Inadequate Care Research Articles

Variation in benefit among patients with serious mental illness who receive integrated psychiatric and primary care.

The population with serious mental illness has high risk for hospitalization or death due to unhealthy behaviors and inadequate medical care, though the level of risk varies substantially. Programs that integrate medical and psychiatric services improve outcomes but are challenging to implement and access is limited. It would be useful to know whether benefits are confined to patients with specific levels of risk. In a population with serious mental illness and increased risk for hospitalization or death, a specialized medical home integrated services and improved treatment and outcomes. Treatment quality, chronic illness care, care experience, symptoms, and quality of life were assessed for a median of 385 days. Analyses examine whether improvements varied by baseline level of patient risk. Patients with greater risk were more likely to be older, more cognitively impaired, and have worse mental health. Integrated services increased appropriate screening for body mass index, lipids, and glucose, but increases did not differ significantly by level of risk. Integrated services also improved chronic illness care, care experience, mental health-related quality of life, and psychotic symptoms. There were also no significant differences by risk level. There were benefits from integration of primary care and psychiatric care at all levels of increased risk, including those with extremely high risk above the 95th percentile. When developing integrated care programs, patients should be considered at all levels of risk, not only those who are the healthiest.

The health consequences of child marriage among rural women: Evidence from Igbo-Eze North, South-east Nigeria

Child marriage has emerged as a significant social issue due to its profound health consequences, particularly within rural communities. This study aims to investigate the health consequences associated with child marriage among rural women. Employing a phenomenological approach, this qualitative study collected information from women with firsthand experiences in the communities of Etteh and Enugu Ezike, both situated in the Igbo-Eze North Local Government Area of Enugu State. Data were collected through in-depth interviews conducted with 20 women selected through purposeful sampling. The sample encompassed married women aged 18 – 45 years, with a specific focus on those married before the age of 18. The findings revealed a significant association between child marriage and adverse physical health outcomes, including heightened rates of maternal mortality, inadequate prenatal care, and increased vulnerability to infectious diseases. Moreover, mental health assessments indicated a higher prevalence of anxiety, depression, and post-traumatic stress disorder among women who experienced child marriage. Reproductive health implications were also observed, with a higher incidence of obstetric complications and adverse birth outcomes among this cohort. This study sheds light on the intricate web of health consequences associated with child marriage among women in Nigerian rural communities. The findings underscore the urgency for social work interventions that address the unique challenges faced by young girls in rural communities. Recognizing the long-term repercussions of child marriage is essential for informing evidence-based strategies aimed at improving the health and well-being of affected women and promoting sustainable development in the region.

INDEX-BASED ASSESSMENT ALGORITHM FOR ORAL HYGIENE IN WEARERS OF FIXED DENTAL BRIDGES

Introduction: The study focuses on the importance of maintaining oral hygiene, especially in wearers of fixed dental bridge. The impact of inadequate oral hygiene care on the development of dental diseases and the necessity for developing effective methods for its assessment are examined. Research objective: The aim of this study is to refine the fluorescent diagnostic method in orthopedic dentistry and to develop an index for assessing the hygienic status of natural teeth and fixed dental prostheses through an in vivo experiment. This method is intended to improve the diagnosis of oral conditions in wearers of fixed prostheses, ultimately enhancing the quality of their orthopedic treatment. Materials and methods: The study is based on the application of fluorescent diagnostics using Rhodamine B dye, which, when exposed to ultraviolet light, allows for the detection of dental deposits. The technique involves treating the surfaces of teeth and prostheses with a special solution that enhances the visibility of dental plaque under ultraviolet illumination. Research results: The experimental results demonstrated the high efficiency of the fluorescent method in detecting dental deposits both on the enamel of natural teeth and on the ceramic surface of fixed dentures. The digital analysis method allows for obtaining specific graphical indicators of the biofilm area, enhancing the relevance of an individual approach. Conclusions: Conclusions: The experimental study confirmed the high efficiency of the refined fluorescent method for assessing the hygienic status of the oral cavity, applicable to both natural teeth and fixed orthopedic constructions. This technique enables accurate assessment of hygiene status, facilitating effective prevention of dental diseases and optimization of treatment procedures. The method is convenient to use, and the software is accessible for clinicians. Further observations on the outcomes of this technique in patients with various orthopedic profiles are planned to expand its applicability.

Clinical Characteristics of Children With Foreign Bodies in the Digestive Tract and Analysis of Risk Factors for Serious Complications.

Foreign bodies (FBs) in the digestive tract are common in children, we analyzed the clinical characteristics of children with FBs in the digestive tract and discuss the risk factors for serious complications. We retrospectively reviewed clinical data of 139 children with FBs in the digestive tract. Based on the severity of complications caused by FBs, the patients were divided into risk and general groups for analysis and comparison. Significant differences were observed in the retention sites of FBs, the diameter of FBs retained in the esophagus, FBs retention time exceeding 24 h, and the absence of witnesses between the 2 groups. Inadequate care, button batteries (BBs), ingested mmFBs, FBs retained in the esophagus, long-term retention, and giant gastric bezoars may cause serious complications. In addition to treating FBs and the complications, clinicians should emphasize the importance of childcare to prevent the ingestion of FBs.

Lifestyle and sociodemographic risk factors for stillbirth by region of residence in South Australia: a retrospective cohort study

BackgroundStillbirth rates remain a global priority and in Australia, progress has been slow. Risk factors of stillbirth are unique in Australia due to large areas of remoteness, and limited resource availability affecting the ability to identify areas of need and prevalence of factors associated with stillbirth. This retrospective cohort study describes lifestyle and sociodemographic factors associated with stillbirth in South Australia (SA), between 1998 and 2016.MethodsAll restigered births in SA between 1998 ad 2016 are included. The primary outcome was stillbirth (birth with no signs of life ≥ 20 weeks gestation or ≥ 400 g if gestational age was not reported). Associations between stillbirth and lifestyle and sociodemographic factors were evaluated using multivariable logistic regression and described using adjusted odds ratios (aORs).ResultsA total of 363,959 births (including 1767 stillbirths) were included. Inadequate antenatal care access (assessed against the Australian Pregnancy Care Guidelines) was associated with the highest odds of stillbirth (aOR 3.93, 95% confidence interval (CI) 3.41–4.52). Other factors with important associations with stillbirth were plant/machine operation (aOR, 1.99; 95% CI, 1.16–2.45), birthing person age ≥ 40 years (aOR, 1.92; 95% CI, 1.50–2.45), partner reported as a pensioner (aOR, 1.83; 95% CI, 1.12–2.99), Asian country of birth (aOR, 1.58; 95% CI, 1.19–2.10) and Aboriginal/Torres Strait Islander status (aOR, 1.50; 95% CI, 1.20–1.88). The odds of stillbirth were increased in regional/remote areas in association with inadequate antenatal care (aOR, 4.64; 95% CI, 2.98–7.23), birthing age 35–40 years (aOR, 1.92; 95% CI, 1.02–3.64), Aboriginal and/or Torres Strait Islander status (aOR, 1.90; 95% CI, 1.12–3.21), paternal occupations: tradesperson (aOR, 1.69; 95% CI, 1.17–6.16) and unemployment (aOR, 4.06; 95% CI, 1.41–11.73).ConclusionFactors identified as independently associated with stillbirth odds include factors that could be addressed through timely access to adequate antenatal care and are likely relevant throughout Australia. The identified factors should be the target of stillbirth prevention strategies/efforts. SThe stillbirth rate in Australia is a national concern. Reducing preventable stillbirths remains a global priority.

Social Factors Associated With Congenital Syphilis in Missouri.

Congenital syphilis disproportionately affects individuals impacted by adverse social determinants of health. Understanding these determinants may help facilitate holistic care. We performed a retrospective review of mother-infant dyads with potential congenital syphilis in a Missouri hospital system. Cases were classified per Centers for Disease Control and Prevention clinical scenarios. Information was collected regarding demographics, prenatal care, substance use, and other social factors. Dyads with confirmed/highly probable or possible congenital syphilis ("congenital syphilis outcomes") were compared to those with less likely/unlikely congenital syphilis ("noncongenital syphilis outcomes") using descriptive statistics. We identified 131 dyads with infant dates of birth from 2015 to 2022: 74 (56%) with congenital syphilis outcomes and 56 (43%) with noncongenital syphilis outcomes. Most mothers were Black/African American (n = 84 [65%]) and lived in areas with a high Social Vulnerability Index. Many had inadequate prenatal care (n = 61 [47%]) and/or had substance use histories (n = 55 [42%]). Significant associations (odds ratio [95% confidence interval]) with congenital syphilis outcomes included limited prenatal care (3.01 [1.38-6.56]), no prenatal care (16.08 [1.96-132.11]), substance use (3.42 [1.61-7.25]), housing instability (3.42 [1.39-8.38]), and justice system interactions (2.29 [1.00-5.24]). Substance use correlated with prenatal care adequacy (P < .001). One-third of infants with congenital syphilis outcomes were taken into protective custody. Adverse social determinants of health are common in dyads impacted by congenital syphilis. Health systems should consider interdisciplinary programming to improve testing and linkage to care. Future studies should evaluate social support for congenital syphilis prevention and management.

Inadequate weight gain and factors influencing it among preterm neonates in neonatal intensive care units in the Amhara region, Ethiopia, in 2022.

Adequate weight gain is crucial for the health and development of preterm neonates admitted to neonatal intensive care units (NICUs). Understanding the factors influencing weight gain in this vulnerable population is essential for improving outcomes. This study aimed to assess the weight gain status and associated factors among preterm neonates admitted to NICUs in specialized hospitals in the Amhara region of Ethiopia. A cross-sectional study design involving 363 preterm neonates admitted to NICUs in specialized hospitals within the Amhara region was used. Data were collected using structured questionnaires and the Kobo Tool Box. Daily weight measurements were recorded for three consecutive days. Descriptive statistics, logistic regression analysis, and graphical presentations were utilized for data analysis and presentation. The study revealed that a significant proportion (80.8%) of preterm neonates experienced poor weight gain during their NICU stay. The factors significantly associated with poor weight gain were older maternal age, delayed initiation of enteral feeding, lack of kangaroo mother care (KMC), and inadequate antenatal care visits. Addressing the identified factors, such as providing adequate support during the antenatal period, promoting a timely initiation of enteral feeding, and encouraging KMC practices, is crucial for improving weight gain outcomes in preterm neonates. The findings highlight the importance of a comprehensive approach to neonatal care targeting both maternal and neonatal factors. Policymakers and healthcare providers should prioritize interventions aimed at optimizing weight gain in preterm neonates to improve these neonates' overall well-being and long-term outcomes.

Redesigning Death Rounds: Alleviating distress for residents in end-of-life care

Introduction Residents report limited end-of-life care training, resulting in negative socio-emotional impacts, burnout, and inadequate patient care. An academic urban county hospital adopted the Death Rounds (DR) conference for residents in the medical intensive care unit as a monthly free-form discussion to help residents cope with the emotional aspects of caring for dying patients. Our goal was to implement and evaluate a newly structured DR curriculum to help residents further reflect on experiences of caring for dying patients, reduce emotional burnout, and improve physician well-being. Methods Using a mixed-methods design, we conducted a qualitative needs assessment using interviews of residents. DR conference modifications based on the needs assessment include shorter, more frequent sessions; breakout groups; prompts for facilitating discussion; and multidisciplinary facilitators. A pre-post modification survey using the Likert scale was administered to all residents to assess the programmatic changes. Results Pre- and post-modification data was received from 30 and 50 of 116 residents, respectively. A greater proportion of post-test DR attendees reported that DR helped them feel less distressed when caring for dying patients (p=0.018). Among residents who did not attend DR, there was greater agreement in feeling emotionally supported by their team when caring for dying patients (p=0.046). Overall, 81% of post-test respondents agreed DR was worthwhile of their time, and almost all respondents agreed discussing the emotional impacts of patient death is important. Conclusion Adding a structured framework to Death Rounds, including small-groups and facilitation cards, may help residents cope with caring for dying patients by improving self-awareness and team support, while reducing distress.

Abstract PO1-12-04: Exploring Factors Associated with Sexual Well-being and Breast Satisfaction Among Women with Early-stage Breast Cancer

Abstract BACKGROUND: Breast cancer affects not only physical health but also psychological and emotional well-being. Among the various aspects that impact the quality of life of breast cancer patients, sexual well-being and body image in terms of breast satisfaction play a crucial role. Unfortunately, these aspects are often overlooked and undervalued in healthcare, leading to inadequate care and support for breast cancer patients. This study delved into the factors that influence breast satisfaction and sexual well-being in early-stage breast cancer patients who have recently received a cancer diagnosis. We aim to offer providers a more patient-centered and comprehensive approach to breast cancer care. METHODS: This prospective questionnaire-based study screened 175 early-stage breast cancer patients recently diagnosed at a university-affiliated community hospital in Michigan from October 2022 to June 2023. Participants with a previous history of chemoradiation and advanced-stage breast cancer were excluded. Structured telephone interviews were conducted to obtain informed consent and assess patients' breast satisfaction and sexual well-being. Participants were interviewed after their recent breast cancer diagnosis and before undergoing surgical intervention. A validated BREAST-Q questionnaire was used, and their scores were converted to equivalent Rasch scores for interpretation (0=worst, 100=best). Pre-existing medical conditions, social history, and other variables were collected through electronic medical records review and confirmed by interview. Statistical analyses were performed using SPSS version 28.0, and a p-value less than 0.05 was considered statistically significant. RESULTS: Of 175 patients initially screened, 56 met the selection criteria. 75% (N=42) participated, while 25% (N=14) were excluded as they declined to participate or were unreachable via telephone. 81% were White, 14% were Black, and 5% were Hispanics. The cancer stages of the patients were Stage 0 (29.3%), I (48.8%), II (12.2%), and III (9.8%). The mean breast satisfaction score of participants was 67.1 (N=42), and the mean sexual well-being score was 44.6 (N=36). The study found that only the type of surgery was observed to be significantly related to the breast satisfaction of patients. Interestingly, patients who chose mastectomy had higher breast satisfaction scores (75.6 vs. 62.9, p&amp;lt; 0.05) and were relatively younger (59 years vs. 67 years, p&amp;lt; 0.05) than those undergoing lumpectomy. No other demographic factors (race, education, marital status, BMI), social history (smoking), bra size, or pre-existing medical conditions (hypertension, diabetes) were found to affect breast satisfaction among these patients. On the other hand, age had a negative correlation with sexual well-being (mean age=64 years, p&amp;lt; 0.05), while income had a positive correlation (mean income=$ 76,170 annually, p&amp;lt; 0.05). No other variables were significantly associated with patients’ sexual well-being. CONCLUSION: The study revealed that the patient's sexual well-being was significantly associated with age and income, while breast satisfaction was only related to the type of surgery. These findings underscore the importance of considering multiple aspects of a patient's life when designing a comprehensive treatment plan following a cancer diagnosis. By providing additional support and resources tailored to these specific needs, healthcare providers can enhance patients' overall quality of life and promote greater satisfaction with their treatment outcomes. Citation Format: Kim Abbegail Aldecoa, Yi Lee, Lisa Deptula, Chioma Mbionwu, Ewomamobuho Eto, Esentur Salamatov, Megan Frame, Andrea Briefs Ferris, Geetha Krishnamoorthy, Amy Kirby, Judie Goodman. Exploring Factors Associated with Sexual Well-being and Breast Satisfaction Among Women with Early-stage Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-12-04.

Demographic Disparities in Brachial Plexus Birth Injury [ID 2683383

INTRODUCTION: Black and Hispanic birthing individuals are at increased risk of delivering an infant with a brachial plexus birth injury (BPBI), but the reasons for these disparities are unclear. We evaluated the association of maternal race/ethnicity with established and suspected risk factors for BPBI to determine if these factors mediate these disparities. METHODS: Institutional review board approval was obtained for this retrospective cohort study of all live births occurring in California-licensed hospitals from 1996 to 2012. Multiple logistic regression was used to model adjusted associations of maternal race and ethnicity with an infant born with BPBI. Causal mediation analyses evaluated established and suspected risk factors for BPBI (obesity, diabetes, gestational diabetes, shoulder dystocia, macrosomia, prolonged second stage of labor, gestational age, post-term, vaginal delivery, insurance status, inadequate prenatal care) as potential mediators of the BPBI–maternal race/ethnicity relationship. RESULTS: The cohort included 6,278,562 births, with 7,762 BPBI. Although Black birthing individuals had an increased risk of obesity (adjusted odds ratio [aOR] 2.48) and diabetes (aOR 1.59) compared to non-Blacks, they had a lower risk of shoulder dystocia (aOR 0.76), macrosomia (aOR 0.60), prolonged second-stage labor (aOR 0.33), precipitous labor (aOR 0.88), and vaginal delivery (aOR 0.79). Blacks had an increased risk of inadequate prenatal care (aOR 1.26) and being underinsured (aOR 1.30). The combination of these factors explained only 16.3% of the increased risk for BPBI in Black people. Findings were similar in Hispanic individuals. CONCLUSION: The increased risk of BPBI in Black and Hispanic individuals is only modestly explained by known risk factors. Prenatal care utilization and socioeconomic factors may play a role.

Understanding the Risk Factors for Overdose in Pregnant and Postpartum Patients With Opioid Use Disorder: A Scoping Review [ID 2683381

INTRODUCTION: The rise in pregnant patients with opioid use disorder (OUD) has led to increased rates of pregnancy-associated deaths due to opioid-related overdoses. The aim of this scoping review is to describe the risk factors of opioid-related overdose in pregnant and postpartum patients. METHODS: We searched PubMed, CIANHL, EMBASE, Web of Science, Scopus, clinicaltrials.gov, and PsycINFO. We included studies that identified pregnant and/or postpartum patients with OUD and differentiated between those who experienced overdose and those who did not. Studies were screened by their title and abstract, and then by full text. Each study was independently screened by two researchers and conflicts were resolved by a group of three researchers. RESULTS: Of the 1,060 articles identified, eight met our criteria. These studies examined 90,860 pregnant and postpartum patients with evidence of OUD. The most frequently identified factor that reduced the risk of overdose was the consistent use of medications for OUD during pregnancy and the postpartum period. Other risk factors found included being houseless, incarcerated, young in age, unmarried, postpartum, publicly insured; not graduating high school; co-occurring substance use disorders; living in a state with punitive prenatal substance use policies; inadequate prenatal care; and complications in pregnancy. There was inconsistent information regarding the effect of race and co-occurring psychiatric disorders. CONCLUSION: This scoping review highlights risk factors for opioid overdose in pregnant and postpartum patients. The review indicates opportunities for future research and calls for the screening and provision of judgment-free services for high-risk individuals.

Anaemia and its Determinants Among Pregnant Women: A Study in Urban Slums of Kolkata Metro City

Anemia among pregnant women remains a significant public health concern, particularly in urban slum areas where access to healthcare and proper nutrition is often limited. Iron deficiency anemia is a pervasive issue, particularly impacting pregnant women and adolescent girls, considered by the World Health Organization with hemoglobin levels below 11 g/dl. On a global scale, as of 2019, 37% of pregnant women and 30% of women aged 15 to 49 experience anemia. NFHS-5 data reveals that the prevalence of anemia among pregnant women in urban areas of India stands at 45.7%. This study explores the multifaceted factors influencing the prevalence of anemia among pregnant women residing in the urban slums of Kolkata, India. The study adopted a mixed-methods approach, combining quantitative surveys and qualitative interviews to comprehensively assess the determinants of anemia among pregnant women in the Urban slums of Kolkata. Quantitative data collection involves structured surveys administered to pregnant women, focusing on socio-demographic characteristics, dietary habits, access to healthcare services, and knowledge of anemia prevention and management. Qualitative interviews delve deeper into the experiences and perceptions of pregnant women regarding anemia, exploring cultural beliefs, social norms, and barriers to accessing healthcare services. Additionally, healthcare providers and community health workers contribute insights into the challenges faced in addressing anemia in urban slum settings. Preliminary findings suggest that several interconnected factors contribute to the high prevalence of anemia among pregnant women in urban slum areas of Kolkata. These include inadequate antenatal care, limited availability of iron-rich foods, poor sanitation and hygiene practices, cultural beliefs surrounding pregnancy and nutrition, and socio-economic constraints. The study underscores the importance of multi-sectoral interventions aimed at addressing the complex determinants of anemia among pregnant women in urban slums. Effective strategies may involve improving access to antenatal care services, promoting nutrition education and supplementation, enhancing sanitation infrastructure, and fostering community engagement to challenge harmful cultural norms. By elucidating the nuanced factors influencing anemia in this vulnerable population, this research seeks to inform targeted interventions and policies aimed at improving maternal and child health outcomes in urban slum areas of Kolkata and similar settings worldwide.

The experiences of patients not conveyed after evaluation by emergency medical services in Southwest Finland – A qualitative survey study

BackgroundThe amount of non-critical Emergency Medical Services missions has been increasing. After examination and treatment, paramedics can decide, based on guidelines, not to convey the patient to a healthcare facility. This study aimed to investigate patients’ experiences in non-conveyance situations in Southwest Finland. Our research questions were: 1) Which patient concerns were not addressed? 2) What key actions improved patient comfort? and 3) What possible enhancements could make the patient experience more positive? MethodsThis was a qualitative survey study. In March 2023, all the patients who met the inclusion criteria (N = 1017) received a survey via mail. The data from three open-ended questions were analyzed using inductive content analysis. ResultsThe response rate was 22.2 % (n = 226). The unaddressed patient concerns were related to inadequate immediate care and guidance and non-clinical factors causing concern. Key actions for improved patient comfort were related to immediate treatment and guidance, as well as non-clinical factors that impact the patient experience. More thorough treatment processes and more attentive encounters would have enhanced the patient experience. ConclusionsPredominantly, patients reported having received excellent services. Utilizing paramedics’ soft skills and keeping the patient as the central focus is key to improving the non-conveyance process and experience.

Alpha-gal syndrome: exploring the link between tick bites and red meat allergy

Introduction: Alpha-gal syndrome (AGS) arises from tick bites, triggering excessive IgE antibodies to galactose-α-1,3-galactose (α-Gal). Symptoms vary, often appearing post-α-Gal ingestion, ranging from mild to severe, including urticaria, angioedema and respiratory issues. Delayed symptom onset complicates diagnosis, posing challenges for patients. AGS can also result from contact with medical animal-derived products, such as bovine-derived heart valves, necessitating heightened healthcare provider awareness, especially in tick-exposed regions. Management involves allergen avoidance and emergency medications like epinephrine. Further research is needed to refine diagnostic and therapeutic approaches. Purpose: Through literature review and clinical presentation description, we aim to raise awareness and enhance understanding of alpha-gal syndrome. Description of the state of knowledge: AGS, an emerging atypical food allergy, stems from immune reactions to α-Gal oligosaccharide in mammalian meat and other animal products. Avoiding medical items containing alpha-gal is crucial to prevent iatrogenesis. Summary: Understanding AGS etiology and symptoms is vital for diagnosis and management. Healthcare providers' lack of awareness may lead to underdiagnosis, inadequate patient care, and underestimation of affected individuals.

Risk Factors of Impediment of the Early Childhood Development in Rural Bengal

Abstract Background: Early childhood development (ECD) is the foundation of future life starting from conception and depends on biological and environmental factors. Seventy-four percent of these children reside in villages; many are underserved and marginalized. Enabling young children to achieve their full developmental potential is a requisite for sustainable development, but globally, 43% of children are still at risk to do so. The problem of ECD is grave for underprivileged rural population in India. Objectives: The objective of the present study was to identify the key risk factors that are prevalent in a marginalized rural community in West Bengal and to observe the impact of these impeding factors on ECD, thereby helping in priority setting in service delivery to optimize ECD promotion. Methods: In this community-based cross-sectional observational study, a random sample survey of 609 households with children 0–6 years was conducted in Purulia district, West Bengal, India, using a Multiple Indicator Cluster Survey III-based questionnaire followed by data analysis. Results: Lack of stimulatory home environment, poor learning opportunities, and inadequate responsive parental care were major hindrances. The cumulative effect of multiple other health and hygiene factors was also hindering ECD. Most factors were strongly influenced by poor maternal education. Conclusion: Education of caregivers, especially parents by dedicated health workers on early learning opportunities, showed the path of applied sciences in pediatric clinical practice. To modulate socioeconomic adversities with responsive parental care, ECD can be fostered.

Exploring Social and Legal Barriers to Educational Access for Students with Disorders of Sexual Development (DSDs) in Pakistan

Students in Pakistan with Disorders of Sexual Development (DSDs) face significant legal and social barriers to education. Cultural misunderstandings, economic hardship, and inadequate medical care exacerbate these issues. This paper uses a systematic literature review (SLR) to examine existing research on social and legal constraints affecting educational access for children with DSDs in Pakistan. Key findings highlight critical barriers: cultural misunderstandings, lack of community and family support, and insufficient legal recognition. These findings underscore the need for legislative reform, more inclusive policies, and community engagement to improve access to education for these students.

Traditional vs. Scientific Eri Silkworm Rearing: A Study in Bhubaneswar Zone

Sericulture holds significant importance in the tribal economy of India, with the country being the sole producer of various natural silks including mulberry, tasar, muga, oak tasar and eri silk. Eri silkworm rearing is particularly prevalent in the Bhubaneswar zone of Odisha, encompassing districts such as Khurdha, Jagatsinghpur, Nayagarh, Cuttack and Kendrapada. This study focuses on the traditional eri culture methods in the region, highlighting indigenous rearing techniques, food plant selection, larvae management etc. Observations revealed that traditional practices were consistent across the Bhubaneswar region, emphasizing the need for adopting scientific methods. Implementing tray/platform rearing, precise feeding techniques, strategic food plant selection during different larval stages, well-designed rearing rooms and advanced spinning methods can optimize space usage, ensure disease-free larvae, promote uniform cocoon production, increase the effective rate of rearing and silk production. The disparities in shell percentage between cocoons at the farmer level and the farm level in the Bhubaneswar zone are indicative of varying practices and care in sericulture. Farmer-level cocoons exhibit a lower shell ratio ranging from 9.17% to 9.82%, implying inadequate care and nutrition provided to growing silkworms. This discrepancy suggests that these farmers might face challenges in maintaining suitable conditions such as proper temperature, humidity and nutrition, leading to inferior cocoon quality. Conversely, at the farm level, the shell ratio ranges from 10.14% to 10.71%, indicating that farmers in this category are comparatively more adept at silk rearing practices. They provide better nutrition, suitable temperature, humidity and other necessary facilities, resulting in higher-quality cocoons. The superior environment and care provided at the farm level are reflected in the Effective Rate of Rearing (ERR%) consistently above 40%, reaching a maximum of 50.85%. This signifies that farm-level cocoons have better attributes such as cocoon weight, shell thickness and filament size compared to those reared by individual farmers, where ERR% ranged from 31% to 42%. The integration of modern techniques not only enhances production potential but also creates employment opportunities for rural youth. This approach fosters better income generation, surpassing the limitations of traditional methods and paving the way for a thriving sericulture industry.

Maternal care utilization and provision during the COVID-19 pandemic: Voices from minoritized pregnant and postpartum women and maternal care providers in Deep South.

The COVID-19 pandemic has significantly affected maternal care services especially for minoritized individuals, creating challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study aims to investigate the experiences of African American and Hispanic pregnant and postpartum women, as well as MCPs, in accessing and providing maternal care services during the COVID-19 pandemic in the Deep South. We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from Obstetrics and Gynecology clinics, pediatric clinics, and community health organizations in South Carolina, and all births took place in 2021. Interview transcripts were analyzed thematically. Maternal care utilization and provision were influenced by various factors at different socioecological levels. At the intrapersonal level, women's personal beliefs, fears, concerns, and stress related to COVID-19 had negative impacts on their experiences. Some women resorted to substance use as a coping strategy or home remedy for pregnancy-induced symptoms. At the interpersonal level, family and social networks played a crucial role in accessing care, and the discontinuation of group-based prenatal care had negative consequences. Participants reported a desire for support groups to alleviate the pressures of pregnancy and provide a platform for shared experiences. Language barriers were identified as an obstacle for Hispanic participants. Community-level impacts, such as availability and access to doulas and community health workers, provided essential information and support, but limitations in accessing doula support and implicit bias were also identified. At the institutional level, mandatory pre-admission COVID-19 testing, visitation restrictions, and reduced patient-MCP interactions were women's common concerns. Short staffing and inadequate care due to the impact of COVID-19 on the health care workforce were reported, along with anxiety among MCPs about personal protective equipment availability. MCPs emphasized the quality of care was maintained, with changes primarily attributed to safety protocols rather than a decline in care quality. The pandemic has disrupted maternal care services. To overcome these issues, health facilities should integrate community resources, adopt telehealth, and develop culturally tailored education programs for pregnant and postpartum women. Supporting MCPs with resources will enhance the quality of care and address health disparities in African American and Hispanic women.

A qualitative study of the experiences of interdisciplinary nurses during the COVID-19 outbreak following the announcement of the "Ten new guidelines" in China.

On December 7, 2022, the Joint Prevention and Control Mechanism of China's State Council released the "Ten New Guidelines" to optimize the coronavirus disease 2019 (COVID-19) prevention policies further. This signaled a broader shift from "dynamic clearing" to "coexisting with the virus" nationwide. This study aims to examine the experiences and perspectives of interdisciplinary nurses during the COVID-19 outbreak in China after the implementation of the "Ten New Guidelines". The goal is to understand the challenges faced by this unique nursing group and inform organizational support to bolster their well-being and resilience. Two tertiary hospitals in southeastern Zhejiang Province were selected, with interdisciplinary nurses chosen as subjects. A constructivist qualitative research approach was employed, using semi-structured face-to-face interviews. Research data were collected through interviews and analyzed using content analysis. Fifteen interdisciplinary nurses were included in this study. The analysis revealed four main themes and nine sub-themes. The main themes were: (1) ineffective organizational support (inadequate organizational care, poor PPE, excessive workload), (2) physiological distress after contracting COVID-19 (extreme physical fatigue, leakage of urine due to severe coughing), (3) fear of being wrong (fear of being reprimanded in public, psychological anxiety), and (4) family responsibility anxiety (difficulty of loyalty and filial piety, obligations to their children). We provide new evidence that organizations must proactively address the support, training, and communication needs of staff, particularly interdisciplinary nurses, to supplement epidemic containment. This is also essential in helping mitigate the work-family conflicts such roles can create.

Exploring nurses' difficulties and strategies when caring for patients with dementia in a neurological ward.

Nurses in neurological wards face numerous challenges when caring for patients with dementia, particularly those who also present other acute illnesses. However, studies focusing on this area are limited. This study aimed to explore the difficulties and strategies in caring for patients with dementia among nurses working in a neurological ward. A qualitative descriptive design was adopted. Twelve nurses from a neurology ward participated in individual semi-structured interviews. The data collected through these interviews were subjected to qualitative content analysis. Two main themes emerged from the analysis: (i) various shortcomings and concerns, which include subthemes: insufficient support, worry about patient safety, inadequate care ability of the caregiver, and insufficient self-competence, and (ii) unique clinical strategies, which include subthemes: cooperate with the caregiver, improve self-competence in dementia care, and employ meticulous resorts. The findings highlighted the nurses' dedication to minimizing patient risks and utilizing available resources as well as stakeholders to provide optimal care. To enhance patient care quality, it is essential to support nurses by addressing care-related barriers, offering continuous education, and establishing care pathways.