Health Professionals Research Articles

"All of these things interact, that's why it's such a wicked problem": Stakeholders' perspectives of what hinders low back pain care in Australia and how to improve it.

Low-quality care for low back pain (LBP) is pervasive in Australia. Drivers of low-quality care have been identified elsewhere and include misconceptions about LBP, vested interests and limited funding for evidence-based interventions. Yet, the literature that identified such drivers is not specific to the Australian context, and therefore, it is likely to represent only part of the local problem. This study aimed to determine where the most influential drivers of LBP care are in the Australian healthcare system and what could be done to address them. Clinical leaders from various disciplines, academics, hospital managers, policy-makers, consumers involved in LBP advocacy, board members of relevant health profession boards and private insurers were invited to participate in one-on-one interviews. Interviews were transcribed verbatim. Interview data were analysed using content analysis. We interviewed 37 stakeholders. Challenges that hinder LBP care in Australia included variability in care and inconsistent messages, funding models that are not supportive of appropriate care for LBP, the community's understanding of LBP, vested interests and commercial forces, difficulties in accessing timely and affordable conservative care, neglect of social determinants and health inequities, short consultations, siloed practices, uncertainties that stem from gaps in evidence and the experience of having LBP, individual and contextual variability, the mismatch between evidence and practice, the Australian healthcare system itself, the lack of political will and acknowledgement of LBP as a public health issue, stigma, the need to improve human aspects and the compensation system. When discussing factors that could improve LBP care, participants raised collaboration, changes in funding, improvement of access to - and affordability of - models of care and care pathways, public health campaigns targeting LBP, enhancement of policy and governance, increasing and better training the workforce, consideration of inequities, making improvements in information sharing and reforming the worker's compensation sector. LBP is a wicked problem, influenced by several systemic factors. An agenda for system change in the LBP landscape should be guided by a collaborative, coherent and integrated approach across sectors to enhance quality of care and system efficiency for those who seek and provide care.

Balancing the voices of the Global South and North in shaping health professions education.

Balancing the voices of the Global South and North in shaping health professions education.

Familiarity and Applications of Artificial Intelligence in Health Professions Education: Perspectives of Students in a Community-Oriented Medical School

Familiarity and Applications of Artificial Intelligence in Health Professions Education: Perspectives of Students in a Community-Oriented Medical School

Determinants of Childbearing Age Couples Perform Early Detection of Cervical Cancer Through IVA Method (Visual Inspection of Acetic Acid) in Sigi Regency

Introduction: Cervical cancer is a malignant disease that is quite often heard among the public. Cervical cancer or commonly referred to as cervical cancer often occurs in women. Cervical cancer can occur due to a poor lifestyle and environment, such as having free sex, changing partners and a lack of personal hygiene. Objective: This study aims to determine the determinants of early detection of cervical cancer in couples of childbearing age (PUS) in Sigi Regency. Method: This study used a cross sectional research design. Result: There was a significant relationship between knowledge, attitude and behavior of early detection of cervical cancer in Sigi Regency. There was no significant relationship between education, employment and support of health workers and early detection behavior of cervical cancer in Sigi Regency. Conclusion: This study concluded that there is a significant relationship between knowledge, attitudes and behaviors for early detection of cervical cancer in Sigi Regency. And there was no significant relationship between education, employment and support of health workers and early detection behavior of cervical cancer in Sigi Regency.

Task-sharing to promote caregiver mental health, positive parenting practices, and violence prevention in vulnerable families in Sierra Leone: a pilot feasibility study.

The prevalence of household violence in low- and middle-income countries (LMICs) is high, and exposure to violence has significant adverse effects on both mental health and child development across generations. Evidence-based services to improve parenting practices and reduce household violence in LMICs are scarce, particularly across rural regions of West Africa. This study explored the feasibility, acceptability, and potential benefits of an evidence-based home-visiting intervention to promote early childhood development and reduce household violence-the Family Strengthening Intervention for Early Childhood Development and Violence-Prevention (FSI-ECD + VP)-among vulnerable families in rural regions of Sierra Leone. Eighty dual-caregiver households in the Makeni region of Sierra Leone were included in the study (N = 160 caregivers; 73% female). Eligibility criteria included having at least one child aged 6-36 months and elevated scores (> 62.5) on the Difficulties in Emotion Regulation Scale (DERS). Community Health Workers (CHWs) employed in the Makeni region completed a 3-week FSI-ECD + VP training. Families were randomized to receive either the FSI-ECD + VP or treatment as usual (TAU). Research assistants blinded to treatment assignment assessed caregiver mental health, caregiver-child interactions, and household violence at baseline, post-intervention, and 3-month follow-up time points. Triangulation of quantitative and qualitative data showed that caregivers, CHWs, and supervisors generally perceived the intervention as beneficial, feasible, and acceptable. Mixed effects models showed that caregivers who received the FSI-ECD + VP had significantly improved caregiver-child relationship outcomes compared to TAU as assessed by the Home Observation for Measurement of the Environment and the Observation of Caregiver-Child Interactions at post-intervention. Preliminary data also suggests that caregivers receiving the FSI-ECD + VP were less likely to have experienced intimate partner physical violence during the post-intervention period, and had lower symptoms of anxiety and depression at 3-month follow-up. FSI-ECD + VP delivery by CHWs in Sierra Leone may be feasible and acceptable; it may also help improve caregiver-child interactions and reduce the likelihood of household violence among vulnerable families with young children. Task-sharing approaches may help increase acceptability and access to evidence-based behavioral interventions that promote early childhood development and violence prevention among families in rural regions of Sierra Leone and other similar settings. The study is registered in clinicaltrials.gov (NCT03045640; 07/22/2020). This study follows the Consort 2010 guidelines for reporting of clinical trials.

Deep Learning in Endoscopic Ultrasound: A Breakthrough in Detecting Distal Cholangiocarcinoma

Introduction: Cholangiocarcinoma (CCA) is a highly lethal malignancy originating in the bile ducts, often diagnosed late with poor prognosis. Differentiating benign from malignant biliary tumors remains challenging, necessitating advanced diagnostic techniques. Objective: This study aims to enhance the diagnostic accuracy of endoscopic ultrasound (EUS) for distal cholangiocarcinoma (dCCA) using advanced convolutional neural networks (CCNs) for the classification and segmentation of EUS images, specifically targeting dCCAs, the pancreas, and the bile duct. Materials and Methods: In this retrospective study, EUS images from patients diagnosed with dCCA via biopsy and an EUS-identified bile duct tumor were evaluated. A custom CNN was developed for classification, trained on 156 EUS images. To enhance the model’s robustness, image augmentation techniques were applied, generating a total of 1248 images. For tumor and organ segmentation, the DeepLabv3+ network with ResNet50 architecture was utilized, employing Tversky loss to manage unbalanced classes. Performance evaluation included metrics such as accuracy, sensitivity, specificity, and Intersection over Union (IoU). These methods were implemented in collaboration with the ADAPTED Research Group at the Technical University of Cluj-Napoca. Results: The classification model achieved a high accuracy of 97.82%, with precision and specificity both at 100% and sensitivity at 94.44%. The segmentation models for the pancreas and bile duct demonstrated global accuracies of 84% and 90%, respectively, with robust IoU scores indicating good overlap between predicted and actual contours. The application performed better than the UNet model, particularly in generalization and boundary delineation. Conclusions: This study demonstrates the significant potential of AI in EUS imaging for dCCA, presenting a robust tool that enhances diagnostic accuracy and efficiency. The developed MATLAB application serves as a valuable aid for medical professionals, facilitating informed decision-making and improving patient outcomes in the diagnosis of cholangiocarcinoma and related pathologies.

Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial.

Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children's gadget addiction. A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups' interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children's gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population's psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. PRR1-10.2196/51833.

The Value of Life and Reproductive and Professional Autonomy.

This article considers John Harris' work on autonomy, specifically reproductive autonomy, outlined in The Value of Life and developed throughout his career. Harris often used the concept of reproductive autonomy to make the case for liberal approaches to developments in reproductive and genetic technologies. Harris argued that reproductive autonomy should be highly valued, and therefore we need compelling arguments to justify limiting it in anyway. When discussing reproductive autonomy, Harris focused mainly on restrictions on the potential users of reproductive technologies autonomy, that is, prospective parents. This article extends the discussion of autonomy and the appropriate limits to individuals exercising their autonomy to medical professionals working in this area. Given reproductive technologies have become part of routine medical practice, this article considers whether the current restrictions on both patients and clinicians, as imposed by regulators and professional guidelines, remain ethically justified.

Impact of COVID-19 pandemic on influenza vaccination rate among health care workers

ABSTRACT Vaccinations against influenza are critical in mitigating the severity of the disease, preventing its transmission, and restricting its dissemination. Concerns about vaccination hesitancy among healthcare workers (HCWs) have been duly recognized during and following the COVID-19 pandemic. To examine the extent to which the COVID-19 pandemic has influenced the adoption of vaccinations among HCWs. A cross-sectional online survey was conducted four years after the COVID-19 pandemic among HCWs in Saudi Arabia. We performed a logistic regression analysis using influenza vaccination uptake as the dependent variable and perceived COVID-19 pandemic’s impact, age, gender, marital status, employment status, education level, monthly income, respondent’s overall health, doctor visits, tobacco use, number of adults in the household, and number of children in the household as independent variables. The study included 574 participants, an 86% response rate. Of the sample, 47% reported they had the influenza vaccination. HCWs who reported a greater negative impact due to the COVID-19 pandemic were 40% more likely to acquire the influenza vaccine (OR = 1.4, 95% CI [1.24, 1.58]). Compared to HCWs without children, HCWs with a child had a 44% lower likelihood of taking the influenza vaccination (OR = 0.34, 95% CI [0.16, 0.69]). The odds of HCWs obtaining the influenza vaccine were 4.5 times higher for those who reported one yearly medical visit, 2.6 times higher for two, and 1.4 times higher for three or more. HCWs who experienced more severe COVID-19 outcomes were more likely to get vaccinated against the virus. However, long-term monitoring of this inclination is necessary.

Evaluating the Impact of an Online Mindfulness Program on Healthcare Workers in Korean Medicine Institutions: A Two-Year Retrospective Study

Background/Objectives: This retrospective study evaluated the effectiveness of a two-year online mindfulness program (five biweekly sessions) combined with a smartphone application for healthcare workers (HCWs) in Korean medicine (KM) institutions. Methods: Twenty-three participants, including KM University students, KM doctors, and nurses, completed a 9-week online mindfulness program in 2023 or 2024. The pre- and post-intervention surveys assessed subjective health status (SHS), knowledge of mind–body modalities (MBMs), hwa-byung (HB) symptoms, emotional labor (EL), burnout, and program satisfaction. Results: Participants showed significant improvements in SHS (p = 0.008) and MBM knowledge (p = 0.035). HB personality scores decreased significantly (p = 0.027), while the reduction in HB symptoms approached statistical significance (p = 0.052). The frequency of interactions among job-focused EL increased (p = 0.003). The subgroup analysis revealed significant reductions in HB personality traits (p = 0.017) and symptoms (p = 0.006) among practicing KM doctors and nurses. No significant changes were observed in burnout levels. Participants reported high satisfaction (median 8.00 [IQR 8.0–9.0]) and willingness to recommend the program (median 5.00 [IQR 4.0–5.0]). Conclusions: Analysis of the 2-year results suggests that the online mindfulness program effectively improved SHS, MBM knowledge, and HB-related symptoms among HCWs in KM institutions, particularly among practicing professionals. High satisfaction rates indicated the acceptability of the program. Future research should use larger sample sizes and randomized controlled designs to further validate these findings and explore long-term outcomes. This intervention shows promise as a tool to promote mental health in Korean healthcare settings.

Comparison of Swallowing Measures to Patient-Reported Dysphagia Symptoms in Head and Neck Cancer Patients.

Head and neck cancer affects patient swallowing function. We set out to examine how objective measures of swallowing compare against subjective patient-reported outcomes in a cohort of head and neck cancer patients. Retrospective analysis of data collected from a large dysphagia HNC registry. Tertiary Academic Cancer Center. Between 2006 and 2019, objective measures of swallowing as scored on Modified Barium Swallow Study or Fiberoptic Endoscopic Evaluation of Swallowing and subjective measures using the SWAL-QOL were collected. Objective measures were scored by the Penetration-Aspiration Score (PAS); subjective measures were assessed by the Dysphagia Domain Score (DDS), collectively forming paired data points. Data on tumor site, T-stage, and treatment modality was collected and evaluated. A total of 253 paired data points were included in this study. A statistically significant relationship between PAS and DDS was observed across all patients (P < .05, chi sq). When stratified by tumor subsite, PAS and DDS relationships were strongest for oral cavity. When stratified by AJCC T-stage, T4 tumors had the strongest relationship between PAS and DDS. The relationship of PAS and DDS was less congruent the further removed from treatment completion. Objective and subjective measures of swallowing provide complementary evaluations of swallow function. The congruency of assessment varies by T stage and tumor subsite. Physicians and allied health professionals can use this information to better understand the value and limitation of objective and subjective swallowing assessments in evaluating head and neck cancer patients.

The prevalence of suboptimal prescribing of medication in First Nations older adults in the Torres Strait.

This study assessed the prevalence of suboptimal prescribing of medicines in First Nations older adults in the Torres Strait. Types of suboptimal prescribing included polypharmacy, over-prescribing, under-prescribing and anticholinergic burden. It also assessed any significant associations between suboptimal prescribing and common age-related problems such as falls, reduced function and cognition. Cross-sectional study (2015-2018) on 18 island and five mainland communities in the Torres Strait and Northern Peninsula Area of Far North Queensland, Australia. Community-dwelling residents aged 45 years and older who identified as Torres Strait Islander and/or Aboriginal with complete medication histories were recruited in this study. Validated prescribing tools were used to identify suboptimal prescribing practises. There were 254 participants with complete medication histories. The mean age was 65.7 (SD ± 10.9, range 45-93), with 65% female. Suboptimal prescribing in this study was 74%. Of these, 49% of participants had polypharmacy, 44% were over-prescribed, and 36% were under-prescribed. Anticholinergic burden was identified in 26% of participants. Polypharmacy was more prevalent in participants who were dependent on instrumental activities of daily living (iADLs). The results demonstrate the importance of general practitioners, health-care workers or pharmacists, to monitor medication prescribing in this population. Frequent review of medications to reduce suboptimal prescribing practices within these communities may help to reduce adverse outcomes because of prescribing practices.

Service Quality and Brand Switching Behaviour in Private Healthcare Centres in Uyo, Nigeria

The study centered on service quality and brand switching behaviour in private healthcare centres inUyo, Nigeria. Three objectives, research questions and research hypotheses were formulated for the study. The population of the study was 210, while the sample size was 138, as determined using Taro Yamane sample size determination technique. Survey research design was used in the study. Using simple linear regression analysis, results from the analysis showed that availability of healthcare personnel and time spent by patients has positive and significant effects on patients’ switching behaviour in private healthcare centers in Uyo, Nigeria. It was concluded that service quality has positive and significant effect on patients witching behaviour in the studied healthcare centres in Uyo, Nigeria. The researcher recommended that management of the studied healthcare centers in Uyo metropolis should improve their working conditions as this will help guarantee the availability of healthcare personnel. Also, time spent by patients should equally be reduced across all units as this will help healthcare personnel to cope with their workloads, leading to negative patients switching behaviours.

A IMPORTÂNCIA DO ALEITAMENTO MATERNO PARA ESTREITAR O VÍNCULO AFETIVO ENTRE MÃE E FILHO

Breastfeeding plays a crucial role in strengthening the bond between mother and child. In addition to providing vital nutrition in the first months and years of a child's life, breastfeeding also promotes a healthy, affectionate relationship. Exclusive practice in the first months is the best form of nutrition, intensifying the emotional bond and contributing to healthy development. Adequate guidance on breastfeeding techniques during the prenatal and postpartum period is essential to ensure the effectiveness of this process. Furthermore, breastfeeding offers benefits for both the baby and the mother, helping with postpartum recovery and protecting against diseases such as breast cancer. However, challenges persist in promoting breastfeeding, with rates below recommendations in some regions due to social and cultural factors. It is essential that health policies and professionals offer support and education to mothers, regardless of their ethnic origin or financial situation. Childcare consultations play a crucial role in monitoring a child's growth and promoting child health. Therefore, the active involvement of health professionals, public policies and society in general is necessary to create an environment favorable to breastfeeding. Breastfeeding is essential for promoting healthy relationships between mothers and children, contributing to the physical and emotional health of both.

Evaluating a Kid’s Dementia Awareness Game with Pre-Licensure Children and Young People’s Nursing (CYP) Students in Northern Ireland – A Pre/Posttest Study

ABSTRACT Dementia not only affects the person living with the condition but also their family and wider social circle. For that reason, it is important to educate family members, the wider public and health professionals. How a child and young people’s (CYP) nurse supports and responds to a CYP whose family member has dementia or acts as a carer is of interest to pre-licensure (pre-registration) CYP nursing programs. With serious games becoming more common as a method to educate a diverse population regardless of age and gender, this study aims to learn if playing a kid’s dementia awareness game improves CYP nursing student’s attitude to dementia using a validated pre-/posttest questionnaire. This study adopted a pretest, posttest design to assess the attitudes of pre-licensure CYP nursing students toward dementia. The Approaches to Dementia Questionnaire (ADQ) was administered before and after playing a serious CYP kid’s dementia game developed by children and people living with dementia for 10- to 11-year-old children. The ADQ measured the total score, Hope subscale, and person-centered approaches. Matched paired t-test was used for analysis conducted with SPSS statistics 29. Seventy-two participants, from one university in Northern Ireland, completed pretest measures, of these, 55 also completed the posttest questionnaire. The participating CYP pre-licensure undergraduate and postgraduate nursing students demonstrated a significant increase in overall dementia attitudes post-gameplay, with an increase from 78.31 to 83.27. Subscales for Hope (27.75 to 30.44) and person-centered approaches also exhibited significant improvement (50.56 to 52.84). Demographic data revealed all participants as female, with 50% knowing a person living with dementia, and limited training experiences. In conclusion, this study has shown a positive response to playing a dementia game relevant to the child population. This adds to the literature building on the use of serious games for health education. Attitudes and hope scales increased with the use of the game.

Establishing a peritoneal dialysis technique survival core outcome measure: A standardised outcomes in nephrology-peritoneal dialysis consensus workshop report.

Technique survival, also reported with negative connotations as technique failure or transfer from peritoneal dialysis to haemodialysis, has been identified by patients, caregivers and health professionals as a critically important outcome to be reported in all trials. However, there is wide variation in how peritoneal dialysis technique survival is defined, measured and reported, leading to difficulty in comparing or consolidating results. We conducted an online international consensus workshop to establish a core outcome measure of technique survival. Discussions were analysed thematically. Fifty-five participants including 14 patients and caregivers from 13 countries took part in facilitated breakout discussions using video-conferencing. The following themes were identified: capturing important aspects of the outcome (requiring a core event to define the outcome, distinguishing temporary from permanent events, recognising heterogeneous experiences of transfers), adopting appropriate neutral nomenclature (conveying with clarity, avoiding negative connotations), and ensuring feasibility and applicability (capturing data relevant to clinical and research settings, ease of adoption). The suggested definitions for the core outcome measure were 'the event of a transfer to haemodialysis', or 'discontinuation of peritoneal dialysis'. Applying the principles described within the workshop, defining the outcome measure as a 'transfer to haemodialysis' was preferable. It is proposed that the core outcome of technique survival is redefined as 'transfer to haemodialysis' and that its components are standardised using simple, neutral terminology Components considered important by stakeholders included recording the reasons for transfer from peritoneal dialysis, and focussing on permanent events whilst ensuring the outcome remains easy to implement.

Enhancing Collaborative Leadership in Healthcare: Addressing Ego Conflicts for Organizational Harmony and Improved Patient Care

In today’s complex healthcare environment, fostering collaboration between medical professionals and administrative teams is essential for delivering high- quality patient care. However, non-clinical conflicts, often driven by differences in authority, communication gaps, and ego clashes, can disrupt organizational harmony. These conflicts between doctors, nursing heads, and corporate teams can negatively affect operational efficiency, care outcomes, and staff morale. This article explores the root causes of these conflicts, highlights successful global strategies for resolving them, and provides a comprehensive framework for promoting a culture of mutual respect and teamwork within healthcare settings. By implementing these approaches, healthcare organizations can create a cooperative environment that enhances both staff satisfaction and patient outcomes. Moreover, the article examines how these strategies can be applied globally to address similar challenges across diverse healthcare settings.

Between coercion, conditionality and abandonment: A descriptive analysis of English mental health spending and provision under austerity

While critical scholarship has demonstrated the harmful effects of austerity on public mental health, relatively little attention has been paid to austerity’s impacts on health services themselves. In response, this paper develops a descriptive analysis of mental health spending and provision in England during the austerity period, from 2009–10 to 2019–20. It examines spending patterns at the national and local level, highlighting a major growth in funding that has been overlooked by prior studies. Then it interrogates national trends in mental health provisioning, utilisation and treatment. The paper argues that austerity has divergent impacts on localities which are best understood as multiple localised austerities. Meanwhile, the overall mental health service landscape under austerity is characterised by three trends, all of which have the potential to harm public health. Inpatient services are utilising more coercion; community services are increasingly conditionalised; and a significant population – too ill for work but judged too healthy for treatment – has been abandoned by services. For critical scholars and practitioners of public health, these findings highlight the complexity of the political, economic and institutional dynamics which distribute spending cuts and therefore mediate austerity’s effects on health.

Against critical thinking in health, social care and social work; Reframing philosophy for professional practice

Against critical thinking in health, social care and social work; Reframing philosophy for professional practice

A IMPORTÂNCIA DOS CUIDADOS DE ENFERMAGEM PARA A SAÚDE MENTAL DOS IDOSOS

Population aging presents significant challenges for healthcare systems, especially with regard to the mental health of older people. This study aims to analyze the importance of nursing care in promoting and maintaining the mental health of this population, emphasizing the role of nurses in the early identification of mental disorders, continuous monitoring and the creation of welcoming environments. The research adopts a literature review methodology, covering articles published in the last ten years in databases such as PubMed, Scielo and LILACS, prioritizing nonpharmacological and holistic care practices. The results indicate that nursing interventions, when carried out in a continuous and humanized manner, are essential to prevent the worsening of psychological disorders and improve the quality of life of the elderly. This study also highlights the need for training health professionals to deal with the psychological demands of this population, as well as the importance of public policies that support actions aimed at the mental health of the elderly. It is concluded that a comprehensive and multidisciplinary approach is essential to face the challenges posed by aging, ensuring that the elderly age in a healthy and active way.