Comprehensive Health Services Research Articles

Trauma exposure across the lifespan among individuals engaged in treatment with medication for opioid use disorder: differences by gender, PTSD status, and chronic pain

BackgroundThere is little study of lifetime trauma exposure among individuals engaged in medication treatment for opioid use disorder (MOUD). A multisite study provided the opportunity to examine the prevalence of lifetime trauma and differences by gender, PTSD status, and chronic pain.MethodsA cross-sectional study examined baseline data from participants (N = 303) enrolled in a randomized controlled trial of a mind–body intervention as an adjunct to MOUD. All participants were stabilized on MOUD. Measures included the Trauma Life Events Questionnaire (TLEQ), the Brief Pain Inventory (BPI), and the Posttraumatic Stress Disorder Checklist (PCL-5). Analyses involved descriptive statistics, independent sample t-tests, and linear and logistic regression.ResultsParticipants were self-identified as women (n = 157), men (n = 144), and non-binary (n = 2). Fifty-seven percent (n = 172) self-reported chronic pain, and 41% (n = 124) scored above the screening cut-off for PTSD. Women reported significantly more intimate partner violence (85%) vs 73%) and adult sexual assault (57% vs 13%), while men reported more physical assault (81% vs 61%) and witnessing trauma (66% vs 48%). Men and women experienced substantial childhood physical abuse, witnessed intimate partner violence as children, and reported an equivalent exposure to accidents as adults. The number of traumatic events predicted PTSD symptom severity and PTSD diagnostic status. Participants with chronic pain, compared to those without chronic pain, had significantly more traumatic events in childhood (85% vs 75%).ConclusionThe study found a high prevalence of lifetime trauma among people in MOUD. Results highlight the need for comprehensive assessment and mental health services to address trauma among those in MOUD treatment.Trial registrationNCT04082637.

Exploring adolescent girls and young women's PrEP-user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa.

Adolescent girls and young women (AGYW), a priority population for HIV prevention in Africa, show high interest but difficulty in sustained effective use of pre-exposure prophylaxis (PrEP). With ongoing PrEP scale-up focused on increasing access, it is important to understand what influences AGYW's choice of PrEP delivery platforms. The POWER implementation study in Cape Town provided PrEP between 2017 and 2020 to AGYW (16-25 years) from four differentiated delivery platforms: mobile clinic, government facility, courier delivery or community-based youth club. Healthcare providers at government and mobile clinics provided PrEP (initiation and refills) as part of comprehensive, integrated sexual and reproductive health services. Courier and youth club platforms provided light-touch PrEP refill services incorporating rapid HIV self-testing. We conducted in-depth interviews with a purposive sample of AGYW who had ≥3 months of PrEP-use and accessed ≥2 PrEP delivery platforms. The thematic analysis explored AGYW's preferences, decision-making and habits related to PrEP access to inform market segmentation. We interviewed 26 AGYW (median age 20) PrEP-users between November 2020 and March 2021. AGYW PrEP-users reported accessing different services with, 24 accessing mobile clinics, 17 courier delivery, 9 government health facilities and 6 youth clubs for their PrEP refills. Qualitative findings highlighted four potential behavioural profiles. The "Social PrEP-user" preferred PrEP delivery in peer spaces, such as youth clubs or adolescent-friendly mobile clinics, seeking affirmation and social support for continued PrEP use. The "Convenient PrEP-user" favoured PrEP delivery at easily accessible locations, providing quick (courier) or integrated contraception-PrEP refill visits (mobile and government clinic). The "Independent PrEP-user" preferred PrEP delivery that offered control over delivery times that fit into their schedule, such as the courier service. The "Discreet PrEP-user" highly valued privacy regarding their PrEP use (courier delivery) and avoided delivery options where unintentional disclosure was evident (youth club). Comfort with HIV self-testing had minimal influence on PrEP delivery choice. Market segmentation of AGYW characterizes different types of PrEP-users and has the potential to enhance tailored messaging and campaigns to reach specific segments, with the aim of improving sustained PrEP use and HIV prevention benefits.

Program of All-Inclusive Care for the Elderly: an untapped setting for research to advance pain care in older persons.

The Program of All-Inclusive Care for the Elderly (PACE) is a community-based care model in the United States that provides comprehensive health and social services to frail, nursing home-eligible adults aged 55 years and older. PACE organizations aim to support adequate pain control in their participants, yet few evidence-based pain interventions have been adopted or integrated into this setting. This article provides a roadmap for researchers who are interested in collaborating with PACE organizations to embed and evaluate evidence-based pain tools and interventions. We situate our discussion within the Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework that considers multi-level influences to implementation and evaluation of evidence-based programs. Within each CFIR domain, we identify key factors informed by our own work that merit consideration by research teams and PACE collaborators. Inner setting components pertain to the organizational culture of each PACE organization, the type and quality of electronic health record data, and availability of staff to assist with data abstraction. Outer setting components include external policies and regulations by the National PACE Association and audits conducted by the Centers for Medicare and Medicaid Services, which have implications for research participant recruitment and enrollment. Individual-level characteristics of PACE organization leaders include their receptivity toward new innovations and perceived ability to implement them. Forming and sustaining research-PACE partnerships to deliver evidence-based pain interventions pain will require attention to multi-level factors that may influence future uptake and provides a way to improve the health and well-being of patients served by these programs.

Inmates' Adaptation to Prison: Investigating the Mediating Role of Resilience in the Relationship between Religiosity and Prison Adjustment.

Incarceration is one of the most stressful life experiences with negative impacts on the health and wellbeing of the prisoners. Sufficient studies exist on the association between religiosity and adjustment to prison (ATP) but no studies have investigated the mediating variables explaining this link. This study examined the mediating role of resilience on the relationship between religiosity and ATP. Participants 513 inmates (males = 410, females = 103; mean age = 30.86, SD = 7.71 years) drawn from Enugu and Nsukka custodial centres in the South East Nigeria. They responded to Prison Adjustment Questionnaire, Religious Orientation Test and Connor-Davidson Resilience Scale in addition to supplying other relevant information. Hayes PROCESS macro for SPSS which uses a regression-based, path-analytical framework, was used in the data analysis. The results showed a significant indirect effect of resilience on the association between religiosity and ATP (β = .45, p < .001, 95% CI [0.27, 0.62]). This result revealed that resilience mediated the relationship between religiosity and ATP, indicating that individuals who are religious may possess higher resilience, leading to improved ATP. In conclusion, the study recommends incorporating comprehensive mental health services with a focus on resilience-building strategies in prison policies. Encouraging detainees' religious beliefs and activities is suggested, along with promoting psychological therapies to enhance resilience and improve adjustment to prison life.

Estimating the Cost of the COVID-19 Response for Local Health Departments: Evidence From Ohio.

This study assessed the staffing allocations and associated costs incurred by Ohio local health departments (LHDs) in response to the challenges posed by the COVID-19 pandemic. Data were extracted from the annual financial reports of Ohio LHDs for 2020 and 2021, encompassing a sample of 38 LHDs in 2020 and 60 LHDs in 2021. Descriptive analysis showed that Ohio LHDs committed substantial resources to responding to the COVID-19 pandemic. Although there was considerable variability across LHDs, median staffing and compensation collectively constituted 22% of total staffing and compensation. Multivariate regression analysis found minimal associations between the examined agency and community-level variables and the differences in staffing allocations and associated costs incurred by LHDs in response to the COVID-19 pandemic. After decades of underfunding and understaffing, securing sustainable funding will be crucial to equip LHDs across the country with the necessary resources to deliver comprehensive public health services in their communities.

Understanding Attitudes of Postpartum Cisgender Women Toward Integration of HIV Prevention Services into Routine Prenatal and Postpartum Sexual Health Discussions.

Oral pre-exposure prophylaxis (PrEP) is an effective, user-controlled method for HIV prevention. However, awareness, uptake, and adherence to PrEP remain low among cisgender women (CGW). The prenatal and postpartum periods present an opportunity for delivery of comprehensive sexual health services that include HIV prevention education and services. However, little is known about postpartum CGW's attitudes toward integration of HIV prevention education and services into obstetric care in the US. We conducted semistructured interviews with 20 postpartum CGW in the Bronx, NY from July to November 2022 to explore their experiences with prenatal and postpartum sexual health care, examine their attitudes toward integration of HIV prevention services into obstetric sexual health care, and identify components of future implementation strategies. Transcripts were analyzed thematically using a framework approach. Among CGW interviewed, fewer than half reported prior knowledge of PrEP. Ten participants preferred long-acting injectable PrEP relative to six who preferred daily oral PrEP. Most participants reported no discussion of sex with their provider during pregnancy, and when discussions occurred, they focused on permission or prohibition of sexual activity. Participants described a reliance on providers to lead prenatal sexual health discussions. Even when not perceived as personally relevant, most respondents valued education on HIV prevention and PrEP services. In the postpartum period, sexual health discussions were similarly limited despite participants describing complex experiential sexual health concerns. This study supports the potential for integration of HIV prevention education and services into routine prenatal and postpartum sexual health discussions in an area of high HIV prevalence in the US.

Neurological Care within the Indian Health Service.

American Indians and Alaska Natives (AI/AN) are the Indigenous peoples of the United States. According to the U.S. Census Bureau, approximately 9.7 million people self-identified as AI/AN (alone or in combination with other races), representing 2.9% of the total U.S. population. These people represent diverse groups of discrete Tribes, each with their language, culture, and geographic home. As part of the conquest and settlement of North America, some Indigenous peoples signed treaties with the U.S. government, surrendering their lands in return for various government commitments, including health care. The Indian Health Service (IHS) was born out of these agreements. The IHS is an agency in the U.S. Department of Health and Human Services under the U.S. Public Health Service. The IHS provides a comprehensive health service delivery system for approximately 2.7 million AI/AN who belong to 574 federally recognized Tribes/nations in 37 states. The aim of this paper is to make recommendations regarding the initiation of sustainable neurology care in marginalized or underserved populations by reviewing 40 years of neurology care provision within the IHS. We will discuss (1) the IHS, (2) neurological care provided within the IHS, including midlevel provider extension of neurology care and traditional medical care, and (3) select neurological diagnoses within AI/AN populations. Marginalized populations, including those in the United States that are rural, remote, or low socioeconomic status, lack access to specialty neurology care. This includes many AI/AN. The IHS has developed novel solutions to promote specialty care, including neurology. Notably, initial IHS investments in full-time neurology providers have led to more robust neurology care, often receiving attention from university programs. This suggests that an initial investment in stable on-site full-time neurology services provides a path to potential sustainable care for marginalized populations.

Key lessons from the establishment of a nurse-led infection prevention and control program for COVID-19 in an Australian hotel quarantine and isolation service

BackgroundA key aspect of Australia's response to the COVID-19 pandemic was to control transmission through legislated quarantine and isolation of overseas returning travellers and potentially infectious community members. In New South Wales, Special Health Accommodation (SHA) was rapidly established as a comprehensive health service for individuals that were at risk of having COVID-19, were confirmed to have COVID-19 or for those with complex health needs that were deemed inappropriate for management in Police managed Quarantine Hotels. SHA services were later expanded to care for community members who were COVID-19 positive and unable to effectively isolate, or contacts of individuals who were unable to quarantine effectively in their homes. SHA's unique nurse-led Infection Prevention and Control (IPC) program offers key lessons that may impact future programs. MethodsA reflection on the experience of leading an Infection Prevention and Control program in SHA was undertaken. This was supported by a review of SHA admission, workforce and transmission data and data obtained from a cross-sectional questionnaire aimed to better understand the experiences of a novel population of health workers (HW) in a comprehensive health-led quarantine and isolation service. ResultsSHA program data demonstrates how its IPC program implementation prevented transmission of COVID-19 to SHA staff and patients. Responses from the questionnaire suggested staff felt safe and well-prepared through the IPC education they received. They also gained transferrable knowledge and skills, which they intend to use in future healthcare roles. ConclusionThe SHA nurse-led IPC program offered successful quarantine and isolation for COVID-19 in non-purpose-built facilities. A review of IPC strategies and key lessons from the establishment of the SHA IPC program are of critical importance to planning and management of current and future pandemics.

Implementation of leadership style to improve the quality of health services in hospitals: Literature review

Hospitals are health care institutions or agencies that organize comprehensive individual health services by providing inpatient, outpatient, and emergency services. The organization of the hospital is expected to provide affordable, quality health services, and optimal results to obtain high quality health service results. Achieving good hospital service quality can be achieved through good team performance as well. In the preparation of good team performance, it is necessary to choose the right leadership style in an organization. The organization in achieving its goals requires the function and role of the leader. The purpose of this study was to identify the implementation of leadership styles that can improve the quality of health services in hospitals. The method of research in this study is a qualitative research design with a literature study. Articles were searched through three data sources, namely PubMed, ScienceDirect, and Google Scholar using the keywords "leadership style" AND "hospital quality". The articles used were published in the last five years, from 2019 to 2023. The study was limited to quantitative and qualitative research methods, but there were no restrictions on specific regions or countries. The results of the study found that the leadership style used can improve the quality of health services in hospitals. The quality of human resource performance is one of the main factors in improving the quality of service in hospitals. There are many leadership styles implemented in hospitals, including democratic, transformational, transactional, authentic, and directive leadership styles. The application of leadership styles must be adjusted to the conditions of the team members.

Development and psychometric testing of the Aesthetics of Everyday Life Scale in Aging (AELSA)

BackgroundThe aesthetics of everyday life improves physical and mental health and social communication. This study aims to develop and test a novel instrument that assesses the aesthetics of the everyday life of older adults.MethodsA mixed-methods study with a sequential exploratory approach was conducted from November 2021 to December 2022. Item generation and questionnaire formation were developed through interviews with older adults and a literature review (stage 1). A cross-sectional study was then conducted to test the psychometric properties of the novel scale among 380 older adults referred to Urban Comprehensive Health Service Centers (stage 2). The construct validity was tested via exploratory factor analysis (EFA) and with the principal component analysis method. Internal consistency and reliability of the scale were evaluated with Cronbach's alpha and test–retest with a 2-week interval.ResultsThe initial scale was prepared with 39 items. In stage 2, EFA revealed a seven-factor model with 34 items. Internal consistency was acceptable for extracted sub-scales (Cronbach's alpha range: 0.67- 0.93) and the total score (0.926). The intra-class correlation coefficient for test–retest reliability was 0.90.ConclusionsThe AELSA is a valid and reliable instrument for evaluating the aesthetics of everyday life in older adults. the scale will help policymakers in formulating interventions to improve mental health and well-being in older adults. Moreover, Further studies is need to provide more support of construct validity.

Prevalence of Elder Abuse and Its Related Factors in Isfahan, Iran

Background: Elder abuse presents a significant public health concern with implications for overall well-being. As Iran undergoes demographic aging, there is a lack of data regarding the prevalence of elder abuse. Objectives: This study aimed to provide insight into the prevalence of elder abuse in Isfahan, Iran. Methods: A cross-sectional study was conducted in Isfahan in 2021, recruiting 424 individuals aged 60 and above from the "Comprehensive Health Services Centers" through simple random sampling. Demographic information and responses to the Elderly Abuse questionnaire were collected via interviews. Descriptive statistics, including mean and confidence intervals, were utilized, while analytical methods such as independent t-tests, chi-square tests, Spearman and Pearson correlation coefficients, and logistic regression were employed for data analysis. Results: The study revealed a 36% prevalence of elder abuse across at least one category, with authority deprivation (19.6%) and emotional neglect (19.3%) being the most prevalent forms. This prevalence was higher among individuals aged 60 - 69 years (adjusted odds ratio (OR) = 2, CI (1.19 - 3.45), P = 0.01), females (adjusted OR = 2.61, CI (1.30 - 5.25), P = 0.007), retirees (adjusted OR = 4.15, CI (1.59 - 10.92), P = 0.004), and those with a history of chronic illness (adjusted OR = 2.11, CI (1.26 - 3.53), P = 0.004). Conclusions: Elder abuse emerges as a significant public health issue in Isfahan. Given the ongoing aging process nationwide, there is a critical need for interventions aimed at preventing and mitigating this public health concern.

Sociodemographic Correlates of Postpartum Depression: A Survey-Based Study.

Objective: Post-partum depression (PPD) has been reported in about one-seventh to one-tenth of women. The aim of this study is to identify the demographic, obstetrics, social, and psychological risk factors of PPD among the eastern region of the United Arab Emirates. Method : A community-based cross-sectional study was performed on 200 women who had a recent singleton pregnancy and delivered newborn within past six months via convenience sampling and email snowballing. Several demographics, obstetrics, social, and psychological factors of the respondents were assessed using a survey form. The Edinburgh depression rating scale (EDRS) was used for the identification of women with possible PPD. Descriptive statistics were utilized for the representation of demographic variables, whereas Chi-square test was employed to assess categorical variables. Also, logistic regression was applied to evaluate the association of investigated variables and PPD. Results: The median EDRS score amongst the study participants was found to be 11 (0-26). The prevalence of PPD was found to be 57% in the studied population. Significant differences were observed in the adverse life events, emotional supports, marital conflicts and history of depression of the participants with and without PPD (P < 0.01). The risk factors significantly associated with PPD were age of the newborn (OR = 6.50, 95%CI: 1.17-19.91), marital relationship (OR = 4.15, 95%CI: 1.31-15.22), maternal educational level (OR = 5.10, 95%CI: 4.30-16.58), adverse life events (OR = 9.32, 95%CI: 1.33-35.32), and history of depression (OR = 5.24, 95%CI: 3.14-11.96). Conclusion: Given the findings, there is an urgent need for policy initiatives to address the identified risk factors, such as improving access to education, strengthening supportive marital relationships, and providing comprehensive mental health services for pregnant women.

Student Health Services at Historically Black Colleges and Universities and Predominantly Black Institutions in the United States.

Student health services are associated with improved health outcomes and academic success, particularly among under-resourced college populations. This study compared student health services at Historically Black Colleges and Universities (HBCUs) and Predominantly Black Institutions (PBIs) and identified factors associated with the availability of comprehensive health services (CHS). We conducted a secondary analysis of 2022 data from the Integrated Postsecondary Education Data System (IPEDS), the Minority Serving Institutions (MSIs) Directory, and the websites of HBCUs and PBIs (n=167). Bivariate and multivariate logistic regression analyses were undertaken to identify institutional variables associated with providing CHS. Institutional variables included college type (public vs. private), MSI category (HBCU vs. PBI), undergraduate enrollment, location, and proportion of Pell grant recipients. Approximately 13% of HBCUs and 26% of PBIs offered no student health services; 65% of HBCUs and 39% of PBIs offered on-campus CHS with prescribing providers. Four-year HBCUs were five times more likely than 4-year PBIs to have CHS (p=0.014). Institutions with more Pell Grant recipients were less likely to offer CHS. Access to health care is an important social determinant of health, academic persistence, and achievement for college students. HBCUs were significantly more likely than PBIs to offer CHS. HBCUs are more likely than PBIs to have resources from federal funding, donors, and endowments that may support the development of student health centers and services. Increased funding for PBI health centers could improve access and promote health equity among the most vulnerable student populations.

Colorectal cancer literacy and related factors in northeast of Iran: A cross-sectional study.

Colorectal cancer (CRC) is a health challenge and the second most common cancer worldwide. Increasing colorectal cancer literacy (CRCL) is one of the most effective factors in CRC prevention. The aim of this study was to determine and evaluate CRCL and its related factors in Torbat Heydarieh, northeastern Iran. This study was a cross-sectional survey conducted in 2021 in Torbat Heydarieh, a city in northeastern Iran, on 200 clients presenting to a comprehensive health service centers. In addition to collecting sociodemographic characteristics, participants were administered the Knowledge and Attitude Questionnaire and the Colorectal Cancer Literacy Questionnaire (CRCLQ). Data were analyzed with SPSS software version 25 using independent samples t-tests, one-way analysis, chi-square, and Pearson correlation coefficients. The statistical significance level was set at p < .05. The results showed that the mean age of the participants was 51.12 ± 8.45 years. The majority of participants (84%) stated that their friends and relatives had no history of CRC. Pearson correlation coefficient results showed a significant correlation between knowledge and attitude toward CRC (r = .15, p = .041). A significant correlation was also found between knowledge and CRCL (r = .4, p ≤ .001). We found low CRCL among clients of comprehensive health service centers. More targeted educational interventions are needed to promote CRCL among Iranian adults.

Exploring challenges and improvement strategies of adolescent-friendly health services in the northwest region of Namibia: A qualitative descriptive study.

Despite global agreements on adolescents' sexual and reproductive health and rights, access to and the utilisation of these services by the adolescents remain underutilised in low and middle-income countries. The aim of the study was to explore challenges and improvement strategies of adolescent-friendly health services in the northwest of Namibia. This study employed a qualitative approach utilising an explorative strategy. Semi-structured interviews were used to collect the data. Fifteen nurses were selected using a convenience sampling technique. The interviews were audio recorded, transcribed verbatim and the data were analysed using thematic analysis. The data analysis led to the emergence of the following three themes: Challenges affecting the delivery of Adolescent Friendly Health Services, Challenges affecting participation of adolescent to AFHS and strategies to improve the provision of adolescent-friendly health services. Findings from this study revealed several barriers reportedly faced by adolescents in accessing AFHS as including a lack of comprehensive sexual reproductive health (SRH) services in many healthcare facilities, a lack of trained staff, unfavourable environments for adolescents, a lack of information about the services provided, and recruitment of providers who are not friendly to young people and adolescents. This study findings may lead to an improvement in the provision of such services in healthcare settings. The study can lead to an improvement in the provision of adolescent-friendly services in health care settings. It can help the Ministry of Health and Social Services, along with its agencies, to formulate strategies that can be used to mitigate the challenges d in the provision of adolescent-friendly services.

Impact of a private sector residential early parenting program on clinically significant postnatal depressive symptoms experienced by women: Audit of routinely collected data.

Early parenting services in Australia offer brief structured residential programs to address moderate to severe non-psychotic mental health problems among women and unsettled infant/toddler behaviours. The aims were to (1) estimate the immediate and medium-term impact of a five-night psychoeducational residential early parenting program on postpartum depressive symptoms and (2) identify the factors associated with improvement or worsening of postpartum depressive symptoms after completing the program and six weeks post-discharge. Audit of routinely collected medical record data from pre-admission, pre-discharge and post-discharge assessments of a consecutive cohort of women admitted, with their infants/toddlers in a 15-month period to Masada Private Hospital Early Parenting Centre. Data included structured questions assessing: demographic characteristics, access to family and social support, past and current mental health problems, reproductive and obstetric health, chronic health conditions, breastfeeding problems, coincidental major life events, health risk behaviours and infant/toddler feeding, sleeping and crying behaviours. Standardised instruments included the Partner Interaction after Birth Scale (PIBS), the MacLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Modified Fatigue Assessment Scale (FAS) and selected items from the Karitane Parenting Confidence Scale. The primary outcomes were Edinburgh Postnatal Depression Scale scores at pre-discharge and follow up assessments. Data were analysed using multinomial logistic regression models in which individual and psychosocial characteristics at pre-admission were included as predictors of the likelihood of the changes of the outcomes from pre-admission to pre-discharge and follow up. Complete data from 1220 of 1290 (95%) eligible women were available to assess pre-admission to pre-discharge and from 559 (45.8%) to assess pre-discharge to six-week follow-up changes. The mean pre-admission EPDS score was 11.7 (95% CI: 11.5; 12.0), pre-discharge it was 7.1 (95% CI: 6.9; 7.4) and at six-week follow up it was 5.7 (95% CI: 5.3; 6.1). We found that almost all women experienced a clinically meaningful and rapid improvement in depressive symptoms of at least this magnitude (reduction in mean EPDS scores of 4.6 points from pre-admission to pre-discharge (five nights) and a further reduction of 1.2 points pre-discharge to follow up) (six weeks) and we identified an interpretable set of risk factors for symptoms that did not improve or worsened. The adverse outcomes were associated with having symptoms of borderline personality disorder, a partner experienced as lacking kindness and care, coincidental adverse events and having a child younger than six months. Residential early parenting programs, which take a psycho-educational approach to strengthening caregiving skills, maximising agency, and reducing helplessness, have a rapid beneficial effect on women's postpartum depressive symptoms. These programs provide a valuable and effective component of comprehensive mental health services. Long-term dialectical behaviour therapy is indicated for women with borderline personality disorder traits for whom early parenting programs alone are insufficient to improve depressive symptoms.

Help-Seeking Preferences and Influencing Factors Among Chinese Nurses Exposed to COVID-19: A Person-Centered Approach

ABSTRACT Purpose This study aimed to explore help-seeking preference categories and crucial influencing factors among community nurses exposed to COVID-19 in China using a new person-centered approach. Design A cross-sectional design including an online self-reported questionnaire survey was used. Methods A total of 667 nurses who participated in COVID-19 prevention and control work were recruited. Latent class analysis and logistic regression were used to analyze the data using Mplus and SPSS. Findings Two latent classes of help-seeking preferences were identified: high help-seeking preferences (33.58%) and low help-seeking preferences (66.42%). Most sampled nurses had relatively low help-seeking preferences when facing psychological threats during COVID-19. Logistic regression showed that career duration, perceived social support, online help-seeking intention, and social media exposure negatively affected low help-seeking preferences. Conclusions Career duration, perceived social support, online help-seeking intention, and social media exposure could be key factors influencing help-seeking preferences among Chinese nurses exposed to public emergencies. It is necessary to implement relevant intervention measures, such as focusing on nurses whose career durations are shorter, improving nurses’ perceived social support, strengthening positive media publicity, and developing comprehensive online mental health services that promote nurses’ help-seeking preferences and behaviors to reduce mental illness during public health emergencies. Clinical Evidence Help-seeking preferences are relatively low among Chinese nurses during public emergencies. Based on the major influencing factors of help-seeking preferences, including social support and social media exposure, more interventions must be developed for prompting psychological help-seeking intentions among Chinese nurses.

Prognostic performance of serum protein markers in assessing mortality risk for North African pediatric population hospitalized with complicated severe acute malnutrition

Background: Complicated severe acute malnutrition (SAM) continues to kill numerous pediatric populations at the global level. Yet, significant progress has been achieved in the clinical management and treatment of this lethal condition in the pediatric population. Aims: To determine the prognostic performance of selected serum protein markers in predicting high-risk mortality in a pediatric population with complicated SAM. Subjects and Methods: This non-interventional cohort prognostic accuracy study included 59 pediatric patients (aged 6 – 60 months) with complicated SAM admitted to Moulay Ali Cherif Regional Hospital, Errachidia, Morocco, during the period from 01.02.2021 to 02.11.2022. Only the SAM pediatric population with medical complications were included in the study. SAM was defined as weight-for-height or weight-for-length z-score &lt; -3 standard deviations, bilateral edema of nutritional origin, or mid-upper arm circumference &lt; 11.5 cm. The enrolled pediatric population received standard inpatient care as per World Health Organization protocols for nutritional rehabilitation of SAM. The pediatric population was divided into two groups, deceased (n=10) and survivors (n=49), based on their outcomes during their hospital stay. Blood samples upon admission were obtained to assess levels of transthyretin, transferrin, albumin, retinol-binding protein, fibronectin, and C-reactive protein. Diagnostic accuracy was assessed using the area under the curve (AUC), the sensitivity, specificity, positive predictive value, and negative predictive value. Results: At a threshold of (≤ 0.13 g/L), transthyretin displayed the best performance of all nutritional markers, with an AUC of 0.71, good sensitivity (80.4%), and specificity (73%). While transferrin, albumin, retinol-binding protein, fibronectin, and C-reactive protein presented good to excellent sensitivity and negative predictive value, their performance was rated “fail” to “poor” (0.5 ≤ AUC &lt; 0.7) with a “poor” positive predictive value. Conclusion: Low levels of transthyretin (≤ 0.13 g/L) demonstrated a prognostic advantage compared to other biomarkers such as transferrin, albumin, retinol-binding protein, fibronectin and C-reactive protein suggesting transthyretin's potential as a prognostic marker for predicting pediatric population with complicated SAM at high mortality risk. Keywords: biochemical markers; death; predictive accuracy; undernutrition.

Is addressing violence against women prioritised in health policies? Findings from a WHO policies database.

Violence against women (VAW) affects almost 1 in 3 women and can lead to short and long-term adverse health outcomes. The health sector is an important entry point to respond to VAW. Globally, countries have committed to eliminating VAW through the SDGs and WHO Member States have endorsed a Global Plan of Action on Violence, which asks countries to provide comprehensive health services to VAW survivors. To track progress and establish a baseline for the Global Plan of Action on Violence, WHO developed a VAW Policies Database to assess how countries are addressing VAW in health and multisectoral policies. This paper presents findings from 15 select indicators related to the existence of VAW-related policies and the inclusion of health services for survivors in policies in line with WHO recommendations. Results show that while 80% of countries have multisectoral VAW policies in place, only 34% have national health policies that include VAW response and/or prevention as a strategic priority, and 48% have clinical guidelines for the health sector response. Policies were analysed to identify inclusion of WHO-recommended VAW health services: 75% of countries' policies mention provision of first-line support; while 50% or fewer of countries mention clinical enquiry to identify intimate partner violence, post-rape care services, or mental health assessment, referral and treatment. The high-income countries group had the lowest proportion of countries that specified each of the above-mentioned health services in policies. Findings show that more efforts are needed to raise the awareness of ministries of health about the public health impact of VAW and the importance of including VAW in health policies. Where policies exist, many are not aligned with WHO-recommendations. Policy dialogues should be conducted with governments on how to better align their VAW policies with internationally-agreed, evidence-based standards, and to implement them through programmes and services.

The effect of positive thinking training on anxiety and happiness among older adults: A quasi-experimental study.

Anxiety and depression are the most prevalent mental disorders associated with aging. Positive thinking training is a way to help older adults cope with anxiety and depression and increase their happiness. This study aimed to determine the effect of positive thinking training on anxiety and happiness among older adults. This quasi-experimental study was conducted with 48 older adults referred to two comprehensive health service facilities in the southeastern Iranian province of Kerman. The intervention (n = 24) and control (n = 24) groups were randomly assigned from a convenience sample of older adults. The intervention group attended eight two-hour training sessions on positive thinking. Data were collected before and one month after the positive thinking training using Beck Anxiety Inventory and Oxford Happiness Inventory. All statistical procedures were performed in SPSS software (version 22), with the significance level set to P = 0.05. Before the positive thinking program was delivered, the mean anxiety scores in the intervention and control groups were 13.98 ± 8.61 and 19.25 ± 11.67, respectively. After the intervention was completed, the mean scores for the intervention and control groups were 4.50 ± 4.07 and 15.54 ± 9.04, indicating a significant reduction in anxiety among intervention group participants (t = -5.45, P < 0.001). The mean baseline happiness scores in the intervention and control groups were 26.58 ± 12.40 and 37.91 ± 5.57, respectively, which changed to 62.91 ± 4.66 and 35.62 ± 10.62 at the post-test. Positive thinking training improved happiness in a significant manner (t = -4.08, P < 0.001). Results revealed that positive thinking training decreased anxiety and enhanced happiness among older adults. Given the growing elderly population, clinical managers, clinical specialists, nurses in health care centers, and those involved in elderly care facilities can benefit from this non-pharmacological treatment program for older adults suffering from anxiety and depression. It is suggested that preventive programs based on positive psychology be developed to aid in the prevention of people's declining happiness and increasing anxiety as they age.