Emergent Themes Research Articles

Work Systems Analysis of Emergency Nurse Patient Flow Management Using the Systems Engineering Initiative for Patient Safety Model: Applying Findings From a Grounded Theory Study.

Emergency nurses actively manage the flow of patients through emergency departments. Patient flow management is complex, cognitively demanding work that shapes the timeliness, efficiency, and safety of patient care. Research exploring nursing patient flow management is limited. A comprehensive analysis of emergency nursing work systems is needed to improve patient flow work processes. The aim of this paper is to describe the work system factors that impact emergency nurse patient flow management using the System Engineering Initiative for Patient Safety model. This study used grounded theory methodologies. Data were collected through multiple rounds of focus groups and interviews with 27 emergency nurse participants and 64 hours of participant observation across 4 emergency departments between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing. Emergent themes were organized according to the first component of the System Engineering Initiative for Patient Safety model, the work system. Patient flow management is impacted by diverse factors, including personal nursing characteristics; tools and technology; external factors; and the emergency department's physical and socio-organizational environment. Participants raised concerns about the available technology's functionality, usability, and accessibility; departmental capacity and layout; resource levels across the health care system; and interdepartmental teamwork. Other noteworthy findings include obscurity and variability across departments' staff roles titles, functions, and norms; the degree of provider involvement in patient flow management decisions; and management's enforcement of timing metrics. There are significant barriers to the work of emergency patient flow management. More research is needed to measure the impact of these human factors on patient flow outcomes. Collaboration between health care administrators, human factors engineers, and nurses is needed to improve emergency nurse work systems.

The Role Foreign Direct Invesment, Financial Development and Institutions Quality of Economic Growth Empirical Evidence From WANA Countries

Research Aims: The study investigates the impact of foreign direct investment, financial development, and institution quality on economic growth in nations located in western Asia and North Africa Methodology: This study methodology employs a panel data regression model using a fixed effect model (FEM) strategy. The study data is collected using the information that was available between the years 2000 and 2022. The WANA nations include Saudi Arabia, Iran, Israel, Jordan, Kuwait, Lebanon, Morocco, Egypt, Oman, Qatar, Tunisia, and the United Arab Emirates. Research Findings: The findings indicated that foreign direct investment (FDI), financial development (FD), and intellectual quotient (IQ) had an impact on economic growth. Specifically, foreign direct investment (FDI) has a beneficial and statistically substantial impact on economic development, but the quality of institutions has an adverse and statistically substantial impact on economic growth. However, financial development does not affect economic growth. Originality: The grand theory used in this research Economic Growth, Foreign Direct Investment, Institutions Quality, Financial Development, and Export and population growth variables are controlled. variables in this study by testing three variables consisting of independent variables, dependent variables and control variables. Research limitation and implication: The findings in this study suggest that policies implemented by governments, public institutions and academics aimed at increasing FDI, FD, and institutional quality can help improve economic growth in WANA countries.

Analysis of the Impact of Chinese Population Aging on Economic Growth and Coping Strategies

Population aging has become a frequent occurrence due to changes in the global population structure, and it has a significant impact on the economic growth of many nations. Particularly in China, with the decline in fertility rates and the extension of life expectancy, the aging problem is further intensifying. The phenomenon of "fewer children and an aging population" is gradually becoming the norm, posing severe challenges to China's economic development. By searching for the relevant population data of the National Bureau of Statistics, this paper analyzes the current situation of Chinese population structure, analyzes the causes of population aging from four aspectsfertility policy, economic and social development, culture and education, and population migration. It also puts forward the impacts of population aging on economic growth, including the decrease in labor supply, the decline in consumption level and the increase in social pension pressure. This paper argues that even though the aging population structure has had a certain impact on China's social economy, people can turn challenges into opportunities. Furthermore, this paper proposes the coping strategies for China's population aging and promoting high-quality economic development, such as improving the elderly consumer market, giving full play to the leading role of government planning, improving the quality of the labor force, and forming an age-appropriate society. The purpose of this paper is to provide theoretical reference and practical guidance for China to cope with the challenges of population aging and the healthy development of population and economy.

Unveiling Truths Amidst the Transition of Instructional Practices in Public High Schools

The study aimed to determine the root cause of stress of secondary public school teachers in Leyte Division during the transition of instructions from modular distance learning or blended learning to face-to-face learning modality. The study also aimed to determine the coping mechanisms of teachers amidst the stress of transition. The study interviewed ten public school teachers from Leyte Division who were selected through purposive sampling technique. The interviews were conducted using a researcher-made interview guide. The interviews were audio recorded, transcribed, and analyzed using Colaizzi’s method of analysis. The study found three emergent themes on the causes of stress among secondary public school teachers during the transition The themes include: readiness to accept the transition, relearning teaching skills and uplifting of learners condition. For the coping mechanism of the participants, the study found four emergent themes. The themes were quality time with family and friends, support system in the workplace, embracing realities towards positive mindset and alleviating stress through rest and recreation. Further, the participants found three emergent themes for their recommendations to improve the plight of secondary public school teachers. The themes were reduced number of students in classrooms, enhanced administrative support and revisit teachers’ roles.

Energy finance strategy and governance nexus with economic growth: Results from emerging economies.

The rapid economic development in emerging economies, particularly in BRICS nations, is closely intertwined with their energy consumption and financial investment in energy sectors. However, the global shift towards sustainability has raised concerns about the continued reliance on fossil fuels and the environmental implications of such practices. Energy finance-particularly the balance between fossil fuel energy finance (FFEF) and renewable energy finance (RENF)-plays a critical role in shaping economic growth trajectories in these economies. At the same time, governance frameworks can either enhance or hinder the effectiveness of energy finance strategies. As the global push for sustainability intensifies, the need to balance these two energy sources becomes increasingly important. This study investigates the impact of energy finance on economic growth in BRICS nations and explores how governance moderates these relationships. Using data from the World Development Indicators (2000-2023) and employing econometric models, including Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS) for robustness, the findings reveal that both FFEF and RENF positively impact EGR. However, RENF also offers the added benefit of environmental sustainability, positioning it as a viable alternative for economic development. Good governance emerges as a critical factor that can mitigate the negative environmental effects of FFEF and further amplify the positive impact of RENF on EGR. The study highlights that BRICS nations have the option to shift from FFEF to RENF, as RENF not only promotes economic growth but also aligns with environmental goals. Strengthening governance frameworks will be essential in facilitating this transition and supporting sustainable economic growth.

Benefit Versus Risk Deliberations on Revisions, Corrections or Rejections of Manuscript Submissions: Reflections of an African Woman Scholar in Audiology

ABSTRACT The academic landscape is fraught with challenges, particularly for scholars whose identities intersect with marginalised backgrounds. This reflective paper explores the nuanced implications of revisions, corrections or rejections (RCRs) on the academic journey of a Black isiZulu-speaking African woman scholar in Audiology from South Africa. It contends that the effects of RCRs extend beyond the confines of a single manuscript, impacting the scholar’s sense of self, existence within the academic realm, and the deliberate ‘cancelling’ of one’s knowledge. Focusing on the unique challenges faced by African scholars, particularly the perceived emphasis on publishing as a measure of belonging, the paper employs a benefit-risk evaluation lens. This approach delves into the complex interaction between personal and environmental factors, shedding light on the multifaceted considerations that African scholars grapple with to establish their presence within the academic sphere. The paper outlines the well-known ‘publish or perish’ phenomenon, emphasising the hypercompetitive nature of the academic and research environment. Peer review, considered a critical component in the publication process, is explored for its role in quality assurance. However, the paper contends that the peer review process can inadvertently perpetuate inequalities, especially for scholars from underrepresented backgrounds. Thematic analysis of reviewer reports from papers I recently submitted forms the core of the paper. Seven emergent themes, such as the influence of proximity to native English speakers and the dominance of Western narratives, illustrate the challenges I faced in both local and international journals. Notably, the paper provides direct quotes exemplifying each theme, offering a very personalised perspective on the adversities encountered during the publication journey. The paper situates the field of audiology within the broader context of institutional and systemic racism, highlighting the underrepresentation of certain racial groups within the profession. It argues that this underrepresentation extends to knowledge generation and publishing, perpetuating the normalisation of Euro-American-centric norms and the exoticisation of Afrocentric standards. The reflective paper concludes by asserting that epistemological racism, intertwined with individual and institutional racism, stifles my pursuit of decolonisation and Africanisation of speech-language and hearing knowledge and practice. It contends that the peer review process, often Euro-American-centric, contributes to the silencing and exclusion of diverse knowledges, hindering local knowledge development and intellectual practices. In navigating the academic minefield, the paper calls for a re-evaluation of existing norms and practices within the peer review process to create a more inclusive and equitable academic environment for scholars with diverse backgrounds.

Factors Impacting the Adoption and Potential Reimbursement of a Virtual Reality Tool for Pain Management in Switzerland: Qualitative Case Study.

Pain and its adequate treatment are an issue in hospitals and emergency departments (EDs). A virtual reality (VR) tool to manage pain could act as a valuable complement to common pharmaceutical analgesics. While efficacy could be shown in previous studies, this does not assure clinical adoption in EDs. The main aim of this study was to investigate which factors affect the adoption and potential reimbursement of a VR tool for pain management in the ED of a Swiss university hospital. Key informant interviews were conducted using in-depth semistructured interviews with 11 participants reflecting the perspectives of all the relevant stakeholder groups, including physicians, nurses, patients, health technology providers, and health insurance and reimbursement experts. The interviews were recorded and transcribed, and the extracted data were systematically analyzed using a thematic analysis and narrative synthesis of emergent themes. A consolidated framework for eHealth adoption was used to enable a systematic investigation of the topic and help determine which adoption factors are considered as facilitators or barriers or as not particularly relevant for the tool subject of this study. According to the participants, the three key facilitators are (1) organizational environment; (2) tension for change, ease of use, and demonstrability; and (3) employee engagement. Further, the three key barriers to adoption are (1) workload, (2) changes in clinical workflow and habit, and (3) reimbursement. This study concludes that the adoption of a VR tool for pain management in the ED of the hospital subject of this study, although benefiting from a high tension for change in pain and workload management, is highly dependent on the respective organizational environment, engagement of the clinical staff, and reimbursement considerations. While tailored incentive structures and ambassador roles could benefit initial adoption, a change in the reimbursement landscape and further investigation of the positive effects on workflow effectiveness are required to drive long-term adoption.

Pengaruh Ekspor, Impor Pengeluaran Pemerintah terhadap Pertumbuhan Ekonomi di Indonesia

This study aims to determine the effect of exports, imports and government spending on national economic growth from 2009 to 2023. The data used in the study is secondary data sourced from the Central Statistics Agency (BPS) and the Ministry of Finance (Kemenkeu). The research employs a quantitative method through multiple linear regression, with the software Eviews 10 used for analysis. The results of the research indicate that, in part, exports exert a negative and significant influence on national economic growth, while imports exert a positive and significant influence. Furthermore, government expenditure exerts a negative and significant influence on national economic growth. These variables, exports, imports and government expenditure, exert a simultaneous influence on national economic growth.

A Rapid Review on Shared Decision Making in Pediatric Palliative Care and End-of-Life Care: Implications for Clinical Practice, Research, and Policy.

Shared decision making is a concept essential to establishing meaningful goals of care that reflect one's preferences, values, beliefs, culture, and quality of life. This rapid review considered shared decision making from the perspective of seriously ill or medically complex children receiving inpatient palliative or end-of-life care, where shared decision making is made on behalf of and in the child's best interest. A total of 118 articles were screened, resulting in the selection of 12 articles using a systematic process. Emergent themes noted and discussed include the roles of family and clinicians, explorative communication, transparency, cultural implications, and ethical challenges.

Examining the Impact of Tungsten Production on China’s Economic Growth: Evidence for the Resource Curse Hypothesis

This study investigates the potential impact of China’s dominant position in global tungsten production on its national economic growth, examining the applicability of the resource curse hypothesis. While prior research has extensively explored the resource curse in relation to oil and other resources, the role of tungsten remains largely unexplored. Utilizing annual data from 1994 to 2022, this study employs an autoregressive distributed lag (ARDL) bounds testing approach to analyze the long-run relationship between per capita income from tungsten production and per capita GDP. The results reveal a significant negative relationship, suggesting that the increased income from tungsten production may be associated with a decline in overall economic output, supporting the resource curse hypothesis. The study contributes to the growing body of the literature on the resource curse by investigating the unique case of tungsten and highlighting the importance of sustainable resource management, diversification, and effective governance in maximizing economic benefits while mitigating potential downsides.

Open Economy Macroeconomics: Developments in Theory and Policy Using the TOPSIS Methodology

Open economy macroeconomics examines the complex interplay between a nation's economic policies and global financial markets. This field of study addresses critical issues such as exchange rate determination, balance of payments, and the effects of trade and capital flows on a country's economic performance. The increased integration of economies through globalization has made it essential to understand how domestic economic policies, such as monetary and fiscal policies, interact with international economic environments. This paper explores the key concepts and models in open economy macroeconomics, including the Mundell-Fleming model, purchasing power parity, and the dynamics of exchange rate regimes. The study of open economy macroeconomics has gained prominence with the growing interconnectedness of global markets. Unlike a closed economy, where all economic transactions occur within national borders, an open economy engages in trade and financial transactions with other countries. This openness introduces new challenges and opportunities for policymakers, as domestic economic conditions are increasingly influenced by external factors such as foreign exchange rates, international trade agreements, and global capital flows. Open economy macroeconomics seeks to understand how these external factors affect key economic variables, such as output, inflation, and employment.The significance of studying open economy macroeconomics lies in its profound implications for both national and global economic stability and growth. As economies become increasingly interconnected, understanding the mechanisms by which international trade, capital flows, and exchange rates influence domestic economies is essential for effective policymaking. This field of study is particularly relevant in today’s world, where financial crises, trade wars, and global economic shocks can have ripple effects across borders, impacting nations' economic well-being regardless of their size or level of development.. Free Trade Agreements, Currency Pegging, Capital Controls, Trade Tariffs, Exchange Rate Floating. GDP Growth Rate (%),Trade Balance (Billion $), Inflation Rate (%),Unemployment Rate (%). The results indicate that Free Trade Agreements achieved the highest rank, while Capital Controls had the lowest rank being attained. The value of the dataset for Corporate Open Economy Macroeconomics according to the topsis Method, Integrated Pest Management achieves the highest ranking.

Urban Nutrition in the Global South: A Narrative Review of Current Research.

According to the Global Food Policy Report 2017, nearly 90% of the projected urban population increase by 2050 is going to be concentrated in Africa and Asia. Parallel evidence suggests that poverty and related challenges of food insecurity and undernutrition are also urbanizing. The dynamics underlying urban nutrition is different from rural ones but also arguably represents a more complex scenario. In this review, we synthesize available evidence on urban nutrition (in)security in the Global South. Although focused on nutrition-centric literature, our review also identifies and discusses studies in the contexts of the broader notion of urban food systems. Articles that analyzed any form of mal/nutrition were eligible for inclusion. One hundred sixty-nine articles were shortlisted based on a systematic search strategy, then expanded through a backward and forward literature survey. Our review identifies key emergent themes from a large body of research on urban food systems, noting that surprisingly few address nutrition directly. Rather, current literature on urban nutrition is scattered and skewed with an overt focus on urban agriculture. Our review reveals that the existing literature with direct nutrition relevance in an urban context can be systematically organized across three themes, i.e., urban agriculture, nutrition transition, and social protection. Noticeably, this literature also draws upon successful interventions having implications for urban nutrition. Finally, the review identifies a few research gaps that hinder a holistic view of urban nutrition. These gaps pertain to gender, equity, water (along with sanitation and hygiene), and local governance.

Using AsianCrit Theory to Understand How Anti-Asian Hate Impacted Mental Health Among Asian Women in STEM Doctoral Programs.

Steeped in the AsianCrit theoretical framework, the current study examined how anti-Asian hate impacted the mental health of Asian and diasporic Asian doctoral women in STEM. Six emergent themes were identified: 1) Witnessing and Experiencing Anti-Asian Hate; 2) Lack of Institutional and STEM Departmental Support; 3) Impact of Anti-Asian Hate on Asian Women's Mental Health; 4) Protecting One's Mental Health; 5) Resist to Persist; and 6) Calls for Action to Combat Lack of Departmental Support. These findings highlight how Asianization through stereotypes such as the forever-foreigner status, viewing Asians as a monolith, the yellow peril stereotype, and model minority myth simultaneously rendered Asian graduate women hypervisible in the U.S. society and invisible in science, technology, engineering, and mathematics (STEM). Implications for teaching and mentoring are included. These highlight the need for faculty to challenge institutional norms that perpetuate the erasure of the toll that anti-Asian hate levied on Asian doctoral women in STEM.

Telehealth in Gynecologic Oncology Clinical Trials

OBJECTIVE: To describe patient, research staff, and clinician perspectives regarding the effects of telehealth and remote clinical trial operations on safety, quality, and experience in gynecologic oncology clinical trials. METHODS: This qualitative study used semistructured interviews conducted from May to June 2022 with purposively sampled clinical trial participants, research staff, and clinicians involved in gynecologic oncology clinical trials with telehealth utilization. Participants described telehealth in clinical trial experiences, including benefits and barriers to receipt and provision of care, satisfaction, and quality. Transcripts were coded and analyzed with a modified content analysis approach based on research objectives and emergent themes. An adapted version of the validated Telehealth Usability Questionnaire was administered to all invited participants. RESULTS: Five patients, seven clinicians, and five research staff were interviewed. Patients and clinicians reported that telehealth, remote testing, and medication delivery positively affected quality of life by reducing financial burden, wait times, and transportation needs. Interviewees did not report telehealth-related changes in treatment-related adverse effects, referrals for urgent evaluation, or compromise of privacy but expressed concerns about the lack of physical examinations. Patients reported that telehealth increased scheduling burden without negative effects on care quality, counseling comprehension, relationships with trial teams, or satisfaction. Clinicians and research staff reported improved workflows regarding remote consent, sponsor interactions, and documentation but challenges with virtual patient education and off-site testing. Clinicians highlighted disparities for patients with limited technology access and reported institutional and insurance-based telehealth policies as barriers. Survey responses supported qualitative findings. CONCLUSION: Despite notable limitations, patients, research staff, and clinicians recommended continued utilization of telehealth and remote clinical trial operations in clinical trials. Future clinical trial designs should consider telehealth inclusion.

Low-stakes Scientist Spotlight Assignment Demonstrates High Value and Multiple Effects for Introductory Biology Students.

Scientist Spotlights are homework assignments that highlight the personal and scientific stories of counterstereotypical scientists. Previous research has focused on whether these assignments promote possible selves in STEM (science, technology, engineering, mathematics). We sought to understand the value students themselves placed on the assignment using expectancy-value theory complemented by further analysis of the assignment's self-reported impacts on students. Therefore, at the end of an introductory biology course with several Scientist Spotlights, we asked students to reflect on how the course would influence them for years to come. We found that although the assignments had low instrumental value, 49% of students mentioned Scientist Spotlights or a highlighted scientist. Thematic analysis on the Scientist Spotlight-related parts of the reflections found novel emergent themes including diversity in science, humanizing scientists, and self-efficacy. Most students mentioned multiple themes, with few differences between students from minoritized and nonminoritized groups. We interpreted our results through the lens of the "mirrors, windows, and sliding glass doors" framework, as Scientist Spotlights appeared to function as "windows" into the diverse scientific world, "mirrors" for seeing human traits in scientists, and "sliding glass doors" inviting students further into science. Our study expands our understanding of the broad, multiple, and intersecting impacts of Scientist Spotlights.

Investigating pre-registration podiatry students approaches to identifying dermatology conditions in different skin tones: A mixed methods protocol.

Health inequalities are a well-known and widespread phenomenon throughout health care settings. In particular, people of color experience higher rates of delayed and/or misdiagnosis contributing to poorer outcomes and an increased mortality risk. Research suggests that health care professionals find it more difficult to correctly diagnose dermatological conditions in the non-White patient demographic. Although podiatrists routinely examine and assess skin lesions, there is a paucity of research exploring their accuracy or confidence in recognizing skin pathologies. This study aims to investigate podiatry student's ability, confidence, approaches, and perceptions in diagnosing dermatology pathologies in different skin tones. A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data. A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

THE INFLUENCE OF SERVANT LEADERSHIP ON FOLLOWERS’ CREATIVITY WITH CLIMATE FOR CREATIVITY AS MEDIATION

Introduction: As a developing nation, Indonesia persists in its endeavors to boost national growth, including initiatives to support the creative industry through startup companies. This research aims to examine the impact of servant leadership on followers’ creativity, with climate for creativity as the mediating factor. Methods: This research is a quantitative study using primary data obtained through a questionnaire survey from 178 employees working in 73 Indonesian startup companies. The sampling method was purposive sampling. The collected data were then processed and analysed using SEM-PLS. Results: The results revealed the significance of climate for creativity as a full mediator in the relationship between servant leadership and followers’ creativity, meaning that servant leadership has an indirect influence on followers’ creativity through climate for creativity. These findings suggest that leaders who adopt servant leadership styles can enhance followers’ creativity through climate for creativity. Conclusion and suggestion: This study found that servant leadership's impact on startup employees' creativity is fully mediated by the perceived climate for creativity. This implies that by fostering a climate supportive of creativity—through flexible work environments, recognition of creativity, and resource provision—servant leaders indirectly enhance employee creativity. Thus, when servant leaders cultivate a climate for creativity, it boosts the creativity of startup employees in their work.

The influence of ‘hidden’ costs of school uniforms for refugee students in Kenya

ABSTRACT Despite the international community’s ongoing commitments to basic education, as demonstrated by the UN Millennium Development Goals and Sustainable Development Goals, an estimated 250 million children are still out of school, of whom seven million are school-aged refugees. Interviews with former students in a refugee camp in Kenya explore how the ‘hidden’ costs of school uniforms ultimately led to their decision to drop out of primary school. Emergent themes reveal that the financial burden of school uniforms, and unsupportive school and classroom environment were the largest contributors to students’ decision to leave school. Although school uniforms were not a compulsory policy in Kenya, they were strictly enforced in most, if not all, schools in the camp, and students out of uniform would be sent home or abused. Despite dropping out, many participants described their hope to one day return to school in order to better support their families.

Being pregnant and obese: A qualitative study of the experiences of pregnancy and birth of women who are obese

ObjectivesThis study explored the views and experiences of maternity care of postnatal women identified as being obese. DesignA qualitative methodology was adopted using individual semi-structured interviews. Data was analysed using a framework approach. SettingTwo National Health Service Hospitals- a large tertiary unit in England, and a district general hospital in Scotland. Participants8 women with a body mass index of greater than 35 who had recently had a baby. FindingsThe overall interpretation ‘Being pregnant and obese; Obese women's experiences of pregnancy and birth’ was underpinned by three key emergent themes: embodiment of obesity; being pregnant and overweight, and resource intensive maternity care. These findings are encapsulated in a conceptual framework that was formed to demonstrate the trajectory from the embodiment of obesity to becoming pregnant as an obese woman, experiencing the maternity regime that is currently in place for the care of obese women and then finally returning to being an obese woman. Key conclusionsWomen who are obese have an intrinsic fear of pregnancy and birth, have a desire for normal birth and ‘obese pregnancy’ presents a window of opportunity for both short and long-term lifestyle change. Implications for practiceCurrently one-fifth of women in the UK are obese. There is increasing evidence of the detrimental effects obesity has on intrapartum outcomes and a lack of research on how to minimise the associated risks of obesity through non-medicalised interventions and how to support women who are obese to maximise their experience of birth. Addressing the intrapartum management through non-medicalised interventions is of paramount importance to maximise the experience of birth and reduce the associated morbidities.

Impact of the COVID-19 pandemic on the HIV care continuum and associated factors in middle-income countries: A mixed-methods systematic review.

The HIV care continuum during the COVID-19 era faced specific challenges. The pandemic, affecting the delivery of HIV care, exacerbated existing healthcare inequities and vulnerabilities in middle-income countries with limited financial resources. This study aims to set the stage for the systematic review, focusing on the impact of COVID-19 on HIV care in middle-income countries with a focus on barriers and facilitators. A systematic search of relevant literature, including electronic databases and manual assessment of references, was done. The review included quantitative, qualitative and mixed-methods studies conducted in middle-income countries, with no age or gender restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for reporting the results. In the course of our systematic review, a comprehensive examination of the pertinent literature published between 2020 and 2024 yielded a total of 76 studies. This adverse impact was prominently attributed to an amalgamation of factors intrinsically associated with pandemic-induced restrictions, fear of contracting the COVID-19 and fear of disclosing HIV status. Moreover, an emergent theme observed in select studies underscored the enduring trend of HIV treatment continuity, which was facilitated by the burgeoning utilization of telemedicine within this context. The pandemic negatively affected income and increased vulnerability to HIV across all phases of the HIV care continuum, except for viral suppression. Prevention measures, such as pre-exposure prophylaxis (PrEP), were compromised, leading to increased risky behaviours and compromised mental health among people living with HIV. HIV testing and diagnosis faced challenges, with reduced access and frequency, particularly among key populations. The pandemic also disrupted linkage and retention in care, especially in urban areas, exacerbating barriers to accessing necessary HIV treatment. Additionally, this review highlights the complex and multifaceted landscape of the pandemic's impact on HIV medical appointments, adherence and treatment engagement, with various barriers identified, including fear of COVID-19, economic constraints and disruptions in healthcare services. The coexistence of pandemics has had negative effects on the HIV care continuum, with restrictions on services, an increase in care gaps and a break in the transmission chain in middle-income countries.