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INTRODUCTION: Expanding access to doula care is a key strategy for improving the perinatal experiences and health outcomes of birthing people of color in the U.S. This study investigates the future of maternal healthcare in the U.S. from the perspective of doulas and highlights emerging technology and other opportunities related to strengthening the doula workforce. METHODS: The study recruited community doulas from 12 unique U.S. states, ensuring at least half of the doulas predominantly served communities of color. Doulas (N = 26) participated in semi-structured, futures-oriented interviews that explored their experiences providing care during the COVID-19 pandemic and utilization of technology. A subset of doulas (n = 8) were engaged in interactive workshops where they envisioned alternative futures for doula care and childbirth. Interviews and workshops were analyzed using the Framework Method. RESULTS: The COVID-19 pandemic heightened technology use among doulas and increased client accessibility. Social media serves as a unique space for critical community building and client outreach. Doulas reported opportunities to strengthen and mobilize the future workforce: recognizing doula care as a reimbursable service by health insurers, utilizing doula collectives for community practice to decrease burnout, increasing emotional support for doulas, and instilling a chain of learning through mentorship. DISCUSSION: Futures thinking served as a valuable approach for doulas to illuminate the implications of present-day challenges and empowered doulas to design roadmaps toward better futures for doulas and maternal health. Doulas should be engaged as partners to hold a meaningful decision-making role when discussing policies, employment structures, emerging technology, and other aspects of doulas positioning within the healthcare system.

Burnout in the medical workforce is a growing global concern. Visual arts-based interventions can be a novel way to mitigate burnout and bolster resilience in medicine. Improving tolerance of ambiguity and uncertainty has been associated with decreased rates of burnout in clinicians. No known systematic review exists summarizing the evidence behind the use of visual arts-based interventions to mitigate burnout in clinicians. The authors conducted a systematic literature review of PubMed, EMBASE, and CINAHL in November 2022 using the terms: art, medicine, burnout, and uncertainty. The authors review the evidence for the effects of visual arts-based interventions on clinician burnout. The search identified 58 articles, of which 26 met study inclusion criteria and were assessed by 2 reviewers. These studies reported mixed methods assessments of changes in burnout, empathy, and stress. Overall, visual arts-based interventions promoted empathy, connectedness, and tolerance of ambiguity and had positive effects on burnout; however, some results were mixed. Visual arts-based interventions to mitigate burnout show promise, and additional research should focus on feasibility and longer-term outcomes.

PurposeThis commentary proposes a new direction to train the MCH workforce by leveraging today's rapidly changing innovation and technology to address persistent health inequities.DescriptionWe outline the creation of an MCH technology and innovation training pipeline developed by harnessing creative funding opportunities, diversifying training modalities, and expanding partnerships beyond traditional academic-practice partners, that be replicated and adapted by other academic programs.AssessmentTechnology and innovation will continue to be a growing intersection between health and equity, and we must create a robust pipeline of MCH leaders prepared to collaborate with entrepreneurial and innovation leaders.ConclusionTechnology offers an important opportunity to improve MCH outcomes and reduce disparities, but only if we train the MCH workforce to seize these opportunities.

We provide an analysis of design in global health through a systematic framework to understand what it is, the value it can add, and how it compares to other common problem-solving approaches in global health. We make the case that design is an essential approach when tackling complex global health challenges.

BackgroundThere is limited evidence regarding the ways in which displacement disrupts social norms, expectations and trajectories for adolescent girls and young women and the resulting impacts on their risks of violence. This knowledge gap is especially marked with regards to Syrian adolescent girls and young women seeking refuge in Turkey. We explored risks of gender-based violence against Syrian adolescent girls and young women in Turkey and examined how these risks were shaped by their displacement.MethodsData were collected in August 2016 in Izmir, Turkey through five sex-specific focus group discussions with Syrian adolescents and young people (aged 15-25 years) and two mixed gender focus group discussions with Syrian adults (18 years and older). Group discussions covered the issues facing Syrian adolescents and young women in Turkey, and how these were influenced by their displacement. Discussions in Arabic were audio-recorded, transcribed and translated into English. Data were coded inductively, and analysed thematically.ResultsSyrian adolescent girls and young women expressed an increased sense of vulnerability to violence since their displacement. Due to financial strains and limited educational opportunities, they were often encouraged by parents to work or marry, both of which they perceived to increase the risks of violence. In contrast, some adults suggested that marriage could protect adolescent girls and young women from risks of violence associated with working. Being alone outside the home was viewed as risky by all participants due to pervasive sexual, verbal and physical harassment, aggression, and even kidnapping attempts. To limit these risks, many parents reported keeping adolescent girls and young women at home, or ensuring that they were accompanied by male relatives when in public.ConclusionsSyrian adolescent girls and young women face multiple risks of violence following displacement related to altered social trajectories. Some family-based strategies to protect young women from violence could reinforce restrictive gender norms and increase risks of violence. Interventions to address violence should include providing safe spaces, access to education and safe transport for young women, and financial support for families as well as community-based interventions to address the daily risks of sexual harassment in public spaces.

The potential of new developments in mobile technology, with capabilities for anytime, anywhere wireless access, to affect pre-engineering education and technical literacy at the K-12 level remains poorly understood Mobile access to digital libraries provides unique opportunities for leveraging valuable experiences outside of the classroom. This paper presents a user needs analysis of teachers, students and parents with regard to understanding the potential of such mobile digital library services to enhance science and technology learning in informal environments for students in U.S. grades 4-5 and middle school To study this area we discuss a methodology at the intersection of design and research that borrows from qualitative research methods and traditional user-centered design, together with frameworks for translating qualitative data into concrete user needs. We present a summary of twelve need "themes" that emerged from the analysis together with recommendations for how these themes inform the development of a mobile digital library infrastructure and its digital learning resources. The recommendations are illustrated on an informal learning scenario intended for a pre-engineering exercise using resources ftom the NEEDS engineering education digital library at www.needs.org.

Purpose This case study provides a high-level overview of the human-centered design (HCD) or 'design thinking' process and its relevance to public health. Description The Best Babies Zone (BBZ) initiative is a multi-year project aimed at reducing inequities in infant mortality rates. In 2012, BBZ launched pilot programs in three US cities: Cincinnati, Ohio; New Orleans, Louisiana; and Oakland, California. The Alameda County Public Health Department (ACPHD), the lead for the Oakland BBZ site, identified HCD as a promising approach for addressing the social and economic conditions that are important drivers of health inequities. HCD is a process for creating innovative products, services, and strategies that prioritizes the needs of the intended population. ACPHD partnered with the Gobee Group (a social innovation design consultancy) to develop the Design Sprint. The Design Sprint was a 12-week pilot in which 14 professionals from nine organizations used the HCD process to develop concepts for stimulating a vibrant local economy in the Oakland Best Babies Zone. Assessment Thirty- to sixty-minute semi-structured interviews were conducted with all 14 individuals involved in the Design Sprint. With the exception of one interview, the interviews were audio-recorded, transcribed, and inductively coded to identify themes. Conclusion Our experience suggests that HCD can: enhance community engagement; expedite the timeframe for challenge identification, program design, and implementation; and create innovative programs that address complex challenges., Author(s): Jessica Vechakul[sup.1] , Bina Patel Shrimali[sup.2] , Jaspal S. Sandhu[sup.3] Author Affiliations: (1) University of California, Berkeley, Berkeley, CA, USA (2) Alameda County Public Health Department, Oakland, CA, USA [...]

The evaluation of postural stability during quiet stance, step up and step up task with perturbation using posturography could be useful in treatment and outcome monitoring in chronic low back pain rehabilitation (CLBP). The aims of this study were twofold and investigating 1) differences of postural stability measures between CLBP patients and healthy participants during above mentioned tasks. 2) postural stability characteristics between control and movement impairment groups of CLBP patients on above tasks. Fourteen CLBP and fifteen normal individuals participated and posturography outcome variables were obtained during above tasks. The low back pain subjects showed significantly different anterior-posterior (p=0 .01) as well as medio- lateral (p=0.05) postural stability characteristics during the step up task with external perturbation, whereas quiet standing and simple step up task did not show any differences. In addition to these values, in CLBP population, the maximum COP excursion (p=0.01), standard stability (p=0.02) and the stability scores (p=0.02) were also found significant in step up with perturbation task compared to healthy participants. As the task difficulty increases CLBP patients exhibited significantly different postural stability characteristics compared to healthy participants. Conversely, sub-group analysis in CLBP patients revealed significant differences only in medio-lateral COP excursions during normal standing (p=0.005). No significant differences were observed in tasks of higher difficulties such as step up and step up task with lateral perturbation in-between patients with movement and control impairment groups of CLBP. These findings have implications for assessment and optimizing postural control interventions on functional back pain rehabilitation.

AbstractGolf is a popular sport and golf swing is a complex movement which requires a coordinated sequence of muscle activity. Two types of golf swing exists i.e. “Classical” and “Modern”. Classical swing differs from modern swing in several respects, which are important when considering their effects on the lower back. The present study compared muscle activation amplitudes in the trunk region of golfers during two different types of golf swing. 22 golfers (21.5 years ±3.4) were instructed to perform modern and classical golf swing and surface EMG activity was recorded from external oblique (E.O.), internal oblique (I.O.), and erector spinae (E.S.) muscles of both sides. Results showed muscle activity of right and left side of E.O. and I.O. to be lower in modern swing than classical swing (significant difference p menor que 0.05 in downswing and impact phase), whereas it is higher for both sides E.S. in modern swing. The E.S. muscle activity during follow-through phase was significantly higher (p menor que 0.05) in modern swing compared to classical swing. Significant differences in E.S. and other muscles activity suggest inappropriate recruitment of these muscles in golfers during the modern swing. EMG evidence proposes that the modern golf swing produces more extension forces in the lower back compared with the forces of classical swing.Resumen El Golf es un deporte popular y el swing en golf es un movimiento complejo que reclama una secuencia coordinada de movimientos. Existen dos tipos de swing: el clásico y el moderno. El Clásico se diferencia del Moderno en varios aspectos que son importantes cuando se consideran sus efectos en la parte inferior de la espalda. Este estudio comparó la amplitud de la activación muscular en el tronco de los golfistas al realizar los dos tipos de swing. Veintidos jugadores de golf (21.5 años ±3.4) fueron instruidos para realizar el swing moderno y clásico, tomándose la actividad muscular (actividad EMG) del Oblicuo Externo (O.E.), Oblícuo Interno (O.I), y Erector Spinae (E.S.) de ambos lados del cuerpo. Los resultados mostraron que la actividad muscular de los dos lados del cuerpo fue menor en el swing moderno que en el clásico, tanto en el O.E. y O.I. (diferencia significativa p menor que 0.05) en el downswing y en la fase de impacto, mientras que fue mayor, en ambos lados del cuerpo, en el E.S. en el swing moderno. La actividad del E.S. durante la fase de seguimiento (follow-through) fue significativamente mayor (p menor que 0.05) en el swing moderno en comparación con el clásico. Las diferencias significativas en la actividad muscular del E.S. y en otros grupos musculares, sugieren el reclutamiento inapropiado de estos músculos en los jugadores de golf. La actividad electromiográfica (EMG) evidenció que el swing moderno produce una mayor extension de las fuerzas en la parte inferior de la espalda, en comparación con las fuerzas que produce el swing clásico.

Purpose: Eccentric exercises may cause fatigue. Fatigue in lower body causes decline in dynamic balance which may cause injury. The purpose of the study was to examine the changes in dynamic balance before and after an acute bout of eccentric exercise using Y-balance test (lower quarter) among athletes and nonathletes and to find injury risk by change in balance. Materials and Methods: This study investigated 39 subjects which were divided into two groups: Group 1 (n = 19) athletes (mean age, 21.89 ± 2.62 years; height, 2.96 ± 0.25 m; mass, 66.52 ± 10.05 kg) and Group 2 (n = 20) nonathletes (mean age, 23.95 ± 1.73; height, 2.77 ± 0.30 m; mass, 60.12 ± 8.25 kg). Before and after acute bout of eccentric exercise, all subjects underwent an assessment for dynamic balance using Y-balance test-lower quarter. Results: After an acute bout of eccentric knee exercises, dynamic balance was not reduced significantly (P > 0.05) in Group 1 (athletes) as well as in Group 2 (nonathletes). Conclusion: In the current study by performing eccentric knee exercises, dynamic balance was not reduced in both the groups. Therefore, these eccentric knee exercises can be done by both the groups without risk of getting injured. [ABSTRACT FROM AUTHOR]

Background: There is an increased prevalence of obesity which is an important risk factor for cardiovascular and mortality risk. Because of the large population, a preferred method of measuring body fat should be simple, portable, and reliable. This study was aimed at measuring the body composition of Indian adults using the Karada scan Omron HBF-701 model. Methods: 64 healthy adults participated in this study including 30 males and 34 females with a mean age of 21 ± 2.60 years and a mean body mass index of 22.58 ± 2.85 kg/m². The measurement was taken with the prescribed guidelines. Results: The results included mean fat % 25.31 ± 6.01, body age 28.96 ± 8.29, resting metabolism 1422.13 ± 227.86 kcal, visceral fat % 4.90 ± 2.97, subcutaneous fat % 19.74 ± 6.09, total muscle mass 31.20 ± 6.27, arms fat % 31.27 ± 10.81, trunk fat % of 16.89 ± 5.43, and legs fat % 29.43 ± 9.45. Conclusion: This study concluded that the Karada scan is a novel and rapid method to reliably measure the different variables of body composition. [ABSTRACT FROM AUTHOR]

Background: There is an increased prevalence of obesity, which is an important risk factor for cardiovascular and mortality risk. Because of the large population, a preferred method of measuring body fat should be simple, portable, and reliable. This study was aimed at measuring the body composition of Indian Adults using the karada scan Omron HBF-701 model. Methods: Sixty-four healthy adults participated in this study including 30 males and 34 females with a mean age of 21 ± 2.60 years and a mean body mass index (BMI) of 22.58 ± 2.85 kg/m2. The measurement was taken with the prescribed guidelines. Results: The results included mean fat % of 25.31 ± 6.01, body age 28.96 ± 8.29, resting metabolism 1422.13 ± 227.86 kcal, visceral fat % of 4.90 ± 2.97, subcutaneous fat % of 19.74 ± 6.09, total muscle mass 31.20 ± 6.27, arms fat % of 31.27 ± 10.81, trunk fat % of 16.89 ± 5.43, and legs fat % of 29.43 ± 9.45. Conclusion: This study concluded that the Karada scan is a novel and rapid method to reliably measure the different variables of body composition. [ABSTRACT FROM AUTHOR]

Context: Improved ankle joint muscular strength decreases the risk of ankle injury; thus, ankle joint muscular strength plays an important role in the prevention of ankle injuries. Aims: To assess the relationship between the peak muscle strength of plantar flexors and dorsiflexors and power of single leg hop jump. Settings and Design: The study design was a cross-sectional observational study. Athletes of university, state, and national levels aged 18–25 years were recruited from Guru Nanak Dev University, Amritsar, Punjab for this study with mean ± standard deviation of age (20.08 ± 1.94 years), body weight (63.43 ± 10.23 kg), and height (170.67 ± 9.25 cm). Methods and Materials: Isokinetic dynamometer (Biodex Medical System Inc., Shirley, NY, USA) was used to determine ankle concentric isokinetic strength. The isokinetic strength of plantarflexors and dorsiflexors at speeds of 30° and 120°/s was measured for both legs and afterward single-leg hop jump performance was measured on the Kinematic Measurement System. Statistical analysis used: Pearson correlation coefficient was used to determine the relationship between isokinetic muscle strength and jump performance. Results: The results showed a high correlation (0.6< | r |<0.8) between the strength of plantarflexors and power of single-leg hop jump and a moderate correlation (0.4< | r |<0.6) between the strength of dorsiflexors and power of single-leg hop jump. Conclusions: The measurement of peak plantarflexors muscle strength and peak dorsiflexors muscle strength is useful in clinical practice to improve jump performance in athletes training for sports such as volleyball and basketball. [ABSTRACT FROM AUTHOR]

Abstract Background Aerobic capacity (VO2max) is highly dependent upon body composition of an individual and body composition varies with ethnicity. The purpose of this study was to check the concurrent validity of the non-exercise prediction equation developed by Jackson and colleagues (1990) using percentage body fat as a variable in Asian Indian adults. Methods One hundred twenty college-aged participants (60 male, 60 female, mean age 22.02 ± 2.29 yrs) successfully completed a maximal graded exercise test (GXT) on a motorized treadmill to assess VO2max. VO2max was then estimated by the non-exercise prediction equation developed by Jackson and colleagues (1990) using percentage body fat. Percentage body fat was calculated by three different models (Sandhu et al’s fat mass equation, Durnin-womersley’s 4 site percentage body fat and Jackson & Pollock’s 4 site percentage body fat) and was used in the above equation. The results of VO2max obtained using “gold standard” treadmill methods were then compared with the three results of VO2max obtained by Jackson et al’s equation (using three different models to calculate percentage body fat) and it was determined which equation is best suited to determine percentage body fat and in turn VO2 max for Indian population. Results Jackson et al’s prediction equation overpredicts VO2max in Asian Indian subjects who have a lower VO2max (33.41 ± 14.39 ml/kg/min) than those reported in other age matched populations. percentage body fats calculated by the three equations were significantly different and the correlation coefficient (r) between VO2max calculated by Jackson and colleagues (1990) using Sandhu et al’s equation for percentage body fat with VO2 max calculated using treadmill (gold standard) (r = .817) was found slightly more significantly correlated than the other two equations and was not statistically different from the measured value. Conclusions This study proves that VO2max equation using Sandhu et al’s model for percentage body fat yields more accurate results than other studied equations in healthy college-aged participants in India.

Abstract Background Work urgency, accuracy and demands compel the computer professionals to spend longer hours before computers without giving importance to their health, especially body weight. Increase of body weight leads to improper Body Mass Index (BMI) may aggravate work related musculoskeletal discomfort and occupational-psychosocial stress. The objective of the study was to find out the effect of BMI on work related musculoskeletal discomforts and occupational stress of computer workers in a developed ergonomic setup. Methods A descriptive inferential study has been taken to analyze the effect of BMI on work related musculoskeletal discomfort and occupational-psychosocial stress. A total of 100 computer workers, aged 25-35 years randomly selected on convenience from software and BPO companies in Bangalore city, India for the participation in this study. BMI was calculated by taking the ratio of the subject's height (in meter) and weight (in kilogram). Work related musculoskeletal discomfort and occupational stress of the subjects was assessed by Cornell University's musculoskeletal discomfort questionnaire (CMDQ) and occupational stress index (OSI) respectively as well as a relationship was checked with their BMI. Results A significant association (p < 0.001) was seen among high BMI subjects with their increase scores of musculoskeletal discomfort and occupational stress. Conclusion From this study, it has been concluded that, there is a significant effect of BMI in increasing of work related musculoskeletal discomfort and occupational-psychosocial stress among computer workers in a developed ergonomic setup.

Abstract Background Shock absorbing insoles are effective in reducing the magnitude and rate of loading of peak impact forces generated at foot strike during running, whereas the foot impact force during running has been considered to be an important cause of intravascular hemolysis in long distance runners. Objective of this study was to evaluate the intravascular hemolysis during running and compare the effect of two different types of insoles (Soft and Firm) on hemolysis. Methods Twenty male long and middle distance runners volunteered to participate in this study. We selected two insoles (Soft and Firm) according to their hardness level (SHORE 'A' scale). Participants were randomly assigned to the soft insole (group 1) and firm insole (group 2) group with ten athletes in each group. Each athlete completed one hour of running at the calculated target heart rate (60-70%). Venous blood samples were collected before and immediately after running. We measured unconjucated bilirubin (mg/dl), lactate dehydrogenase (μ/ml), hemoglobin (g/l) and serum ferritin (ng/ml) as indicators of hemolysis. Results Our study revealed a significant increase in the mean values of unconjucated bilirubin (P < 0.05) while running with soft insoles indicating the occurrence of hemolysis in this group of athletes. Graphical analysis revealed an inverse relationship between hardness of insoles and hemolysis for the observed values. Conclusion Our results indicate that intravascular hemolysis occurs in athletes during long distance running and we conclude that addition of firm insoles effectively reduces the amount of hemolysis in runners compared to soft insoles.

Abstract Background A bloodless operative field is considered mandatory for most surgical procedures on the upper and lower extremity. This is accomplished by using either an Esmarch bandage or a pneumatic tourniquet, but a number of complications are associated with both. Nerve palsy is one of the most frequently encountered complications of this procedure. Wider cuffs have been found to cause reduced risk of tourniquet induced injury to the underlying soft tissues than the narrower ones due to the fact that lower occlusion pressures are caused by the former. To address and investigate this question, conduction in the median nerve has been measured proximal to tourniquet as well as distal to the tourniquet. Parameters of nerve conduction measured are nerve conduction velocity, latency and amplitude. Methods Sphygmomanometer cuffs with widths 14 cm and 7 cm were applied to the upper extremities of 20 healthy, normotensive volunteers (9 males and 11 females with age ranging from 22 to 27). Systolic blood pressure was measured first and then the cuff was inflated to about 20–30 mm Hg above it and was kept inflated for 15 minutes. Recordings were done prior to, for the period of tourniquet inflation, and following release of the tourniquet. Results Nerve conduction was found to be more severely affected by the 14 cm cuff than the 7 cm cuff. Conclusion Wider cuffs resulted in more severe changes in the nerve. This brings us to the conclusion that though lower inflation pressures are required for the occlusion of the blood supply using wider cuffs, the nerve conduction is more severely affected by the wider ones. Both electrophysiological changes and occlusion pressure should be kept in mind while choosing the width of the cuff.

Objectives: Variations in work-related stress, anxiety, and physical activity levels have been seen with an emphasis on sex differences. This cross-sectional study was designed to report the gender difference in stress dynamics, trait anxiety, and physical activity and propose a framework for finding out the source causing these differences. Hence, the aim of the study is to find out the comparison of these variables between teachers and students. Methodology: A cross-sectional study was designed which analyzed 120 participants consisting of teachers of assistant professors grade (n = 60) and students (n = 60) from various teaching departments in Guru Nanak Dev University, Amritsar. Further these subjects were categorized into male and female participants. For which, validated questionnaires and methods were used to measure stress and anxiety among these group of participants. Physical activity levels were also measured with a questionnaire focusing on lifestyle. Results: The perceived stress measured by the Perceived Stress Scale-14 and trait anxiety measured by the Self-Rating Anxiety Scale, did not show any significant differences between female participants (37.54 ± 7.27 and 38.85 ± 7.02, respectively) as compared to male participants (37.91 ± 7.11 and 38.14 ± 5.85, respectively). However, higher physical activity expenditure was observed in male students as compared to their female counterparts, which is measured by the International Physical Activity Questionnaire in metabolic equivalent (MET) (3293 ± 1698 and 2234 ± 1674, respectively). Conclusion: Teachers had higher trait anxiety than students. A student shows a higher level of stress and MET values than a teacher. Female teachers showed a higher level of trait anxiety and stress than male teachers but had a lesser value of MET than male teachers. Female students shows greater anxiety level whereas male students shows increased stress level as compared to their respective counterparts. Male students had a higher value of MET. [ABSTRACT FROM AUTHOR]