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OBJECTIVE: Internally displaced persons (IDPs) can have limited access to HIV and hepatitis C Virus (HCV) treatment and prevention. IDPs comprise > 7% of Georgian population but prevalence and levels of HIV and HCV knowledge in this population remain unknown. We tested 100 IDPs in Georgia for HIV and HCV, many of whom had drug injecting experience, and interviewed them about their migration experience, sexual and drug injecting practices, and HIV/HCV transmission knowledge. RESULTS: The average age of participants was 37.5 years (range 18-63); 31% were women. Almost half (N = 48) of participants reported ever injecting drugs; 17% of those (N = 8) started injecting drugs within the last year. Anti-HCV and HIV prevalence was 11% and 0%, respectively. Fewer people without drug use experience compared to people who inject drugs correctly answered all questions on the HIV knowledge test (13% vs. 35%, p = 0.015) or knew where to get tested for HIV (67% vs 98%, p

BACKGROUND: Middle age is increasingly acknowledged as a critical window for prevention of Alzheimers disease and related dementia (ADRD) since research has shown that AD develops in the course of 20-30 years (1) but we know very little about middle-aged individuals perspectives on ADRD. Knowledge gaps are particularly large for Latinas living in regions typically underrepresented in ADRD research, such as rural and/or agricultural regions. This is important given that over the next 40 years Latinos are projected to have the largest increase in ADRD cases in the U.S. Therefore, this study aims to assess knowledge, perceptions, and feelings associated with ADRD among a sample of middle-age, Spanish-speaking Latina women. METHOD: Using qualitative methods involving semi-structured interviews, we examined knowledge, perceptions, and feelings associated with ADRD among a subsample of the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) study. Participants are Latina women residing in an underserved agricultural community entering mid-life (mean = 46.5 years old). Interviews were conducted with 20 women and data was analyzed with inductive thematic content analysis. RESULTS: We identified themes regarding perceptions, knowledge, and feelings. First, participants perceive ADRD as involving (1) Loss of memory, (2) Getting lost; (3) Losing the person they once were. With regard to knowledge about ADRD, participants reported: (1) Some knowledge about protective and risk factors for ADRD, (2) No awareness of the links between cardiovascular risk factors and ADRD; (3) A desire to learn prevention methods alongside signs and symptoms of ADRD. Themes related to feelings about ADRD were: (1) Fear of developing ADRD and not being aware of reality or who they are; (2) Worry about losing relationships with loved ones and caretaking if diagnosed with ADRD; (3) Sadness about forgetting ones family and depending on others if diagnosed with ADRD. CONCLUSION: The knowledge gaps and negative feelings associated with ADRD highlighted in this study underscore the need for ADRD interventions to include CVD prevention, particularly for mid-life Latino populations residing in rural regions.

INTRODUCTION: The goal of our research programme is to develop culturally appropriate patient-specific interventions for primary and secondary prevention of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) among people living with HIV (PLWH); PLWH are at a higher risk for OPC than the general population and, as with many cancers, there are disparities in OPC health outcomes by race and ethnicity. Our study incorporates an anti-racist research framework that proposes considering racism as a foundational sociocultural system that causes ill health. We expand the framework to include biases due to gender, sexual orientation, HIV status and membership in other non-dominant groups. Our research programme focuses on HPV-related OPC among people living with PLWH, and on how intersecting identities may impact an individuals experience with oral health, obtaining regular and appropriate oral healthcare, knowledge and perceptions of oral HPV infection, risk factors for OPC and HPV vaccination. METHODS AND ANALYSIS: We will follow a grounded theory (GT) qualitative research methodology using focus group discussions (FGDs) to collect data. We will invite PLWH with intersecting identities to participate in one of 12-18 FGDs with 5-8 participants per group. Focus groups will be formed based on self-reported domains, including race, ethnicity, gender identity, sexual orientation and other identities that could impact oral health, such as smoking status, experience with homelessness or experience with drug use disorders. We do not know which aspects of intersecting identities are most salient to accessing oral healthcare. Using FGDs will allow us to gain this knowledge in a setting where participants can build on and reinforce shared understandings about oral healthcare. Following our GT methodology, analysis will occur concurrently with data collection, and emerging concepts or theories may result in changes to focus group guide questions. Initial focus group questions will be organised around our main objectives: (1) to identify individual, interpersonal and structural health equity factors that serve as barriers or facilitators to oral health status and care; (2) to explore knowledge and perceptions about causes, risk factors, prevention and screening for oral or OPC and (3) to elicit recommendations for improving access to regular and appropriate oral healthcare and suggestions on engaging PLWH from diverse identity groups in prevention interventions. ETHICS AND DISSEMINATION: All methods and procedures were approved by the University of California, San Francisco, Institutional Review Board (approval number: 23-39307) and are in accordance with the Declaration of Helsinki of 1975, as revised in 2000. Participants are required to provide informed consent. The results of this study will be presented at scholarly meetings and published in peer-reviewed journals. In addition, a lay summary of results will be created and distributed to our participants and community through our website and social media. TRIAL REGISTRATION NUMBER: NCT06055868.

BACKGROUND: Prostate cancer mortality rates are high in Nigeria. While prostate cancer is highly curable with early detection and effective multidisciplinary management, the quality of care is suboptimal in this setting. Sustainable delivery of high-quality care for patients with localized prostate cancer is needed to save more lives. To inform future interventions to improve care, this study aimed to identify barriers and facilitators that influence prostate cancer detection and management in Nigeria. METHODS: Six focus group discussions (FGDs), stratified by stakeholders were conducted with a purposive sample of prostate cancer patients (n = 19), caregivers (n = 15), and healthcare providers (n = 18), in two academic tertiary hospitals in northern and southern Nigeria. A discussion guide organized based on the socio-ecological model was used. FGDs were recorded, transcribed, and analysed using the framework technique. RESULTS: Barriers and facilitators were identified at the individual, interpersonal, and organizational levels. Barriers to detection included limited knowledge and misperceptions among patients, caregivers, and community-based non-specialist healthcare providers, and limitations of centralized opportunistic screening; while facilitators included the potential for religious institutions to encourage positive health-seeking behaviour. Barriers to management included non-uniformity in clinical guideline usage, treatment abandonment amidst concerns about treatment and survival, absence of patient interaction platforms and follow-up support systems, difficulty in navigating service areas, low health insurance coverage and limited financial resource of patients. Facilitators of management included the availability of resource stratified guidelines for prostate cancer management and the availability of patient peers, caregivers, nurses, and medical social workers to provide correct medical information and support patient-centred services. Participants also provided suggestions that could help improve prostate cancer detection and management in Nigeria. CONCLUSION: This study identified multiple determinants affecting the detection and management of localized prostate cancer. These findings will inform the refinement of implementation strategies to improve the quality of prostate cancer care in Nigeria.

Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A booster round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

The aim of this project was to increase willingness to receive the influenza vaccine to the optimal rate of ≥ 70%. Low acuity adult patients who visited an Emergency Department (ED) were assessed regarding their willingness to receive the influenza vaccine before and after an educational intervention that included a provider recommendation and an educational handout. A total of seventy-six patients (n = 76) were assessed. Patients willingness to receive the influenza vaccine rose from 29% pre-intervention to 72% post-intervention without disrupting the clinical flow in a busy ED. Similar vaccine educational strategies can be applied to influenza and other vaccines in EDs  to increase vaccination willingness in patients, including those who use the ED as a primary point of contact for healthcare, decreasing the burden of influenza illness in the community.

BackgroundCervical and other vaccine-preventable HPV-associated cancers disproportionately impact Hispanic/Latinos in the USA. HPV vaccine uptake may be impacted by community agreement with common HPV vaccine misperceptions. It is unknown whether Hispanics/Latinos have a greater agreement with these misperceptions relative to non-Hispanic whites.MethodsHPV vaccine misperceptions were assessed through a 12-item Likert scale included in a population health assessment mailed to households in the southwest United States. Linear regression models assessed the association between identifying as Hispanic/Latino and summed misperception score.ResultsAmong the 407 individuals in the analytic sample, 111 (27.3%) were Hispanic/Latino and 296 (72.7%) were non-Hispanic white. On average, Hispanics/Latinos had a 3.03-point higher HPV vaccine misperception sum score relative to non-Hispanic whites, indicating greater agreement with misperceptions (95% confidence interval: 1.16-4.88; p

As behavioural science is increasingly adopted by organizations, there is a growing need to assess the robustness and transferability of empirical findings. Here, we investigate the transferability of insights from various sources of behavioural science knowledge to field settings. Across three pre-registered randomized controlled trials (RCTs, N = 314,824) involving a critical policy domain-COVID-19 booster uptake-we field tested text-based interventions that either increased vaccinations in prior field work (RCT1, NCT05586204), elevated vaccination intentions in an online study (RCT2, NCT05586178) or were favoured by scientists and non-experts (RCT3, NCT05586165). Despite repeated exposure to COVID-19 vaccination messaging in our population, reminders and psychological ownership language increased booster uptake, replicating prior findings. However, strategies deemed effective by prediction or intention surveys, such as encouraging the bundling of COVID-19 boosters and flu shots or addressing misconceptions, yielded no detectable benefits over simple reminders. These findings underscore the importance of testing interventions transferability to real-world settings.

BACKGROUND: Following a breast cancer diagnosis, it is uncertain whether womens breast density knowledge influences their willingness to undergo pre-operative imaging to detect additional cancer in their breasts. We evaluated womens breast density knowledge and their willingness to delay treatment for pre-operative testing. METHODS: We surveyed women identified in the Breast Cancer Surveillance Consortium aged ≥ 18 years, with first breast cancer diagnosed within the prior 6-18 months, who had at least one breast density measurement within the 5 years prior to their diagnosis. We assessed womens breast density knowledge and correlates of willingness to delay treatment for 6 or more weeks for pre-operative imaging via logistic regression. RESULTS: Survey participation was 28.3% (969/3,430). Seventy-two percent (469/647) of women with dense and 11% (34/322) with non-dense breasts correctly knew their density (p

PURPOSE: Little is known about the shared decision-making (SDM) needs, barriers, and facilitators of patients with newly diagnosed advanced cancer in the hospital. Understanding this may improve SDM and cancer care quality in this vulnerable population. METHODS: A single-site, mixed-methods study of hospitalized patients with newly diagnosed advanced cancer, caregivers, and oncologists was conducted. After discharge, patient ± caregiver semi-structured interviews exploring SDM needs, barriers, and facilitators regarding their most important upcoming cancer-related decision were conducted. Oncologists were surveyed about patient knowledge and SDM needs using closed- and open-ended questions, respectively. Thematic analysis was performed for qualitative data with a focus on themes unique to or amplified by hospitalization. Descriptive statistics and the Chi-squared test were performed for quantitative data. RESULTS: Patients and caregivers reported high SDM needs surrounding treatment and prognostic information, leading to decisional conflict. Eight themes emerged: anticipated cancer treatment decisions, variable control preferences in decision-making, high cancer-related information needs and uncertainty, barriers and facilitators to information gathering during and post hospitalization, and decision-making facilitators. Among 32 oncologists, most (56%) reported patients were poorly informed about treatment and prognosis. Oncologists reported variable expectations about patient knowledge after hospitalization, facilitators to patient decision-making, and patient uncertainty while awaiting an outpatient oncologist appointment. CONCLUSION: Patients newly diagnosed with advanced cancer in the hospital have high SDM needs and experience decisional conflict. This may be due to barriers unique to or exacerbated by hospitalization. Further research is needed to develop strategies to address these barriers and enhance the facilitators identified in this study.

Storylines of Family Medicine is a 12-part series of thematically linked essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'V: ways of thinking-honing the therapeutic self', authors present the following sections: 'Reflective practice in action', 'The doctor as drug-Balint groups', 'Cultivating compassion', 'Towards a humanistic approach to doctoring', 'Intimacy in family medicine', 'The many faces of suffering', 'Transcending suffering' and 'The power of listening to stories.' May readers feel a deeper sense of their own therapeutic agency by reflecting on these essays.

KEY POINTS: In one hospital-based safety-net dialysis unit, only one half of patients with ESKD knew their cause of kidney failure, which did not differ by English proficiency status. Patients with limited English proficiency (versus English-proficient patients) reported poorer communication with the dialysis care team (less listening, fewer clear explanations, less time spent). We highlight the need for tailored, patient-centered communication between limited English-proficient patients and dialysis care team members. BACKGROUND: ESKD is a chronic health condition for which communication between health care teams and patients is important to guide patient self-management activities. Yet, little is known about the quality of communication among patients with ESKD and their care team members. We examined the influence of patient's limited English proficiency (LEP) status on communication experiences at one dialysis center. METHODS: A survey was administered to adults receiving ESKD care at a dialysis unit within a public health care delivery system between July 2022 and February 2023, to ascertain kidney disease knowledge and perceptions of communication quality with the dialysis care team. Multivariable logistic and ordinal logistic regression models adjusted for age and sex were used to determine associations between LEP status and CKD knowledge. RESULTS: Among 93 eligible patients, 88.2% (n=82) completed the survey. Approximately 37.8% (n=31) had LEP, mean age was 58.8 years, 68.3% were men, mean dialysis vintage was 3.9 years, and 25% had a positive depression screen (LEP 30%; English-proficient 22%). A higher proportion of English-proficient patients screened positive for limited health literacy compared to those with LEP (74.5% versus 38.7%, P = 0.002). Overall, knowledge of assigned cause of ESKD (53.4%) and CKD/transplant knowledge (57.3%) was suboptimal. After adjustment, LEP status was not significantly associated with knowing the correct cause of kidney failure (odds ratio, 0.49; 95% confidence interval, 0.19 to 1.27) but was significantly associated with having a higher score on a CKD/transplant knowledge scale (odds ratio, 3.99; 95% confidence interval, 1.66 to 9.58). Patients with LEP reported poorer communication quality with dialysis providers and staff (less listening, fewer clear explanations, less time spent with patients) compared with English-proficient patients, although differences were not statistically significant. CONCLUSIONS: Overall communication between patients with ESKD and members of the dialysis care team was suboptimal, regardless of English proficiency. Interventions to enhance communication for ESKD patients are needed.

BACKGROUND: Dementia is a global public health priority. The World Health Organization adopted a Global Action Plan on Dementia, with dementia awareness a priority. This study examined the knowledge, attitudes, and self-confidence with skills required for providing dementia care among primary health care providers in Vietnam. METHODS: A cross-sectional study was conducted with 405 primary health care providers who worked at commune health stations and district health centers in eight provinces across Vietnam. RESULTS: The results showed that primary health care providers had poor knowledge and little confidence but more positive attitudes toward dementia care and management. CONCLUSIONS: The results suggest the training needs for building capacity amongst primary health care providers, which will be critical as Vietnams population ages.

BackgroundDespite decades of a call to action to engage men in reproductive health, men are often left out of programs and interventions. In India, where half of pregnancies are reported as unintended, patriarchal gender norms and still dominant patterns of arranged marriages make engaging men in family planning and strengthening couples communication critical in increasing reproductive autonomy and helping young couples meet their reproductive goals. This study explores the feasibility and acceptability from the men's perspective of the pilot of a gender transformative intervention for newly married couples in India.MethodsA pilot study was conducted of TARANG, a 4 month intervention for newly married women, with light touch engagement of husbands (4 sessions). A total of 41 husbands participated in the pilot, and we collected baseline knowledge and endline feasibility and acceptability data from them, along with in depth qualitative interviews with 13 men. The study was conducted in June 2023-January 2024.ResultsMen had low levels of knowledge about biology, family planning, with the majority of men reporting that no one had provided them information about these topics. Most men wanted to delay the first birth by at least 2 years, yet less than a quarter had discussed childbearing plans with their partner or engaged in family planning methods. While all men reported high acceptability (satisfaction and usefulness), feasibility (participation) was low, with only 43% attending 2 or more sessions. Main barriers to participation included commitments due to work and migration. Men reported that the intervention led to improvements in their relationships with their wives, gave them a sense of empowerment, and led them to become resources for other men in their community.ConclusionsMen in these rural communities are not receiving the information that they need to meet their reproductive goals, however, they greatly desire this information and ways to improve relationships with their new wives. Such an intervention appears to have the potential to help change norms and spread information in the community and provide men with positive, life affirming feelings. Providing information through technology could address barriers to in-person engagement. TRIAL REGISTRATION CLINICALTRIALS.GOV : 03/13/24.NCT06320964.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) represents an important but limited treatment for patients with severe COVID-19. We assessed the effects of an educational intervention on a persons ECMO care preference and examined whether patients and providers had similar ECMO preferences. METHODS: In the Video+Survey group, patients watched an educational video about ECMOs purpose, benefits, and risks followed by an assessment of ECMO knowledge and care preferences in seven scenarios varying by hypothetical patient age, function, and comorbidities. Patients in the Survey Only group and providers didnt watch the video. Logistic regression was used to estimate the probability of agreement for each ECMO scenario between the two patient groups and then between all patients and providers. RESULTS: Video+Survey patients were more likely (64% vs. 17%; p = 0.02) to correctly answer all ECMO knowledge questions than Survey Only patients. Patients in both groups agreed that ECMO should be considered across all hypothetical scenarios, with predicted agreement above 65%. In adjusted analyses, patients and providers had similar predicted agreement for ECMO consideration across six of the seven scenarios, but patients showed greater preference (84% vs. 41%, p = 0.003) for the scenario of a functionally dependent 65-year-old with comorbidities than providers. DISCUSSION AND CONCLUSIONS: An educational video increased a persons ECMO knowledge but did not change their ECMO preferences. Clinicians were less likely than patients to recommend ECMO for older adults, so advanced care planning discussion between patients and providers about treatment options in critically ill patients with COVID-19 is critical.

BackgroundDelivering methadone treatment in community health facilities by primary care providers is a task-shifting strategy to expand access to drug use treatment, especially in rural mountainous areas. This study aims to investigate factors related to confidence in providing methadone treatment among primary care providers in Vietnam to inform good practice development.MethodsWe conducted a cross-sectional survey with 276 primary care providers who were physicians, physician assistants, nurses, pharmacists or dispensing staff from 67 communes in a mountainous province in Northern Vietnam. Using self-report scales, we measured providers' confidence in providing methadone treatment, beliefs in harm reduction, perceived work-related support, perceived stigma and risk in working with drug-using patients, and empathy towards this population. We used multiple linear regression analyses to explore factors associated with providers' confidence in providing methadone treatment in the whole sample and to compare two groups of providers who did and did not have experience providing methadone. Potential associated factors were measured at facility and provider levels.Result114 (41.3%) participants had previously experience in providing methadone treatment. Providers with methadone treatment experiences had higher confidence in and more accurate knowledge of methadone treatment, perceived less stigma of working with drug-using patients, and reported more work-related support than those without experiences. Higher medical education is associated with lower confidence in providing methadone treatment among providers without methadone experiences, but higher confidence among providers with methadone experiences. Better methadone knowledge was associated with greater confidence in providing methadone treatment among inexperienced providers but not among those with experiences. Receiving work-related support was associated with greater confidence in providing treatment in both groups, regardless of their past methadone experiences.ConclusionIn rural provinces where methadone treatment has been expanded to primary care clinics, interventions to improve primary care providers' confidence should benefit professionals with diverse experiences in providing methadone treatment. Continued training and support at work for providers is essential to ensuring quality in decentralized methadone treatment.

Background: Speech and language therapists (SLTs) play an important role in assessing and rehabilitating communication disorders in people with dementia, but there is evidence to suggest that they do not receive appropriate training to provide management and support during their training. Aim: To investigate the level of awareness and knowledge that practising SLTs from Brazil have about dementia and their role in the care of dementia through an online survey. Methods & Procedures: An online survey tool was developed to collect information from practising Brazilian SLTs regarding their knowledge about dementia, awareness about their role in the care of people with dementia, and opinions on how SLTs may be better prepared to work in the dementia field. The survey was disseminated via social media, websites, and e‐mail lists of researchers and stakeholders. Outcomes & Results: A total of 227 SLTs completed the survey. Participants showed good knowledge of dementia in general, while their answers were less accurate on primary progressive aphasia. Regarding the awareness by SLTs of their role in the care of people with dementia, most agreed or strongly agreed that SLTs could help people in the diagnosis, treatment and prevention of dementia (> 80%). However, fewer participants agreed or strongly agreed that they felt confident in contributing to the treatment and diagnosis process of dementia (about 50%). To improve the training of SLTs in Brazil, most participants believed that it would be necessary to improve the teaching of dementia at the undergraduate speech and language therapy curriculum level and to develop recommendations or guidelines about speech and language therapy practice in dementia. Conclusions & Implications: The results of this survey point to a need for improvement in the knowledge and confidence of Brazilian SLTs about dementia. To reach this goal, targeted training courses and applied practice opportunities should be embedded within university curricula and training programmes. WHAT THIS PAPER ADDS: What is already known on the subject: Many studies confirm the importance of speech and language therapy in the non‐pharmacological treatment of people with dementia. However, other evidence suggests to a possible lack of training for Brazilian SLTs, especially in the curriculum of undergraduate courses. What this paper adds to existing knowledge: This study reveals that Brazilian SLTs have substantial knowledge of dementia and recognize the significance of their role in treating people with dementia. However, a minority expressed confidence in their ability to assess and treat people with dementia. What are the potential or actual clinical implications of this work?: The findings of this research demonstrate that Brazilian SLTs have good knowledge of dementia and endorse their professional role in dementia care; however, they lack confidence in their own skills and expertise in diagnostic assessment and treatment of dementia. Interventions aimed at boosting the SLT's confidence level could lead to improved patients outcomes and overall quality of care within clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: To investigate current practices, changes, and perceptions of rheumatologists regarding GC use in RA patients. Methods: A cross-sectional survey was conducted using a structured questionnaire between April and August 2023. Rheumatologists from 31 province-level regions of Mainland China were invited to participate. Chi-squared tests were adopted to investigate the differences by sociodemographic characteristics. Results: 1,717 rheumatologists from 598 hospitals completed the survey with a response rate of 92%. Up to 60% of participants expressed currently infrequent initiation of GC co-therapy with csDMARDs (hardly ever 7.0%; occasionally 24.6%; sometimes 29.1%), accompanied by a decline of frequency over time reported in 64.2%. Regarding attitudes towards bridging therapy with GC, 604 (35.2%) participants supported this approach, 468 (27.3%) opposed it, and 645 (37.6%) remained inconclusive. Time to GC discontinuation in context of csDMARDs was commonly reported within 6 months in current practice which has been narrowed over time. Reasons for chronic GC use were mostly reported due to suboptimal disease control, followed by the need of RA complications, and pre-existing comorbidities. After failure of GC cessation, majority of respondents (84.4%) would escalate RA therapy (commonly by addition of JAK inhibitors, TNF inhibitors), which usually or often facilitated the GC cessation. The most frequently reported advantages and weaknesses of GC were rapid and strong efficacy, adverse events, respectively. Regarding long-term low-dose GC use for RA, the percentage of respondents who supported, opposed, or depended on the situation were 15.9%, 17.2%, and 66.9%, respectively. Conclusions: The current data demonstrate that GC initiation for RA treatment is not as frequent as before and the awareness of GC discontinuation is growing in current practice. Attitudes towards GC co-therapy with csDMARDs vary considerably and long-term low-dose GC use remain situation dependent. [ABSTRACT FROM AUTHOR]

Background: ICU nurses play a critical role in managing delirium in critically ill patients, yet their competency in this area remains under-explored. Aim: To assess ICU nurses' competency including their knowledge, practice, and attitudes toward delirium among critically ill patients. Methods: A correlational descriptive study was conducted with 67 nurses in the medical intensive care unit at Suez Canal University Hospitals. Data was collected using an online survey and analyzed using descriptive statistics, ANOVA, and Pearson's correlation. Results: Nurses showed a moderate knowledge level (M = 8.55), a low practice level (M = 6.62), and positive attitudes (M = 21.65) toward ICU delirium. ANOVA results indicated significant differences in practice scores based on educational level, F (2, 64) = 3.361, p =.041, and in knowledge scores based on ICU experience, F(3, 63) = 6.455, p <.001. Nurses with Master of Science in Nursing (MSN) degrees had higher practice scores than those with diplomas or Bachelor of Science in Nursing (BSN) degrees. There were no significant differences in knowledge and attitude scores based on educational level or age. Gender differences were minimal, with male nurses slightly outperforming female nurses. Correlation analysis showed positive relationships between age, education, ICU experience, and ICU nurses' levels of knowledge and practice. Conclusion: ICU nurses demonstrate a knowledge-practice gap in delirium management. Targeted educational interventions, mentorship programs, and a focus on practical skills are essential to enhance delirium care. Relevance to clinical practice: These findings highlight the urgent need for comprehensive delirium education and training programs for ICU nurses. By improving nurses' knowledge and practice, healthcare organizations can significantly enhance the early detection, prevention, and management of delirium, ultimately leading to improved patient outcomes and reduced length of stay in the ICU. [ABSTRACT FROM AUTHOR]

Purpose: Clinical specialists are supposed to inform childhood cancer patients of infertility risk and conduct fertility preservation (FP). However, little is known about whether doctors in China are fully prepared. This study aimed to investigate behavior, attitude, perception, and knowledge regarding FP among pediatric oncological specialists in a nation wide survey, to set the stage for improvements in current clinical practice patterns. Methods: This study was conducted on physicians and surgeons specialized in pediatric oncology using a questionnaire through the WeChat platform. The behavior, attitude, perception, and knowledge were assessed by Likert questions and results were quantified to obtain scores. Data were then described and analyzed using R and GraphPad. Results: Totally 373 specialists in pediatric tumors were included in the analysis. Hematologists, oncological surgeons, and reproductive medicine specialists won most trusts to be responsible for FP job. Most respondents did not have habits of delivering FP information or cooperating with FP specialists during treatment though they were well equipped with FP knowledge and desired for uniform national guideline for FP procedures. The severity of illness was regarded as the primary barrier of FP delivery. When a doctor was more educated and experienced, he was more likely to have better performance in FP. The total score, the knowledge score, and the single score concerning frequency of patients' inquiry showed aggregational trend on geographic distribution. Conclusion: Chinese pediatric oncologists demonstrated unsatisfactory practice behaviors based upon this self-reporting survey, although their attitude towards FP was generally positive. [ABSTRACT FROM AUTHOR]

Background Corneal blindness is a significant global health issue, particularly in developing countries. The availability of donated corneas for transplantation is crucial in addressing this challenge. Objectives This study aimed to assess the knowledge, attitude, and practice regarding eye donation, eye banking, and corneal transplant among the non-teaching staff at a tertiary care hospital to identify potential areas for intervention that could improve donation rates. Methods A prospective, cross-sectional questionnaire-based study was conducted over 12 months at the Adichunchanagiri Institute of Medical Sciences. The sample consisted of 400 non-teaching faculty members aged 18 to 60 years. Participants completed a 15-item questionnaire designed to evaluate their knowledge, attitudes, and practices concerning eye donation. Descriptive statistics were utilized for data analysis. Results The study encompassed 360 non-teaching faculty members, constituting 90% of the intended sample size. Participants, spanning ages 18 to 60, exhibited a balanced gender distribution, with 54.5% male and 45.5% female representation. Findings revealed a high level of awareness (90%) regarding eye donation, primarily disseminated through educational institutions (82%). Notably, 53% expressed willingness to donate their eyes, while reluctance stemmed from factors such as lack of awareness (43%) and religious beliefs (38%). Additionally, while 50% were receptive to participating in eye donation campaigns, only 28% actively promoted eye donation Conclusions The results suggest that while awareness about eye donation is high among non-teaching staff at the tertiary care hospital, this does not necessarily translate into positive attitudes or practices towards eye donation. By improving knowledge and attitudes among this key group, there may be a broader impact on the community's willingness to engage in eye donation, thus potentially increasing the donor cornea supply. [ABSTRACT FROM AUTHOR]

Background: This study, conducted at Baghdad Teaching Hospital, Iraq, aimed to investigate the impact of education and home-based follow-up on diabetes awareness and behavior modifications among Type 2 Diabetes Mellitus (T2DM) patients. Given the high prevalence and mortality rate of diabetes in Iraq, this research addresses a critical public health issue by exploring effective management strategies for one of the country's leading causes of death. Methods: We employed a semi-experimental, two-group design with pretest and posttest assessments. The study was conducted in 2023 in Baghdad, Iraq. Using the hospital's records and through direct involvement at the diabetes and endocrinology treatment center, 60 T2DM patients were selected. Participants, aged between 30 and 80 years with an HbAI c level of greater than 9%, were randomly assigned to either an intervention or a control group. The intervention group underwent four 1-hour training sessions and received 3 monthly home visits. Data were collected using a researcher-made questionnaire and analyzed employing chi-square test, t-test, and ANOVA in SPSS software. Results: Post-intervention, significant improvements were observed in the intervention group in terms of diabetes awareness and health behaviors, with F and P values demonstrating these changes. For example, walking frequency improved (F = 58.45; P = 0.001), and better adherence to dietary guidelines was noted (F = 26.47; P = 0.004). These results contrast with less pronounced changes in the control group, indicating the effectiveness of the educational intervention and home follow-up. Conclusion: The findings confirm the effectiveness of Hospital-based education with home follow-up and follow-up in enhancing diabetes awareness and self-management behaviors in T2DM patients. This approach led to significant improvements in health behaviors and diabetes awareness, with potential economic benefits. Future research should explore the scalability and sustainability of these interventions in different settings. [ABSTRACT FROM AUTHOR]

Background: Hyperuricemia is a relatively common condition, with a prevalence of over 20% among the general population. Also, most patients initially present no symptoms. This study aimed to investigate the knowledge, attitude, and practice (KAP) toward hyperuricemia among healthcare workers in Shandong, China. Methods: Healthcare workers were recruited in this cross-sectional study conducted in Shandong in December 2022. A self-designed questionnaire was used to collect demographic information and KAP data. Results: A total of 372 questionnaires were distributed, and 216 (58.06%) valid questionnaires were collected from 131 physicians, 80 nurses, and five other healthcare workers. The participants had a mean score of 10.76 ± 2.53 (possible range: 0–14, 76.9%) and 31.94 ± 2.58 (possible range: 0–40, 79.9%) in knowledge and attitude, respectively. The physicians' and nurses' practice scores were 47.57 ± 5.34 (possible range: 0–55, 86.5%) and 30.06 ± 4.11 (possible range: 0–35, 85.9%), respectively. The attitude scores were independently associated with proactive practice in both physicians (P < 0.001) and nurses (P = 0.046). Conclusion: This study found that healthcare workers in Shandong had adequate knowledge, positive attitudes, and proactive practices towards hyperuricemia. However, there is room for improvement in the attitudes of both physicians and nurses to achieve better practice. [ABSTRACT FROM AUTHOR]

Background/Objectives: Access to cardiac rehabilitation (CR) is contingent upon physician referrals, yet these are often inadequate, particularly in low-resource settings. This multi-method study aimed to translate, culturally adapt, and validate the Portuguese version of the Provider Attitudes toward CR and Referral (PACRR-P) scale, as well as to identify key factors influencing CR referral in a Latin American context for the first time. Methods: The PACRR was translated into Brazilian Portuguese through a rigorous process involving independent translation, back-translation, and expert panel review to ensure face, content, and cross-cultural validity. A total of 44 Brazilian physicians completed the questionnaire, allowing for an assessment of internal consistency, criterion validity, and convergent validity. Results: The findings confirmed the face, content, and cultural validity of the 20 translated items, with a mean item clarity rating of 4.8/5. The final version included 17 of the original 19 PACRR-P items, with a Cronbach's alpha of 0.73. Referral rates were significantly associated with over one-third of the PACRR-P items, preliminarily supporting the scale's criterion validity, while correlations with the ReCaRe scores further supported its convergent validity. The most prominent barriers to referral were a lack of familiarity with CR site locations, absence of a standard referral form, and lack of automatic referral processes. Conclusions: The PACRR's validity and reliability among Portuguese-speaking providers are preliminarily supported. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic and often disabling disease that impacts the central nervous system, leading to significant public health concerns. This study aimed to assess the level of awareness and knowledge of MS among the population of Tobruk, Libya. Methods: A community-based cross-sectional study was conducted in Tobruk, Libya, during August 2023. A total of 1,427 participants were surveyed using the Multiple Sclerosis Knowledge Questionnaire (MSKQ-25). Data were collected via an online Google form and analyzed using RStudio and SPSS. The analysis included descriptive statistics, Chi-square tests, t-tests, Mann-Whitney tests, ANOVA, Kruskal-Wallis tests, and Pearson's correlation coefficients. Results: The study found a low level of MS awareness among participants, with a mean MSKQ-25 score of 8.32 ± 5.44. Significant differences in MS knowledge were observed between individuals with relatives who had MS and those without (p < 0.001), and between medical field students and students from other backgrounds (p < 0.001). No significant association was found between MS knowledge scores and marital status or educational levels. However, significant associations were observed between MS knowledge and age, gender, and financial status (p < 0.05 for all). The majority of participants lacked knowledge about genetics, etiology, and treatment of MS. Conclusion: The findings highlight a critical need for comprehensive public outreach and education programs to improve MS awareness in Tobruk, Libya. Health education initiatives focused on MS are essential for increasing community knowledge, facilitating early detection, and improving disease management. Further research is needed to understand the reasons for misinformation and to develop strategies for increasing awareness across the country. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is characterized by hyperglycemia during pregnancy. There are many diabetes-specific tools for collecting information validated in Brazilian Portuguese. However, there are no specific instruments to assess knowledge about GDM in Brazilian Portuguese. The aim of this study was to cross-culturally adapt and validate the Brazilian Portuguese version of the Knowledge of Gestational Diabetes Mellitus questionnaire (GDMKQ). Methods: This study was conducted in southern Brazil from January to December 2023. Women with GDM or diabetes identified during pregnancy were considered eligible based on specific criteria. Clinical and demographic data were obtained through a medical records search. The GDMKQ underwent a multistep adaptation process, including translation, back-translation, content validity assessment, and cognitive interviews. After administration to participants, internal consistency, item-total correlation, and intraclass correlation were assessed. Confirmatory factor analysis was also conducted to ensure validity. Results: A total of 155 pregnant women were recruited for the study. Most participants were aged 18–30 years, and hypertension was the main comorbidity (25.2%). Regarding education, most participants (58.7%) attended high school. The Brazilian Portuguese version of the GDMKQ consisted of 32 items. The intraclass correlation was established by two independent interviews with 57 participants, yielding a correlation coefficient of 0.79 (p < 0.01). Internal consistency (Cronbach's alpha) was 0.81 overall but was less than 0.7 for each domain. Item-total correlations were calculated, and confirmatory factor analysis indicated a good model fit. The final Brazilian Portuguese version of the questionnaire consisted of 32 items. Conclusions: The Brazilian Portuguese version of the GDMKQ yielded a reliable and valid tool for evaluating diabetes knowledge in pregnant women. [ABSTRACT FROM AUTHOR]

Despite widespread availability of human papillomavirus (HPV) vaccines and recommendations for routine use, awareness and uptake of HPV vaccination are not universal. We assessed self-reported history of HPV vaccination in a sample of low-income men and women recruited from the community using respondent-driven sampling as part of the National HIV Behavioral Surveillance (NHBS) survey in San Francisco. Of the 384 respondents, a minority (12.5%) reported they had received the HPV vaccine. In multivariate analysis, independent associations with HPV vaccination history were female sex (adjusted odds ratio [AOR] = 3.76, 95% confidence interval [CI] = [1.73, 8.17]), younger age (AOR = 0.89 per year, 95% CI = [0.86, 0.92]), and education above high school (AOR = 2.84, 95% CI = [1.37, 5.90]). Missed opportunities for HPV vaccination were evident in 84.4% of respondents having visited a health care provider in the last year, including 40.1% tested for a sexually transmitted infection, and entry into higher education programs (33.4%).

Abstract Background ICU nurses play a critical role in managing delirium in critically ill patients, yet their competency in this area remains under-explored. Aim To assess ICU nurses’ competency including their knowledge, practice, and attitudes toward delirium among critically ill patients. Methods A correlational descriptive study was conducted with 67 nurses in the medical intensive care unit at Suez Canal University Hospitals. Data was collected using an online survey and analyzed using descriptive statistics, ANOVA, and Pearson’s correlation. Results Nurses showed a moderate knowledge level (M = 8.55), a low practice level (M = 6.62), and positive attitudes (M = 21.65) toward ICU delirium. ANOVA results indicated significant differences in practice scores based on educational level, F (2, 64) = 3.361, p = .041, and in knowledge scores based on ICU experience, F(3, 63) = 6.455, p

Immobility complications are challenging for healthcare professionals because they negatively affect individuals' overall health. Following recovery from a severe illness or accident, patients' movement is often impaired, so they may be unable to perform activities of daily living, thus impacting their quality of life. Nurses play a proactive role in preventing immobility's physical and mental impacts. However, several studies have suggested that nurses worldwide lack knowledge, attitude, and practice (KAP) toward immobility complications. Therefore, stakeholders must prioritize this problem to optimize healthcare provision. Accordingly, this study aimed to explore nurses' KAP toward immobility complications. A scoping review of relevant articles utilized PubMed, Scopus, Cochrane, Web of Science, Embase, CINAHL Plus, and EBSCOhost databases. Hawker's tool assessed the risk of bias among the included primary articles. The results were analyzed according to the KAP toward four main immobility complications: pressure injury, deep vein thrombosis, ventilator-associated pneumonia, and urinary tract infection. The database search generated a total of 1398 articles. Of them, only 39 articles met the inclusion criteria for the review. Most articles concluded that nurses' KAP were below the expected level. Education and training were found to optimize nurses' KAP. The KAP toward immobility complications was good among nurses with work experience, high academic grades, and prior training. These findings indicate that nursing staff should receive continuous education and in-service training to improve their KAP toward immobility complications.

Abstract Background Multiple sclerosis (MS) is a chronic and often disabling disease that impacts the central nervous system, leading to significant public health concerns. This study aimed to assess the level of awareness and knowledge of MS among the population of Tobruk, Libya. Methods A community-based cross-sectional study was conducted in Tobruk, Libya, during August 2023. A total of 1,427 participants were surveyed using the Multiple Sclerosis Knowledge Questionnaire (MSKQ-25). Data were collected via an online Google form and analyzed using RStudio and SPSS. The analysis included descriptive statistics, Chi-square tests, t-tests, Mann-Whitney tests, ANOVA, Kruskal-Wallis tests, and Pearson’s correlation coefficients. Results The study found a low level of MS awareness among participants, with a mean MSKQ-25 score of 8.32 ± 5.44. Significant differences in MS knowledge were observed between individuals with relatives who had MS and those without (p

Abstract Background Gestational diabetes mellitus (GDM) is characterized by hyperglycemia during pregnancy. There are many diabetes-specific tools for collecting information validated in Brazilian Portuguese. However, there are no specific instruments to assess knowledge about GDM in Brazilian Portuguese. The aim of this study was to cross-culturally adapt and validate the Brazilian Portuguese version of the Knowledge of Gestational Diabetes Mellitus questionnaire (GDMKQ). Methods This study was conducted in southern Brazil from January to December 2023. Women with GDM or diabetes identified during pregnancy were considered eligible based on specific criteria. Clinical and demographic data were obtained through a medical records search. The GDMKQ underwent a multistep adaptation process, including translation, back-translation, content validity assessment, and cognitive interviews. After administration to participants, internal consistency, item-total correlation, and intraclass correlation were assessed. Confirmatory factor analysis was also conducted to ensure validity. Results A total of 155 pregnant women were recruited for the study. Most participants were aged 18–30 years, and hypertension was the main comorbidity (25.2%). Regarding education, most participants (58.7%) attended high school. The Brazilian Portuguese version of the GDMKQ consisted of 32 items. The intraclass correlation was established by two independent interviews with 57 participants, yielding a correlation coefficient of 0.79 (p

BACKGROUND: Given the sensitive nature of COVID-19 beliefs, evaluating them explicitly and implicitly may provide a fuller picture of how these beliefs vary based on identities and how they relate to mental health. OBJECTIVE: Three novel brief implicit association tests (BIATs) were created and evaluated: two that measured COVID-19-as-dangerous (vs. safe) and one that measured COVID-19 precautions-as-necessary (vs. unnecessary). Implicit and explicit COVID-19 associations were examined based on individuals demographic characteristics. Implicit associations were hypothesized to uniquely contribute to individuals self-reports of mental health. METHODS: Participants (N = 13,413 US residents; April-November 2020) were volunteers for a COVID-19 study. Participants completed one BIAT and self-report measures. This was a preregistered study with a planned internal replication. RESULTS: Results revealed older age was weakly associated with stronger implicit and explicit associations of COVID-as-dangerous and precautions-as-necessary. Black and Asian individuals reported greater necessity of taking precautions than White individuals (with small-to-medium effects); greater education was associated with greater explicit reports of COVID-19-as-dangerous and precautions-as-necessary with small effects. Replicated relationships between COVID-as-dangerous explicit associations and mental health had very small effects. CONCLUSIONS: Implicit associations did not predict mental health but there was evidence that stronger COVID-19-as-dangerous explicit associations are weakly associated with worse mental health.

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Abstract This study aimed to explore physicians’ and pharmacists’ knowledge, attitudes, and practice (KAP) regarding the prevention and treatment of cardiovascular toxicity associated with cancer treatment. A multicenter cross-sectional study included physicians and pharmacists between April 2023 and June 2023. The study included 918 participants (514 physicians and 404 pharmacists). The average scores of knowledge, attitudes, and practice were 11.6 ± 3.39, 24.7 ± 2.6, and 26.3 ± 6.8 points. Sufficient knowledge was significantly associated with age ≥ 41 years (odds ratio (OR) = 2.745, 95% confidence interval (CI) 1.086–6.941, P = 0.033), male (OR = 2.745, 95% CI 1.150–2.223, P = 0.005), bachelor’s degree (OR = 0.084, 95% CI 0.013–0.533, P = 0.009), master’s degree and above (OR = 0.096, 95% CI 0.015–0.609, P = 0.013), physician occupation (OR = 7.601, 95% CI 1.337–43.207, P = 0.022), pharmacy department (OR = 18.858, 95% CI 3.245–109.57, P = 0.001), oncology department (OR = 4.304, 95% CI 2.426–7.634, P

Abstract Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas.

Yan Wu,1 Zhenzhen Xu,2 Jing Dong,3 Wenzhong Zhang,2 Jing Li,2 Hong Ji1 1Department of Nursing, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, 250014, People’s Republic of China; 2School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, People’s Republic of China; 3School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, 271016, People’s Republic of ChinaCorrespondence: Hong Ji, Department of Nursing, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, 250014, People’s Republic of China, Tel +86-13791120369, Email honghongji-2005@163.comBackground: Older age and female sex are risk factors for osteoarthritis and osteoporosis (OP). This study evaluated the knowledge, attitudes, and practices of patients with knee osteoarthritis (KOA) in China regarding OP and its prevention. This cross-sectional, questionnaire-based study enrolled patients with KOA at four grade-A tertiary hospitals in Shandong Province between 1st September and 20th November 2022.Methods: The administered questionnaire contained 55 items across four dimensions (demographic information, knowledge, attitude, and practice). Logistic regression analyses were performed to identify factors associated with an overall questionnaire score ≥ 70% of the maximum possible score. SPSS 26.0 was used for the analyses; P< 0.05 was considered significant.Results: The analysis included 434 participants (261 females). The median knowledge, attitude, and practice scores were 7 (interquartile range: 5– 10) (possible range, 0– 17 points), 44 (interquartile range: 42– 49) (possible range, 11– 55 points), and 43 (interquartile range: 38– 47) (possible range, 13– 65 points), respectively. Multivariable logistic regression indicated that female sex (odds ratio [OR], 2.421; 95% confidence interval [95% CI] 1.558– 3.762; P< 0.001), age 56– 65 years-old (OR, 4.222; 95% CI, 1.763– 10.109; P=0.001 vs ≤ 55 years-old), age > 65 years-old (OR, 4.358; 95% CI, 1.863– 10.195; P=0.001 vs ≤ 55 years-old), middle/high/technical secondary school education (OR, 1.853; 95% CI, 1.002– 3.428; P=0.049 vs primary school or below), and having KOA for 4– 5 years (OR, 2.682; 95% CI, 1.412– 5.094; P=0.003 vs ≤ 3 years) were independently associated with a high KAP score.Conclusion: There is room for improvement in the knowledge and practices of patients with osteoarthritis in China regarding OP. The findings of this study may facilitate the design and implementation of education programs to increase awareness about OP prevention among patients with KOA.Keywords: osteoarthritis of the knee, osteoporosis, disease prevention, surveys and questionnaires, health knowledge, attitudes, practice

Background: Birth preparedness and complication readiness serve as valuable tactics for enhancing the provision of maternal and child care services, consequently reducing morbidity and mortality associated with childbirth. Anticipating childbirth and possessing prior awareness of potential complications enables women to access services promptly. Methods: In 2022, a community-based cross-sectional study was conducted involving a sample of 480 pregnant women. Data on Birth Preparedness and Complication Readiness (BPCR) were gathered using a pretested and standardized questionnaire. Data analysis was performed utilizing SPSS version 20. The questionnaire encompassed inquiries regarding birth preparedness, such as the selection of a health facility, designation of a birth attendant, arrangement for transportation, securing a blood donor, and whether the woman had saved money for delivery. Complication readiness was assessed through questions concerning complications during pregnancy, delivery, and the neonatal period. Results: Out of the 480 pregnant women included in the study, 30.8% were classified as belonging to the upper middle class. Additionally, 55% of the participants had experienced multiple pregnancies, while 74.2% were identified as being in their third trimester. Furthermore, 70% of the women had undergone their initial Antenatal Care (ANC) checkup before reaching 12 weeks of gestation. Despite these demographics, the study found a general lack of awareness regarding Birth Preparedness and Complication Readiness (BPCR) among the participants. Conclusion: The study indicates a low level of birth preparedness and complication readiness within Rural Tamilnadu. To address this issue effectively, targeted health education strategies should be directed towards young couples and adolescent girls, who represent the future mothers. Implementing both individual and community-level interventions focused on birth preparedness and complication readiness has the potential to enhance maternal service delivery and ultimately reduce both morbidity and mortality rates associated with childbirth.

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas. [ABSTRACT FROM AUTHOR]

This study aimed to explore physicians' and pharmacists' knowledge, attitudes, and practice (KAP) regarding the prevention and treatment of cardiovascular toxicity associated with cancer treatment. A multicenter cross-sectional study included physicians and pharmacists between April 2023 and June 2023. The study included 918 participants (514 physicians and 404 pharmacists). The average scores of knowledge, attitudes, and practice were 11.6 ± 3.39, 24.7 ± 2.6, and 26.3 ± 6.8 points. Sufficient knowledge was significantly associated with age ≥ 41 years (odds ratio (OR) = 2.745, 95% confidence interval (CI) 1.086–6.941, P = 0.033), male (OR = 2.745, 95% CI 1.150–2.223, P = 0.005), bachelor's degree (OR = 0.084, 95% CI 0.013–0.533, P = 0.009), master's degree and above (OR = 0.096, 95% CI 0.015–0.609, P = 0.013), physician occupation (OR = 7.601, 95% CI 1.337–43.207, P = 0.022), pharmacy department (OR = 18.858, 95% CI 3.245–109.57, P = 0.001), oncology department (OR = 4.304, 95% CI 2.426–7.634, P < 0.001), cardiology department (OR = 3.001, 95% CI 1.387–6.492, P = 0.005), hospitals located in Eastern China (OR = 1.957, 95% CI 1.120–3.418, P = 0.018), and hospitals located in Western China (OR = 3.137, 95% CI 1.783–5.518, P < 0.001). Positive attitudes were significantly associated with a senior professional title (OR = 2.989, 95% CI 1.124–7.954, P = 0.028) and hospitals located in Eastern China (OR = 0.424, 95% CI 0.257–0.698, P = 0.001), Western China (OR = 0.231, 95% CI 0.136–0.394, P < 0.001), and Southern China (OR = 0.341, 95% CI 0.198–0.587, P < 0.001). Proactive practice was significantly associated with male (OR = 1.414, 95% CI 1.029–1.943, P = 0.033), senior professional title (OR = 3.838, 95% CI 1.176–12.524, P = 0.026), oncology department (OR = 3.827, 95% CI 2.336–6.272, P < 0.001), and cardiology department (OR = 2.428, 95% CI 1.263–4.669, P = 0.008). Both physicians and pharmacists had positive attitudes toward the prevention and treatment of cardiovascular toxicity associated with cancer treatment, while their knowledge and practice were not as proactive. [ABSTRACT FROM AUTHOR]

This study aimed to develop and validate an instrument, the Sustainable Diets Questionnaire (SDQ), to assess the knowledge, attitude, and practice of sustainable diets in adult populations. A panel of four nutritionists identified 63 items through a literature review and refined them to a 54-item model for validation across four domains: Knowledge domain (K, eight items), Attitude domain (A, 18 items), Practice domain (P, 16 items) and Consumption Habits domain (D, 12 items). The validation process consisted of a pilot with 86 individuals (Phase 1) and a larger study with 389 participants (Phase 2). Confirmatory Factor Analysis (CFA) was conducted in both phases to verify model fit. In Phase 1, the initial four-factor model did not converge, indicating a need for item modification and a revised three-factor model (K domain, eight items; A domain, 18 items; new P domain, 28 items). In Phase 2, the new model showed improvement in fit indices with a Scaled Chi-Square of 2.415, Comparative Fit Index (CFI) of 0.863, Goodness of Fit Index (GFI) of 0.747, Tucker-Lewis Index (TLI) of 0.851 and the Root Mean Square Error (RMSE) was 0.066, although some indices fell below the 0.9 threshold. The Cronbach's α for the Knowledge, Attitude, and Practice domains were 0.9, 0.96, and 0.897, respectively, with an overall α of 0.959. There was no significant difference between the first and second attempts of the SDQ model, indicating good test-retest reliability. There was also a significant positive correlation between the response scores of K, A, and P domains (K vs. A, r = 0.575, p < 0.001; K vs. P, r = 0.496, p ≤ 0.001 and A vs. P, r = 0.665, p ≤ 0.001). The study concludes that the three-factor model of SDQ is a valid and reliable tool for understanding the knowledge, attitudes, and practices of sustainable diets among adults. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to understand how university student's academic discipline relates to sleep factors including attitudes, hygiene, quality, and duration. Methods: Using a cross-sectional approach, a 30-min survey was advertised to students at two Canadian universities in March of 2022. Sleep measures included the Dysfunctional Beliefs and Attitudes Scale, the Sleep Hygiene Index, the Pittsburgh Sleep Quality Index, and the Insomnia Severity Index. Academic discipline was categorized into four groups: Health, Arts, Sciences, and Engineering. Multiple linear regressions were used to investigate (1) the effect of academic discipline on sleep measures, and (2) the effect of academic discipline, dysfunctional sleep attitudes, and sleep hygiene practices on insomnia, sleep quality and duration. Results: 1,566 students completed the survey (69.4% women; 80.3% undergraduates). Compared to Health students, Art students had worse dysfunctional sleep attitudes, hygiene, quality, and insomnia severity (p < 0.001). This relationship disappeared after controlling for differences in mental health (p = 0.05). Art students had longer sleep durations (p < 0.01), whereas Engineering students had shorter sleep durations (p < 0.05). When dysfunctional sleep attitudes and hygiene were included in the model, both academic discipline (p < 0.05) and sleep hygiene (p < 0.001) were associated with sleep duration. Sleep hygiene and attitudes were also associated with sleep quality and insomnia severity (p < 0.001), while academic discipline was not (p = 0.05). Discussion: These results suggest differences in sleep quality across academic discipline are impacted by dysfunctional sleep attitudes, sleep hygiene, and mental health, whereas differences in sleep duration appear to be independent of these factors. Overall, students in different academic disciplines have unique relationships with sleep and thus may require targeted approaches to improve their sleep. Future interventions should focus on supporting sleep hygiene and attitudes to improve students' sleep and well-being. [ABSTRACT FROM AUTHOR]

Background: Literature reviews reveal poor knowledge and awareness of palliative care in the public. Health literacy deficits impact access to palliative care. Objectives: The aim of this manuscript is to explore the public perception of palliative care in Germany. Design: Triangulated qualitative research design: a snowball-spread online survey and a random pedestrian survey. Setting/Subjects: Citizens in Germany. Results: The pedestrian survey (n = 100) revealed 34% of the participants being not familiar with palliative care. The online survey (n = 994) 5.7% of participants reported to not know what palliative care was. The public's perception of palliative care is mainly medicine oriented, referring to inpatient care for the immediately dying; however, further significant misperceptions were scarce. Conclusions: The public perception shows an indistinct picture of palliative care, and some misconceptions about the objectives and areas of responsibility of the subject, meanwhile, palliative care is known to a majority of people. Understanding partly incomplete pictures of patients and relatives may help to react appropriately in staff–patient interactions and improve public relations. [ABSTRACT FROM AUTHOR]

Background: Reading nutritional labelling helps consumers select healthier food, thereby benefitting their oral health. The purpose of this study was to describe the knowledge, attitudes, and practices (KAPs) of parents and carers of children and preteens, associated with reading nutritional labelling, selecting sweetened ultra-processed foods, and their impact on oral health. Materials and Methods: This was a descriptive cross-sectional study in which a validated questionnaire was administered to 298 parents and caregivers of children aged 1–12 years from different districts in Villavicencio, Colombia. Participants' scores, based on the number of correct answers, were used to classify their level of KAP as low, medium, or high. In addition, the frequency of responses, the KAP levels, and the median scores were analysed. Finally, associations were determined using the chi-square test. Results: Most participants reached a medium level in terms of knowledge (41.6%) and attitudes (49.3%) and a low level in terms of practices (43.3%). An association was found between participants' level of KAPs and their socioeconomic and educational level (p < 0.05). Conclusions: The study findings reveal inadequate KAPs associated with nutritional labelling, adequate food selection, and the importance of oral health. [ABSTRACT FROM AUTHOR]

Immobility complications are challenging for healthcare professionals because they negatively affect individuals' overall health. Following recovery from a severe illness or accident, patients' movement is often impaired, so they may be unable to perform activities of daily living, thus impacting their quality of life. Nurses play a proactive role in preventing immobility's physical and mental impacts. However, several studies have suggested that nurses worldwide lack knowledge, attitude, and practice (KAP) toward immobility complications. Therefore, stakeholders must prioritize this problem to optimize healthcare provision. Accordingly, this study aimed to explore nurses' KAP toward immobility complications. A scoping review of relevant articles utilized PubMed, Scopus, Cochrane, Web of Science, Embase, CINAHL Plus, and EBSCOhost databases. Hawker's tool assessed the risk of bias among the included primary articles. The results were analyzed according to the KAP toward four main immobility complications: pressure injury, deep vein thrombosis, ventilator-associated pneumonia, and urinary tract infection. The database search generated a total of 1398 articles. Of them, only 39 articles met the inclusion criteria for the review. Most articles concluded that nurses' KAP were below the expected level. Education and training were found to optimize nurses' KAP. The KAP toward immobility complications was good among nurses with work experience, high academic grades, and prior training. These findings indicate that nursing staff should receive continuous education and in-service training to improve their KAP toward immobility complications. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity is increasing worldwide at an alarming rate, yet obesity remains under-addressed during clinic encounters. A lack of training in how to treat obesity is one crucial factor contributing to this deficiency. Objective: This study explored resident physicians' perceptions of their education on obesity and its relationship with confidence and practice behaviors when caring for patients with obesity. Design: A survey was distributed to residency directors to share with residents in their programs. Participation was voluntary and anonymous. Data was collected over a 3-month period. Participants: Residents in Family Medicine and Internal Medicine programs in West Virginia and Indiana who saw adult patients in an ambulatory care setting. Main Measures: The electronic survey queried the presence of a formal curriculum on Obesity Medicine (OM) and each resident's knowledge, confidence, practice behaviors, and attitudes pertaining to OM. Key Results: The survey was distributed to 490 residents in 12 programs. Response rate was 22.9% (112 resident physicians). All respondents felt that medical training in obesity should be strengthened. Residents who reported having a formal curriculum on OM were more likely than those without a curriculum to rate their confidence as "high" when discussing weight (35.0% vs. 16.7%, p = 0.03) and when counseling patients about diet and nutrition (37.5% vs. 18.1%, p = 0.02). They also more frequently reported learning enough from faculty to manage obesity (65.0% vs. 29.2%, p < 0.001). Residents with an OM curriculum reported discussing obesity as a problem with patients (100.0% vs. 86.1%, p = 0.01), and completing motivational interviews (90.0% vs. 58.3%, p = < 0.001), more frequently than their peers without a curriculum. Conclusions: Residents with a formal OM curriculum were more confident in addressing and discussing obesity with patients. Formal training in OM will strengthen resident training to better address and treat patients with obesity. [ABSTRACT FROM AUTHOR]

Objective: The present study explored Swedish clinical psychologists' attitudes and practices of informing patients about possible negative effects of psychological treatment. Method: An anonymous online survey with closed and open-ended questions was distributed via Facebook and two mailing lists. In total, 320 clinical psychologists (age M = 38.6, SD = 10.3; 76% women; 77.3% Cognitive Behavior Therapy) completed the survey. Responses were analyzed using χ2, binominal regression analysis, and thematic analysis. Results: No significant associations were identified between demographic variables selected a priori and informing patients about possible negative effects, i.e., years in practice, therapeutic orientation, age, and male gender. The thematic analysis resulted in several positive (e.g., creating realistic expectations of treatment and increasing resilience) and negative attitudes (e.g., causing excessive worry) of sharing patients with information about possible negative effects. It also revealed various factors that prevent an open discussion on the topic, despite being seen as important. Conclusion: The need to offer patients information about possible negative effects should be included in ethical guidelines, codes of conduct, and taught during clinical training. Lack of knowledge, fear, lack of time, and patient characteristics however seem to prevent therapists from discussing the issue during the informed consent procedure. [ABSTRACT FROM AUTHOR]

Sanitation is the quality of living that is expressed in a clean home, a clean firm, a clean business, and a clean community to prevent disease and promote health. Poor water, sanitation, and hygiene (WASH) negatively impacts health, development, economic and social growth, and significantly hinders poverty alleviation. This study aimed to assess the knowledge, attitude, and practices regarding water, sanitation, and hygiene among holy water users in Amhara regional state Orthodox churches, Ethiopia, in 2024. An institutional-based cross-sectional study was conducted in April 2023 in five randomly selected Orthodox Tewahido churches in the Amhara region. The study employed an interviewer-administered structured questionnaire to gather data from 423 study participants. The response rate was 91% and 219 (57% of the respondents) were female. Good knowledge, positive attitudes, and good practice on WASH was found in 39.2, 42.5, and 47.2%, respectively. In conclusion, Ethiopian Amhara Orthodox Tewahido churches, holy water users frequently lacked information, had an unfavorable attitude, and practiced poor WASH. This demands for immediate effort to raise knowledge about health education and hygiene in order to impact holy water user’s attitudes toward personal and communal cleanliness and sanitation. [ABSTRACT FROM AUTHOR]

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In January 2021, Australia initiated a national COVID-19 vaccine rollout strategy but faced setbacks, leading to negative press and media controversy, which may have diminished vaccine confidence. This study aimed to assess the factors influencing vaccine confidence in Australian adults (≥18 years of age) following the administration of a COVID-19 vaccine. Conducted at Blacktown Hospital, Sydney, a cross-sectional survey with 1053 respondents gauged vaccine confidence and influencing factors. The results showed overall high confidence (mean score 33/40). Trusted sources included the Australian Department of Health (77.8%), NSW Health (76.7%), and general practitioners (53.7%), while social media was distrusted (5.9%). The motivations for vaccination varied: university-educated individuals prioritised personal health (X2 = 17.81; p < 0.001), while religious and/or older respondents (≥50 years of age) emphasised community (X2 = 11.69; p < 0.001) and family protection (X2 = 17.314; p < 0.001). Multivariate logistic regression revealed use of the Australian Department of Health website as a trusted source of COVID-19 information as the strongest predictor of high confidence (>30; OR 1.43; p = 0.041), while exposure to fake news decreased confidence (OR 0.71; p = 0.025). The study underscores the importance of reliable health information sources in bolstering vaccine confidence and highlights the detrimental effects of misinformation. Promoting awareness of trustworthy health channels is crucial to combat vaccine hesitancy in Australia. [ABSTRACT FROM AUTHOR]

BackgroundOpioid and methamphetamine co-use is increasing across the USA with overdoses involving these drugs also rising. West Virginia (WV) has led the US in opioid overdose death rates since at least 2013 and rising co-use of methamphetamine with opioids has played a greater role in deaths over the last 5 years.MethodsThis study used rapid ethnography to examine methods and motivations behind opioids and methamphetamine co-use from the viewpoint of their consumers. Participants (n = 30) were people who injected heroin/fentanyl also using methamphetamine who participated in semi-structured interviews.ResultsWe found multiple methods of co-using opioids and methamphetamine, whether alternately or simultaneously and in varying order. Most prioritized opioids, with motives for using methamphetamine forming three thematic categories: 'intrinsic use', encompassing both inherent pleasure of combined use greater than using both drugs separately or for self-medication of particular conditions; 'opioid assisting use' in which methamphetamine helped people manage their existing heroin/fentanyl use; and 'reluctant or indifferent use' for social participation, reflecting methamphetamine's low cost and easy availability.ConclusionsMethamphetamine serves multiple functions among people using opioids in WV. Beliefs persist that methamphetamine can play a role in preventing and reversing opioid overdose, including some arguments for sequential use being protective of overdose. 'Reluctant' uptake attests to methamphetamine's social use and the influence of supply. The impact on overdose risk of the many varied co-use patterns needs further investigation.