Health Professionals Research Articles

Stakeholder perspectives on educational needs and supports for students with developmental language disorder.

Students with developmental language disorder (DLD) often experience academic underachievement, and require adjustments and accommodations to access the curriculum. Teachers, allied health professionals and parents/caregivers have varying roles in the education process, and it is essential they work together to provide optimal support. However, their perspectives on the areas of functioning most impacting learning, the difficulty of school-based tasks and the helpfulness of educational support have received limited attention. A between-group survey design was used with recruitment occurring from September 2020 to October 2021. A total of 293 participants was comprised of teachers (n = 78), allied health professionals (n = 138) and parents/caregivers (n = 77). All respondents rated the learning impact of seven areas of functioning (academic behaviour, fine/gross motor, language/communication, literacy, numeracy, sensory and social/emotional), the difficulty of 39 school-based tasks, and the helpfulness of 27 educational supports for primary and/or secondary school-aged students with DLD. The groups of school-based tasks were combined into seven subscales (academic behaviour-related tasks, fine/gross motor tasks, language/communication tasks, literacy tasks, numeracy tasks, sensory-related tasks and social/emotional tasks) for analysis. The educational supports were also combined into six subscales (additional time, differentiation/adjustments, individualized support, social/emotional support, technology and visual supports). All participants rated literacy and language/communication as the areas of functioning most impacting learning and requiring the highest level of support for students with DLD. Literacy tasks were rated the most difficult across stakeholder groups. However, comparison between stakeholder groups showed statistically significant differences between ratings for six (of seven) areas of functioning. Statistically significant differences were identified when rating the difficulty of four (of seven) school-based task subscales. Additional time and visual supports were rated the most helpful educational supports across groups. Overall, teachers and allied health professionals rated areas of functioning and school-based tasks as more difficult than parents/caregivers, although they shared similar perspectives on five (of six) educational support subscales. Literacy and language/communication are the areas of functioning rated to be most impacting learning for students with DLD. However, literacy tasks were reported to be the most difficult for students with DLD to complete. Teachers, allied health professionals and parents/caregivers are recommended to regularly discuss the areas of functioning, school-based tasks and educational support to facilitate inclusive educational practices. Future research needs to consider the perspectives of students with DLD. What is already known on the subject There is extensive evidence demonstrating the increased risk of academic failure for students with DLD, particularly with literacy and numeracy. Although research on academic achievement or individual groups has occurred, limited research has compared stakeholders supporting students with DLD, which is vital for collaboration and optimal inclusive educational practices. What this study adds to the existing knowledge Teachers, allied health professionals and parents/caregivers have unique roles in the education of students with DLD and show differing perspectives that may link to these roles. Literacy and language/communication were the areas of functioning rated as most impacting learning, whilst literacy tasks were the most difficult activity undertaken at school for primary and secondary school-aged students with DLD. Additional time and visual support were rated as the most helpful educational supports for students with DLD. What are the practical and clinical implications of this work? Stakeholders demonstrate variable views on the areas of functioning and school-based tasks requiring support for students with DLD; however, they agreed on the helpfulness of most educational supports. Participants rated social/emotional tasks easier and their related supports less helpful than other areas of functioning. Given the associations between academic underachievement and mental health difficulties, more consideration needs to be given to the social/emotional well-being of students with DLD in school. Taken together, establishing differences in perspective will help with the implementation of inclusive educational practices.

Юридические противоречия применения медицинских стандартов при осуществлении медицинской деятельности

The article presents a review of regulatory legal acts and judicial practice on the application of clinical recommendations. Medical-organizational problems and legal contradictions are indicated, which can be used by medical organizations as grounds for challenging in court some provisions of their application in the implementation of their professional activities. The relevance of the study. Providing procedures and standards of medical care are the basis for the establishment of insurance support in the compulsory medical insurance system and at the same time guarantee the equal amount of medical care provided throughout the Russian Federation. Based on the procedures, standards, and from January 1, 2019, the clinical recommendations, criteria for assessing the quality of medical care are formed. In addition, since January 2025, medical organizations should proceed to the provision of medical care based on clinical recommendations. In this regard, the legal description of the ratio of the procedure for the provision of medical care, standards of medical care and clinical recommendations becomes especially relevant for both the purpose of the control and supervision functions in the field of medical services, and for specific individuals and legal entities carrying out medical activities. Relevance is also due to the fact that health protection for a single person occurs at the level of receipt of goods, works and medical services. And the safety and quality of medical services necessary to restore and maintain the patient’s health depend on corresponanse of pay services and quality of medical services. Materials and methods. Within the framework of this study, an analysis of regulatory legal acts and literary sources on the implementation of medical activities in terms of applying the procedures for the provision of medical care, standards of medical care and clinical recommendations posted in the scientific electronic library was carried out. The specified analysis was performed using the reference legal system Consultant Plus. At the same time, along with general scientific logical methods of cognition, they used formally - legal and comparative and legal research methods. The goals and objectives of the study. Conduct an analysis of the content and legal status of medical standards, determine their ratio in issues of regulating medical activities, identify existing problems in the studied sphere and, based on the data obtained, formulate proposals to harmonize the legal regulation of the standardization of the therapeutic and diagnostic process. Results and discussions. Medical activity in its main manifestations is multifaceted. Its legal regulation is also difficult, including in relation to the process of providing medical care. The normative determination of medical care is enshrined in law as a set of measures aimed at maintaining and (or) restoration of health and including the provision of medical services [Article 2 of the Law of the Russian Federation No. 323-ФЗ]. According to federal law, the organization and provision of medical care should be carried out in accordance with the procedure for the provision of medical care, on the basis of clinical recommendations and taking into account the standards of medical care [part 3 of article 2, part 1 of article 37 of the Law of the Russian Federation No. 323-ФЗ] .

Community-dwelling older people's experiences of advance care planning with health care professionals: a qualitative systematic review.

The objective of this review is to examine community-dwelling older people's experiences of advance care planning with health care professionals. The importance of health care professionals initiating advance care planning for patients has been reported; however, because of the shift from institutionalized to community care, community-dwelling older people have fewer opportunities to discuss these plans with health care professionals compared with those living in other settings. The timely initiation of advance care planning and sustainable discussions among older people, their families, and community health care professionals is necessary and may improve palliative and end-of-life care. Studies with participants aged 60 years and older who have experience with advance care planning and live in their own homes in the community were included. We considered qualitative studies and the qualitative component of mixed methods studies published between January 1999 and April 2023 in English or Japanese. MEDLINE, CINAHL, Embase, PsycINFO, JSTORE, Scopus, Japan Medical Abstract Society, and CiNii were searched for published papers, and Google Scholar, ProQuest Dissertations and Theses Global, and MedNar were searched for unpublished papers and gray literature. Study selection, critical appraisal, data extraction, and data synthesis were conducted by 2 independent reviewers using the JBI approach and JBI standardized tools. Findings were pooled using a meta-aggregation approach. The synthesized findings were graded using the ConQual approach for establishing confidence in the output of qualitative research syntheses and presented in a Summary of Findings. Five studies published between 2017 and 2022 were included in the review. Each study's total score was between 6 and 8 out of 10 on the JBI critical appraisal checklist for qualitative research. We extracted 28 findings and aggregated them into 7 categories, generating 3 synthesized findings: i) A trusting relationship with health professionals is essential for older people's decision-making. Health professionals' attitudes, knowledge, and skills play a role in this, influencing the perceived quality of care; ii) Shared decision-making and patient-centered communication are essential. Older people feel ambiguity toward end-of-life decision and advance care planning and they want their wishes to be heard in any situation to maintain their autonomy and quality of life; iii) Older people need the appropriate forms and accessible and coordinated care to begin advance care planning. Qualitative studies on community-dwelling older people's experiences of advance care planning with health care professionals are scarce. The experiences have illustrated that trusting relationships influence people's perception of the quality of care they receive; there is uncertainty about their future; and they have varying feelings or attitudes toward their impending death, including denial and avoidance. This review highlighted the need for appropriate forms, and accessible and coordinated care to begin advance care planning; thus, an approach that meets the individual's health and psychosocial status should be selected carefully. Further research is recommended to include older populations from broader geographical and cultural backgrounds and to assess and evaluate the different advance care planning approaches and their implementation processes among groups of community-dwelling older people with different health and psychosocial statuses. PROSPERO CRD42020122803.

Mental health professionals’ beliefs and attitudes towards compulsory admission in Athens: a token of social stigma or good faith in psychiatry?—a cross-sectional study

BackgroundMental health professionals’ (MHPs) attitudes towards involuntary admissions have not received adequate attention in efforts to curb their rates. Thus, the present study set out to (i) explore MHP attitudes regarding involuntary hospitalisation, (ii) describe their perceived dangerousness of people with severe mental illness (SMI) and their trust in psychiatry, (iii) identify the predictors of attitudes towards compulsory admissions and (iv) gauge the contribution of perceived dangerousness versus trust in psychiatry to explaining them.MethodsA random sample of 300 mental health professionals working in public mental health services located in the Northern part of Athens and in the two psychiatric hospitals of Attica participated in the study. Respondents had to complete a self-reported instrument garnering information about participants’ attitudes towards involuntary hospitalisation (original scale), the perceived dangerousness of people with SMI (Perceived Dangerousness Scale) and their trust in psychiatry (based on the Attitudes to Mental Illness scale) as well as various socio-demographic and work-related variables.ResultsRespondents largely accepted involuntary hospitalisations, considering them to be beneficial (72.96%) and disagreeing with the view that they adversely influence the course of illness (54.85%). Nonetheless, they believe that people with SMI should be treated in the community (89.93%), that compulsory admission should be the last therapeutic resort (84.01%) and that people with SMI should not be placed in psychiatric hospitals against their will in order to be under surveillance (90.64%). However, they acknowledge that involuntary admission is often the only treatment options(61.19%). Concomitantly, they report moderate levels of perceived dangerousness and high levels of trust in psychiatry. Trust in psychiatry had the strongest positive association with acceptance of involuntary hospitalisation among mental health professionals whereas postgraduate studies and working in outpatient settings were linked to less favourable attitudes. Interestingly, perceived dangerousness did not yield an independent effect; rather, it weakened the association between trust in psychiatry and acceptance of involuntary admissions.ConclusionsMental health professionals hold complex attitudes towards involuntary hospitalisation, which are largely explained by their trust in psychiatry. Efforts to reduce the rates of involuntary admissions should address both them and their determinants.

An Integrative Review of Exclusive Breast Milk Expression.

A growing number of families are using exclusive breastmilk expression to feed their newborns. They need accurate information and support from their providers. The purpose of this integrative review was to explore the prevalence, characteristics, practices, and outcomes of families who fed exclusively expressed breastmilk to their infants. The electronic databases of CINAHL, Scopus, PubMed, Web of Science, and article reference lists for articles on expressing human milk for infants were searched. Results were filtered to glean published studies between 2012 and 2022, academic journals, human studies, and English language journals while excluding secondary reviews and expert opinions. Both authors screened records within Covidence systematic review management software. Selected studies were evaluated for quality of evidence using the Johns Hopkins Research Evidence Appraisal Tool. Twenty-seven studies were included in this review. Most families who exclusively expressed originally planned to directly breastfeed their newborns and only began pumping after encountering problems. The most frequently recurring theme was that advice from health care personnel was inconsistent. Women described a knowledge deficit and received more help with exclusive expression from informal social media groups than their providers. Prevalence of exclusive breastmilk expression is highest in Asian countries and in the neonatal intensive care unit environment. These women had a shorter duration of human milk feeding and higher likelihood of cessation compared with women who both fed expressed milk and directly breastfed. Only recently have breastfeeding researchers begun distinguishing the type of milk (human milk or artificial formula) from the feeding method in their publications. This approach allows clinicians to provide better guidance on the outcomes of each feeding method. As clinicians, we can help families by encouraging them and providing consistently accurate information. Solely feeding expressed human milk is a valid option when the lactating person is unable or unwilling to directly breastfeed.

Absenteeism Among National Health Service Workers During the COVID-19 Pandemic in Portugal

By March 2020, the first COVID-19 cases were detected in Portugal. Anecdotal evidence showed that the National Health Service absenteeism rate rose. The present study aimed to quantify and characterize the absenteeism rate among these healthcare workers during the COVID-19 pandemic in Portugal. This study used data from the Portuguese National Health Service Transparency Portal for the number of National Health Service workers and absence days (2015 - 2021). Absenteeism was compared, before and after the pandemic onset, in absolute terms, and as absenteeism rates. Additionally, we performed an interrupted time series analysis, by fitting a Poisson regression model with level change. We controlled for data seasonality using Fourier terms. The results showed that, between 2015 and March 2020, the average monthly absenteeism rate was of 12.2%, rising to 14.5% in the subsequent period. This represented an increase of 19% in the absenteeism rate. The interrupted time series analysis showed an increase of 10.8% in the National Health Service absenteeism rate after the pandemic onset [relative risk = 1.10; 95% CI 1.10 - 1.11; p < 0.01]. When accounting for seasonality in the data, the interrupted time series analysis showed an increase of 11.0% in the National Health Service absenteeism rate [relative risk = 1.11; 95% CI 1.00 - 1.23; p < 0.05]. These results suggest an increased number of days of absence rate among the National Health Service healthcare workers during the COVID-19 pandemic.

Evaluation of Heath Care Commitment with Prevention and Infectious Control Protocols in Mofid Children Hospital, IRAN

Background: The dedication of healthcare teams to adhering to protocols for the use of personal protective equipment (PPE), maintaining vaccination coverage among healthcare workers (HCWs), and ensuring environmental health are crucial elements in managing hospital-acquired infections. Objectives: This study aimed to evaluate adherence to PPE use, vaccination history, hand hygiene protocols, and environmental health practices in a tertiary children's hospital in Iran. Methods: This cross-sectional study evaluated compliance with PPE use, vaccination history among doctors, nurses, and hospital staff, adherence to strict hygiene practices, patient isolation protocols, and environmental health measures based on an Iranian Health Ministry query. Data collection was conducted over three months, from May to August 2023. Results: During the study, 285 staff members were assessed for compliance with hand hygiene protocols. Nurses demonstrated the highest level of compliance, reaching 51%. The highest compliance with hand hygiene protocols at the five designated moments was approximately 79%, with the transplantation and hemodialysis wards achieving the highest rates. Nurses also showed the most positive vaccination records. Personal protective equipment was used correctly in various wards, with an overall compliance rate of 79%. Conclusions: This study revealed that compliance with health protocols in different parts of the hospital was suboptimal and required significant improvement.

“To Be or Not to Be” a Conscientious Objector to Voluntary Abortion: An Italian Web-Survey of Healthcare Workers

Background and Objectives: Conscientious objection to voluntary abortion remains a hot debate topic. This could affect the accessibility to pregnancy termination. Our aim is to evaluate the possible aspects related to an operators’ choice about objection for voluntary abortion, such as the following: the abolition of the time limit, the instruction of a multi-collegiate commission, the introduction of pharmacological rather than surgical procedures, the fetal/maternal illness and the case of sexual violence. Materials and Methods: This is an observational, descriptive study that involves a cohort of Italian healthcare workers who answered a web-survey. Results: Of the total 352 respondents, only 20.8% affirmed to be objectors versus 79.2% of non-objectors. For the objectors, 72.2% declared that they would not change status in case of pharmacological abortion; 79.7% would not suspend their choice for interruption in the second trimester; 63.3% would suspend the objection with a multi-collegiate commission, and 69.0% would discontinue their objection in the case of sexual violence. 72.0% of the total participants declared that the abolition of the time limit could have a resecuring impact on women’s choice. Conclusions: Most operators declared that the abolition of the time limit could have beneficial effects. Among the objectors, the status would change especially with the introduction of a multi-collegiate commission, and in case of serious maternal/fetal illness and/or sexual violence.

Navigating (Dis)empowerment: Dialectical Tensions in the Enactment of Resilience of College Students with Eating Disorders

ABSTRACT Research has shown a dramatic increase of eating disorders (EDs) among young people during disruptive times. Understanding the role of communication in impeding or enacting resilience not only helps those with EDs develop better strategies for coping and changing their lives but can also inform effective interventions at familial, community, and system levels. Guided by the communication theory of resilience (CTR), our study explores how college students with EDs enacted resilience through recalled interactions with parents, friends, community members, and health professionals during the COVID-19 pandemic. Semi-structured in-depth interviews with 13 college students diagnosed or self-identified with EDs revealed that communication intended as interventions or protective measures can be perceived as (dis)empowering, triggering (mal)adaptive resilience. The study contributes to CTR by expanding perspectives on resilience triggers as socially constructed risks aligned with multiple contexts to display how communicatively constructing resilience is complex, dynamic, power-laden, and imbued with dialectical tensions of anticipatory-reactive resilience for self and others.

Phenomenological Studies: Experiences of Family Members Taking Care of Post-Stroke Patients

Most of the global stroke burden occurs in low- and lower-middle-income countries. The most common obstacles families face when caring for stroke patients appear to cause various tensions between patients and their families. This study examines family members' experiences of caring for patients after a stroke. This study uses a qualitative method with a descriptive phenomenological design. The research participants were 11 participants using purposive sampling techniques. Data were analyzed using NVivo 12 qualitative data analysis software, and interview results were analyzed using thematic analysis. This study identified five phenomena related to the experience of caring for patients after stroke: fulfillment of patient's daily activities, patient treatment, participant psychological response, participant support, and barriers to patient care. Most participants had a less pleasant experience caring for patients after a stroke. This is reflected in sad reactions, angry reactions, the need for help and support from the government, health workers, and other family members, and barriers to patient care. It is important to ensure good coordination between health services and patients and their families, as patients and participants do not have access to health services due to distance and physical disability.

Innovative strategies and implementation science approaches for health delivery among migrants in humanitarian settings: A scoping review.

Over 100 million displaced people rely on health services in humanitarian contexts, defined as unstable or transitory settings created in response to complex emergencies. While services are often described, there is a dearth of evidence on best practices for successful implementation to guide efforts to optimize health delivery. Implementation science is a promising but underutilized tool to address this gap. This scoping review evaluates implementation science in health services for forced migrants in humanitarian settings. We conducted a scoping review according to JBI methodologies. A search of eight databases yielded 7,795 articles, after removal of duplicates, that were screened using PRISMA-ScR guidelines. Data extraction assessed study descriptors, implementation objects, barriers, facilitators, implementation strategies, and use of implementation frameworks in service delivery. Data from 116 studies represented 37 countries and 11 topic areas. Methods were mainly cross-sectional with low-medium evidence rigor. Mental health programs (25%) and vaccination services (16%) were the most common objects of implementation. Thirty-eight unique barriers were identified including resource limitations (30%), health worker shortages (24%), and security risks (24%). Among 29 facilitators, the most common were health worker availability (25%), pre-existing partnerships (25%), and positive perceptions towards the intervention (20%). More than 90% of studies collectively identified 35 implementation strategies, the most common being capacity building (44%), stakeholder engagement (35%), information dissemination (38%), and feedback mechanisms (25%). Only 10 studies used formal implementation models, with RE-AIM (n = 3) and Intervention mapping (n = 2) being most frequent. In this scoping review, we found similar barriers, facilitators, and implementation strategies across diverse humanitarian migrant settings and services. However, the use of rigorous methods and formal implementation models was rare. Frameworks included RE-AIM, CFIR, and Precede-Proceed. Increased use of implementation science frameworks and methods will help humanitarians more rigorously and systematically evaluate and develop best practices for implementation of health services for migrants in humanitarian settings.

Refusal of Surgical Treatment for Advanced Oral Squamous Cell Carcinoma in a Long-Term Naswar Consumer: A Case Report

Introduction: Oral squamous cell carcinoma (OSCC) is a significant global health concern, primarily associated with tobacco use, including naswar—a smokeless tobacco mixture widely used in South Asia. Naswar is composed of ground tobacco leaves, slaked lime, and occasionally flavoring agents. When mixed with saliva, it releases carcinogenic nitrosamines, nicotine, and other harmful toxins. Despite the well-documented risks, including oral cancer, naswar continues to be used by many. Its harmful effects extend beyond oral health, contributing to heart disease, gastrointestinal issues, and reproductive health problems. It is also associated with mouth lesions, gum disease, and an elevated risk of oral cancers. This study emphasizes the urgent need for targeted global strategies to address naswar-related oral cancers. Case Presentation: This article details the case of a 62-year-old woman with a 40-year history of naswar consumption, who was diagnosed with advanced oral squamous cell carcinoma (SCC) affecting the right side of her face. She was referred to the Maxillofacial Surgery Department of Zahedan University of Medical Sciences. Despite recommendations for surgical intervention, the patient declined treatment following comprehensive consultations with medical professionals. This case highlights the complexities of managing advanced oral SCC in chronic naswar users and underscores the role of patient autonomy in treatment decisions. Conclusions: This case illustrates the challenges in treating advanced oral SCC in long-term naswar users and emphasizes the critical importance of respecting patient autonomy in treatment decision-making.

Основные направления совершенствования диабетологической помощи в условиях поликлиники (по результатам социологического исследования).

A sociological assessment of satisfaction with outpatient care for patients with diabetes mellitus in the Republic of North Ossetia-Alania was carried out. The results of the study make it possible to identify the main problems faced by patients at the primary health care level and identify possible ways to level them. The purpose of the study: to assess the satisfaction of patients with diabetes mellitus with the quality of medical care provided in outpatient settings. Materials and methods. The questionnaires of 450 patients with diabetes mellitus, urban (66%) and rural (34%) residents were analyzed. Of these, 45% are men and 55% are women aged 39–59 years (39.0%), 60–79 years (36.0%), over 80 years (6.0%). The questionnaire included 12 questions on various aspects of the clinic’s activities. Data processing and analysis were performed using the IBM SPSS Statistics 27.0.1 software and analytical complex. Results. A study of the satisfaction of patients with diabetes mellitus with outpatient medical care has revealed a number of organizational and medical problems. The regularity of visits to the endocrinologist by patients is one of their main conditions for the effectiveness of therapeutic and preventive measures and dispensary supervision. A fairly high percentage (72%) visit the clinic from 2 to 5 times a year. It is alarming that 28% of patients visit an endocrinologist only once a year, which is a sign of low adherence to treatment on the part of patients. Rural residents visit an endocrinologist less often than urban residents. Young people are more often dissatisfied with the time that the doctor spends at the reception and more often face rude treatment from the medical staff. The comorbidity of diabetes mellitus requires the provision of high-quality medical care in accordance with the expectations of patients, which is provided with logistical equipment and staffing Conclusion. The results obtained are an indicator of the quality of medical care and indicate the presence of problem areas in the activities of medical organizations providing outpatient care to patients with diabetes mellitus. Special attention should be paid to the organization of dispensary follow-up in order to reduce the risks of developing complications of the disease. It is necessary to increase the availability of primary health care by making appropriate management decisions at the level of regional health authorities.

Building a culture of quality in maternal and newborn health: experience from the quality, equity and dignity network in Ethiopia

ABSTRACT Background Building a culture of quality is vital for sustaining high-quality healthcare, emphasising shared values and continuous improvement. The Quality Equity and Dignity (QED) network was a global initiative working toward this objective, focusing on maternal and newborn health. This paper aims to describe how QED influenced five identified attributes of quality culture in Ethiopia: leadership, people-centered interventions, collaboration, rewards, and ownership towards building and sustaining a culture of quality in healthcare establishments. Methods This qualitative study, conducted at two points six months apart, incorporated data from key informant interviews, observations, and document reviews. It included 18 national and 22 sub-national key informant interviews, seven facility observations, and one technical working group meeting observation. Data analysis was performed using NVivo 12 software, focusing on identified thematic areas related to quality culture. Result Leadership was crucial for building a quality culture in Ethiopia, and the QED network strengthened government leadership structures, although leadership capacity and staff turnover were challenges. QED enhanced people-centered care and data tracking, but the added data focus burdened healthcare workers. Opportunities for collaboration and shared learning were facilitated, although not accessible to all actors. Motivation and rewards encouraged good performance, but addressing intrinsic behavioral change remained a challenge. Conclusion Achieving high-quality healthcare involves more than tools and infrastructure; it requires a cultural shift with behavior change consistently demonstrated at various levels. The QED network faced challenges in building a culture of quality but serves as an exemplary initiative for other networks to learn from.

Engaging stakeholders in embedded newborn health services/systems research in Kenya; a continuous process involving multiple actors.

Background Engaging relevant stakeholders throughout the research cycle is increasingly recognised as critical to conducting quality health systems research. There are few descriptions and analyses of stakeholder engagement in practice for embedded health systems research especially those that must navigate multi-level decentralised health systems. We describe and reflect on the stakeholder engagement activities of an international multi-disciplinary programme of research focused on newborn care in hospitals in Kenya. Methodology Our experienced project stakeholder engagement group coordinated engagement activities across multiple stakeholders with differing interests in the research. We conducted a stakeholder mapping and analysis using an engagement matrix to include national and county-level policymakers, professional communities, associations and regulators, health managers, frontline healthcare workers, patients, families and patient representative groups. Our engagement group maintained a log of engagement activities and had regular programme feedback meetings and discussions. As part of our analysis of stakeholder engagement, we drew on project documents and meeting minutes, and on a conceptual framework which distinguishes between the moral, strategic and practicaldimensions of stakeholder engagement. Results Stakeholder engagement was essential but complex in practice. Although we had significant prior engagement experience and relationships at the hospitals and the counties, introducing new staff into NBUs triggered complexities that required careful consultation along the bureaucracies at the counties. Despite the counties having similar hierarchical architectures, engagement processes varied and achieved different outcomes across counties. There were also multiple officeholder transitions over the research period, occasioned by factors in our external environment, often necessitating engaging afresh. Conclusion Even with a carefully developed stakeholder engagement plan, an experienced team, and a landscape backed by long-term embeddedness, health research stakeholder engagement can unfold in unexpected ways and requires continuous effort, resources, and adaptability. Meeting the moral, strategic, and practical potential of engagement requires flexibility, responsiveness, and commitment, including adequate resources.

Psychological problems and related factors among primary healthcare staff in major cities in China during the COVID-19 pandemic

This study aimed to explore psychological problems and related factors among frontline primary healthcare workers who belongs to community health service centers and directly provides medical security services to community residents during the COVID-19 in Shanghai. We used a cross-sectional data analysis design to investigate the anxiety and depression levels of 929 frontline healthcare staff (primary healthcare providers, nurses, village doctors, and public health workers) during the Shanghai epidemic.The prevalence of depression among frontline primary healthcare workers was 39.7% (369 cases) and that of anxiety was 30%(279 cases). There was a significant correlation between the depression symptoms and anxiety symptoms. And factors associated with depression were being female, advanced education, expecting psychological interventions, expecting vacations as a reward, and expecting financial rewards. Factors strongly associated with anxiety were being female, expecting psychological interventions, and expecting vacations as a reward. Psychological problems among frontline primary healthcare workers merit more attention during the COVID-19 outbreak, especially those who are vulnerable (e.g., females and those with an advanced education).

A qualitative description of HIV testing and healthcare experiences among trans women in Ghanaian urban slums BSGH-012.

Achieving the UNAIDS 90-90-90 targets hinges on identifying and engaging individuals with HIV in care, requiring 90% of those infected to be diagnosed, initiated on ART, and achieving viral suppression. Despite this imperative, HIV testing services as well as research in Ghana often overlook the unique experiences of transgender women in urban slums, impacting their engagement with care. Using the gender affirmative model lens, this study reports the HIV testing experiences of trans women in Ghanaian slums, highlighting how the healthcare environment, counseling, and healthcare provider attitudes shape these experiences. The study used a qualitative descriptive interview design with 20 trans women aged 18 to 31 from urban slums in Greater Accra Metropolitan Area, Ghana. Participants were recruited through purposive and snowball sampling. Data were collected via face-to-face interviews, transcribed, and analyzed using NVivo, with results presented in categories and subcategories. Two main categories emerged from our data analysis: 1) Positive Experiences with HIV Testing, and 2) Negative Experiences with HIV Testing. Positive experiences with HIV testing among trans women in Ghanaian slums included a welcoming environment at healthcare facilities, supportive counseling, and relatability with HIV-positive nurses. Negative experiences were characterized by fear and anxiety during testing, often intensified by healthcare worker attitudes, including unwelcoming behaviors and judgmental body language, especially in facilities that are not key population friendly. These categories provided a framework for understanding the varied experiences of trans women in Ghanaian slums regarding HIV testing. The study highlights the urgent need for Ghanaian slum healthcare facilities to address discrimination against trans women by creating inclusive, supportive environments. It stresses the importance of using a gender-affirmative approach to improve HIV testing and health outcomes for trans women. Policymakers and healthcare providers must focus on training, inclusive care, and cultural competence to reduce health disparities for this population.

Acute remote home monitoring of acutely ill patients with COVID-19: how Dutch home monitoring initiatives were organized during the pandemic

BackgroundAcute remote home monitoring of acutely ill patients with COVID-19 holds potential for early detection of deterioration and thus subsequentearly intervention that may prevent or mitigate progression to severe illness and need for respiratory support. Our aim was to describe common features of acute remote home monitoring programs for acutely ill patients with COVID-19 in the Netherlands.MethodsWe performed literature searches (both grey and academic) between 1st March 2020 and 1st March 2023 to identify Dutch acute remote home monitoring initiatives, excluding studies on early hospital discharge. From the available protocols, we extracted relevant information on patient eligibility, organization of acute remote home monitoring and home management.ResultsWe identified and approached ten acute remote home monitoring initiatives for information regarding their used protocols. Seven out of ten protocols were retrieved and assessed. All initiatives focused on adult patients with COVID-19 who where at risk of developing severe COVID-19, and all initiatives provided close follow-up through remote home monitoring using medically certified pulse oximeters. Daily measurements included peripheral oxygen saturation (all initiatives, n = 7), body temperature (n = 6), heart frequency per minute (n = 4) and breathing rate per minute (n = 4). For follow-up and review of measured values, in most initiatives (n = 6) the physician (general practitioner or hospital physician) in charge was supported by a dedicated monitoring center. In 5 out of 7 initiatives, the general practitioner (GP) was responsible for supervising the patients and monitoring staff.ConclusionThe acute remote home monitoring initiatives that emerged in the Netherlands during the first wave of the COVID-19 pandemic were similarly organized. Common building blocks for home monitoring include daily check of peripheral oxygen saturation, monitoring through a dedicated remote monitoring center alongside healthcare personnel and a supervising physician.

There is no place for Tobacco Industry sponsorship in Continuing Professional Development

Continuing Professional Development (CPD) plays a key role in ensuring that health professionals maintain competence in their professional roles. The delivery of CPD requires provision of education and information that is independent of vested interests. Recent efforts by the Tobacco Industry to move into provision and sponsorship of CPD for doctors represents an ethical challenge and potentially contravenes South Africa’s obligations under the Framework Convention on Tobacco Control. The College of Medicine of South Africa (CMSA) has taken the position that there is no place for tobacco company sponsorship of CPD activities in light of its mandate to promote the highest degree of skill and efficiency in medical and dental practice and to advance the highest ethical standards and professional conduct in the profession. This position is in line with the CMSA’s position on sponsorship of its own CPD activities and we urge other health institutions to adopt a similar approach. The Health Professions Council of South Africa (HPCSA) should issue guidelines to CPD accreditors to exclude tobacco company-sponsored activities from HPCSA-accredited CPD. This is particularly important at this point while South Africa’s parliament is considering further legislation to control tobacco-related harms.

Facing the challenges

Nina Garlo offers a guide for oral health professionals on aiding patient's mental health.