Ongoing Support Research Articles

Received and Desired Support Needs of Postoperative Bariatric Surgery Patients.

Obesity is a worldwide health concern with one highly effective solution being bariatric surgery. The purpose of this descriptive study was to explore the experiences of postoperative bariatric surgery patients related to perceptions of helpful interventions for achieving and maintaining weight loss. Fifteen participants shared their perceived support received and their perceptions of desired support needed after bariatric surgery. The results indicated that the participants felt they primarily received support from their spouse/significant other and others who had surgery. They felt additional support was needed in the areas of nutrition, exercise, mental/emotional health, and expected stages of recovery, provided during the time when the information was needed. According to the participants, this support could be delivered in online educational modules or via telemedicine. While bariatric surgery can result in significant weight loss, ongoing support is necessary to help patients address postsurgical complications, adjustment to lifestyle modifications, maintenance of weight loss, and emotional support during times of stress.

Staff perceptions and experiences of using Key Word Signing with children with Down syndrome and their peers in the first year of mainstream primary education.

Key Word Signing (KWS) is one system that can be used to support the communication needs of children with Down syndrome (DS) who attend mainstream school. The success of KWS in schools is mediated by staff experiences and perceptions of KWS. The current study is one of the first to explore KWS use in mainstream schools. To explore the perceptions and experiences of teachers and special needs assistants (SNAs) with reported varying levels of experience, using KWS with children with DS and their peers in the first year of mainstream primary school. Secondly, we aimed to explore how those perceptions and experiences evolved throughout the year. Five mainstream schools were recruited where children with DS attended. A speech and language therapy (SLT) researcher taught 25 key word signs to the relevant class in each school at four time points across the year. Five teachers and eight SNAs from participating schools engaged in a series of semi-structured interviews to explore their perceptions/experiences of using KWS (Lámh) over the course of the year. Longitudinal data were analysed using inductive qualitative content analysis. Four categories were generated from the data: Challenges, Facilitators, Benefits, and Incorporation into the whole school environment. Findings suggest that the supported introduction of KWS in school by an SLT researcher can assist inclusive educational practices; facilitate children's comprehension and expression; reduce frustration in children with DS; and facilitate interaction with peers. Results also indicate an increasingly positive attitude among teachers and SNAs towards KWS as the year progressed. Teachers reported the absence of a pedagogical framework as an obstacle to the integration of KWS into the curriculum, while SNAs highlighted inconsistent access to funded entry-level training. Overall, using KWS was a positive experience that supported communication in children with DS in mainstream school. However, future training should embed knowledge on key facilitators and consider how challenges can be addressed to maximize the potential of all children with communication needs attending mainstream primary school. What is already known on the subject It is well established that the use of KWS is beneficial in supporting the language and communication needs of children with DS. It is also accepted that if KWS is to be effective as a system of communication, the system needs to be understood and used by the communicative partners of those who rely on it. However, many staff in mainstream schools (with children with DS in attendance) have had limited exposure to KWS, little to no experience of using KWS and limited support available to help them create a signing environment. What this paper adds to the existing knowledge This study provides a current account of the perceptions and experiences of teachers and SNAs to the use of KWS in mainstream primary schools in Ireland. Through qualitative approaches it identifies a number of benefits, facilitators and challenges to the use of KWS in schools, as well as the need for KWS to be incorporated into a whole-school approach to communication. Lastly, the study indicates that with ongoing support over the course of the school year, staff attitudes towards KWS changed and became increasingly positive. What are the potential or actual clinical implications of this work? To facilitate the successful implementation of KWS in schools there is a need to develop a whole school-tiered intervention approach to KWS in mainstream schools. This study also highlights the need for ongoing support for school staff to use KWS to ensure successful implementation.

Key stakeholder's attitudes towards the professional accountabilities and responsibilities of newly qualified Pharmacist Independent Prescribers (IPs) in England and enablers to implementation at scale?

BackgroundIndependent prescribing is set to expand amongst community pharmacists in the next few years. This study aims to explore the different accountabilities and responsibilities associated with independent prescribing compared to more traditional pharmacist roles. ObjectiveTo inform commissioning frameworks that will allow independent prescribing by community pharmacists to be commissioned safely and appropriately at scale. Design/MethodologyA series of qualitative semi-structured interviews were undertaken with key stakeholders. Interviews were analysed using thematic analysis, and over-arching themes developed from emergent findings. ConclusionsThis study identified three themes, supported by twelve sub-themes, associated with pharmacist independent prescribing being viewed positively. Those three themes were self, environment and competence. Whilst pharmacists are well placed through their initial education and training to undertake a prescribing role, we found that there are perceived differences in responsibility between a prescribing and a non-prescribing role, attitude towards risk and the training and support need to adapt to those changes. These differences are explored leading to a series of overarching themes and recommendations, including that ongoing support is critical and should be built into commissioning frameworks, that newly qualified prescribers need to start prescribing immediately after qualifying and that experiential learning should be built into all training programmes.

Daily participation in preterm-born children: An exploratory and comparative study.

Preterm birth, particularly with lower gestational age and respiratory complications, can impact neurodevelopmental outcomes and participation in daily activities. Understanding how these children engage in everyday tasks, particularly from the perspective of their parents, is critical for assessing long-term health outcomes and quality of life. This study aims to assess parental perceptions of participation and daily performance in children born preterm, comparing early preterm infants with and without chronic lung disease, late preterms, and term-born children. A total of 48 children aged 7-11years (M=8.9, SD=1.1) were examined: 25 born at term (GA≥37.0weeks), 23 early preterms (GA≤30weeks) with bronchopulmonary dysplasia (BPD), 15 early preterms without BPD, and 21 late preterms (GA 34.0-36.6weeks). Daily functioning and participation were evaluated using the Behavioral Rating Inventory of Executive Function (BRIEF) and the Children's Assessment of Participation and Enjoyment (CAPE). While atypical executive function scores were more prevalent among early preterm children with BPD (14.2%), no statistically significant differences were found in participation across groups. Children with BPD participated in leisure activities at rates comparable to their full-term and preterm peers. Despite executive function impairments, children born preterm, including those with BPD, exhibited similar participation levels as full-term peers. These findings highlight the participation patterns, which may reflect potential compensatory strategies or other factors of preterm children in daily activities. Long-term monitoring of executive function is necessary, particularly in academic settings, to ensure ongoing support and interventions.

Recovery support services as part of the continuum of care for alcohol or drug use disorders.

The definition of 'recovery' has evolved beyond merely control of problem substance use to include other aspects of health and wellbeing (known as 'recovery capital') which are important to prevent relapse to problematic alcohol or other drug (AOD) use. Developing a Recovery Oriented System of Care (ROSC) requires consideration of interventions or services (Recovery Support Services, RSS) designed to build recovery capital which are often delivered alongside established treatment structures. Lived experience and its application to the process of engaging people, changing behaviour and relapse prevention is an essential part of these services. To map out the evidence base for RSS as part of guidance for commissioners of addiction services in each of the 152 local authorities in England. The authors updated the findings of a 2017 systematic review of RSS through a further rapid scoping review, aiming to map out the extent, range and nature of research under six headings: (1) Peer-based recovery support services (P-BRSS); (2) Employment support approaches; (3) Recovery housing; (4) Continuing care and recovery check-ups; (5) Recovery community centres (RCC); and (6) Recovery support services in educational settings. A systematic search of the PubMed, Embase, CINAHL, CENTRAL and PsychINFO databases was conducted. The abstracts of all articles published since 2017 were reviewed by two of the authors, and the full text versions of all relevant articles were obtained and relevant data extracted. A narrative review of the findings was then prepared, mapping them on to the ROSC continuum of care. The review was restricted to adults (over 18 years), but all substances and available outcomes were included. Four of the six forms of RSS were well supported by evidence. RCTs of interventions to increase levels of employment demonstrated large effect sizes, and continuing care interventions that extend treatment intervention into the early recovery phase have shown small but significant benefit. Peer-delivered interventions to link people to ongoing support were associated with decreased rates of relapse and re-admission, increased engagement, and increased social support for change. However, the variability in the design of these studies means that further work is required to clarify the effective components of the intervention. Studies of recovery housing have also shown positive results, including significant differences from standard care. No controlled studies exist to support RCCs or RSS in educational settings, but the complexity of these interventions and the wide range of potential outcome measures mean that other study designs may be more relevant. This monograph provides a structure to help policy makers, commissioners and service providers describe and understand an emerging field of research. Recovery Support Services (RSS) are proving to have clinical, public health and cost utility. A rational social and fiscal response to endemic alcohol or other drug challenges should therefore include the more intensive acute care clinical services linked with more extensive community-based RSS.

Indigenous Owned Aquatic Monitoring Programs in the Inuvialuit Settlement Region Work: An Adaptive Framework with example Traditional & Local Knowledge Quotes and Coastal Marine Water Quality Data Collected from 2019 to 2022 near Sachs Harbour and Ulukhaktok

Canadian Arctic residents are experiencing longer open water seasons and observing significant change in aquatic species and habitats. Rapid ecosystem change threatens Inuit people’s food security and adds to existing generational trauma caused by ongoing colonialism and industrialization. Indigenous owned environmental monitoring programs prioritize safety, support community empowerment and self-determination to increase the understanding of and resilience to the impacts of this human caused global climate crisis. To this end, in 2019 local expert fishers and hunters from the Inuvialuit Settlement Region worked collaboratively with an independent research scientist to start up community owned aquatic monitoring and observation (AMO) programs in Sachs Harbour and Ulukhaktok in the Inuvialuit Settlement Region. The field teams received training to collect year-round data of lake and coastal water quality data using scientific instruments that measure water temperature, conductivity/salinity, turbidity and dissolved oxygen with depth from the surface down to 150 meters. ROV’s, drones and hydrophones extend observations and Traditional & Local Knowledge (TLK) directs the programs. External clients can hire the teams to augment core funding. AMO teams are finalizing their program and data ownership protocols, which are informed by the Canadian UNDRIP Act and OCAP® principles. Indigenous owned, directed and operated environmental monitoring programs justly deserve funding priority and ongoing public support to help conserve and protect critical areas for future generations.

The position of the Kingdom of Saudi Arabia on the Palestinian issue during the years (1927-1931)

The Palestinian cause is one of the most prominent Arab and Islamic issues that has received the attention of the Kingdom of Saudi Arabia since its establishment. The Kingdom realized early on the importance of supporting the Palestinian people in their journey towards regaining their legitimate rights and establishing their independent state on their land. Based on its Islamic and Arab principles, the Kingdom made the Palestinian cause a fundamental focus of its foreign policies, as it stood by the Palestinian people in various international forums and provided political, economic and humanitarian support. In this research, we will review the Kingdom’s position on the Palestinian issue, starting with diplomatic efforts, through the initiatives it has presented to achieve peace, and ending with the ongoing support it provides at the regional and international levels. We will also discuss the impact of this position in strengthening Arab and Islamic solidarity towards the Palestinian issue.

The effectiveness of providing training and ongoing support to foster cultural humility in volunteers serving as mentors to youth of color: a mixed-methods study protocol

BackgroundThe aim of this randomized control trial is to test the impact of providing additional training and support to volunteers who are paired with youth of color in the Big Brothers Big Sisters (BBBS) community-based mentoring program. The aim of the intervention activities is to enhance the capacity of mentors to have more culturally responsive and informed interactions with their mentees of color, thereby strengthening the youth’s ethnic/racial identity and abilities to both cope with experiences of racism and contribute to causes that advance social justice.MethodsRecruitment started in June 2022, with a goal of enrolling 240 dyads (i.e., “matches”), each consisting of a volunteer mentor and a youth of color aged 9- to 17-years old with whom they were paired through BBBS. Each match is assigned randomly to receive either standard BBBS services or to services that incorporate the intervention activities (i.e., approximately 3 h of initial training that is then supplemented with booster emails and in the context of the contacts that case managers have with mentors routinely in the program). The BBBS staff who are responsible for delivering the enhancements receive preparatory training as well as ongoing support with implementation. The study has a mixed-methods design. Survey data, on outcomes (e.g., ethnic/racial identity, sense of mattering, efficacy) aligned with the theory of change, are collected at multiple time points within 12 months from mentors, youth and their parent/guardian, and BBBS staff. Multiple qualitative interviews are conducted with a subset of youth, mentors, parents and BBBS staff to examine how the intervention works and how it impacts relationship development and youth outcomes over time. Integration of quantitative and qualitative data will aim to better understand whether and how the intervention works with respect to its potential influence on mentor attitudes (e.g., cultural humility), mentor-youth interactions, and emergent identities and capacities that have well-documented importance for the resilience and well-being of youth of color.DiscussionThis culturally tailored training and support intervention for volunteer mentors may be one way to increase the effectiveness of mentoring programs for youth of color. Study findings will have implications for youth mentoring programs and for other settings (e.g., schools, after school programs) in which children and adolescents form relationships with adults.Trial registrationwww.clinicaltrials.gov—Clinical Trial #NCT05391711; original 05.21.2022; Amendment 07.01.2022: study status was updated and more details were provided on outcome measures; Amendment 11/13/2022: sample size was modified, a few mentor outcome measures were added in the 12-months survey, the timing of a mentor measure was updated.

Congenital Titinopathy: Comprehensive Characterization of the Most Severe End of the Disease Spectrum.

To better understand the presentation and clinical needs of the under-characterized extreme end of the congenital titinopathy severity spectrum. We comprehensively analyzed the clinical, imaging, pathology, autopsy, and genetic findings in 15 severely affected individuals from 11 families. Prenatal features included hypokinesia or akinesia and growth restriction. Six pregnancies were terminated. Nine infants were born at or near term with severe-to-profound weakness and required resuscitation. Seven died following withdrawal of life support. Two surviving children require ongoing respiratory support. Most cohort members had at least 1 disease-causing variant predicted to result in some near-normal-length titin expression. The exceptions, from 2 unrelated families, had homozygous truncating variants predicted to induce complete nonsense mediated decay. However, subsequent analyses suggested that the causative variant in each family had an additional previously unrecognized impact on splicing likely to result in some near-normal-length titin expression. This impact was confirmed by minigene assay for 1 variant. This study confirms the clinical variability of congenital titinopathy. Severely affected individuals succumb prenatally/during infancy, whereas others survive into adulthood. It is likely that this variability is because of differences in the amount and/or length of expressed titin. If confirmed, analysis of titin expression could facilitate clinical prediction and increasing expression might be an effective treatment strategy. Our findings also further-support the hypothesis that some near-normal-length titin expression is essential to early prenatal survival. Sometimes expression of normal/near-normal-length titin is due to disease-causing variants having an additional impact on splicing. ANN NEUROL 2025.

Application of the Omaha System-Based Continuous Care Model in Diabetes Health Management for Outpatients within the Framework of "Internet +".

Aims/Background Diabetes is a chronic lifelong condition that requires consistent self-care and daily lifestyle adjustments. Effective disease management involves regular blood glucose monitoring and ongoing nursing support. Inadequate education and poor self-management are key factors contributing to increased mortality among diabetic individuals. Providing personalized guidance and behavioral interventions through continuous nursing care is crucial for achieving optimal glycemic control and fostering positive societal outcomes. This study aimed to evaluate the impact of an Omaha System-based continuous nursing model, implemented through the "Internet+" framework, on enhancing self-health management skills, glycemic control, and treatment adherence among patients with type 2 diabetes mellitus (T2DM). Methods This retrospective study analyzed clinical data of T2DM patients who visited the diabetes health management clinic of Zhang Ye People's Hospital affiliated to Hexi University between December 2023 and May 2024. Participants were categorized into intervention and control groups based on whether they received the "Internet+"-enabled Omaha System continuous nursing care model. Variables, including demographic characteristics, self-management behaviors, cognitive abilities, environmental factors, glycemic control indicators, and treatment adherence (medication compliance, dietary compliance, lifestyle adherence, and follow-up punctuality), were assessed and compared at baseline, 1 month, and 3 months post-intervention. Results The study included 52 patients in the intervention group and 68 in the control group. Baseline characteristics revealed no significant differences between the two groups (p > 0.05). At 1 and 3 months post-intervention, the intervention group exhibited significant improvements in self-management behaviors, cognitive abilities, environmental factors, and overall scores compared to baseline and the control group (p < 0.05). Fasting plasma glucose (FPG) levels were also significantly reduced in the intervention group compared to baseline and the control group (p < 0.05). 3 months post-intervention, the intervention group demonstrated significantly higher adherence rates to dietary recommendations, healthy lifestyle practices, and treatment compliance compared to the control group (p < 0.05). Conclusion The "Internet+"-based Omaha System continuous nursing model significantly enhances self-health management capabilities, stabilizes glycemic control, and promotes adherence to healthy behaviors among patients with T2DM. These findings highlight the potential of the model for broader clinical application in diabetes management.

Long-Term Family Needs After a Traumatic Brain Injury: A VA TBI Model Systems Study.

To describe the self-reported needs of family caregivers of service members and veterans (SMVs) with traumatic brain injury (TBI) at 10 to 15years post-injury and to identify unique predictors of unmet family needs. Five Department of Veterans Affairs Polytrauma Rehabilitation Centers. A total of 209 family caregivers of SMVs with TBI from the VA TBI Model Systems national database who completed a 10- or 15-year follow-up assessment. Observational study. Family Needs Questionnaire-Revised (FNQ-R). Item-, domain-, and total score-level descriptive analyses of FNQ-R responses were conducted. On average, 56.3% of the FNQ-R family caregiver needs were reported as met. Health information and involvement in care needs were the most often met, and emotional support and instrumental support needs were the least often met. Adjusted multivariable regression models demonstrated that urban-dwelling SMVs (compared to suburban) and spouses/significant others (compared to parents) were associated with more unmet family needs. Distinct associations were identified between the 6 FNQ-R domains and SMV environmental factors (ie, urbanicity, rurality, and being active duty at follow-up), SMV comorbidities (ie, receiving mental health treatment in the year prior to the follow-up), and caregiver factors (ie, spouses/significant others). Family caregivers of SMVs with TBI reported multiple unmet needs at 10 to 15years post-injury, emphasizing the importance of ongoing caregiver support after TBI. Policy and programming to support military caregivers should consider the current findings to direct resources to address the identified unmet needs.

Patient satisfaction with a clinically integrated sleep apnea care model vs. the current sleep care paradigm

IntroductionSleep apnea can have severe negative health effects, including cardiovascular diseases, metabolic disorders, and decreased quality of life. Continuous positive airway pressure (CPAP) therapy is highly effective and the gold standard treatment for sleep apnea; however, traditionally fragmented sleep healthcare has resulted in low levels of treatment adoption and adherence. A recent white paper analysis of traditional health plan claims found that a comprehensive model significantly outperformed traditional health plans with higher rates of adoption (80 vs. 49%), adherence (62 vs. 25%), and persistence (53 vs. 11%) to CPAP therapy, which resulted in lower total healthcare costs. To understand the patient experience in these models of care, this study compared patient satisfaction between the traditional sleep care approach and a clinically integrated, comprehensive sleep care program.MethodsA survey was developed to understand differences in the patient experience with the two different care models with respect to: access to sleep care, including time from initial appointment to seeing a sleep specialist, referral and insurance process; ease of sleep testing process and receiving a diagnosis; adoption, quality of education, and training with CPAP; ongoing adherence support with CPAP, and quality of life. Data were compared using descriptive statistics and Chi-square analyses.ResultsA significantly higher proportion of patients in the comprehensive model were satisfied with all measured points in the patient's journey. Notably, twice as many patients in the comprehensive model were very satisfied with: ease of navigating the testing process, time between diagnosis and CPAP adoption, insurance navigation for CPAP approval, and availability and level of ongoing CPAP support. Comprehensive care patients experienced fewer work disruptions due to sleep apnea: only 7% missed work in the past 3 months, compared to 58% in the traditional model.DiscussionOverall, the study highlights the benefits of a comprehensive care model in improving patient satisfaction with their sleep apnea journey and overall quality of life for individuals with sleep apnea. Pairing this positive patient experience data with prior data from the same treatment model shows that removing obstacles within a patient's journey positively impacts satisfaction while simultaneously improving adherence rates and reducing total healthcare costs.

Tracking Physical Activity and Nutrition Policies and Practices in Early Childhood Education and Care: Five Years Post-Implementation of a Provincial-Level Active Play Standard.

Background: Early childhood education and care (ECEC) settings are key for improving health behaviors, including physical activity (PA) and nutrition. In 2017, the province of British Columbia (BC) implemented a provincial-level Active Play policy supported by a capacity-building intervention. Significant improvements in all PA policies and practices and the majority of nutrition policies were observed post-implementation. The purpose of this study was to understand if PA and nutrition policies and practices were maintained at 5+ years post-provincial policy implementation. Methods: This study employed a repeated cross-sectional design to distribute surveys querying about PA and nutrition policies and practices to ECEC centers across BC at three time points: time 1, prior to implementation of the Active Play standard (2016-2017) and capacity-building intervention, time 2, 1-2 years post-implementation (2018-2019), and time 3, 5+ years post-implementation (2022-2023). Results: The majority of PA and all nutrition policies were maintained from time 2 (n = 378) to time 3 (n = 639). Prevalence of policies related to the provision of activities that address fundamental movement skills (odds ratio [OR] = 0.30) and total amount of active play (OR = 0.56) significantly decreased from time 2 to time 3. All reported PA practice prevalence levels decreased to time 1 levels. Conclusions: Center-level health behavior policies were largely maintained 5 years post-implementation, except some PA policies and practices returned to pre-implementation levels. Staff capacity and turnover as well as change in implementation support may explain these changes. Ongoing implementation support is needed to ensure maintenance of health promoting policies and practices in ECEC.

Adapting to the emotional complexity of palliative care communication: Palliative care clinicians' experiences.

Communication is essential to medical care and is key in improving patient outcomes. We aimed to understand clinicians' emotions when communicating with patients in palliative care (PC) and the evolution of their communication skills. Between October and November 2021, 231 Swiss PC clinicians participated in an online cross-sectional survey (65% nurses, 35% physicians). Three questions invited participants to reflect on the development of their communication skills and on their emotions when communicating with patients in PC. Answers to these questions were analyzed thematically. Constantly adapting to complex emotions in communication was the overarching theme. Three main themes further allowed for an understanding of different communication challenges: emotions as a dynamic compass, not always under control, and evolving comfort and competence through personal and professional growth. In evolving comfort and competence, 6 strategies helped clinicians overcome fears and improve their confidence in communication: learning by doing and formal training, integrating life experiences and gaining insight from private life, taking time, collaborating and connecting with peers, acknowledging individuality, and connecting with one's own and patients' emotions. Participants described powerful emotional experiences when communicating with patients in PC, underscoring the emotional labor involved in PC communication. Our study highlights the need to re-conceptualize emotions as a valuable resource rather than a hindrance in clinical practice. The interplay between personal and professional identities in shaping communication skills, emphasizes the importance of emotional competence as a core professional skill. As clinicians often develop these skills individually, our findings suggest a need for earlier integration of emotional competence training in medical education, along with ongoing support through collaboration, and improved allocation of time resources, to enhance clinician well-being and patient care.

Case Study Analysis of Dyslexia and Dysgraphia in a 10-Year-Old Male: Intervention and Outcomes

Specific Learning Disabilities (SLD) represent a range of persistent difficulties in acquiring academic skills, often evident in areas like reading, writing, and mathematics. This study presents a detailed case analysis of a 10-year-old male diagnosed with mixed scholastic difficulties, specifically dyslexia and dysgraphia. The participant exhibited significant challenges with reading and writing, including issues with mirror images of letters and spelling errors, impacting academic performance. Comprehensive assessments, including the Malin’s Intelligence Scale for Indian Children (MISIC) and NIMHANS educational battery, were administered, revealing average IQ and academic performance equivalent to a second grader. The intervention involved 72 individualized sessions over six months, targeting attention span, reading comprehension, and spelling. Adjustments to the school curriculum, such as extra exam time and exemption from a third language, were implemented to support his learning needs. Post-intervention results indicated substantial improvements in reading, spelling accuracy, and academic confidence, as reported by teachers and parents. This study highlights the importance of personalized education plans and ongoing support for children with SLD, providing a framework for clinicians handling similar cases. Key Words: Specific Learning Disabilities (SLD), Dysgraphia, Dyslexia, Dyscalculia, Individualized Education Plan (IEP), Reading and writing difficulties, Mirror image errors, SLD Asssessments, MISIC, NIMHANS neuropsychological battery, School accommodations, Case study, Therapeutic outcomes, Therapeutic Interventions

Innovations in TB Screening and Preventive Therapy Services for PLHIV in Yogyakarta City, Indonesia.

Tuberculosis preventive therapy (TPT) for people living with HIV (PLHIV) has been recommended by Indonesia's National TB Program since 2014 but has seen limited implementation. This study describes TB screening and TPT initiation from 2019 to 2022 among eight healthcare facilities supported by the Zero TB Yogyakarta (ZTB) project. ZTB assigned a dedicated nurse to assist with active TB screening among PLHIV and recommended the immediate initiation of TPT as an innovation implemented. Data were obtained from the national HIV program reporting system, routinely reported by ART clinics from 2019 to 2022. We conducted a descriptive analysis, comparing the pre-intervention and intervention periods. During the intervention, there was a significant increase in PLHIV visits to healthcare facilities where TPT eligibility was assessed. At health centers, TB screening coverage for PLHIV decreased toward the end of the baseline period but recovered during the intervention. The number of PLHIV starting TPT also rose during the intervention. While the direct impact of ZTB is difficult to measure, the changes observed indicate progress in integrating TB/HIV services and enhancing TB prevention among PLHIV. Ongoing support, training, and supervision of healthcare facilities are crucial for improving TB screening and TPT provision.

Association Between Persistent Maternal Depression among Japanese New Mothers and their Toddlers' Behaviors.

To determine the association between mothers' persistent maternal depression and their toddlers' behavior. Online surveys were conducted twice with mothers who gave birth to their first child between March and June 2020. The survey periods were November 2020 and May-June 2022. Measures included baseline characteristics and family environment factors, maternal postpartum depression (Edinburgh Postnatal Depression Scale [EPDS]), maternal lifestyle and mother-reported toddler behaviors, and Internet/media use. Statistical analysis was performed using the χ² test, trend test, and logistic regression. Of the 339 participants, 82 (24.1%) were in the "persistent maternal depression" group with high EPDS scores (≥ 9 points) at both time points, and 178 (52.5%) were in the "no maternal depression" group with low EPDS scores (< 9 points) at both time points. Persistent maternal depression was associated with sleep, eating behavior, physical activity, parenting emotions, and abusive behavior of mothers. Furthermore, persistent maternal depression may be related to undesirable toddler behaviors such as smartphone overuse and hyperactivity-like symptoms. The persistence of postpartum depression is influenced by factors such as mothers' parenting emotions. Preventing and supporting maternal depression in mothers can foster favorable behaviors in toddlers. In Japan, enhanced individualized, ongoing support for postpartum mothers, tailored in duration and form, could promote both maternal well-being and positive parenting practices.

Implementation of a Laboratory Information Management System (LIMS) for microbiology in Timor-Leste: challenges, mitigation strategies, and end-user experiences

BackgroundEffective diagnostic capacity is crucial for clinical decision-making, with up to 70% of decisions in high-resource settings based on laboratory test results. However, in low- and middle-income countries (LMIC) access to diagnostic services is often limited due to the absence of Laboratory Information Management Systems (LIMS). LIMS streamline laboratory operations by automating sample handling, analysis, and reporting, leading to improved quality and faster results. Despite these benefits, sustainably implementing LIMS in LMIC is challenging due to high costs, inadequate infrastructure, and limited technical expertise.MethodsThis study evaluated the implementation of a customised microbiology LIMS at the National Health Laboratory (NHL) in Timor-Leste. The LIMS was deployed in November 2020, with an accompanying online results portal introduced in early 2021. The implementation was assessed via a checklist based on key challenges and requirements for LIMS in LMIC, alongside a post-implementation survey of scientists and clinicians.ResultsThe assessment revealed significant improvements in laboratory processes, including enhanced sample throughput, data management, and result reporting. The LIMS reduced transcription errors and standardised reporting of antimicrobial susceptibility testing (AST), improving data quality and accessibility. However, challenges such as unreliable internet connectivity and the need for ongoing funding and technical support persist. The user satisfaction survey, with responses from 19 laboratory scientists and 15 clinicians, revealed positive feedback on workflow improvements and result accessibility, although concerns about internet speed, sustainability, and the need for further training were noted.ConclusionThis study highlights the importance of careful planning, customisation, and stakeholder engagement in LIMS implementation in LMIC. The success in Timor-Leste demonstrates the potential for improved laboratory quality and patient outcomes, but also underscores the need for ongoing investment in infrastructure, technical expertise, and sustainability planning.

Experiences of Emergency Nurses Providing End-of-Life Care During the COVID-19 Pandemic.

To explore the experiences of emergency nurses providing end-of-life care during the COVID-19 pandemic. A qualitative descriptive study. Data were collected between May and August 2023. Individual, semi-structured interviews were conducted face to face or by videoconferencing with a purposive and snowballed sample of 11 emergency nurses. Data were analysed using thematic analysis. There were four main themes identified: (1) Isolation and loneliness that emergency nurses felt when providing end-of-life care throughout COVID-19. (2) Comparison of Care Relating to Communication; whereby emergency nurses compared the provision of end-of-life care before COVID-19 to end-of-life care provided during the pandemic. (3) Frustration and guilt: emergency nurses felt when providing end-of-life care. (4) Teamwork: participants interviewed explored the meaning of having a supportive team when providing end-of-life care. This study explores in-depth experiences of emergency nurses providing care to those who were dying during the COVID-19 pandemic. This study identified that emergency nurses were impacted emotionally by providing end-of-life care during the pandemic, and ongoing support is likely to be needed. This study also reinforced the strength of teamwork amongst emergency nurses. No patient or public contribution.

Teaching in the Digital Age-Developing a Support Program for Nursing Education Providers: Design-Based Research.

Health care systems and the nursing profession worldwide are being transformed by technology and digitalization. Nurses acquire digital competence through their own experience in daily practice, but also from education and training; nursing education providers thus play an important role. While nursing education providers have some level of digital competence, there is a need for ongoing training and support for them to develop more advanced skills and effectively integrate technology into their teaching. This study aims to develop a needs-based support program for nursing education providers to foster digital competencies and to test this intervention. We used a design-based research approach, incorporating iterative development with expert consultation to create and evaluate a support program for nursing education providers. Focus groups were conducted online to assess needs, and thematic content analysis was used to derive key insights. The support program was then refined through expert feedback and subjected to a feasibility and satisfaction test, with participant evaluations analyzed descriptively. Six main categories emerged from the focus groups, highlighting key areas, including the use of digital technology, ongoing support needs, and the current state of digitalization in nursing education. The support program was developed based on these findings, with expert validation leading to adjustments in timing, content prioritization, and platform integration. Preliminary testing showed good overall satisfaction with the support program, although participants suggested improvements in content relevance and digital platform usability. Although the feasibility test showed high satisfaction with the support program, low participation rates and limited perceived knowledge gain were major concerns. The results suggest that while the program was well received, further refinements, including a focus on competency-based approaches and addressing workplace barriers, are needed to increase participation and effectiveness of such interventions. The findings of this research can be used as a basis for the development of similar programs in other educational and health care contexts.