Health Care Research Articles

Evaluation of an updated educational intervention on nutritional care to prevent undernutrition among older adults in primary health care.

The aim of this study was to evaluate district nurses' perceived and factual knowledge about nutritional care after an updated and expanded educational intervention. Furthermore, we aimed to compare the outcomes of the revised and the original educational intervention. In-depth knowledge of nutritional care is a prerequisite to supporting older adults' well-being and health. District nurses' actual knowledge of the nutrition care process, older adults' need for food, and palliative care in diverse phases of disease is therefore of utmost importance. An updated and expanded educational intervention meeting these needs was evaluated. A study-specific questionnaire about nutritional care was used before and after the educational intervention. Participants (n = 118) were district nurses working in primary health care in Region Stockholm. Additionally, a pre- and post-test quasi-experimental design was used to assess differences in learning outcomes of the revised intervention compared with the original intervention. District nurses who completed the questionnaire had worked in health care for about 18 years and as district nurses for 5 years after their specialist examination. After the revised educational intervention, significant improvements were found in all statements concerning perceived challenges and actions related to nutritional care, while questions about factual knowledge showed significant improvements in three of the four questions.Comparison between the revised and the original intervention revealed no differences in most areas of perceived challenges and actions related to nutritional care. Additionally, in half of the areas assessed, factual knowledge improved more after the revision than after the original educational intervention, including the maximum length of overnight fast and the type of oral nutritional supplements (ONS) that should be prescribed. The intervention was successful in increasing knowledge about nutritional care, nutritional counselling, food adaptation, and prescribing ONS in an individually tailored way. In-depth knowledge supports usability in clinical practice. Nevertheless, we need to follow-up and understand how increased knowledge about undernutrition and ONS prescription are implemented in primary health care when caring for older adults' desires and needs.

On-TRACC Pilot Study: A Novel Intervention for Persistent Post-Concussive Cognitive Symptoms.

To present the results of a pilot study of On-TRACC (Tools for Recovery and Clinical Care), a novel intervention for individuals experiencing persistent cognitive difficulties after mild traumatic brain injury (mTBI). On-TRACC is a 5-session, 1:1 manualized treatment that integrates psychoeducation, cognitive rehabilitation strategies, and self-management skills to target symptoms and increase understanding of the interaction between cognitive difficulties, injury history, and comorbid medical and psychological conditions. The primary study goals were to evaluate the feasibility, acceptability, and preliminary effectiveness of On-TRACC. Veterans Affairs medical center and an academic medical center. Veterans and civilian adults (n=28) >3months post-mTBI with current self-reported cognitive difficulties. In this single-group, open-label pilot study, all participants received On-TRACC (5 sessions) via video-based telehealth. Primary measures were feasibility (eg, session attendance and homework completion rate, dropout rate, and treatment fidelity) and acceptability (treatment satisfaction/helpfulness ratings). Preliminary effectiveness was explored by measuring pre- to post-intervention change in cognitive symptom level and attribution, perceived self-efficacy, use of compensatory strategies, daily functioning, quality of life, and planned future engagement in health care. The On-TRACC completion rate for all enrolled participants was 79% (with 88% treatment completion rate for participants who started On-TRACC); homework was fully or partially completed for 98% of attended sessions. Treatment satisfaction ratings were high, with 95% satisfied with the information and skills learned. There were no adverse events. Positive pre- to posttreatment changes were seen in cognitive self-efficacy, symptom attribution, functional status, quality of life, and planned engagement in care for comorbid conditions. On-TRACC was a feasible and acceptable intervention for individuals with chronic cognitive difficulties following mTBI. Additional research, including a randomized clinical trial, is needed to evaluate the efficacy of this intervention and its long-term impact on outcomes in this clinical population.

Digital Mindfulness Training for Burnout Reduction in Physicians: Clinician-Driven Approach.

Physician burnout is widespread in health care systems, with harmful consequences on physicians, patients, and health care organizations. Mindfulness training (MT) has proven effective in reducing burnout; however, its time-consuming requirements often pose challenges for physicians who are already struggling with their busy schedules. This study aimed to design a short and pragmatic digital MT program with input from clinicians specifically to address burnout and to test its efficacy in physicians. Two separate nonrandomized pilot studies were conducted. In the first study, 27 physicians received the digital MT in a podcast format, while in the second study, 29 physicians and nurse practitioners accessed the same training through a free app-based platform. The main outcome measure was cynicism, one dimension of burnout. The secondary outcome measures were emotional exhaustion (the second dimension of burnout), anxiety, depression, intolerance of uncertainty, empathy (personal distress, perspective taking, and empathic concern subscales), self-compassion, and mindfulness (nonreactivity and nonjudgment subscales). In the second study, worry, sleep disturbances, and difficulties in emotion regulation were also measured. Changes in outcomes were assessed using self-report questionnaires administered before and after the treatment and 1 month later as follow-up. Both studies showed that MT decreased cynicism (posttreatment: 33% reduction; P≤.04; r≥0.41 and follow-up: 33% reduction; P≤.04; r≥0.45), while improvements in emotional exhaustion were observed solely in the first study (25% reduction, P=.02, r=.50 at posttreatment; 25% reduction, P=.008, r=.62 at follow-up). There were also significant reductions in anxiety (P≤.01, r≥0.49 at posttreatment; P≤.01, r≥0.54 at follow-up), intolerance of uncertainty (P≤.03, r≥.57 at posttreatment; P<.001, r≥0.66 at follow-up), and personal distress (P=.03, r=0.43 at posttreatment; P=.03, r=0.46 at follow-up), while increases in self-compassion (P≤.02, r≥0.50 at posttreatment; P≤.006, r≥0.59 at follow-up) and mindfulness (nonreactivity: P≤.001, r≥0.69 at posttreatment; P≤.004, r≥0.58 at follow-up; nonjudgment: P≤.009, r≥0.50 at posttreatment; P≤.03, r≥0.60 at follow-up). In addition, the second study reported significant decreases in worry (P=.04, r=0.40 at posttreatment; P=.006, r=0.58 at follow-up), sleep disturbances (P=.04, r=0.42 at posttreatment; P=.01, r=0.53 at follow-up), and difficulties in emotion regulation (P=.005, r=0.54 at posttreatment; P<.001, r=0.70 at follow-up). However, no changes were observed over time for depression or perspective taking and empathic concern. Finally, both studies revealed significant positive correlations between burnout and anxiety (cynicism: r≥0.38; P≤.04; emotional exhaustion: r≥0.58; P≤.001). To our knowledge, this research is the first where clinicians were involved in designing an intervention targeting burnout. These findings suggest that this digital MT serves as a viable and effective tool for alleviating burnout and anxiety among physicians. ClinicalTrials.gov NCT06145425; https://clinicaltrials.gov/study/NCT06145425.

The Perspectives of Young Adults with Cerebral Palsy on Transition to Adult’s Health Care and Rehabilitation

The Perspectives of Young Adults with Cerebral Palsy on Transition to Adult’s Health Care and Rehabilitation

Ten pressure points in primary care during COVID-19: findings from an international narrative review.

Strong primary care (PC) services are the foundation of high-performing health care systems and can support effective responses to public health emergencies. Primary care practitioners (PCPs) and PC services played crucial roles in supporting global health system responses to the COVID-19 pandemic. However, these contributions have come at a cost, impacting on PC services and affecting patient care. This secondary analysis of data from an integrative systematic review across international PC settings aimed to identify and describe burdens and challenges experienced by PCPs and PC services in the context of their contributions to COVID-19 pandemic responses. We conducted an integrative systematic review and narrative analysis, searching PubMed/Medline, Scopus, Proquest Central and Cochrane Database of Systematic Reviews, plus reference lists of key publications. Included studies were published in peer-reviewed English or Chinese language journals, and described collective responses to COVID-19 undertaken in PC settings or by PCPs. Narrative data regarding impacts on PC services and challenges experienced by PCPs were extracted and analysed using inductive coding and thematic analysis. From 1745 screened papers 108, representing 90 countries, were included. Seventy-eight contained data on negative impacts, challenges or issues encountered in PC. Ten 'pressure points' affecting PC during COVID-19 were identified, clustered in four themes: demand to adopt new ways of working; pressure to respond to fluctuating community needs; strain on PC resources and systems; and ambiguity in interactions with the broader health and social care system. PCPs and PC services made critical functional contributions to health system responsiveness during the COVID-19 pandemic. However, both practitioners and PC settings were individually and collectively impacted during this period as a result of changing demands in the PC environment and the operational burden of additional requirements imposed on the sector, offering lessons for future pandemics. This study articulates ten empirically derived 'pressure points' that provide an initial understanding of burdens and demands imposed on the international primary care sector during the COVID-19 pandemic. The impact of these contributions should inform future pandemic planning, guided by involvement of PCPs in public health preparedness and policy design.

Actual Roles of Occupational Therapists in Palliative and Hospice Care: A Scoping Review.

This study reviewed the role of occupational therapist's in palliative and hospice care over the past 20years. A scoping review following Arksey and O'Malley's five stages was undertaken using PubMed, OTseeker, Scopus, Elsevier, Cochrane Library-Medline, CINAHL, PsychInfo, Web of Science and Google Scholar. A total of 41 articles were reviewed. The most publications occurred in 2010, 2011, 2015, and 2023. The majority of the studies (48.7%) were of qualitative design. Various roles of occupational therapists have been defined in palliative care: discovering occupational meaning in the last periods of life and supporting occupational participation, management of persistent physical and psychological symptoms, especially pain and fatigue, improving or supporting the quality of life for individuals under palliative care, supporting mental well-being, supporting social participation, use of adaptive technologies, providing individuals with confidence and comfort. Occupational therapists also have various duties in maintaining palliative-hospice care at home include evaluating the individual at home and supporting home care and rehabilitation after discharge. Interventions for caregivers or supporting caregivers who have lost their roles, occupations or jobs in the care process are also among the roles of occupational therapists. Occupational therapy within the context of palliative care aims to assist individuals in attaining their highest level of independence in important occupations. Occupational therapists play a crucial role in coordinating and facilitating safe transitions from the hospital to home, aiming to improve the overall quality of life and reduce hospital stays.

What are family caregivers' experiences of coordinating end-of-life care at home? A narrative review.

People with life-limiting diseases, who are no longer receiving active or curable treatment, often state their preferred place of care and death as the home. This requires coordinating a multidisciplinary approach, using available health and social care services to synchronize care. Family caregivers are key to enabling home-based end-of-life support; however, the 2 elements that facilitate success - coordination and family caregiver - are not necessarily associated as being intertwined or one and the same. This narrative review explores family caregiver experiences of coordinating end-of-life care in the home setting. Studies were identified systematically following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search of 5 databases (CINAHL, AMED, MEDLINE, Joanna Briggs Institute for Systematic Reviews, and the Cochrane Database) was conducted using Medical Subject Headings search terms and Boolean operators. Seven hundred and eighty papers were screened. Quality assessment was conducted using the JBI Critical Appraisal Checklist for Qualitative Research. Characteristics of included studies were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) extraction tool. Ten qualitative studies were included. A meta-aggregative approach was used to assemble findings and categories extracted from the included papers, which led to identification of 3 overall themes: (1) family caregiver identity, (2) strategies for care, and (3) practicalities of care. Research suggests there should be a designated care coordinator to support people nearing the end of life at home. However, this review shows that family caregivers intrinsically take on this role. Their experiences, frequently share commonalities across different cultures and regions, highlighting the universal nature of their challenges. Difficulties associated with providing home-based care are evident, but the undertaking of care coordination by relatives highlights a need for a change in approach. Future studies could explore the impact of having a designated "facilitator" or single point of contact for families, as well as the development of tailored communication strategies.

Challenging Mental Health Professionals to Look Beyond the Consulting Room

Challenging Mental Health Professionals to Look Beyond the Consulting Room

Mapping the regional and remote specialised mental health workforce: Commentary on the AIHW data for 2022-2023.

The Australian Institute of Health and Welfare publishes statistical indicator reports on the specialised mental health workforce. These include data for 2022-2023 on psychiatrists, mental health nurses, mental health occupational therapists, psychologists and mental health social workers. We provide a brief commentary on these reports, reflecting upon the implications of such changes for psychiatric practice and patient care. Overall, there are fewer mental health workers with increasing distance from urban centres. There are insufficient rural psychiatrists with the NT and Queensland having higher rates per 100,000 in outer regional and remote areas. Psychologists and mental health nurses have the highest rates per 100,000 in rural areas. Though low in absolute rates per 100,000, mental health social workers are better distributed in rural compared to urban areas. Further data on public, private and non-governmental sector employment would be useful.

Willingness and determinants of elder care modes among elderly individuals: insights from underdeveloped regions in Western China.

The aim of the present study was to investigate the willingness of elderly individuals regarding their choice of elderly care modes in underdeveloped regions of Western China and to identify the key factors influencing the willingness. We distributed a total of 20 000 questionnaires using the multistage stratified cluster random sampling method, and successfully collected 19 460 of them. After conducting quality checks, we deemed 19 040 questionnaires valid for analysis. The survey covered seven cities, 24 counties, and 255 villages in Gansu Province. We conducted statistical analyses, including univariate χ2 test, Kruskal-Wallis test and multivariate logistic regression, to assess the willingness of elderly individuals regarding care modes and the factors influencing these choices. Among the 19 040 valid responses, 88.55% preferred home care, 5.01% opted for community care, 5.01% chose institutional care, 1.08% preferred mutual care, and 0.36% selected smart care. Elderly individuals who have a lower level of education, residence within a 15-minute walking distance to the nearest health care facility, and believe that elder care should rely on themselves or their children, etc. exhibit a higher willingness for choosing the home care mode (P < 0.05). Elderly individuals who believe that elderly care should be reliant on their children, and possess a greater knowledge for the combination of medical and elderly care, etc. exhibit a stronger willingness for choosing the community care (P < 0.05). Elderly individuals with lower educational level and lack endowment insurance, etc. exhibit a higher willingness for choosing the mutual care (P < 0.05). Elderly individuals who are not afflicted with chronic illnesses and reside within a 15-minute distance from the nearest medical centre exhibit a higher willingness for choosing the smart care mode (P < 0.05). In underdeveloped regions in China, home care continues to be the predominant choice among elderly individuals. However, the growing demand for diverse elderly care modes warrants attention. Multiple factors influence the willingness of elderly individuals when selecting care modes. This study offers valuable insights for policymakers, enabling government departments to implement targeted strategies and interventions to meet the diverse service needs of the elderly population effectively.

Impact of delirium on post-discharge mortality in coronary care unit patients: A retrospective cohort study.

Coronary care unit (CCU) patients surviving to discharge still face significant mortality. Delirium is common in CCU patients and has been associated with poorer CCU and in-hospital outcomes. To assess the association between delirium and mortality after hospital discharge in CCU survivors. This was a retrospective observational study that included patients admitted to CCU. All data were extracted from the Medical Information Mart for Intensive Care IV database. The exposure was delirium during CCU stay. The primary outcome was mortality 180 days after hospital discharge. Secondary outcomes included post-hospital discharge mortality at 90 days, length of CCU and hospital stays, and hospital discharge disposition. Of the 3609 CCU patients included, 891 were considered delirium-positive during their CCU stay. Delirium was associated with an increased risk of mortality at 180 days after hospital discharge (adjusted hazard ratio [HR], 1.33; 95% confidence interval (CI), 1.08-1.64). Similar results were observed for 90-day post-discharge mortality (adjusted HR,1.43; 95% CI, 1.13-1.83). CCU patients who experienced delirium had longer stays in both the CCU and hospital (adjusted β, 2.11; 95% CI, 1.79-2.43 and 3.87; 95% CI, 3.06-4.69, respectively). They were also more likely to require nursing care after hospital discharge (adjusted odds ratio [OR], 1.65; 95% CI, 1.22-2.22). Delirium during CCU stay was associated with an increased risk of all-cause mortality up to 180 days in CCU patients who survived hospital discharge. Delirium places CCU patients at a higher risk of post-discharge mortality and increased health care resource requirements. Given the high prevalence of delirium in CCU patients and its significantly deleterious impact on both short-term and long-term post-discharge mortality, nurses and physicians should enhance the post-discharge management of patients who experience delirium in order to improve prognosis. This also highlights the importance of preventing and managing delirium during hospitalization.

Critical mobility in policy making for epidemic containment.

When considering airborne epidemic spreading in social systems, a natural connection arises between mobility and epidemic contacts. As individuals travel, possibilities to encounter new people either at the final destination or during the transportation process appear. Such contacts can lead to new contagion events. In fact, mobility has been a crucial target for early non-pharmaceutical containment measures against the recent COVID-19 pandemic, with a degree of intensity ranging from public transportation line closures to regional, city or even home confinements. Nonetheless, quantitative knowledge on the relationship between mobility-contagions and, consequently, on the efficiency of containment measures remains elusive. Here we introduce an agent-based model with a simple interaction between mobility and contacts. Despite its simplicity, our model shows the emergence of a critical mobility level, inducing major outbreaks when surpassed. We explore the interplay between mobility restrictions and the infection in recent intervention policies seen across many countries, and how interventions in the form of closures triggered by incidence rates can guide the epidemic into an oscillatory regime with recurrent waves. We consider how the different interventions impact societal well-being, the economy and the population. Finally, we propose a mitigation framework based on the critical nature of mobility in an epidemic, able to suppress incidence and oscillations at will, preventing extreme incidence peaks with potential to saturate health care resources.

Risk factors and preventivemeasures for severe orofacial and neck infections: a three-yearobservational study.

The purpose of this study was to identify the risk factors of severe orofacial and neck infections and the factors that could prevent them and reduce their severity. A three-year prospective observational study was conducted from 8.15.2016 to 8.31.2019 at a tertiary care hospital. 94 patients participated the study. The criteria for inclusion in the study were that the patients were adults with neck and severe orofacial infections that required treatment in hospital. Patients under the age of 18 and patients who did not consent to participate in the study were excluded. The responses to the questionnaire designed for this study were collected, as was supplemental data from medical records. The patient data were analyzed. Length of stay (LOS), intensive care unit (ICU) stay, complications and mortality were used as the main outcome variables, and various pre-admission factors and clinical and laboratory parameters were used as the predictor variables. The method used was univariate analysis. In 79 (84.0%) cases, surgery confirmed an abscess and pus. Age (p = 0.001) and underlying diseases (p = 0.024) contributed to complications. Bulging of the lateral pharyngeal wall or laryngeal swelling on admission was significantly related to the need for intensive care treatment (p < 0.001). The spaces most often involved were the submandibular (n = 15; 16.0%), sublingual (n = 15; 16.0%) and parapharyngeal (n = 14; 14.9%) spaces. Sixty-three cases (67.0%) were of odontogenic origin, and 58.5% of the patients reported having attended previous health care appointments due to an acute dental problem. The patients with odontogenic infections had poor oral hygiene and most likely did not brush their teeth daily (p = 0.029). "Dishwater" pus was associated with longer hospitalization (p < 0.001), intensive care treatment (p < 0.001), and surgical revisions (p < 0.001). One lethal outcome (1.1%) was reported. Age and underlying illnesses should be considered complicating factors, and lateral pharyngeal or laryngeal edema should be considered risk factors for ICU treatment. This study also emphasized the preventive role of good dental hygiene and the importance of patients' follow-up treatment after acute dental interventions.

Effectiveness of Digital Mental Health Interventions in the Workplace: Umbrella Review of Systematic Reviews.

There is potential for digital mental health interventions to provide affordable, efficient, and scalable support to individuals. Digital interventions, including cognitive behavioral therapy, stress management, and mindfulness programs, have shown promise when applied in workplace settings. The aim of this study is to conduct an umbrella review of systematic reviews in order to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. A systematic search was conducted to identify systematic reviews relating to digital interventions for the workplace, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The review protocol was registered in the Open Science Framework. The following databases were searched: PubMed, Web of Science, MEDLINE, PsycINFO, and Cochrane Library. Data were extracted using a predefined extraction table. To assess the methodological quality of a study, the AMSTAR-2 tool was used to critically appraise systematic reviews of health care interventions. The literature search resulted in 11,875 records, which was reduced to 14 full-text systematic literature reviews with the use of Covidence to remove duplicates and screen titles and abstracts. The 14 included reviews were published between 2014 and 2023, comprising 9 systematic reviews and 5 systematic reviews and meta-analyses. AMSTAR-2 was used to complete a quality assessment of the reviews, and the results were critically low for 7 literature reviews and low for the other 7 literature reviews. The most common types of digital intervention studied were cognitive behavioral therapy, mindfulness/meditation, and stress management followed by other self-help interventions. Effectiveness of digital interventions was found for many mental health symptoms and conditions in employee populations, such as stress, anxiety, depression, burnout, and psychological well-being. Factors such as type of technology, guidance, recruitment, tailoring, and demographics were found to impact effectiveness. This umbrella review aimed to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Despite the low quality of the reviews, best practice guidelines can be derived from factors that impact the effectiveness of digital interventions in the workplace. OSF Registries osf.io/rc6ds; https://doi.org/10.17605/OSF.IO/RC6DS.

Diabetes Risk After Treatment for Childhood and Young Adult Cancer.

Diabetes is a potential late consequence of childhood and young adult cancer (CYAC) treatment. Causative treatments associated with diabetes have been identified in retrospective cohort studies but have not been validated in population-based cohorts. Our aim was to define the extent of diabetes risk and explore contributory factors for its development in survivors of CYAC in the United Kingdom. Cancer registration data (n = 4,238) were linked to electronic health care databases to identify cases of diabetes through clinical coding or HbA1c values. Total effect of prespecified treatment exposures on diabetes risk was estimated using flexible parametric modeling and standardized cause-specific cumulative incidence functions (CIFs). After median follow-up of 14.4 years, 163 individuals (3.8%) were identified with diabetes. Total body irradiation (TBI) increases diabetes risk over time, with a 40-year CIF reaching 21.0% (95% CI 13.8-31.9) compared with 8.4% (95% CI 6.1-11.5) without TBI. Survivors treated with corticosteroids had a 7.7% increased risk at 40 years after cancer diagnosis. Hematopoietic stem cell transplant (HSCT) survivors had markedly higher risk, with a 40-year CIF of 19.6% (95% CI 13.4-28.6) versus 8.2% (95% CI 6.0-11.3) for patients who had not undergone HSCT. Among patients who received allogeneic HSCT, the 40-year CIF of diabetes was 25.7% (95% CI 17.4-38.0), compared with 7.9% (95% CI 3.3-19.1) in patients who received autologous transplants. This evaluation of a hospital-based cohort of patients with CYAC identifies these patients' increased long-term risk of developing diabetes and how this varies temporally according to treatment modalities. Notable contrasts in risk by treatment were detected as early as 10 years after cancer diagnosis. Findings should inform the development of risk-stratified evidence-based screening.

Translation and psychometric evaluation of the Thai version of TeamSTEPPS® teamwork attitudes and teamwork perceptions questionnaires

ABSTRACT Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) is a strategy for improving communication and team climate in hospitals. While it shows promise, it remains an untested tool among health care professional teams. A cross-sectional design with survey methodology was implemented. We scrutinized the psychometric properties of the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and Teamwork Perceptions Questionnaire (T-TPQ) among 301 health care professionals in Thailand. This study follows an instrument testing design guided by two phases: I) Translation phase and II) Psychometric properties testing. A content validity index (CVI), confirmatory factor analysis (CFA), and McDonald’s omega were conducted. The study presents confirmatory factor analyses and descriptive data. Both the T-TAQ and T-TPQ are self-administered questionnaires consisting of 27 and 32 items, respectively, utilizing a five-point Likert scale to assess five key components: Team structure, Leadership, Situation monitoring, Mutual support, and Communication. Psychometric evaluations indicated good internal consistency and validity for these instruments among Thai health care professionals, with McDonald’s omega values ranging from 0.68 to 0.89 for T-TAQ and 0.85 to 0.95 for T-TPQ. Confirmatory factor analysis supported the construct validity of both the Thai T-TAQ and T-TPQ. The T-TAQ and T-TPQ prove to be reliable and valid instruments. The scale can be effectively utilized as a tool for assessing Thai health professionals’ teamwork attitudes and perceptions.

A Collaborative Stakeholder Approach for Reducing the Use of Custodial Restraints in Hospitalized Patients.

In hospitals across the country, most patients admitted from jails or prisons receive their care in custodial restraints regardless of clinical concerns or public safety risk. Blanket restraint protocols are deemed necessary for public safety; however, the indiscriminate use of custodial restraints causes harm to patients physically, mentally, and through propagation of prejudice. Hospitals and correctional officials must create policies that allow for a case-by-case analysis of patients to develop an individualized custodial restraint plan that will balance public safety and patient care needs. In this Viewpoint, we recommend a collaborative stakeholder approach to address this needed public policy evolution. Now is the time for health care professionals, correctional and hospital administrators, those with lived incarceration experience, and community members to work together to create policies on custodial restraints that support patient healing and reduce physical harm, emotional distress, and prejudice while optimizing staff and public safety.

What are the problems and suggestions related to cancer health education in Sichuan, China? A qualitative study of community health workers (CHWs).

Health education conducted by community health workers (CHWs) is an evidence-based strategy for promoting cancer prevention, cancer screening, and adherence to medical guidance from doctors. However, CHWs are confronted with some problems related to cancer health education in China. This study aimed to clarify CHWs' awareness of problems in cancer health education in China and the solutions that they were considering to improve the quality and efficiency of cancer health education. A qualitative descriptive design with purposive sampling was applied in eight primary health care sectors in Guangyuan and Chengdu in Sichuan, China. Face-to-face, in-depth, semistructured interviews were conducted, and a total of 60 CHWs were interviewed. The interviews were transcribed verbatim and imported into Nvivo12.0. Thematic analysis using the constant comparative method was used to analyze the data. Uncooperative inhabitants, poor organization, low-frequency provision, and inadequate training for CHWs were problems related to cancer health education provided by CHWs in China. CHWs proposed some suggestions to improve the accessibility and acceptability of cancer health education, including combining online and offline education, health education after screening, cancer plus others, health education in the workplace, and volunteer recruitment. Both the problems and suggestions described in this study may provide evidence for cancer health education and policy-making related to cancer prevention and control in China.

The first 1000 days: the price of inequalities in high and middle-income countries.

The first 1000 days of human life start from conception until the child turns 2 years of age. This is a unique period in which the foundations of a child's lifelong health are built. Disadvantaged socioeconomic circumstances and limited access to health care services can globally affect a child's health outcomes and educational and vocational potential. This article discusses health inequalities over the first 1000 days of life and possible mitigation programs. Governments and politicians should promote fairer health interventions and pediatric healthcare workers should be aware of the main health determinants to advocate for more equitable and child-focused resource allocation. Therefore, the main approaches to contrast health inequalities include cooperation between governments and public health professionals, removing barriers to accessing medical care, and raising staff awareness about health determinants. Finally, pro-equality interventions should include providing services commensurate with the level of need, in adherence to the principle of social justice. IMPACT: This review aims to elicit a detailed understanding of how inequalities affect early childhood development in different socio-economic contexts, focusing on both the short and long-term consequences. The greatest impact comes precisely from providing valuable tools for both clinicians and public health practitioners to understand and read, in daily practice, the effects produced by health determinants and health inequalities.

Age- and sex-specific care cascades to detect gaps in the care of children with tuberculosis in Bangladesh: a cohort study.

Programmatic interventions to increase the detection of children with tuberculosis (TB) are rarely evaluated to understand age- and sex-specific completion rates. We applied modified TB screening and treatment cascade frameworks to assess indicators of effective implementation by age and sex of a TB screening program for children (zero to 14 years) in Bangladesh. We implemented an intensified screening program for paediatric TB detection in 119 health care facilities (2018-21). We followed systematic verbal screening by referral for full evaluation for children who reported symptoms or contact history with a patient with TB. Further, we linked children to treatment if diagnosed and followed for outcomes. We calculated the percentage of children, by age and sex, progressing through each step of the care cascade and compared the frequency of step completion by sex using χ2 tests. In total, we screened 552 182 males and 461 419 females for TB. 2.8% of males and 2.6% of females screened positive (P < 0.001). 74.2% of males and 73.9% of females underwent appropriate evaluation (P = 0.560). 10.3% of males and 11.5% of females were diagnosed with TB (P = 0.008). 100% of children initiated treatment, and 97.6% of males and 97.1% of females achieved a successful treatment outcome (P = 0.428). The percent of children screening positive on verbal screen, who were clinically evaluated for TB, and who were diagnosed with TB generally increased with age, with some variability throughout (ranges: 1.2-9.1%, 59.8-88.5%, 6.5-21.9%, respectively). The largest gap observed for both sexes and among all ages was children who were not appropriately evaluated for TB despite screening positive. In our research, we highlight the value of identifying gaps in paediatric TB care to inform innovative, age- and sex-tailored interventions to improve future care in children.