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Background: Needs-based, patient-oriented palliative care includes palliative day care clinics as a specialized semi-inpatient care offer. However, the establishment and development of these facilities has been unsystematic. Research is needed to strengthen their transparency and ensure their accessibility, quality, and structural adequacy. A national Delphi study was conducted to generate appropriate recommendations for the establishment and development of palliative day care clinics in Germany. Methods: Recommendations were formulated from focus group data on the development and expansion of palliative day care clinics in Germany. Experts on in- and outpatient palliative care rated 28 recommendations for relevance and feasibility, respectively, using a 4-point Likert-type scale. Suggestions for improvement were captured via free text comments. Items were considered consented when more than 80% of the experts scored them 4 (strongly agree) or 3 (somewhat agree), regarding both relevance and feasibility. Results: A total of 23 experts (32% response rate) completed three Delphi rounds. Following the first round, 10 of 28 recommendations were revised according to participants' comments; 1 recommendation was rejected. After the second round, 3 of these 10 recommendations were revised, while 3 were rejected. Consensus was achieved after the third round for 22 of the initial recommendations. Conclusions: The Delphi-consented recommendations provide a basis for the targeted evidence- and needs-based development of palliative day care clinics. The findings show a need for standards setting and the meaningful integration of these clinics into existing structures. Trial registration: The present study was prospectively registered on April 20, 2020, with the German Clinical Trials Register (DRKS00021446). [ABSTRACT FROM AUTHOR]

Complex care patients who spend extended time in hospital often have unmet spiritual care needs, including exploring questions of meaning and purpose, and benefiting from deep, humanizing connections. This study explored how social workers and Allied Health professionals identify and respond to the unmet spiritual care needs of these patients. It highlights the opportunities and limitations of providing spiritually-focused care within the managerial approaches that are dominant in hospital settings and provides recommendations including increased recognition of patients' spiritual care needs and training for the workers who journey with them. [ABSTRACT FROM AUTHOR]

One of the Sustainable Development Goals of the United Nations is to bring the global maternal mortality ratio down to less than 70 per 100,000 live births by 2030. Therefore, pinpointing the factors that influence maternal near-misses would help expedite the accomplishment of this goal. Studies on these topics are, nevertheless, scarce in the Hadiya zone and throughout Ethiopia as a whole. Therefore, the purpose of this study was to determine the factors that contribute to maternal near-misses among women who are admitted to public hospital maternity wards in the Hadiya zone in central Ethiopia. A facility-based, unmatched case-control study was conducted from February 17 to August 16, 2019. The study covered all secondary and tertiary public healthcare facilities in the Hadiya zone, which includes three district hospitals and one referral hospital offering comprehensive emergency obstetric care services. The study included 279 women in total (70 cases and 209 controls). Mothers who had had a near-miss were the cases, and mothers who had not had one were the controls. The Statistical Package for Social Sciences version 24 was used to analyze the data, and the multivariable binary logistic regression model was used to control confounders. The odds ratios (OR) and 95% confidence intervals (CI) were used to determine statistical significance at a p-value of less than 0.05. Living in a rural area [adjusted OR (AOR)=3.16; 95% CI: 1.62, 6.16], no birth preparedness (AOR=3.50; 95% CI: 1.66, 7.41), ever gave birth by cesarean section (AOR=3.68; 95% CI: 1.63, 8.31), previous history of hypertension (AOR=3.69; 95% CI:1.52, 8.96), and poor knowledge of pregnancy danger signs (AOR=3.15; 95% CI: 1.32, 7.52) were all determinants of maternal near-miss. Thus, strengthened public health and clinical interventions in these arenas need to prioritize rural women and women with a previous history of hypertension. [ABSTRACT FROM AUTHOR]

Introduction: Work-related musculoskeletal disorders have a greater negative impact on nurses' well-being, both physically and emotionally. Because of this issue, nurses take excessive leave, are absent from work, quit their profession, and have a lower quality of life. This leads to an increase in human and economic losses to health care institutions. However, there is a paucity of information about work-related musculoskeletal disorders among nurses in the study area. Objective: This study aimed to assess the magnitude of work-related musculoskeletal disorders and its factors associated among nurses in Hospitals of West Shoa Zone, Central Ethiopia, 2021. Materials and methods: A cross-sectional facility-based study was conducted with 406 systematically selected nurses from March 2021 to June 2021. A simple random sampling was used to select study subjects. Data were gathered through face-to-face interviews. The data has been cleaned and checked, entered Epi Data 3.1, and exported into Statistical Package for Social Sciences software version 25 for further analysis. Bivariable and multiple logistic regressions were used to determine the factors associated with outcome variable. The level of statistical significance was reported to be less than 0.05. Results: The prevalence of work-related musculoskeletal disorders was 73.8% and the highest report 247 (62.2%) was seen in the lower back which was followed by the neck 182 (45.8%) and elbow 126 (31.7%), while the lowest affected body part was ankle 46(11.6%). Working in the medical ward (COR = 5.91, 95%CI: 2.53–13.79), surgical ward (COR = 9.63, 95%CI: 3.64–15.51), and operation room theater (COR = 6.02, 95%CI: 2.37–15.27) had higher risk to work-related musculoskeletal discomfort as compared to those who were worked in outpatient department. Nurses those experienced bending or twisting back as a problem during work 2.33 times more likely to have higher risk WMSDs as compared to those who didn't perceive it with (COR 2.33, 95% CI: 1.47–3.71). Conclusion: In this study, the prevalence of work-related musculoskeletal disorders among nurses was high. Working in room/ward, working in malposition, have no on job training to prevent work-related musculoskeletal disorders and bending or twisting back during work were identified as associated factors. Since work-related musculoskeletal disorders are preventable, educating the staff about the use of proper body mechanics and modifying the work environment is essential. [ABSTRACT FROM AUTHOR]

Introduction. Common mental health disorders (CMD) during pregnancy are a public health concern because of the implications for the mother and infant's health during pregnancy and after birth. The prevalence and factors related to common mental disorders vary globally. Therefore, this study assessed the magnitude and factors associated with common mental disorder among pregnant women attending ANC follow-up in North Wollo Zone, Northeast Ethiopia. Methods. An institutional-based cross-sectional study was conducted in North Wollo, Amhara Region, Northeast Ethiopia. A multistage sampling technique was used to select 777 study participants. The common mental disorder was assessed by using SRQ-20. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23. Logistic regression analysis was done to identify the independent variables associated with common mental disorders. Independent variables with a p value less than 0.05 were considered significantly associated with CMD. Results. The magnitude of CMD was 18.1% (95% CI: 15.5, 21.0). Factors significantly associated with CMD were the educational level of participants (AOR = 0.17 , 95% CI: 0.06, 0.48), husband's educational status (AOR = 11.13 , 95%: 4.18, 29.66), unplanned pregnancy (AOR = 2.54 , 95% CI: 1.26, 5.09), self-reported complication on the current pregnancy (AOR = 0.11 , 95% CI: 0.05, 0.21), self-reported complication during the previous delivery (AOR = 3.38 , 95% CI: 1.39, 8.18), undernutrition (AOR = 2.19 , 95%: 1.26, 3.81), high psychosocial risk (AOR = 20.55 , 95% CI: 9.69, 43.59), having a legal issue (AOR = 2.06 , 95%: 1.12, 3.79), and relationship problem (AOR = 7.22 , 95% CI: 3.59, 14.53). Conclusions and Recommendation. One in five pregnant women has common mental disorder. Educational status of the participants and their spouses, unplanned pregnancy, self-reported complication during current and previous pregnancy, psychosocial risk, and legal and relationship problems were the main determinants of common mental disorders. Therefore, screening pregnant women for mental disorders and provision of necessary mental health services are recommended to minimize the adverse health outcome of CMD during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To determine the proportion of women who experienced disrespect and abuse (D&A) and the type of D&A during labor and postpartum, and to determine the factors significantly associated with D&A. Methods: A cross‐sectional mixed‐methods study undertaken in tertiary care teaching institute South India. After ethical approval, 380 postpartum women within 72 h of delivery were recruited for the study. The determinants of respectful maternity care (RMC) were assessed quantitatively and qualitatively. For quantitative assessment, they were interviewed using questionnaires adopted from the United States Agency for International Development‐ Maternal and Child Health Integrated Program (USAID‐MCHIP) protocol, which has verification criteria for RMC. As a second method for quantitative assessment, they were asked to rate the care from their perspective on a 10‐point score. For the qualitative component, they were asked to identify the healthcare workers associated with D&A by their designation and to answer three open‐ended questions. IBM SPSS Statistics 25 (IBM Corporation, Statistical Package for Social Sciences, version 25) was used for analysis. D&A as per RMC standards I–VII and its severity were expressed as frequencies and percentages with 95% confidence interval. Univariate analysis was used to determine the associated factors, and severity was determined by χ2 test. Results: The prevalence of D&A was high (85%) according to the RMC standards of the USAID‐MCHIP questionnaire, whereas it was only 33% according to women's perspective. The most common type of D&A was non‐dignified care. The factors significantly associated with D&A were women over 25 years, those admitted as an emergency referral, having a recommendation letter, and relatives working at the same healthcare facility. Conclusion: The prevalence of D&A was high as measured by the USAID‐MCHIP questionnaire, and the most common type was non‐dignified care followed by physical abuse. Synopsis: The prevalence of disrespect and abuse during childbirth is high according to the standards of the USAID‐MCHIP, but it is lower from the women's perspective. [ABSTRACT FROM AUTHOR]

Cervical cancer (CC) is one of the leading causes of cancer-related deaths among females in Ghana. Despite the magnitude of the public health challenge posed by CC in Ghana, survival data as well as reported incidence and mortality rates are primarily based on studies conducted in the capital city of the country. Even though age at diagnosis is known to affect the overall survival of CC patients, the role of this factor in the prognosis of CC patients in Ghana has not been sufficiently explored. The aim of this study was to determine the 5-year survival rate of Ghanaian woman treated for CC at a large tertiary healthcare facility in Ghana. This research was a single-institution-based quantitative retrospective cohort study conducted among patients with histopathologically confirmed CC. Clinical and socio-demographic data were retrieved from patients' medical records. Data analysis was done using the Statistical Package for the Social Sciences software version 23. Kaplan Meier curves were used to present the survival rates and median survival time. The peak age at diagnosis was between 45 and 80 years with the modal age group of patients between 75 and 80 years. The mean age at diagnosis was 63.3 ± 15.7 years ranging from 27 to 104 years. The overall survival rates at 1, 3 and 5 years were 76.5%, 51.5% and 32.4%, respectively. The median survival time was 65.8 months. Age < 50 years was associated with higher survival estimates than age >50 years. The 5-year overall survival rate of CC patients reported in this study (32.4%) is relatively low compared with countries in the developed world but like previous reports at other healthcare facilities in Ghana as well as in other underdeveloped countries. [ABSTRACT FROM AUTHOR]

Background: The tongue is susceptible to a multitude of conditions that can be of developmental, neoplastic, or inflammatory nature, whose occurrence varies globally by age, sex, and ethnicity. The objective of the present study was to determine the incidence of tongue lesions among cases managed in a tertiary hospital in Tanzania. Methods: This study analyzed histological results of patients with tongue lesions diagnosed between 2016 and 2021. Data on the age and sex of the patients and histological diagnosis were collected. Data analysis was done using Statistical Package for the Social Sciences version 27. Results: A total of 190 samples of tongue lesions were studied and 18 different histological diagnoses were observed. Generally, a majority (84.2%) of the biopsied tongue lesions were malignant. The most common (74.7%) lesions diagnosed were squamous cell carcinoma followed by hemangioma (5.3%). A significant association was noted between the nature of the lesions and the age group and sex of the patients. Conclusion: This analysis depicts that tongue lesions are frequently encountered in patients managed in tertiary health facilities in Tanzania. A majority of these lesions are malignant tumors. The sex and age of the patients are determining factors for the occurrence of tongue lesions. [ABSTRACT FROM AUTHOR]

Purpose: Tuberculosis (TB) has far-reaching effects on the social, mental, and emotional well-being of patients and consequently, their health-related quality of life (HRQOL). Few studies in Nigeria have examined changes in quality of life over the course of treatment. changes in (PTB) and factors associated with HRQOL. Methods: A prospective cohort study was conducted with patients recruited from health facilities in Lagos State. The World Health Organization Quality of Life Instrument, Short-Form (WHOQOL-BREF) was used to assess HRQOL. A semi-structured questionnaire was also administered to elicit information on socio-demographic characteristics and the medical and social history of the respondents. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23. A repeated measures analysis of variance (ANOVA) test with polynomial contrasts was used to assess how domain scores varied over time. Multivariable analysis was conducted using generalized estimating equations (GEE) to assess change in HRQOL and its predictors. Results: Two hundred and ten patients, predominantly male [108 (63.3%)] were recruited. The mean age was 36.7 ± 12.3 years. The HRQOL was impaired in all four domains at baseline. However, HRQOL scores increased over the treatment period with the largest improvement being in the 'environment' domain, where mean scores increased from 45.27 ± 14.59 to 61.28 ± 15.86. The proportion of respondents that expressed satisfaction with their health increased from 13.5% at baseline to 55.7% at the end of treatment. Low socio-economic status, delay in presentation, and an HIV-positive status were found to be significantly associated with reduced HRQOL at baseline (p < 0.05). In the multivariable longitudinal analysis, patients who were employed had higher HRQOL scores while persistent symptoms and a delay in presentation (≥ 4 weeks) were negatively associated with change in HRQOL scores over the course of treatment. Conclusion: The HRQOL of respondents progressively improved over the six-month treatment period. However, change in HRQOL was influenced by a delay in presentation and persistence of symptoms. The study also highlights the need for increased recognition of patient-reported outcomes as an adjunct outcome measure. [ABSTRACT FROM AUTHOR]

Simple Summary: This research delves into the realm of pancreatic cystic neoplasms (PCNs), specifically focusing on a subtype with a high malignancy potential that is known as intraductal papillary mucinous neoplasms (IPMNs). By analyzing data from 113 patients across two European medical centers, this study assesses the effectiveness of two key guidelines, the Fukuoka consensus guidelines and the European evidence-based guidelines, in diagnosing severe disease stages in IPMNs. The findings reveal comparable diagnostic accuracies between the guidelines, highlighting the importance of personalized patient care and the potential indicators for surgical intervention. This study underscores the need for continuous research to refine these guidelines to improve patient outcomes and deepen our understanding of PCNs. Through this research, the authors seek to contribute to more accurate diagnosis and treatment strategies, ultimately influencing the broader medical community's approach to managing these complex cystic formations in the pancreas. This study addresses the critical need for the accurate diagnosis and management of intraductal papillary mucinous neoplasms (IPMNs), which are pancreatic cystic neoplasm types holding a substantial potential for malignancy. It evaluates the diagnostic effectiveness of the Fukuoka consensus guidelines and the European evidence-based guidelines in detecting high-grade dysplasia/invasive carcinoma in IPMNs, utilizing a retrospective analysis of 113 patients from two European medical centers. The methods include a comparative analysis of clinical, radiological, and endoscopic ultrasonography data, alongside an assessment of guideline-driven diagnostic performance. The results demonstrate that both guidelines offer similar accuracy in identifying severe disease stages in IPMNs, with certain clinical markers—such as jaundice, solid mass presence, and an increase in CA 19-9 levels—being pivotal in predicting the need for surgical intervention. This study concludes that while both guidelines provide valuable frameworks for IPMN management, there is an inherent need for further research to refine these protocols and improve patient-specific treatment strategies. This research contributes to the ongoing discourse on optimizing diagnostic and treatment paradigms for pancreatic cystic neoplasms, aiming to enhance clinical outcomes and patient care in this challenging medical field. [ABSTRACT FROM AUTHOR]

The article describes the effects of ageism on health and social care and proposes actions to reduce ageism and promote healthy longevity. It discusses the manifestations and consequences of endemic and internalized ageism, formative ageism or lack of education, clinical ageism or focus on treatment rather than prevention, ageism in research or lack of evidence-based medicine, health care system ageism, and ageism in the design and operation of health care facilities and in health care access.

By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs. [ABSTRACT FROM AUTHOR]

Previous studies of service reconfiguration in healthcare have explored the influence of power on processes and outcomes. However, in these accounts the moral agency of managers is often underemphasised. This paper draws on the theoretical tools provided by the sociology of morality to help deepen understanding of the interaction between power and moral agency in service reconfiguration in healthcare. It presents results from a qualitative study of a pan-organisational service reconfiguration in the NHS in England, involving nineteen in-depth interviews with those leading the change and the analysis of twelve programme documents. We combine concepts of the moral background and epistemic governance to interpret participants' conviction that the service change was 'the right thing to do'. The paper shows how epistemic work carried out by service change regulations shaped the moral background within which participants worked. This, in turn, channelled their moral agency – specifically their commitment to patient care – in a way that also reflected central priorities. The paper adds to sociological understandings of service reconfiguration through considering the interaction of structure, agency and power, while also developing the concept of the moral background to show how power relations can influence moral beliefs. • Managers can show strong faith in uncertain evidence for healthcare service change. • The moral background explains this in a way which considers power and moral agency. • Confidence in evidence depends on background assumption of future as predictable. • Confidence also depends on premise that finances are not open to moral evaluation. • Service change regulations carry out epistemic work on background assumptions. [ABSTRACT FROM AUTHOR]

Background: Pre-Exposure Prophylaxis (PrEP) has demonstrated efficacy in preventing HIV infection. Female Bar Workers (FBWs) often act as informal sex workers, placing them at risk of HIV infection. Despite expressing interest in PrEP, FBWs face barriers to accessing public-sector clinics where PrEP is delivered. We developed a study to compare the effectiveness of workplace-based PrEP provision to standard-of-care facility-based provision for PrEP initiation, retention and adherence among FBWs. Methods: In this double-randomized intervention study, FBWs aged 15 years and above will be screened, consented and initiated on PrEP (emtricitabine/tenofovir disoproxil), and followed for six months. Participants will be randomized at the bar level and offered PrEP at their workplace or at a health facility. Those who are initiated will be independently individually randomized to either receive or not receive an omni-channel PrEP champion intervention (support from an experienced PrEP user) to improve PrEP adherence. We expect to screen 1,205 FBWs to enroll at least 160 HIV negative women in the study. Follow-up visits will be scheduled monthly. HIV testing will be performed at baseline, month 1, 4 and 6; and TDF testing at months 2 and 6. Primary outcomes for this trial are: (1) initiation on PrEP (proportion of those offered PrEP directly observed to initiate PrEP); and (2) adherence to PrEP (detectable urine TDF drug level at 6-months post-enrollment). The primary outcomes will be analyzed using Intention-to-Treat (ITT) analyses. Discussion: Using a randomized trial design, we will evaluate two interventions aiming to reduce barriers to uptake and retention on PrEP among FBWs, a vulnerable population at risk of HIV acquisition and onward transmission. If these interventions prove effective in promoting PrEP among FBWs, they could assist in abating the HIV epidemic in Africa. Trial registration: Registered with German Clinical Trials Register (www.drks.de) on 29 April 2020; Registration number DRKS00018101. [ABSTRACT FROM AUTHOR]

In this article, we analyse how health professionals educate cancer patients to care for their condition and keep strict control over therapy safety. We study how much room for negotiation is left to patients during medical consultations so resources can still be exchanged. We pay particular attention to the trade of knowledge and powers between patients and doctors (power to act and to express oneself in an imbalanced relationship where knowledge is unequally shared). We opted for a qualitative approach with 41 interviews and several ethnological observations, first of consultations in haematology, then of pre-planned phone calls made to patients during the course of a cancer therapy follow-up scheme. The declared ambition of turning cancer patients into self-responsible patients actually re-enacts well-known procedures of control and knowledge acquisition aimed at narrowing their margin of manoeuvre for the sake of therapy safety. Even if some freedom is conceded, patients remain under the control of their medical hierarchy. Health professionals privilege two methods to keep control over patients and teach them therapy safety procedures. Which method is chosen, and how it is used, is dictated by the relationship between socially-diverse patients and health professionals. In the end, what the patient learns and the amount of control the doctor keeps over this process will depend on the distribution of power and knowledge among them, but asymmetry will always remain. [ABSTRACT FROM AUTHOR]

Background: Nursing homes and other long-term care services account for a disparate share of COVID-19 cases and casualties worldwide. During COVID-19 there is a distinct need to preserve a holistic view of the wellbeing of residents of nursing homes, be mindful of their rights as citizens, and to be aware of protecting residents from infection. The delivery of health and social care throughout a pandemic must remain person-centred and adhere to a human rights-based approach. Methods: This study aimed to capture nursing home residents, their families and staff's perspective of the nursing homes residents experience, approaches of staff and the nursing home environment. An online survey was distributed via stakeholder networks and online platforms across Ireland. This study was performed and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Results: 25 residents, 42 family members and 51 staff completed the survey (n = 118). Across the domains measured all but one aspect scored above 50% (residents get up and go to bed when they want 41.5%) with the highest score of 89.1% scored for the nursing home is comfortable and well-kept. Results highlight evidence of positive experiences and endeavours to preserve social connections, residents were in a safe place cared for by staff who did their best in a difficult position and who went above and beyond their duty of care. However, some families reported poor communication, no internet connections, not enough phones or tablets, and that staff were busy and unable at times to assist residents who needed help using phones/tablets. Conclusion: This study highlights the importance of human rights and how they ought to inform and shape the advancement of public health advice and policy documents. Overall, nursing home residents, their families and staff reported favourably on the study measures. However, issues pertaining to communication are essential and there is a need to address issues such as the provision of accurate timely information, communication infrastructure and resources, and inconsistencies in communications. Of note is that while healthcare professionals have a duty to uphold the rights of nursing home residents, they themselves have human rights which must also be protected and supported. [ABSTRACT FROM AUTHOR]

Background: Nursing homes and other long-term care services account for a disparate share of COVID-19 cases and casualties worldwide. During COVID-19 there is a distinct need to preserve a holistic view of the wellbeing of residents of nursing homes, be mindful of their rights as citizens, and to be aware of protecting residents from infection. The delivery of health and social care throughout a pandemic must remain person-centred and adhere to a human rights-based approach. Methods: This study aimed to capture nursing home residents, their families and staff's perspective of the nursing homes residents experience, approaches of staff and the nursing home environment. An online survey was distributed via stakeholder networks and online platforms across Ireland. This study was performed and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Results: 25 residents, 42 family members and 51 staff completed the survey (n = 118). Across the domains measured all but one aspect scored above 50% (residents get up and go to bed when they want 41.5%) with the highest score of 89.1% scored for the nursing home is comfortable and well-kept. Results highlight evidence of positive experiences and endeavours to preserve social connections, residents were in a safe place cared for by staff who did their best in a difficult position and who went above and beyond their duty of care. However, some families reported poor communication, no internet connections, not enough phones or tablets, and that staff were busy and unable at times to assist residents who needed help using phones/tablets. Conclusion: This study highlights the importance of human rights and how they ought to inform and shape the advancement of public health advice and policy documents. Overall, nursing home residents, their families and staff reported favourably on the study measures. However, issues pertaining to communication are essential and there is a need to address issues such as the provision of accurate timely information, communication infrastructure and resources, and inconsistencies in communications. Of note is that while healthcare professionals have a duty to uphold the rights of nursing home residents, they themselves have human rights which must also be protected and supported. [ABSTRACT FROM AUTHOR]

Introduction: Globally, a shift is occurring to recognize the importance of young peoples' health and well-being, their unique health challenges, and the potential they hold as key drivers of change in their communities. In Haiti, one of the four leading causes of death for those 20–24 years old is pregnancy, childbirth, and the weeks after birth or at the end of a pregnancy. Important gaps remain in existing knowledge about youth perspectives of maternal health and well-being within their communities. Youth with lived experiences of maternal near-misses are well-positioned to contribute to the understanding of maternal health in their communities and their potential role in bringing about change. Objectives: To explore and understand youth perspectives of maternal near-miss experiences that occurred in a local healthcare facility or at home in rural Haiti. Methods: We will conduct a qualitative, community-based participatory research study regarding maternal near-miss experiences to understand current challenges and identify solutions to improve community maternal health, specifically focused on youth maternal health. We will use Photovoice to seek an understanding of the lived experiences of youth maternal near-miss survivors. Participants will be from La Pointe, a Haitian community served by their local healthcare facility. We will undertake purposeful sampling to recruit approximately 20 female youth, aged 15–24 years. Data will be generated through photos, individual interviews and small group discussions (grouped by setting of near-miss experience). Data generation and analysis are expected to occur over a three-month period. Ethics and dissemination: Ethics approval will be sought from Centre Médical Béraca in La Pointe, Haiti, and from the Hamilton Integrated Research Ethics Board in Hamilton ON, Canada. We will involve community stakeholders, especially youth, in developing dissemination and knowledge mobilisation strategies. Our findings will be disseminated as an open access publication, be presented publicly, at conferences, and defended as part of a doctoral thesis. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to identify the fundamental and geographic characteristics of the primary healthcare personnel mobility in Nanning from 2000 to 2021 and clarify the determinants that affect their transition to non-primary healthcare institutions. Methods: Through utilizing the Primary Healthcare Personnel Database (PHPD) for 2000–2021, the study conducts descriptive statistical analysis on demographic, economic, and professional aspects of healthcare personnel mobility across healthcare reform phases. Geographic Information Systems (QGIS) were used to map mobility patterns, and R software was employed to calculate spatial autocorrelation (Moran's I). Logistic regression identified factors that influenced the transition to non-primary institutions. Results: Primary healthcare personnel mobility is divided into four phases: initial (2000–2008), turning point (2009–2011), rapid development (2012–2020), and decline (2021). The rapid development stage saw increased mobility with no spatial clustering in inflow and outflow. From 2016 to 2020, primary healthcare worker mobility reached its peak, in which the most significant movement occurred between township health centers and other institutions. Aside from their transition to primary medical institutions, the primary movement of grassroots health personnel predominantly directs towards secondary general hospitals, tertiary general hospitals, and secondary specialized hospitals. Since 2012, the number and mobility distance of primary healthcare workers have become noticeably larger and remained at a higher level from 2016 to 2020. The main migration of primary healthcare personnel occurred in their districts (counties). Key transition factors include gender, education, ethnicity, professional category, general practice registration, and administrative division. Conclusions: This study provides evidence of the features of primary healthcare personnel mobility in the less developed western regions of China, in which Nanning was taken as a case study. It uncovers the factors that impact the flow of primary healthcare personnel to non-primary healthcare institutions. These findings are helpful to policy refinement and support the retention of primary healthcare workers. [ABSTRACT FROM AUTHOR]

Primary healthcare plays a pivotal role in enhancing health conditions. In Singapore, such services are predominantly manifested through the implementation of the Community Health Assistance Scheme (CHAS). CHAS is an initiative aimed at providing fundamental preventive and therapeutic services, especially for those seniors and low‐income adults with chronic diseases. In spite of considerable efforts in policy and research in this domain, there is a dearth of studies focusing on the spatial optimization of these primary healthcare services. In this study, an innovative multi‐objective medical service facility siting model has been developed based on coarse‐grained parallel genetic algorithm to address the intricate challenges associated with the optimization of locations for CHAS clinics. The proposed optimization model aims to simultaneously maximize accessibility, minimize inequity, and minimize the number of clinics. The successful application of this model in the siting of CHAS clinics in Singapore demonstrates its effectiveness in enhancing residents' access to healthcare services. Apart from its novel academic contributions to the field of spatial optimization of primary healthcare facilities in general, we have also discussed the inherent limitations and identified certain aspects as the future directions of this research. [ABSTRACT FROM AUTHOR]

The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country. [ABSTRACT FROM AUTHOR]

Background: Women's childbirth experiences provide a unique understanding of care received in health facilities from their voices as they describe their needs, what they consider good and what should be changed. Quality Improvement interventions in healthcare are often designed without inputs from women as end-users, leading to a lack of consideration for their needs and expectations. Recently, quality improvement interventions that incorporate women's childbirth experiences are thought to result in healthcare services that are more responsive and grounded in the end-user's needs. Aim: This study aimed to explore women's childbirth experiences to inform a co-designed quality improvement intervention in Southern Tanzania. Methods: This exploratory qualitative study used semi-structured interviews with women after childbirth (n = 25) in two hospitals in Southern Tanzania. Reflexive thematic analysis was applied using the World Health Organization's Quality of Care framework on experiences of care domains. Results: Three themes emerged from the data: (1) Women's experiences of communication with providers varied (2) Respect and dignity during intrapartum care is not guaranteed; (3) Women had varying experience of support during labour. Verbal mistreatment and threatening language for adverse birthing outcomes were common. Women appreciated physical or emotional support through human interaction. Some women would have wished for more support, but most accepted the current practices as they were. Conclusion: The experiences of care described by women during childbirth varied from one woman to the other. Expectations towards empathic care seemed low, and the little interaction women had during labour and birth was therefore often appreciated and mistreatment normalized. Potential co-designed interventions should include strategies to (i) empower women to voice their needs during childbirth and (ii) support healthcare providers to have competencies to be more responsive to women's needs. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is a common sexually transmitted infection and the leading cause of cervical cancer. The HPV vaccine is a safe and effective way to prevent HPV infection. In Zambia, the vaccine is given during Child Health Week to girls aged 14 years who are in and out of school in two doses over two years. The focus of this evaluation was to establish the cost to administer a single dose of the vaccine as well as for full immunisation of two doses. Methods: This work was part of a broader study on assessing HPV programme implementation in Zambia. For HPV costing aspect of the study, with a healthcare provider perspective and reference year of 2020, both top-down and micro-costing approaches were used for financial costing, depending on the cost data source, and economic costs were gathered as secondary data from Expanded Programme for Immunisation Costing and Financing Project (EPIC), except human resource costs which were gathered as primary data using existing Ministry of Health salary scales and reported time spent by different health cadres on activities related to HPV vaccination. Data was collected from eight districts in four provinces, mainly using a structured questionnaire, document reviews and key informant interviews with staff at national, provincial, district and health facility levels. Administrative coverage rates were obtained for each district. Results: Findings show that schools made up 53.3% of vaccination sites, community outreach sites 30.9% and finally health facilities 15.8%. In terms of coverage for 2020, for the eight districts sampled, schools had the highest coverage at 96.0%. Community outreach sites were at 6.0% of the coverage and health facilities accounted for only 1.0% of the coverage. School based delivery had the lowest economic cost at USD13.2 per dose and USD 28.1 per fully immunised child (FIC). Overall financial costs for school based delivery were US$6.0 per dose and US$12.4 per FIC. Overall economic costs taking all delivery models into account were US$23.0 per dose and US$47.6 per FIC. The main financial cost drivers were microplanning, supplies, service delivery/outreach and vaccine co-financing; while the main economic cost drivers were human resources, building overhead and vehicles. Nurses, environmental health technicians and community-based volunteers spent the most time on HPV related vaccination activities compared to other cadres and represented the greatest human resource costs. Conclusions: The financial cost of HPV vaccination in Zambia aligns favourably with similar studies conducted in other countries. However, the economic costs appear significantly higher than those observed in most international studies. This discrepancy underscores the substantial strain placed on healthcare resources by the program, a burden that often remains obscured. While the vaccine costs are currently subsidized through the generous support of Gavi, the Vaccine Alliance, it's crucial to recognize that these expenses pose a considerable threat to long-term sustainability. Consequently, countries such as Zambia must proactively devise strategies to address this challenge. [ABSTRACT FROM AUTHOR]

Background: The provision of supportive environments is essential in clinical and environmental psychology. Mental health disorders are a major issue, and the experience of being at a mental health facility is affected by numerous factors related to the building's design. Aim: The aim of this study is to explore the expectations of a mental health facility planning group regarding the potential impact of a supportive design on patients' mental health and staff's therapeutic practices when planning and designing a new mental health facility. Methods: The new mental health facility is a case study and data were collected through qualitative in-depth interviews with nine participants and analyzed using a thematic analysis. The participants came from a mental health facility planning group in a new mental health facility in Norway. Results: The overall expectation of the new building was related to a future orientation to support patients' mental health and therapeutic practices. Three main themes were identified: toward a future orientation, supportive building design, and work environment. Conclusions: Supportive environments are expected to influence patients' mental health and staff's therapeutic practices, including providing options for novel treatment needs in contrast to older and more outdated buildings that are perceived as hindering appropriate treatment conditions. [ABSTRACT FROM AUTHOR]

Objective: This study aims (1) to understand the needs and challenges of the current intensive care unit (ICU) environments in supporting patient well-being from the perspective of healthcare professionals (HCPs) and (2) to explore the new potential of ICU environments enabled by technology. Background: Evidence-based design has yielded how the design of environments can advocate for patient well-being, and digital technology offers new possibilities for indoor environments. However, the role of technology in facilitating ICU patient well-being has been unexplored. Method: This study was conducted in two phases. First, a mixed-method study was conducted with ICU HCPs from four Dutch hospitals. The study investigated the current environmental support for care activities, as well as the factors that positively and negatively contribute to patient experience. Next, a co-creation session was held involving HCPs and health technology experts to explore opportunities for technology to support ICU patient well-being. Results: The mixed-method study revealed nine negative and eight positive patient experience factors. HCPs perceived patient emotional care as most challenging due to the ICU workload and a lack of environmental support in fulfilling patient emotional needs. The co-creation session yielded nine technology-enabled solutions to address identified challenges. Finally, drawing from insights from both studies, four strategies were introduced that guide toward creating technology to provide holistic and personalized care for patients. Conclusion: Patient experience factors are intertwined, necessitating a multifactorial approach to support patient well-being. Viewing the ICU environment as a holistic unit, our findings provide guidance on creating healing environments using technology. [ABSTRACT FROM AUTHOR]

The study systematically analyzes the literature's reflections to determine the dimensions and criteria affecting innovation performance in the healthcare sector and healthcare organizations. In order to achieve this goal, studies published between 2018 and 2022 in the Web of Science and Google Scholar databases are searched with the keywords "innovation" and "healthcare." Out of 1,103 studies, 52 that met the screening criteria are included in the research analysis. The results show that the dimensions affecting innovation performance in the health sector and health institutions can be grouped as organizational culture, leadership, human resources, organizational structure, knowledge acquisition and knowledge sharing, cooperation, policy and management support, and technology. As a result of the study, explanations of the scope of each dimension are given, and suggestions are presented as to which areas healthcare organizations that want to increase their innovation performance should focus on improving. It is thought that healthcare organizations that want to evaluate their current innovation performance can also measure and assess within the scope of the exact dimensions. [ABSTRACT FROM AUTHOR]

Background: Diversification of artemisinin-based combination therapy (ACT) is suggested as one of the strategies that can be used to contain artemisinin resistance. Artesunate-amodiaquine (ASAQ) is one of the artemisinin-based combinations that can be used in the diversification strategy as an alternative first-line treatment for uncomplicated malaria in mainland Tanzania. There is however limited data on the efficacy of ASAQ in mainland Tanzania. This study assessed the efficacy of ASAQ for treatment of uncomplicated Plasmodium falciparum malaria in selected sentinel sites for therapeutic efficacy studies in mainland Tanzania. Methods: Between December 2018 and March 2020, children aged between 6 months and 10 years, attending at Nagaga, Mkuzi, and Mlimba primary health facilities, and with suspected uncomplicated malaria infection were screened for eligibility to participate in the study. Malaria infection was screened using microscopy. Children with uncomplicated P. falciparum monoinfection and who fulfilled all other inclusion criteria, and had none of the exclusion criteria, according to the World Health Organization (WHO) guidelines, were treated with ASAQ. Follow-up visits were scheduled on days 0, 1, 2, 3, 7, 14, 21, and 28 or on any day of recurrent infection for clinical and laboratory assessment. Polymerase chain reaction (PCR)-corrected cure rate on day 28 was the primary outcome. Results: A total of 264 children, 88 in each of the three study sites (Mlimba, Mkuzi and Nagaga health facilities) were enrolled and treated with ASAQ. The ASAQ PCR-corrected cure rate was 100% at all the three study sites. None of the participants had early treatment failure or late clinical failure. Furthermore, none of the participants had a serious adverse event. Conclusion: ASAQ was highly efficacious for the treatment of uncomplicated P. falciparum malaria in mainland Tanzania, therefore, it can be deployed as an alternative first-line treatment for uncomplicated malaria as part of diversification strategy to contain the spread of partial artemisinin resistance in the country. [ABSTRACT FROM AUTHOR]

To assist psychiatrists and clinical psychologists to assess their patients' psychological immune competence-based capacities and resources, depending on the mental health disorder diagnosis and the severity of the symptoms, the present study examined the psychometric properties of the Mental Health Test in a psychiatric sample. The research was carried out in four Hungarian healthcare facilities using a cross-sectional design. A total of 331 patients (140 male, 188 female, and 3 who preferred not to disclose their gender) completed the Mental Health Test, six well-being and mental health measures, and the Symptom Checklist-90. Psychiatrists and clinical psychologists reported the mental disorder status of each participant. Confirmatory factor analysis showed a good fit of the five-factor model to the data for the clinical version of the Mental Health Test (CFI = 0.972, RMSEA = 0.034). High internal consistency coefficients (α: 0.70–0.84; ω: 0.71–0.85) and excellent external and content validity were reported. The test is not sensitive to sociodemographic indicators but is sensitive to the correlates of well-being and to the symptoms of different types of mental disorders. Our preliminary findings suggest that the Mental Health Test is a suitable measure for assessing mental health capacities and resources in psychiatric samples. [ABSTRACT FROM AUTHOR]

Background: For adults living with HIV (ALHIV) and comorbidities, access to comprehensive healthcare services is crucial to achieving optimal health outcomes. This study aims to describe lived experiences, challenges, and coping strategies for accessing care for hypertension and/or diabetes (HTN/DM) in HIV care and treatment clinics (CTCs) and other healthcare settings. Methodology: We conducted a qualitative study that employed a phenomenological approach between January and April 2022 using a semi-structured interview guide in six HIV CTCs in Dar es Salaam, Tanzania. We purposively recruited 33 ALHIV with HTN (n = 16), DM (n = 10), and both (n = 7). Thematic content analysis was guided by the 5As framework of access to care. Findings: The majority of the participants were females, between the ages of 54–73, and were recruited from regional referral hospitals. HIV CTCs at regional referral hospitals had more consistent provision of HTN screening services compared to those from district hospitals and health centers. Participants sought HTN/DM care at non-CTC health facilities due to the limited availability of such services at HIV CTCs. However, healthcare delivery for these conditions was perceived as unaccommodating and poorly coordinated. The need to attend multiple clinic appointments for the management of HTN/DM in addition to HIV care was perceived as frustrating, time-consuming, and financially burdensome. High costs of care and transportation, limited understanding of comorbidities, and the perceived complexity of HTN/DM care contributed to HTN/DM treatment discontinuity. As a means of coping, participants frequently monitored their own HTN/DM symptoms at home and utilized community pharmacies and dispensaries near their residences to check blood pressure and sugar levels and obtain medications. Participants expressed a preference for non-pharmaceutical approaches to comorbidity management such as lifestyle modification (preferred by young participants) and herbal therapies (preferred by older participants) because of concerns about side effects and perceived ineffectiveness of HTN/DM medications. Participants also preferred integrated care and focused patient education on multimorbidity management at HIV CTCs. Conclusion: Our findings highlight significant barriers to accessing HTN/DM care among ALHIV, mostly related to affordability, availability, and accessibility. Integration of NCD care into HIV CTCs, could greatly improve ALHIV health access and outcomes and align with patient preference. [ABSTRACT FROM AUTHOR]

Objective: Access to family planning services is a human right that plays an essential role in society's health, particularly women's health. The COVID-19 pandemic has affected all aspects of human life including access to family planning services. Accordingly, the main goal of this study was to explore the experiences of women and service providers from the main challenges and obstacles of access to family planning services and abortion services in Bangladesh, Iran, and the Netherlands during the COVID-19 pandemic. Methods: In this qualitative study, the data were collected through online, telephone, or in-person semi-structured interviews with key informants. Participants selected by purposive sampling method. The participants included women aged 15 to 49 (n = 63) and service providers (n = 54) in the 3 abovementioned countries. These individuals were included from October 2020 until December 2020. Conventional thematic analysis was employed to analyze the collected data. Results: The main extracted themes were challenges (reduction of referral; disruption of access to services; insufficient knowledge; worries among staff; rising prices; and unavailability of some contraceptives), measures (time extension and visit scheduling; telephone, online, and door to door services; and support of the media) and recommendations (health facility improvements; free, online, and closer services; and ongoing trainings and awareness campaigns). Conclusion: The COVID-19 pandemic has affected family planning and reproductive health services in different ways and has uncovered existing inequalities in access to these services. However, in Iran, the reported challenges were also rooted in new population policies that have further limited access to family planning and abortion services. [ABSTRACT FROM AUTHOR]

Aim: To determine antecedents and outcomes of work engagement (WE) among nursing staff in long‐term care (LTC) using the Job Demand‐Resources model. Design: A systematic review following the Preferred Reporting Items for Systematic Review and Meta‐Analysis statement and Synthesis Without Meta‐analysis in systematic reviews guideline. A study protocol was registered in PROSPERO (registration number CRD42022336736). Data Sources: The initial searches were performed in PsycInfo, Medline, Academic Search Premier, CINAHL and Scopus and yielded 3050 unique publications. Updated searches identified another 335 publications. Sixteen studies published from 2010 to 2022 were included. Review Methods: The screening of titles and abstracts, and subsequently full‐text publications, was performed blinded by two author teams using the inclusion/exclusion criteria. When needed, a mutual consensus was obtained through discussion within and across the teams. A descriptive and narrative synthesis without a meta‐analysis of the included studies was performed. Results: The extent of research on WE in LTC facilities is limited and the factors examined are heterogeneous. Of forty‐two unique antecedents and outcomes, only three factors were assessed in three or more studies. Antecedents—in particular job resources—are more commonly examined than outcomes. Conclusion: Existing literature offers scant evidence on antecedents and outcomes of WE among nursing staff in LTC facilities. Social support, learning and development opportunities and person‐centred processes are the most examined factors, yet with ambiguous results. Impact: Antecedents and outcomes of engagement among nursing staff in LTC facilities have not previously been reviewed systematically. Engagement has been correlated with both more efficient and higher‐quality service delivery. Our findings suggest opportunities to improve health and care services by enhancing engagement, whilst at the same time better caring for employees. This study lays the groundwork for more detailed research into the contributing factors and potential results of increasing caregivers' engagement. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objectives: Inpatient health institutions provide continuous service. Nursing service in these institutions continues on a shift basis. The mental difficulties of working on the shift in maintaining the profession of nurse have been shown in the literature before. This study aims to emphasize the possible psychological effects of working on a shift basis and the factors that may affect the nurse's quality of life from a broad perspective. Methods: A total of 114 nurses working on shift (n=51) and not working on change (n=63) at Tokat Gaziosmanpaşa University Hospital were included in the study. The sociodemographic data form, generalized anxiety disorder scale-7 (GAD-7), patient health questionnaire-9 (HSQ-9), Pittsburgh sleep quality index (PUKI), and Short Form-36 (SF) were filled out by the participants. Results: No statistically significant difference existed between the GAD-7 and HSQ-9 scale mean scores and the PUKI and SF-36 subscale mean scores between the groups with and without a shift. In evaluating the PUKI total score results, it was determined that the sleep quality of the participants in both the shift-working and non-shift-working groups was poor. According to the results of the correlation analysis, the PUKI total score averages of the participants showed a positive correlation with the GAD-7 and HSQ-9 mean scores. It was determined that the mean score of the SF Mental Component (SFMC) and SF Physical Component (SFPC) showed a negative correlation with the mean score of GAD-7 and HSQ-9 for the SFPC scores of the HSA-9 scale mean scores. The GAD-7 scale mean scores were found to be predictive of SFMC scores. Conclusion: On-shift working is ineffective on quality of life and sleep. It was determined that anxiety and depressive symptoms adversely affected the quality of life and sleep. With these results, studies on nurse quality of life and sleep quality need to be evaluated from a broader perspective. [ABSTRACT FROM AUTHOR]

Background: Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient‐centred approach that utilises Māori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care. Method: The research was concerned with indigenous Māori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment. The research specifically focused on the impact of introducing a customised sticker prompt on the front cover of clinical notes of Māori tamariki (children) to assist with correct ethnicity identification. Surveys were conducted on the paediatric ward over a 3‐week period, prior to and during the intervention to evaluate the effect of the customised stickers. This study sought to (1) assess the efficacy of a sticker to improve recognition of Māori tamariki (children), (2) examine key barriers to identifying ethnicity and (3) identify wider impacts of a sticker prompt on clinical practice. Results: Results showed wide ranging positive impacts on clinical practice and culturally responsive care. Sixty‐four per cent of participants indicated that the stickers were a useful tool to improve identification of Māori tamariki. Respondents reported increased accuracy of identifying patients by ethnicity, as well as improved awareness of existing ethnicity documentation, and increased engagement regarding cultural needs and ethnicity. Conclusions: This study identified that sticker prompts are a useful tool for healthcare workers to improve recognition and awareness of ethnicity and to increase dialogue around cultural needs. The stickers led to increased consideration of the wider elements of holistic wellbeing and therefore improved culturally responsive care for Māori tamariki. [ABSTRACT FROM AUTHOR]