Frontline Workers Research Articles

Food Insecurity Among Community College Caregivers During the COVID-19 Pandemic

Objective: The purpose of this paper was to examine variables associated with food insecurity among community college caregivers during the COVID-19 pandemic. Methods: We used data from a multi-institutional survey of 15,051 caregivers enrolled at 130 community colleges in 42 states in fall 2020. We used a logistic regression to examine whether demographic, academic, caregiving-related, financial, or COVID-19-related variables were associated with caregivers’ food insecurity. Results: Over half (52%) of community college caregivers experienced food insecurity. Transgender caregivers, first-generation caregivers, and caregivers who were divorced or single, had multiple disabilities, were previously in foster care, and had a family that experienced trouble making ends meet growing up had significantly ( p < .05) higher probabilities of experiencing food insecurity. Community college caregivers who used childcare and those with at least one child up to 12 years old also had increased probabilities of experiencing food insecurity. Moreover, caregivers who felt childcare was not affordable and believed that they did not earn enough money to make employment worthwhile after paying for childcare expenses had higher probabilities of experiencing food insecurity, as did those who experienced housing insecurity and used Pell grants, student loans, and support from friends or family to pay for college. Losing a job, experiencing cuts to work hours or wages, employment as a frontline worker, and contracting COVID were associated with higher probabilities of food insecurity. Contributions: Community college caregivers experienced high rates of food insecurity during the pandemic and some caregivers were at greater risk of exacerbated probabilities of food insecurity. We advocate for targeted interventions, wraparound services, and increased advocacy for legislation to support student caregivers.

Effect of acid-thermal coupling on the chemical structure and wettability of coal: An experimental study

Coal is the primary fossil fuel in China's energy sector. As the amount of mining continues to increase, the high concentration of dust generated poses a severe threat to equipment and frontline workers. The coupling influence of HCl and temperature on the structure and wettability of coal were conducted by experiments. The phenomenon indicates that the contact angle between coal treated with HCl of different temperatures and water is reduced, the settling distance in an aqueous solution is longer, and the effect is significant with the increase of temperature, demonstrating the acid-thermal coupling solution improves the wettability of coal. Secondly, detailed analysis of coal functional groups and surface element, shows that the percentage of hydrophilic groups increased, such as OH⋯O, free –OH, and hydrophobic groups were destroyed, such as the asymmetric deformation vibration of adjacent H. The L, ‘C', and DOC show an increasing trend, while I first increase and then decrease by analyzing the trends of IR indices of coal. The conclusions prove that the degree of coal deterioration changed after treatment with acid-thermal coupling conditions. The influence mechanism of acid-thermal coupling solution on coal was explored to provide ideas for improving the wettability of coal from the source.

Family experiences reported by healthcare worker parents during the COVID-19 pandemic

PurposeParents, who were working as essential frontline healthcare workers experienced unique stressors during the COVID-19 pandemic including disruption of regular routines, long lapses away from family, extreme work stress and subsequent difficulty in compartmentalizing work-related concerns when at home. The purpose of this study was to assess COVID-19 exposure and impact of frontline healthcare workers who are parents. Design & methodsThis study quantitatively assessed the COVID-19 exposure and impact and qualitatively explored perceptions of parents of children 9 to 17 years of age, who were also frontline healthcare workers. ResultsParticipants (N = 79) using the COVID-19 Exposure and Family Impact Survey (CEFIS) reported exposure mean scores of 10.03 (SD = 2.63); and impact scores mean scores of 3.18 (SD = 0.46). Thematic analysis identified four themes, each with 2 subthemes: 1) family stressors increased (e.g., concerns about health and safety, losses of lifestyle patterns); 2) changes in children's health and well-being (e.g., isolation from family and friends, mental health problems); 3) virtual school difficulties (e.g., parent and student challenges, home school option); 4) skill building opportunities (e.g., enhanced emotional connections, increased family activities). ConclusionThe CHAMPS Family Health Study suggests that families of essential workers are especially vulnerable to the effect of COVID-19, as are those families of essential workers who include child/ren with special health care needs. Practice implicationsPreparation for future emergencies requires strategies to mitigate consequences and promote well-being. These results highlight the need for supportive approaches to decrease the negative consequences of stress and to augment skills for family connection and cooperation.

Facilitating knowledge transfer to policy makers and front-line workers during a pandemic: Implementation, impact and lessons learned.

Stakeholders working on the COVID-19 pandemic response needed access to evidence, requiring a systematic approach to identify and disseminate relevant research. Outlinethe stages of development of a COVID-19 Literature Digest; demonstrate the impact the Digest had on decision-making and knowledge gain; identify the lessons learned. A standardised process was developed to identify and select papers. The main sources for content were PubMed, bioRxiv and medRxiv. A shared EndNote library was used to deduplicate and organise papers. Three user surveys obtained feedback from subscribers to determine if the Digest remained valuable, and explore the benefits to individuals. 40-60 papers were summarised each week. 211 Digests were produced from March 2020 to March 2022, with around 10,000 papers included altogether. Survey results suggest benefits of the Digest were gaining new knowledge, saving time and contributing to evidence-based decision making. Digest procedures constantly evolved and were adapted in response to survey feedback. Lessons identified: learn from failure, communication is key, measure your impact, work collaboratively, reflect and be flexible. The Digest was successfully produced within the limits of available resource. The learning from this Digest will inform evidence monitoring, selection and dissemination for future health crises.

Hybrid Immunity and SARS-CoV-2 Antibodies: Results of the HEROES-RECOVER Prospective Cohort Study.

There are limited data on whether hybrid immunity differs by count and order of immunity-conferring events (infection with severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] or vaccination against coronavirus disease 2019 [COVID-19]). From a multi-site cohort of frontline workers, we examined the heterogeneity of the effect of hybrid immunity on SARS-CoV-2 antibody levels. Exposures included event count and event order, categorized into 7 permutations. Outcome was level of serum antibodies against receptor-binding domain (RBD) of the ancestral SARS-CoV-2 spike protein (total RBD-binding immunoglobulin). Means were examined up to 365 days after each of the first to seventh events. Analysis included 5793 participants measured from 7 August 2020 to 15 April 2023. Hybrid immunity from infection before 1 or 2 vaccine doses elicited modestly superior antibody responses after the second and third events (compared with infections or vaccine doses alone). This superiority was not repeated after additional events. Among adults infected before vaccination, adjusted geometric mean ratios (95% confidence interval [CI]) of anti-RBD early response (versus vaccinated only) were 1.23 (1.14-1.33), 1.09 (1.03-1.14), 0.87 (.81-.94), and 0.99 (.85-1.15) after the second to fifth events, respectively. Post-vaccination infections elicited superior responses; adjusted geometric mean ratios (95% CI) of anti-RBD early response (versus vaccinated only) were 0.93 (.75-1.17), 1.11 (1.06-1.16), 1.17 (1.11-1.24), and 1.20 (1.07-1.34) after the second to fifth events, respectively. Evidence of heterogeneity in antibody levels by permutations of infection and vaccination history could inform COVID-19 vaccination policy.

Documenting Decentralization: Empirical Evidence on Administrative Unit Proliferation from Uganda

Abstract Decentralization is an important and commonplace type of reform, yet our understanding of its effects remains limited. This paper documents the effects of the 2009–10 wave of district creation in Uganda, which increased the country’s districts by 42 percent, using rich data on subdistrict units to assess the effects of district creation on a broad range of post-decentralization outcomes in a difference-in-differences framework. The effects of decentralization are concentrated in newly split off—rather than split from—districts, and are heterogeneous across outcome types. Newly split-off districts have more per capita frontline workers, but appear to have worse quality infrastructure and lower economic development. The study also presents suggestive evidence that administrative capacity decreases for newly formed districts post-split. These findings demonstrate the importance of considering a broad range of outcomes when thinking about decentralization.

Characteristics Associated with COVID-19 Breakthrough Infections after Booster Vaccinations in Healthcare Workers: Insights from the TüSeRe:exact Study.

Background: The prevalence of COVID-19 breakthrough infections in healthcare workers (HCWs) remains an issue of concern. This study examines the different characteristics associated with breakthrough infections in HCWs. Methods: From the total participants in the TüSeRe:exact study (n = 1046), we specifically included study participants who had received three vaccinations and were not infected prior to the third vaccination. Participants were invited to complete an online questionnaire, which included inquiries about any breakthrough infections they might have experienced. Univariate Cox regression analysis was used to investigate the association between participant characteristics and breakthrough infections. Results: Among 629 HCWs (497 female and 132 male), 241 (38%) experienced breakthrough infections during the follow-up period. The frequency of breakthrough infections was 39.2% (195/497) among female participants and 34.8% (46/132) among male participants (p = 0.357). The Cox regression model adjusted for age and sex showed that participants with cardiovascular disease (hazard ratio (95%CI) = 0.621 (0.392-0.985); p = 0.043) and those taking antihypertensives (hazard ratio (95%CI) = 0.551 (0.331-0.915); p = 0.021) had a significantly lower hazard ratio for breakthrough infections. The use of analgesics after the first vaccine (hazard ratio (95%CI) = 1.343 (1.025-1.759); p = 0.032) was associated with an increased risk of breakthrough infections. Conclusions: These findings can inform targeted preventive measures and risk management strategies to protect frontline workers and maintain a resilient healthcare system during the ongoing pandemic.

The prevalence of and factors associated with depressive and anxiety symptoms during the COVID-19 pandemic among healthcare workers in South Africa.

Healthcare workers globally have experienced increased social and occupational stressors in their working environments and communities because of COVID-19 which has increased the risk of mental health concerns. This study aimed to explore the prevalence and correlates of depression and anxiety amongst healthcare workers during the COVID-19 pandemic in the Western Cape, South Africa. In addition, role-related stressors and coping strategies were explored. We conducted a cross-sectional survey of doctors and nurses working in public healthcare facilities across the Western Cape, South Africa. Participants completed the Generalized Anxiety Disorder-7 (GAD-7), the Center for Epidemiologic Studies Depression (CES-D), the Professional Quality of Life (PROQL-R-IV), and the Brief Coping Orientation to Problems Experienced (COPE-R) scales. Data were analysed using multivariable logistic regression analysis. The sample comprised 416 health workers (303 nurses, 113 doctors). Almost 40% of the sample (n = 161) had CES-D scores suggestive of probable depression, and 45.9% (n = 186) had GAD-7 scores suggestive of anxiety. In the logistic regression model, the odds of probable depression were higher for female participants compared to men (OR = 2.26, 95% CI 1.00-5.10) and for participants who used behavioural disengagement as a coping strategy (OR = 1.50, 95% CI 1.14-1.97). More time spent working with COVID patients was associated with increased odds of having high levels of anxiety [OR = 1.13, 95% CI (1.02-1.25). Substance use (OR = 1.39, 95% CI 1.08-1.81), venting (OR = 1.31, 95% CI 1.01-1.70), and self-blame (OR = 1.42, 95% CI 1.08-1.87) were some of the coping strategies used by healthcare workers. High levels of secondary traumatic stress and burnout were found to increase the odds of both depression and anxiety. Findings of this study suggest that there is a high prevalence of mental health issues among healthcare workers, and a critical need to focus on workplace mental health interventions to support these frontline workers.

When a Crisis Hits, Send in the Psychologists? A Latent Transition Analysis of Help-Seeking Behavior Among Swedish Healthcare Workers During the COVID-19 Pandemic

During a crisis, there is limited time to plan support initiatives for healthcare workers and few resources available to ensure that they engage with them. Using the context of the recent COVID-19 pandemic, this study aimed to investigate help-seeking behaviors among healthcare workers in relation to psychological support initiatives offered to them. Data from a Swedish longitudinal survey following healthcare workers from early (N = 681) to mid-pandemic (N = 396) were analyzed using latent class and transition analyses. We found three patterns of healthcare workers’ help-seeking behavior that applied to both time points: (1) engaging with different forms of group-based support, (2) not participating in any kind of offered support, and (3) only having been offered information-based support. The availability of support declined during the mid-pandemic. Group support users were primarily nurses and frontline workers, with higher levels of burnout symptoms. Our findings suggest that healthcare organizations should limit their implementation of psychological support during a crisis to a few key formats based on social support. Promoting participation from all staff groups may enhance the inclusivity, effectiveness, and sustainability of the support.

Healthcare workers' knowledge and risk perception regarding the first wave of COVID-19 in Khyber Pakhtunkhwa, Pakistan: an online cross-sectional survey.

Increased COVID-19 transmission among the populace may be caused by healthcare workers (HCWs) who lack knowledge, awareness, and good preventive practices. Additionally, it may cause elevated stress levels, anxiety, poor medical judgement, and situational overestimation. The present survey aimed to assess knowledge and risk perception regarding COVID-19 among HCWs in Khyber Pakhtunkhwa (KP), Pakistan. A web-based online, pre-tested questionnaire comprising 26 items was circulated via social media in April 2020 amongst HCWs in major tertiary care facilities in KP. The study's results, revealing both the commendable knowledge levels among HCWs about COVID-19 and their heightened risk perception, highlight the critical need for targeted interventions to address the potential impact on self-protective behaviour and mental health within this vital workforce. This insight is important for designing strategies that not only enhance HCWs' well-being but also ensure the continued effectiveness of healthcare delivery during pandemics. The percentage mean score (PMS) of COVID-19 knowledge was 85.14±10.82. Male HCWs and those with an age older than or equal to 32 years demonstrated a higher knowledge score (85.62±11.08; P=0.032 and 87.59±7.33, P=0.021, respectively). About 76% of HCWs feared contracting COVID-19. Nearly 82% of respondents were mentally preoccupied with the pandemic and also terrified of it. 'Of these, 81% were nurses, 87% had a job experience of 6-8 years and 54.45% were frontline workers. Feelings of panic and concern about the pandemic were found to be more in HCWs who were physicians above the age of 32, and who had 3-5 years of work experience. HCWs' overall risk perception was found to be significantly different between males (7.04±2.26) and females (8.01±1.97), job experience of 6-10 years (8.04±177) with 3-5 years and younger than or equal to 2 years job experience (7.18±2.43,6.93±2.22), respectively, and between frontline HCWs (7.50±2.10) and non-frontline HCWs (6.84±2.40). HCWs demonstrated good knowledge about COVID-19. As the risk perception of COVID-19 among HCWs is high, it can raise concerns about their self-protective behaviour, and mental health. These issues need to be addressed.

Into the Unknown: Conceptualizing the Experience of Uncertainty in Citizen–State Interactions

Abstract It is often argued that uncertainty is an inherent characteristic of citizen–state interactions. It is therefore hardly surprising that many scholars of street-level bureaucracy have studied how frontline workers cope with and make discretionary decisions under uncertain conditions. However, citizens’ experiences of uncertainty have received limited attention in the street-level bureaucracy literature. This article argues that understanding citizens’ experiences of uncertainty is highly relevant because experiences of uncertainty are likely to affect mental well-being of individuals negatively. The article seeks to address this gap by building a conceptual framework for understanding and analyzing citizens’ experiences with uncertainty in state–citizen interactions based on theoretical insights from the existing literature and in-depth qualitative analysis of 20 narrative interviews with former coronavirus disease 2019 (COVID-19) patients and their relatives concerning their encounter with health authorities. The article proposes a conceptual framework that distinguishes between epistemic uncertainty and moral uncertainty. Epistemic uncertainty concerns uncertainty about empirical facts or knowledge. Moral uncertainty concerns uncertainty about values due to conflicting or competing norms and values. The article illustrates how these forms of uncertainty may arise before, during, and after citizens’ interaction with frontline workers.

Surveillance of COVID-19 vaccines: A comprehensive analysis of the first immunization drive in Ecuador

The initial phase of the COVID-19 vaccination in Ecuador occurred between April and November 2021. Initially, it focused on priority populations, including health professionals and other front-line workers. During this period, there was limited knowledge about the vaccine's adverse effects. A non-probability, observational study was conducted among university staff in Guayaquil, Ecuador, who received the AstraZeneca vaccine (n = 423) between April and November 2021. This study aimed to compare the acute adverse reactions by doses and to report the incidence of long-term adverse reactions within the AstraZeneca group. As a result, comparing acute adverse reactions between doses, the odds ratio for local pain, headache, muscle pain, fever, and chills are statistically higher after the first dose than the second dose. Survival curves indicated these symptoms appeared mainly within the first 6 h post-vaccination. This is the first pharmacovigilance study from Ecuador that analyzes survival probabilities for the AstraZeneca vaccine's adverse effects.

Social and behavior change communication competency among front-line healthcare system actors in Ethiopia: a cross-sectional study

IntroductionSocial and Behavior Change Communication (SBCC) plays a critical role in improving behavior and health outcomes across the continuum of healthcare. Failing to implement tailored SBCC strategies continues to pose a risk of ill health, increase disease burden, and impact the quality life of people. In Ethiopia, front-line healthcare system actors’ knowledge and skills about SBCC have not been rigorously assessed. Thus, the current study aimed to assess healthcare system actors’ competencies in designing, implementing, monitoring, and evaluating SBCC interventions in Ethiopia.MethodsA cross-sectional study was conducted between 01 August and 31 October, 2020. Five hundred twenty-eight frontline healthcare system actors in SBCC in Ethiopia were included using simple random sampling technique. Data was collected using a self-administered structured questionnaire adopted from Communication for Change; SBCC capacity assessment tool. Descriptive analysis frequencies, percentages, mean, median, standard deviation (SD), interquartile range (IQR) were employed. Besides correlations and linear regression with robust standard errors were carried out. A 95% confidence interval and a p-value of less than 0.05 were used to declare significant statistical association.ResultsA total of 488 frontline workers participated in the study, with a response rate of 92.4%. The mean SBCC knowledge score was 13.2 ± standard deviation (SD) 3.99 and 59.2% scored below 60% of the expected maximum score. The standard mean score of overall skill in SBCC intervention was 2.36 (SD ± 0.98) and 52.6% of them scored below mean score. The SBCC knowledge was significantly predicted by the service year and the regional variation. On the other hand, SBCC skills was significantly predicted by sex, service year, profession, regional variation, and SBCC knowledge. The regional variation was the main predictor of both knowledge and skill on SBCC. The regression models explained 23.1% and 50.2% of the variance in knowledge and skill of SBCC, respectively.ConclusionFront-line healthcare system actors in Ethiopia has low knowledge and skills in SBCC. Variations in SBCC knowledge and skill were observed based on demographic and professionals experience related characteristics. Hence, continuous capacity building activities need to be given to frontline healthcare system actors to enhance their knowledge and skill on SBCC program and achieve the intended health results.

감정표현규칙이 서비스 직원의 소진에 미치는 영향: 도전적 평가와 방해적 평가의 매개효과를 중심으로

Emotional display rules are official and unofficial requirements on how people
 should express their emotions to others in organizations, playing crucial roles
 in emotional management. According to the job demand-resources model,
 emotional display rules can cause job stress and burnout because they are
 job demands. However, in light of the challenge-hindrance job stress model,
 the effect of job demands on burnout may differ according to whether people
 perceive them as challenges or hindrances. The purpose of this study is to
 determine the causal relationship among emotional display rules, challenge
 appraisal, hindrance appraisal, and service worker burnout. In this study, we
 postulate that emotional display rules increase burnout, while challenge and
 hindrance appraisals mediate the display rules-burnout relationship. A total
 of 213 survey responses were collected from frontline workers in the service
 industry, and an analysis of results revealed that emotional display rules are
 positively associated with burnout, while challenge appraisal negatively mediates
 the display rules-burnout relationship. We also found that hindrance appraisal
 did not mediate between emotional display rules and burnout, while perceived
 organizational support and self efficacy did not moderate the relationship
 between emotional display rules and burnout. These results may demonstrate
 the possibility that service worker burnout can be buffered with the perception
 of emotional display rules as challenging rather than hindering job demands.
 In addition, they imply that service workers’ perceptions and mind controls
 are more important than external factors like organizational support in managing
 job demands, such as emotional display rules. This study shows the importance
 of job appraisal in understanding service workers’ stresses and burnout.

Effect of community based intervention on childhood pneumonia and its risk factors in slums of Dibrugarh, Assam

Background: Pneumonia, one leading cause of mortality in children. Preventing pneumonia related deaths is an urgent priority to meet sustainable development goals. Settings and Design: Community based cross sectional study in two registered slums Chandmarighat and Graham bazar in Dibrugarh, Assam. Methods and Material: 2 out of 10 registered slums were chosen and a baseline cross sectional study was done to list out the risk factors. Based on the risk factors, community based intervention was done by capacity building of frontline workers and monitoring and suportive supervision in one while only monitoring was done in non intervention slum. Taking 95% confidence interval for two tail distribution, the sample size in each of the slums was 300. Statistical analysis: done by using SPSS 20, rates, ratios, proportions, univariate and multivariate analysis. Results: Prevalence of pneumonia was significantly low (9.33% vs 16.33%) in intervention and non-intervention area (p<0.001). Univariate analysis reported that initiation of complementary feeding before 6 months and indoor air pollution were associated with pneumonia in intervened area(p<0.001). Multivariate analysis was done and type of family, complementary feeding before 6 months and indoor air pollution were associated with pneumonia in intervened area. Conclusions: Community based interventions targeting the established risk factors found effective in reducing the childhood pneumonia.

Visible minority status and occupation were associated with increased COVID-19 infection in Greater Vancouver British Columbia between June and November 2020: an ecological study.

The COVID-19 pandemic has highlighted health disparities, especially among specific population groups. This study examines the spatial relationship between the proportion of visible minorities (VM), occupation types and COVID-19 infection in the Greater Vancouver region of British Columbia, Canada. Provincial COVID-19 case data between June 24, 2020, and November 7, 2020, were aggregated by census dissemination area and linked with sociodemographic data from the Canadian 2016 census. Bayesian spatial Poisson regression models were used to examine the association between proportion of visible minorities, occupation types and COVID-19 infection. Models were adjusted for COVID-19 testing rates and other sociodemographic factors. Relative risk (RR) and 95% Credible Intervals (95% CrI) were calculated. We found an inverse relationship between the proportion of the Chinese population and risk of COVID-19 infection (RR = 0.98 95% CrI = 0.96, 0.99), whereas an increased risk was observed for the proportions of the South Asian group (RR = 1.10, 95% CrI = 1.08, 1.12), and Other Visible Minority group (RR = 1.06, 95% CrI = 1.04, 1.08). Similarly, a higher proportion of frontline workers (RR = 1.05, 95% CrI = 1.04, 1.07) was associated with higher infection risk compared to non-frontline. Despite adjustments for testing, housing, occupation, and other social economic status variables, there is still a substantial association between the proportion of visible minorities, occupation types, and the risk of acquiring COVID-19 infection in British Columbia. This ecological analysis highlights the existing disparities in the burden of diseases among different visible minority populations and occupation types.

How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program

BackgroundOver 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials.MethodsWe conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis.ResultsWe interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients.ConclusionThis study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.

A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis.

As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster. We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline's quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale. Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as "recommended," and three guidelines were evaluated as "recommended with modifications." Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn't recommend iliac bone graft and three guidelines recommended PMMA bone cement. Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.

Exploring the Significance and Implementation Strategies of Mental Health Education for College Students

College students are influenced by diverse cultures in the new era, thus their inner world is rich and changingrapidly. The acceleration of social rhythm can easily lead to different kinds of psychological problems. Mental health education is people-oriented, using scientific methods and means to train high-quality talents with all-round development across the world. A healthy psychological state can promote the sound development of students, make them establish correct core social values, and realize self-value. At present, there are some problems in university mental health education, such as single form and imperfect system. At the same time, college education plays an important role in the formation of ideas for college students’ ideological values. As a front-line student worker, college counselors should cooperate with the school’s psychological departments to improve the college psychological education system, rationally plan the psychological teaching program, and pay attention to the college students’ mental health education. The government should also take into account the need to ensure that the education system is not undermined by the lack of a comprehensive and effective education system.

Women's empowerment and power relations: Evidence from Grameen Bank China

Women's empowerment fundamentally shifts power relations, a systematic process of removing deeply embedded unequal power structures. Drawing upon qualitative data from Grameen Bank China (GBC) and an inductive case study, this paper asserts an empowering methodology based on preconditions for membership and three mechanisms through which traditional gendered hierarchical power relations shift: relational justice, self-governance, and repetitive praxis. Women's empowerment, to achieve equal and shared relationships, is neither imposed on women nor naturally occurring among poor rural Chinese women. The findings suggest a development intervention and the crucial front-line worker who facilitates empowerment by “nudging” GBC women borrowers to empower themselves.