care and the other types of care and no reports of serious adverse events. Three low to high quality full economic evaluations studies (one cost-effectiveness, one cost-minimization and one cost-benefit) compared chiropractic to medical care. Given the diverge

Background: There is an increasing number of older adults living with long-term musculoskeletal pain and related disabilities. These problems are frequently unrecognized, underreported, and inadequately treated. Since many older adults desire to remain at home for as long as possible, it is important that individualized and holistically tailored care is provided in these settings. However, there is a complexity in providing care in this context. The aim of this study was to describe health care professionals’ experiences of providing health care to older adults living with long-term musculoskeletal pain at home. Methods: The phenomenon, “To provide health care to older adults living with long-term musculoskeletal pain at home”, was studied using reflective lifeworld research (RLR) which is based on phenomenological epistemology. Ten health care providers (nurse, physiotherapists, and occupational therapists) were interviewed and data was analysed. Results: The health care professional’s emotions fluctuated between powerlessness and meaningfulness. Needs, opportunities, understanding and respect had to be balanced in the striving to do good in the provision of health care in differing situations. Caring for older adults with long-term pain required courage to remain in the encounter despite feelings of insecurity and uncertainty about the direction of the dialogue. The essence of caring for older adults with long-term pain consisted of the following constituents: Sense of powerlessness; striving to provide good health care; and understanding and respect. Conclusions: The findings indicated that the health care professionals strived to do good and to provide health care that was holistic and sensitive to the older adults’ needs. A significant sense of powerlessness in the situation was experienced by the health care professionals. These findings address and support the need to develop methods that can be used to guide health care providers who support older adults in

Comunicación y Salud es un campo de conocimiento que, actualmente, está en un proceso de crecimiento y consolidación. El propósito del artículo es analizar tres investigaciones cualitativas sobre articulaciones en comunicación y salud realizadas en Buenos Aires, Argentina: comunicar un mensaje de cuidado de la salud en un servicio de un hospital público, comunicar políticas públicas, comunicar noticias de salud en los medios de comunicación. Fueron aplicadas, respectivamente, entrevistas semiestructuradas a profesionales de la salud, tomadores de decisión, y periodistas. Los hallazgos muestran cómo el campo de la comunicación y salud contribuye a construir ciudadanía y participación social., Health Communication is a field of knowledge, which is in a growing and strengthening process at present. The aim of this article is to analyze three qualitative studies about communication and health articulations conducted in Buenos Aires, Argentina: to communicate a message of health promotion in a public hospital; to communicate public policies in the Ministry of Health, Argentina; and, finally, to communicate health news on the press. Semi-structured interviews were conducted with health care providers, decision makers and journalists, respectively. Findings show how Health Communication contributes to building citizenship and social participation.

Background: Despite the progress towards the MDG4 and 5, compared to the developed world maternal and newborn deaths are still high in Bangladesh. Poor quality of maternal and newborn health care is often blamed for this high mortality. However, only few studies assessed the quality of health care of the facilities in Bangladesh. This study assessed the two important components of quality of maternal and newborn health care namely, infrastructure and performance of health care providers (HCPs) of three different levels of health facilities in Bangladesh. Methodology: A cross sectional survey including observation and document reviews conducted to measure the quality of infrastructures and to assess the clinical care performance of the health care providers related to maternal and newborn services. Two district hospitals, two maternal and child welfare centres, and 10 upazila (sub-district) health complexes were purposively selected from Thakurgaon and Jamalpur districts of Bangladesh to conduct the study. Six components including human resource, physical infrastructure, infection prevention, equipments/logistics/supplies, essential drugs and recordkeeping were assessed under infrastructure. Maternal and newborn care services provided by the health care providers were evaluated during antenatal care, postnatal care, conduction of delivery care and newborn care. Sixteen doctors using pre-tested infrastructure survey and observation checklists collected data between November and December 2011. The average of the sub-items of each item was calculated and then the mean average of the items were calculated and expressed in percentage. Ethical clearance was obtained from a competent authority and informed consent was obtained from the hospital authorities and the persons who participated in the study. Results: The percentage of mean average scores of all items of infrastructure for district hospitals, maternal and child welfare centres and upazila health complexes were 57.

Bakgrund Forskning visar att hälso- och sjukvården har ett övervägande heteronormativt synsätt och brister i bemötandet av personer utsatta för samkönat partnervåld. Betydligt fler HBTQ-personer som utsatts för partnervåld skulle enligt forskning sökt vård om de kunde förvissas om att bli bemötta på ett adekvat sätt baserat på kunskap om deras livsvillkor. Därför är det av stor vikt att genom djupintervjuer av våldsutsatta HBTQ-personer belysa hur de upplever bemötandet och hur de själva velat bli bemötta av hälso- och sjukvårdspersonal. Syfte Syftet var att belysa HBTQ-personers upplevelser av hälso- och sjukvårdens bemötande när de sökt vård på grund av samkönat partnervåld. Metod Enfallsdesign (Single Case Study Design). En (1) semistrukturerad djupintervju genomfördes och intervjun analyserades med kvalitativ innehållsanalys med induktiv ansats. Resultat Studien visar på åsidosättande av adekvat behandlings- och undersökningsmetodik och att råd och föreslagen behandling endast gavs i enlighet med den egna begränsade kompetensen. Studien visar även på bristande kunskaper om vad som särskiljer det samkönade partnervåldet gentemot heterosexuellt partnervåld hos hälso- och sjukvårdspersonalen. Vidare saknades anpassning av adekvata behandlingsåtgärder lämpade för situationen och okunskap kring remitteringsvägar. En osynlighet avseende hur initial och vidare kontakt upprättas framträdde och så även okunskap om vart personer utsatta för samkönat partnervåld kan vända sig för hjälp och stöd. Dessa brister i bemötandet ledde till personliga upplevelser av frustration, ambivalens, missförstånd, hopplöshet och osynlighet hos personer som söker vård på grund av samkönat partnervåld. Slutsats Det finns brister hos hälso- och sjukvården avseende bemötandet gentemot en person utsatt för samkönat partnervåld. Ökade kunskaper hos hälso- och sjukvårdspersonalen kring HBTQ-personers livsvillkor och det samkönade relationsvåldets praktik skulle förhoppningsvis leda till bättre bem, Background Previous research has shown that health care is permeated with heteronormative ideals resulting in sub optimal encounters with victims of same-sex domestic violence. According to previous studies, victims of same-sex domestic violence would be far more likely to approach health care services if they felt secure in health care service's knowledge and experience concerning LGBTQ-specific circumstances. It is therefore of upmost importance to highlight/report, through in-depth interviews, LGBTQ persons subjected to domestic violence, encounters with health care services.Aim The aim of this study was to highlight LGBTQ domestic violence victims’ experiences of encounters with health care services. Method Single Case Study Design. One semi structured in-depth interview was conducted with interviews analyzed through qualitative content analysis. Results Results of this study showed a lack of adequate treatment and examination methods as well. In addition, professional recommendations for treatment to the LGBTQ victims of domestic partner violence tended to be based primarily on the health care provider's own limited competence and knowledge of LGBTQ subject matter. Furthermore, health care providers' lack of knowledge concerning discrepancies between same-sex domestic violence and heterosexual domestic violence was identified. Additionally, there was an inability to adapt situation-appropriate treatment measures as well as a lack of knowledge concerning referral management. An apparent imperceptible lack of guidelines for facilitating initial and follow-up contact emerged as well as a lack of awareness concerning avenues of help and support for LGBTQ domestic violence victims. These shortcomings of professional treatment of LGBTQ persons resulted in feelings of frustration, ambivilance, confusion, despair, and a feeling of invisibility among LGBTQ persons seeking care for domestic violence. Conclusion There are deficiencies among health care personnel's ability