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This study aims to comprehend the contributions of Iran's health‐care system (HCS) in the "crisismanship" of the coronavirus (COVID‐19) pandemic from the perspectives of citizens, policy makers, managers, and public sector employees. The primary question is what have been the contributions of Iran's HCS in the crisismanship of COVID‐19? The study was designed and conducted using a qualitative strategy. It is reported that three core contributions were made: (1) the leadership of "a whole of crisis governance," (2) the leading "a whole of crisis management," and (3) conducting "a whole of operational activities during the COVID‐19." Through this empirical study, we hope to fill a gap by examining the leadership contributions of the Iranian HCS in fighting COVID‐19. The findings of this study can provide researchers and thinkers with insights into policy and strategy making in times of crises such as those surrounding COVID‐19. Related Articles: Kasseeah, Harshana, and Susan Opp. 2023. "Wicked policy problems and COVID‐19 in small island developing states: The cases of Mauritius and Seychelles." Politics & Policy 51(6): 1008–27. https://doi.org/10.1111/polp.12565. Onyango, Gedion, and Japheth Otieno Ondiek. 2022. "Open Innovation during the COVID‐19 Pandemic Policy Responses in South Africa and Kenya." Politics & Policy 50(5): 1008–31. https://doi.org/10.1111/polp.12490. Vince, Joanna. 2023. "A Creeping Crisis When an Urgent Crisis Arises: The Reprioritization of Plastic Pollution Issues during COVID‐19." Politics & Policy 51(1): 26–40. https://doi.org/10.1111/polp.12512. [ABSTRACT FROM AUTHOR]

The metaverse functions as a spatial computing platform that integrates both the physical and virtual realms, enabling individuals to engage with holographic elements within an environment facilitated by advanced technologies such as augmented reality, virtual reality, extended reality, mixed reality, high-speed Internet, blockchain, and artificial intelligence. These technologies are further empowered by an abundance of data. The recent evolution of the metaverse into a social network and recreational space holds the potential to significantly impact clinical practices and healthcare. In the foreseeable future, the metaverse may play a role in promoting health, particularly given the increasing screen time among various demographics, notably children and teenagers. This research delves into the existing literature on the metaverse within the health-care system, employing the Preferred Reporting for Systematic Reviews and Meta-Analysis for Scoping Reviews methodology to define the study’s scope. A total of 989 articles were initially retrieved from electronic databases such as Scopus, PubMed, and Web of Science. After applying the eligibility criteria, 30 articles were included, reviewed, and analyzed. The findings reveal a limited volume of literature considering the vastness of the health-care system. The majority of published articles consist of reports, letters, and case studies exploring the metaverse’s impact on healthcare, with only a few studies utilizing metaverse technology to address specific health-care issues.

Background As health-care demand is growing, our health-care system will require the optimization of the care trajectories. Patients with an alternate level of care (ALC) status could be a target for flow optimization. We aimed to characterize ALC patients and risk factors for ALC status, and to propose an integrated model to analyze the trajectory of ALC patients and discuss solutions to reduce their burden. Methods A case-control design was used to compare 60 ALC and 60 non-ALC patients admitted to the geriatric unit of the Centre hospitalier de l'Université de Montréal in 2021, collecting medical and sociodemographic data. Based on our model, univariate statistical analyses were computed to compare groups and identify risk factors for ALC status. Results ALC patients were less independent (22% performed five to six activities of daily living vs. 43%, p = .03). Both groups were comparable in terms of mobility and neurocognitive disorders. ALC patients were more likely to receive a new diagnosis of a neurocognitive disorder or new behavioural or psychological symptoms (37% vs. 15%, p = .008). Up to 25% of ALC patients were admitted despite presenting no active medical condition (vs. 3% of non-ALC patients, p = .002). Conclusions The optimization of the care trajectory of ALC patients is mainly based on pre-hospital and post-hospital factors. A proportion of ALC admissions might be avoidable with additional investment in home care resources and relocation procedures. Fluidity of ALC trajectory may benefit from improved orientation at discharge procedures. Full optimization of ALC trajectories requires a systemic understanding of the health-care system. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In 1988, the APP hosted a conference on psychoanalytic psychotherapy (PP) in the public sector in other European countries. This taught us that Britain had much to learn from other countries as well as much to share. The APP realised the need for a European Federation of PP in the public sector (EFPP) to represent and facilitate the field. The APP therefore joined with representatives from the Association of Child Psychotherapy and the Institute of Group Analysis and in 1991 formally created such an organisation by linking with similar representatives from European Union countries. This article takes an overview of PP in European countries, comparing the situation now in 2022 with the time of the founding of the EFPP in 1991. Despite significant setbacks in some countries, the indications are that PP has made very significant process in most countries in terms of the number of training organisations and practitioners in all four EFPP sections. The impact on public mental health provision is impressive in some countries but remains limited if not very limited in many. The article reviews some of the factors that have led to progress and setbacks, pinpointing 'lessons' and warning signs. [ABSTRACT FROM AUTHOR]

Aim: Since 2011, the conflict in Syria has led to the migration of 5.6 million refugees, mainly to neighbouring countries. By the start of 2019, over 3.5 million people had moved to Turkey to seek safety, meaning that Turkey is hosting the majority of these refugees. Most of them are today settled in urban and peri-urban locations. A large part of the health services of these populations had been cut before their move, leaving a significant population that had been unprotected and under-provided for. The Turkish health system has provided a cost-free way for these populations to use health services, especially public health services at the primary and secondary levels. The objective of this study was to identify the size and the geography of the health shock as a result of the Syrian influx, starting in 2011. The resulting health effects of the refugee integration and the resilience of the health system are also assessed. Subject and methods: We investigated the medical treatment given in public hospitals for the Syrian population for the years 2012–2014, at the primary and secondary health levels. We investigated 10,444,290 cases of health visits, 7,211,342 of them occurring at the secondary level and representing more than 70% of total applications. The overall coverage of the health system for the Syrian population is estimated to be 64%, with 115,000 live-births among Syrian refugees occurring in the same time period. Results: Since the influx of Syrian refugees, there has been a considerable shock to the regional part of the Turkish health system located closest to the Syrian border. From the Syrian refugee point of view, no significant over-crowding or lowered quality effect was observed in the health system. The Syrian refugee's health demand was observed to be different from that of the Turkish average, as this population's unique vulnerabilities and access evolution came to the fore. However, significant convergence was then observed in the health demand, as urgent needs were converted into more routine health requirements over time. Conclusion: This initial investigation of the Turkish health system after the Syrian integration underlies the case for a significant resilience being shown, especially in areas where it has been most severely tested. [ABSTRACT FROM AUTHOR]

Purpose: To improve of the systemic understanding of the causes of CKD mortality for the ideation of solutions with Public Research Centers. Methodology: A community-based system dynamics methodology was implemented to generate a map of systems and solutions. Theoretical Findings: Four causal cycles were identified: Primary risk management; comprehensive management of patients at risk; management of the patient in the final stage; and comprehensive management of the patient in the final stage. Practical Findings: The axes of solution were to increase the number of patients with self-care from stage four to five, and in the Renal Replacement Therapy stage; and increase the number of patients with end-stage treatment.Originality: The discoveries of the map guide the development of solutions and research programs of public research centers, as well as the disciplinary integration of medicine, psychology, nutrition, social work, and community. Conclusions and limitations: The generated map can be used to prospect the potential impact of both interventions and scenarios with current conditions. [ABSTRACT FROM AUTHOR]

Objective The current study aimed to investigate the temporal trend of in-hospital and intensive care unit (ICU) mortality of coronavirus disease 2019 (COVID-19) patients over 6 months in the spring and summer of 2021 in Iran. Design We performed an observational retrospective cohort study. Setting Qazvin Province- Iran during 6 month from April to September 2021. Participants All 14355 patients who were hospitalized with confirmed COVID-19 in hospitals of Qazvin Province. Intervention No intervention. Main outcome measures The trends of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease. Results The overall in-hospital mortality, early mortality and ICU mortality were 8.8%, 3.2% and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU mortality = 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (Odds ratio = 1.3, 95% confidence interval = 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P -value < 0.001). Conclusions We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of severe acute respiratory syndrome coronavirus 2 infection in Iran. The lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Abant Social Sciences / Abant Sosyal Bilimler Dergisi is the property of Journal of Abant Social Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background The views and experiences of the Australian public are an important barometer of the health system. This study provides key findings about the changing views held by Australians over time regarding their individual experiences and perceptions of the overall performance of the health system. Methods A population‐based online survey was conducted in 2018 (N = 1024). Participants were recruited through market research panels. The results were compared with previous Australian population survey data sets from 2008 (N = 1146), 2010 (N = 1201) and 2012 (N = 1200), each of which used different population samples. The survey included questions consistent with previous surveys regarding self‐reported health status, and questions about use, opinions and experiences of the health system. Results Overall, there has been a shift in views from 2008 to 2018, with a higher proportion of respondents now viewing the Australian health‐care system more positively (X2 (2, N = 4543) = 96.59, P

During the spring of 2020, the coronavirus disease 2019 (COVID-19) epidemic caused an unprecedented demand for intensive-care resources in the Lombardy region of Italy. Using data on 43,538 hospitalized patients admitted between February 21 and July 12, 2020, we evaluated variations in intensive care unit (ICU) admissions and mortality over the course of 3 periods: the early phase of the pandemic (February 21–March 13), the period of highest pressure on the health-care system (March 14–April 25, when numbers of COVID-19 patients exceeded prepandemic ICU bed capacity), and the declining phase (April 26–July 12). Compared with the early phase, patients aged 70 years or more were less often admitted to an ICU during the period of highest pressure on the health-care system (odds ratio (OR) = 0.47, 95% confidence interval (CI): 0.41, 0.54), with longer ICU delays (incidence rate ratio = 1.82, 95% CI: 1.52, 2.18) and lower chances of dying in the ICU (OR = 0.47, 95% CI: 0.34, 0.64). Patients under 56 years of age had more limited changes in the probability of (OR = 0.65, 95% CI: 0.56, 0.76) and delay to (incidence rate ratio = 1.16, 95% CI: 0.95, 1.42) ICU admission and increased mortality (OR = 1.43, 95% CI: 1.00, 2.07). In the declining phase, all quantities decreased for all age groups. These patterns may suggest that limited health-care resources during the peak phase of the epidemic in Lombardy forced a shift in ICU admission criteria to prioritize patients with higher chances of survival. [ABSTRACT FROM AUTHOR]

Pakistan currently ranks 154 out of 189 countries on the UNDP's Human Development Index. In this paper, we use a 'political settlements analysis' to understand how the distribution of political, economic and social power explains this ranking and the inequity in Pakistan's health system. We investigate elite power struggles over the last seven decades to explain how ad hoc policy-making, instability, patronage politics and rent-seeking have led to a maldistribution of resources, lack of oversight, and inequitable access and service provision for a burgeoning population. We argue that these factors have had two consequences: the privatisation of health care, and the opening up of a considerable sphere of influence to the donor community to direct state policy. Despite promising ongoing reform efforts, we conclude that Pakistan's health system will remain hamstrung by the constraints of a political settlement in which elites with short-term horizons bargain for influence rather than developing an inclusive, consensus-based approach to improving governance outcomes for citizens. [ABSTRACT FROM AUTHOR]

Pediatric access to exoskeletons lags far behind that of adults. In this article, we promote inclusiveness in exoskeleton robotics by identifying and addressing challenges and barriers to pediatric access to this potentially life-changing technology. We first present available exoskeleton solutions for upper and lower limbs and note the variability in the absence of these. Next, we query the possible reasons for this variability in access, explicitly focusing on children, who constitute a categorically vulnerable population, and also stand to benefit significantly from the use of this technology at this critical point in their physical and emotional growth. We propose the use of a life-based design approach as a way to address some of the design challenges and offer insights toward a resolution regarding market viability and implementation challenges. We conclude that the development of pediatric exoskeletons that allow for and ensure access to health-enhancing technology is a crucial aspect of the responsible provision of health care to all members of society. For children, the stakes are particularly high, given that this technology, when used at a critical phase of a child’s development, not only holds out the possibility of improving the quality of life but also can improve the long-term health prospects.

Background: Globally, there is a high demand for nurses, resulting in migration from low-to high-income countries. The emigration of nurses is the act of leaving one's own country to settle permanently in another country, leading to a shortage in the number of nurses in their home countries. Consequently, this study aims to assess the impact of the emigration of nurses on the health-care delivery system in Nigeria. Materials and Methods: A descriptive cross-sectional survey was conducted with a stratified sampling technique to select 270 nurses from three selected hospitals in Benin-city Edo state. A self-structured questionnaire with open and Likert scale questions were used as an instrument to assess the Impact of the Emigration of nurses on the Health Care Delivery System. Data collected were analyzed using tables, percentages, means, standard deviation and t-test. Results: The result showed a mean score of 1.59 ± 0.92 impacts of the emigration of nurses on health-care delivery system and identified how to reduce it. The study also showed that there is no significant difference between gender and reason for emigration among nurses (t = 3.84, P ≤ 0.001). Conclusion: The emigration of nurses is severely affecting the health care delivery system in the country. Recently, the Nursing and Midwifery Council of Nigeria gave the directive for training schools to increase their training capacity and number of students' intake to cushion the effect, and this study shows that this palliative can only be a short time measure, and however will encourage more nurses traveling abroad on the long run. Therefore, the hospital managers and government should provide a conducive working environment, better remuneration, attractive retirement benefit, and other incentives as a push in factor for nurses to stay back in their home countries.

Abstract Background Parent experiences of caring for children with neurodevelopmental disease have been silenced and constrained by social, political and health influences. There is a need to co‐construct new meanings and interpretations of parenting a child with complex disabilities by having an increased understanding of the struggles and barriers for parents. Methods A hermeneutic phenomenology approach was applied in this inquiry. Fifteen parents of children with rare neurodevelopmental diseases participated in semi‐structured interviews. Results Parents experienced silencing or being silenced within interactions with health‐care and social care systems and providers. Interpretive thematic analysis revealed three insights: (a) parents experience a sense of disconnect and silencing as little is known or understood by health‐care providers about the experience of caring for children at home; (b) parents make strong efforts to be heard and acquire services within health and social systems as fighters, saviours and navigators; and (c) parents sacrifice themselves to the caregiving role and become therapists and caregivers to their medically fragile children at the cost of losing themselves as parents. Conclusion An understanding of parents’ experiences in caring for a child with a rare neurodevelopmental disease may provide insight to systemic health and social support challenges faced by families and mitigate appropriate and supportive policies and services.

Universal health coverage (UHC) has been elevated to the status of a global policy target, but this was at the expense of losing its aspirational meaning. As a case in point, Turkey has been one of the countries that has achieved UHC, according to the technocratic definition. This article employs a combination of deductive and inductive thematic analysis methods to explore patient organisation (PO) perspectives on the Turkish health‐care system based on 26 respondent interviews from 19 POs in Istanbul. Highlighting the inadequacy of the technocratic definition of UHC, the article maintains that an analysis of PO perspectives opens the way for a nuanced and bottom‐up assessment of essential service coverage and financial protection by identifying elusive gaps in both dimensions that would otherwise be lost in generalist evaluations. The findings also underline the importance of keeping intact the UHC's aspirational element to enable POs to participate in the politics of priority setting in health care. [ABSTRACT FROM AUTHOR]

Introduction: The assessment of the health-care system by its beneficiaries is based on evaluation of the public perception in regards to the performance of healthcare workers, the functioning of the health system, the effectiveness of health policy measures, and a number of other components. The aim of this study was to determine patients' trust in the work of physiotherapists and the health-care system; determine the quality of communication between the patient and the physiotherapist; and determine the quality of cooperation between healthcare workers in the provision of health services. Methods: The study is descriptive, conducted in five cities: Banja Luka, Bihać, Herceg Novi, Nikšić, and Podujevo. The confidence in health-care questionnaire developed by Calnan and Sanford (2004) was used as a research instrument, containing six areas of research: Attitude toward the patient, Health policy and patient care, Professionalism and expertise, Quality of health care, Communication and information, and Quality of cooperation. Results: The mean age of the subjects was 41 years, 24 females and 26 males. Subjects expressed the greatest satisfaction on subscales I - Attitude toward the patient (27.44 ± 3.59 out of 30) and IV - Quality of health care (36.60 ± 4.19 out of 40), which represents 91.5% of the possible maximum. This is followed by subscale V - Communication and information (20.8 ± 3.17 out of 25) corresponding to 83.2% of the possible maximum, followed by subscale III - Professionalism and expertise (15.68 ± 3.29 out of 20) which represents 78.4% of the possible maximum. Subjects showed the least satisfaction on subscales II - Health policy and patient care (16.94 ± 5.56 out of 25), which represents 67.8% of the possible maximum, and subscales VI - Quality of cooperation (9.94 ± 0.42 out of 15) which corresponds to 66.3% of the possible maximum. Conclusions: The research showed a high degree of satisfaction of subjects in various fields, which indicates a high degree of confidence in the work of physiotherapists and the health-care system. Research on a larger sample in needed for creation and implementation of the guidelines in the strategic documents of the countries in the region and for improvement of health policies and patient care. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, COVID-19 pandemic caused millions of infected people and thousands of deaths. Due to enormous pressure on health-care systems and its inadequate preparedness, utter collapse is expected. In the current epidemic response, healthcare workers’ (HCWs) knowledge and practice are crucial, while the impact on their mental health is still unknown. Methods: The cross-sectional study was conducted among HCWs redeployed to COVID points in the Public Institution Health Centre of Sarajevo Canton. According to guidelines and information provided by the World Health Organization and Ministries of Health, a questionnaire was developed. In addition, General Anxiety Disorder-7 as a screening tool for anxiety disorders was used. Results: Of 180 respondents, 26 (14.4%) were in direct contact with the sick patient. In total, 79 (43.9%) respondents consider their personal protective equipment is in accordance with the guidelines of the world health authorities. A total of 72 (39.7%) of respondents used the same mask for several days. In general, the danger from new coronavirus was considered minimal by 59 (32,6%) HCWs. Based on the achieved score for assessing the anxiety disorder, in 63 (35%) subjects, the presence of severe symptoms was detected. Conclusion: This study found that most HCWs do not have enough knowledge about the COVID-19 pandemic. We identified that there are differences in the sources of information and gap in perceptions of the native origin of the virus. Considering the frequency of anxiety symptoms among HCWs, interventions are necessary in order to preserve their mental health.

Background: The views and experiences of the Australian public are an important barometer of the health system. This study provides key findings about the changing views held by Australians over time regarding their individual experiences and perceptions of the overall performance of the health system. Methods: A population‐based online survey was conducted in 2018 (N = 1024). Participants were recruited through market research panels. The results were compared with previous Australian population survey data sets from 2008 (N = 1146), 2010 (N = 1201) and 2012 (N = 1200), each of which used different population samples. The survey included questions consistent with previous surveys regarding self‐reported health status, and questions about use, opinions and experiences of the health system. Results: Overall, there has been a shift in views from 2008 to 2018, with a higher proportion of respondents now viewing the Australian health‐care system more positively (X2 (2, N = 4543) = 96.59, P <.001). In 2018, areas for attention continued to include the following: the need for more doctors, nurses and other health workers (29.0%); lower costs for care or Orion medicines (27.8%); more access to care (13.1%); and enhancements in residential aged care (17.3% rated these services as 'bad' or 'very bad'). Conclusions: This research suggests that Australians' perceptions of their health‐care system have significantly improved over the last decade; however, concerns have emerged over access to medicines, inadequate workforce capacity and the quality of aged care facilities. Our study highlights the value of periodically conducting public sentiment surveys to identify potential emerging health system problems. [ABSTRACT FROM AUTHOR]

Background: Consumer involvement in health-care policy and quality management (QM) programming is a key element in making health systems people-centered. Involvement of health-care consumers in these areas, however, remains underdeveloped and under-prioritized. When consumer involvement is actively realized, few mechanisms for assessing its impact have been developed. The New York State Department of Health (NYSDOH) embraces consumer involvement of people with HIV in QM as a guiding principle, informed by early HIV/AIDS advocacy and a framework of people-centered quality care.Method: HIV consumer involvement is implemented statewide and informs all quality of care programming as a standard for QM in health-care organizations, implemented through four key several initiatives: (i) a statewide HIV Consumer Quality Advisory Committee; (ii) leadership and QM trainings for consumers; (iii) specific tools and activities to engage consumers in QM activities at state, regional and health-care facility levels and (iv) formal organizational assessments of consumer involvement in health-care facility QM programs.Results: We review the literature on this topic and place the methods used by the NYSDOH within a theoretical framework for consumer involvement.Conclusion: We present a model that offers a paradigm for practical implementation of routine consumer involvement in QM programs that can be replicated in other health-care settings, both disease-specific and general, reflecting the priority of active participation of consumers in QM activities at all levels of the health system. [ABSTRACT FROM AUTHOR]

The protection of individuals regarding to the processing of personal data is one of the fundamental rights. The General Data Protection Regulation (GDPR) lays down rules relating to the protection of natural persons with regard to the processing of personal data and rules relating to the free movement of personal data. Data concerning health is one of the areas the GDPR defines as special personal data, the so-called sensitive data. With regard to these data, the GDPR allows their processing only on an exceptional basis, in certain situations. According to Art. 6 sec. 1 let. e GDPR and art. 9 sec. 2 let. b GDPR, data processing is allowed, inter alia, when such processing is necessary for the purposes of meeting the obligations and exercising specific rights of the controller or of the data subject in the field of employment and social security and social protection law. In turn, Art. 9 sec. 2 let. h GDPR permits the processing of health data that is necessary for the purposes of providing health or social care or treatment, or for managing health or social care systems and services on the basis of European Union or Member State law. The article discusses the national legal regulations regarding the collection and processing of personal data concerning health in the light of the organization of the health care system and the tasks of the National Health Fund (NFZ) as a placeholder, whose task is only to manage financial resources and conclude health care contracts on its own behalf with independent healthcare providers and their accounting. Against the background of the GDPR, the author discusses the provisions of the acts on health care services financed from public funds and on the information system in health care. Finally, specific regulation regarding the COVID-19 pandemic are presented.

Introduction: Worldwide, COVID-19 pandemic caused millions of infected people and thousands of deaths. Due to enormous pressure on health-care systems and its inadequate preparedness, utter collapse is expected. In the current epidemic response, healthcare workers' (HCWs) knowledge and practice are crucial, while the impact on their mental health is still unknown. Methods: The cross-sectional study was conducted among HCWs redeployed to COVID points in the Public Institution Health Centre of Sarajevo Canton. According to guidelines and information provided by the World Health Organization and Ministries of Health, a questionnaire was developed. In addition, General Anxiety Disorder-7 as a screening tool for anxiety disorders was used. Results: Of 180 respondents, 26 (14.4%) were in direct contact with the sick patient. In total, 79 (43.9%) respondents consider their personal protective equipment is in accordance with the guidelines of the world health authorities. A total of 72 (39.7%) of respondents used the same mask for several days. In general, the danger from new coronavirus was considered minimal by 59 (32,6%) HCWs. Based on the achieved score for assessing the anxiety disorder, in 63 (35%) subjects, the presence of severe symptoms was detected. Conclusion: This study found that most HCWs do not have enough knowledge about the COVID-19 pandemic. We identified that there are differences in the sources of information and gap in perceptions of the native origin of the virus. Considering the frequency of anxiety symptoms among HCWs, interventions are necessary in order to preserve their mental health. [ABSTRACT FROM AUTHOR]

Psychoanalytic psychotherapy is one of the most commonly practiced psychotherapy orientations in Finland. It has secured continuity in the recently renewed university-based educational programs for training psychotherapists, although the proportion of psychoanalytic therapists in relation to other orientations has been decreasing during the past decade. Psychodynamic psychotherapy is reasonably well acknowledged in the Finnish Current Care Guidelines as one option in the treatment of the most common mental disorders, due to recent advances in effectiveness research. There is funding provided by the national insurance system for patients attending long-term rehabilitative psychotherapy. It has been shown to be effective and allows access to up to 3-year long psychotherapy for persons who need help for improving their lowered ability to work or to progress in their studies. However, greater focus on evidence-based short-term treatment models and more strained competition of the public mental health-care resources are expected. In order to survive the struggle, proponents of psychoanalytic psychotherapy need to be active in securing high quality of service delivery and in helping the health care system and political decision makers to recognize the value of our approach. As an example, we present experiences of a successful implementation of the Mentalization-Based Treatment. A viable future of psychoanalytic psychotherapy is highly dependent of continuing high-quality, clinically relevant research and psychotherapist training, as well as organizational cooperation in these areas and in health policy issues. [ABSTRACT FROM AUTHOR]

Objective: It is known that job satisfaction and quality of life influence nurses' intention to resign from their jobs. However, health-care systems should examine all the possible factors that contribute to nurse turnover to retain them for the long term. To this purpose, this study further explores the aspects that affect the intention of nurses who work in Saudi Arabia to leave their current jobs. Methods: A sample of 318 staff nurses working in two public hospitals in Saudi Arabia was surveyed in this cross-sectional study. A questionnaire was used to assess job satisfaction, stress, quality of life, and intention of recruited nurses to leave their current jobs. Data were collected between April and May 2018. Results: Quality of life dimensions, such as physical and psychological health, predict nurses' intention to resign from their current workplaces. We found that being single or of Filipino or Indian origin, working in the medical and surgical department, or having a low monthly gross salary is correlated with a high intention to leave. Conclusion: The results present a unique theoretical underpinning that expands on the previous knowledge and literature on the factors that affect nurses' intent to leave their organizations. The findings of this study can be used as a guide to establish human resource policies toward satisfying nurses' needs and improving job satisfaction and quality of life to promote retention. [ABSTRACT FROM AUTHOR]

This paper aims to describe and analyze the therapeutic itineraries of female migrants from Bolivia residing two neighborhoods of Buenos Aires, "Bajo Flores" and "Villa 31". Qualitative methodology, using techniques of interviews and focus groups, oriented the investigation of health care strategies. As a principle result, we identified the articulation of various healthcare systems, particularly that of frequent consultation of pharmacists as substitution for physicians, be this a form of avoiding the barriers and obstacles of access to the public health system or as an alternative to previous therapeutic failures. In addition, the barriers that these women encounter when trying to access care in the public health system are described. Finally, we observed that the circulation of information among family members, neighbors, friends and "countrymen" is the most frequent means of accessing knowledge about the available care alternatives in each territory. [ABSTRACT FROM AUTHOR]

Background: Parent experiences of caring for children with neurodevelopmental disease have been silenced and constrained by social, political and health influences. There is a need to co‐construct new meanings and interpretations of parenting a child with complex disabilities by having an increased understanding of the struggles and barriers for parents. Methods: A hermeneutic phenomenology approach was applied in this inquiry. Fifteen parents of children with rare neurodevelopmental diseases participated in semi‐structured interviews. Results: Parents experienced silencing or being silenced within interactions with health‐care and social care systems and providers. Interpretive thematic analysis revealed three insights: (a) parents experience a sense of disconnect and silencing as little is known or understood by health‐care providers about the experience of caring for children at home; (b) parents make strong efforts to be heard and acquire services within health and social systems as fighters, saviours and navigators; and (c) parents sacrifice themselves to the caregiving role and become therapists and caregivers to their medically fragile children at the cost of losing themselves as parents. Conclusion: An understanding of parents' experiences in caring for a child with a rare neurodevelopmental disease may provide insight to systemic health and social support challenges faced by families and mitigate appropriate and supportive policies and services. [ABSTRACT FROM AUTHOR]

The frequency of consultations and the waiting times in pediatric hospital outpatient clinics are steadily increasing. The aim of this study was to compare the occurrence of patients in a large pediatric group practice and a hospital-based general pediatric outpatient clinic. Primary parameters were the most common reasons for consultation, the waiting times and the reasons for selecting a certain institution. Most frequent diagnoses in the pediatric practice were upper respiratory tract infections (22.7% (n = 141/621)), otitis media (5.2% (n = 32/621)), and viral pharyngitis (3.9% (n = 24/621)). Most common reasons for consultation in the hospital outpatient clinic were upper respiratory tract infections (18.4% (n = 121/658)) and bacterial pharyngitis (17.9% (n = 118/658)). In the pediatric practice, bacterial pharyngitis was only diagnosed in 3.1% (n = 19/621) of the cases. Only slight differences exist between the two institutions regarding the observed entities, which mainly comprise mild to moderate acute illnesses. It can be concluded from this that the majority of patients might as well be treated in the nonhospital setting. Facilitating the communication and coordination between practices and hospitals might allow a better utilization of capacities. Thereby, waiting times, unnecessary reexaminations, and costs in the health-care system could be reduced. [ABSTRACT FROM AUTHOR]

From 2015, Norway has implemented high‐risk human papilloma virus (hrHPV) testing in primary screening for cervical cancer. Women aged 34–69 years, living in four counties, have been pseudo‐randomly assigned (1:1 randomization) to either hrHPV testing every 5 years (followed by cytology if hrHPV is positive), or cytology testing every 3 years (followed by hrHPV testing if low‐grade cytology is detected). We compared anxiety and depression scores among participants by screening arm and results. In total, 1,008 women answered a structured questionnaire that included the validated Patient Health Questionnaire‐4 (PHQ‐4). The Relative Risk Ratio (RRR) of mild vs. normal anxiety and depression scores, and moderate/severe vs. normal anxiety and depression scores, were estimated by multinomial logistic regression with 95% confidence intervals (95% CIs). Compared to women who were screened with cytology, women randomized to hrHPV testing were not more likely to have mild anxiety and depression scores (RRR 0.96, CI 0.70–1.31) nor more likely to have moderate/severe anxiety and depression scores (RRR 1.14, CI 0.65–2.02). Women with five different combinations of abnormal screening test results were not more likely to have mild or moderate/severe vs. normal anxiety and depression scores than women with normal screening results. The likelihood of having abnormal long‐term (4–24 months after the screening) anxiety or depression scores among women 34 years and older was not affected by screening method or screening results. The results of our study suggest that a change to hrHPV testing in primary screening would not increase psychological distress among participants. What's new? Norway is one of the first countries to implement high‐risk human papilloma virus (hrHPV) testing in primary cervical‐cancer screening. Does this newer type of testing impact the emotional well‐being of patients? In this study, the authors found no significant difference in either anxiety or depression scores between the viral‐screening arm and standard cytology screening. These findings could be useful for other countries considering implementing hrHPV testing, and are reassuring for the ongoing implementation process in Norway. [ABSTRACT FROM AUTHOR]

This paper aims to contribute to a better understanding of multilevel governance processes. We do so by focusing on the in-depth examination of the institutional changes recently implemented in the Quebec health care delivery system that require a close collaboration between interdependent actors acting at various levels of governance. Our three research questions are: (1) How does multi-level governance emerge in a pluralist institutuional context? (2) How do multi-level governance processes shape the adaptive capacity of the organization to its environment? (3) How does institutional context influence these multi-governance processes?Our empirical investigation is inspired by the theory of complexity which invites us to pay attention to three processes: self-organization, eco-self organization and co-evolution. This study shows that the effectiveness of multi-level governance processes do not only go through the implementation of instruments aiming at aligning the action of lower government levels with the objectives of the upper levels as suggested by numerous existing works. More precisely, it suggests that more distributed and coordinated processes favor a more homogenous form of adaptation (Miller and Page, 2007) taking into account the interdependence between stakeholders. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adherence to medical ethics principles by medical professionals is required to improve health-care system's quality. Recognizing medical ethics' challenges and attempting to resolve them are important in the implementation of medical ethics in practice. This study aimed to explore such challenges at Iran's medical sciences universities in 2018. MATERIALS AND METHODS: This descriptive, qualitative study utilized a conventional content analysis approach for data analysis. This study was conducted using purposeful sampling from participants with experience in teaching or practicing of medical ethics field, and by considering maximum variety of disciplines (e.g., gynecology, internal medicine, surgery, and medical ethics). The data were gathered using semi-structured interviews. The interview guide was designed based on previous research findings by two members of the research team and contained the main interview questions and participants had the opportunity to express their perspectives in detail. Participants were chosen from clinical and ethical faculty members as well as managers. The data collection process continued until the data saturation stage, beyond which no new information or concept achieved by continuing interviews. RESULTS: After interviewing 14 faculty members and managers, findings were classified into 4 themes, 9 categories, and 42 sub-categories; four main categories of medical ethics challenges are affected by cognitive, educational, practical, and structural factors, respectively. CONCLUSION: This study suggested that medical ethics' cognitive and educational challenges can alleviate using educational programs intended for improving qualitative and quantitative aspects of medical ethics teaching for medical professionals ranging from students to faculty members. Medical ethics' structural and practical challenges are within policymaking and scheduling activities dealt with through future researches by health-care system's managers and planners.

BACKGROUND: According to the importance of health education (HE) in disease control and prevention and inadequacy of HE in the Iran's health-care system, clarifying the HE barriers is necessary. OBJECTIVES: This study aimed to clarifying the comprehensive model of HE barriers of health-care system in Iran. METHODS: This qualitative study was conducted in 2019. Twenty-one health experts and physicians at different levels of the health system, a former health deputy of the Ministry of Health, and 26 community health workers (CHWs) were selected through purposive sampling. Data were collected through semi-structured individual interviews and group discussions and analyzed simultaneously by conventional content analysis. RESULTS: Five themes were extracted including individual barriers (most important categories: inadequate ability of CHWs in HE, poor motivational factors at individual level, and educator's wrong beliefs), interpersonal (most important categories: weakness of other health-care providers in the education of CHWs, lack of proper understanding by health authorities of scientific and correct HE, inappropriate communication, unrealistic expectations from CHWs, problems with monitoring and supervision, poor work commitment, and client-related problems), organizational (most important categories: high workload of CHWs, problems related to educational resources, inappropriate attitude of managers and officials, and inappropriate evaluation and monitoring), community (most important categories: not believing CHWs by people, people's disinterest and lack of motivation in education, cultural problems, problems with the Internet and virtual social networks, and weak cross-sectoral cooperation), and contextual barriers (most important categories: barriers related to universities, broadcasting, the nature of HE science, as well as gap between practical education and theory). CONCLUSION: Considering the multidimensional barriers such as individual, interpersonal, organizational, community, and contextual barriers, compiling and executing a comprehensive document with the participation of authorities, specialists, and service providers is recommended to remove barriers. This is in line with the Ottawa Charters' “reorienting health services.”