Healthcare Practice Research Articles

Comparing the Prevalence and Characteristics of Chest Pain in Children and Adolescents Pre- and Post-COVID-19: A Retrospective Study.

Chest pain is a common complaint among pediatric patients, often leading to visits to Emergency Departments or outpatient clinics. While most cases are benign, timely diagnosis is essential to prevent fatalities in those with serious conditions. The COVID-19 pandemic has shifted healthcare dynamics, necessitating an understanding of its impact on pediatric health, including potential complications such as chest pain, fever, cough, shortness of breath, sore throat, and headache. This study aims to explore the prevalence, characteristics, and potential association between COVID-19 and chest pain in children during two time periods: 2019 (before the COVID-19 pandemic) and 2021 (the full year during the pandemic). Data were collected from medical records and telephone interviews with pediatric patients presenting with chest pain at the University of Jordan Hospital. The study included a sample size of 3294 patients with selection criteria based on presenting symptoms and COVID-19 status. Data collection occurred from 2019 and 2021, and demographic information (age, gender, weight), medical history (perinatal and family history), COVID-19 status (vaccination, infection history), and details about chest pain (frequency, onset) were documented. Statistical analyses were performed to evaluate differences between the two time periods using IBMSPSSStatistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States). The results indicate a significant increase in the number of patients presenting with chest pain in 2021 compared to 2019 (P value = .0157). The mean age of patients was 11 years, predominantly male. There was a notable increase in the percentage of patients with comorbidities in 2021. Echocardiography results were normal in approximately 84% of cases across both years, with no significant differences in ECG outcomes. Palpitations remained the most common associated symptom. 4.6 % of patients in 2021 were confirmed to have COVID-19, most of whom were diagnosed with muscular causes of chest pain. Notably, none of the patients had received the COVID-19 vaccine. This study highlights a marked increase in pediatric patients presenting with chest pain during the pandemic, although characteristics and underlying causes remained consistent between years. The rise in cases may be attributed to heightened awareness rather than a direct link to COVID-19. Recommendations for clinical practice include careful evaluation of chest pain in pediatric patients during the pandemic, considering psychosocial factors and the broader impact of COVID-19 on health-seeking behaviors. Future research should investigate the long-term effects of COVID-19 on pediatric populations and explore the psychological implications on health service utilization. This study underscores the need for ongoing assessment of pediatric healthcare practices amid evolving pandemic conditions.

Effectiveness of cognitive interventions in mitigating mental fatigue among healthcare professionals in hospital settings: A systematic review

Mental fatigue poses a significant challenge to healthcare professionals in hospital settings, impairing cognitive performance, emotional well-being, and job satisfaction. This systematic review evaluates the effectiveness of cognitive interventions, including mindfulness programs, online psychological interventions, and telehealth cognitive-behavioral therapy (CBT), in mitigating mental fatigue among healthcare workers. A comprehensive literature search across PubMed, b-on, Web of Science, and Scopus identified six studies published between 2016 and 2023. These studies reported that cognitive interventions significantly reduced burnout and stress levels, with up to a 30% decrease in emotional exhaustion and improved coping mechanisms. In addition, participants demonstrated enhanced emotional well-being, reflected in increased mindfulness and life satisfaction scores of as much as 25%. Mindfulness-based programs and telehealth CBT were particularly effective in fostering resilience and improving overall cognitive function. However, the review also highlighted the need for future research to explore the long-term effects of these interventions, their cost-effectiveness, and innovative methods to improve accessibility and scalability, such as digital platforms. Integrating cognitive interventions into routine healthcare practice can enhance staff well-being, improve patient outcomes, and contribute to a more supportive work environment.

Formation of new health care practices: what sociology [does not] see

The article was prepared for the 50th anniversary of the journal “Sociological Studies”. An array of articles (N = 29) on the topic of health care norms and practices published in the journal from 2010 to 2023 was analyzed. To validate the research presented in the publication and the results of qualitative content analysis, data from eight public opinion surveys were analyzed by the ZIRCON research group and the Higher School of Economics, conducted as part of various projects in 2010– 2023, including those with authors participation (five of them represent the population of the Russian Federation, three relate to individual regions and cities of Russia). Along with the identified thematic gaps in the field of modern sociology of health, it has been ascertained that the studies complement each other and make it possible to build a logic for the presentation of the health care topics covering all its main links.

Implementing Industry-Inspired Quality Practices in Healthcare: A Study From the Pathology Department of the University Hospital Center of Tangier.

In Morocco's public health sector, scientific research has produced only theoretical models of quality, with empirical studies sometimes producing practical recommendations. In contrast, benchmarks from the industrial sector demonstrate a much smoother and more effective implementation of a quality culture. This article considers practices inspired by the quality culture in the industrial sector, applying them in the Department ofPathological Anatomy and Cytology (ACP) of the University Hospital Center of Tangier (CHUT). The ACP department has demonstrated a strong commitment to fostering a dynamic quality culture in its professional activities, focusing on the advancement and regulation of pathology techniques to enhance procedures and deliver accurate diagnoses to patients. This approach could facilitate the implementation of quality systems management that would earn certification and/or accreditation. Our methodology applied the "Plan-Do-Check-Act" and "Standardize-Do-Check-Act" models to analyzethe initial quality and compare this with the Join Commission International standards chosen by CHUT. We then planned the implementation of corrective actions for each deviation and verified the efficiency of the action plan, and finally maintained a dynamic cycle.There was an implementation score of 60% in two years, mainly starting with the development and implementation of risk analysis for all activities of laboratory development and the implementation of specific Key Performance IndicatorsKPI and specific methods to manage all human resources items.

Healthy in ancient and modern times

Background: Health practices have evolved from ancient holistic approaches to modern scientifically driven methods. This comparative study aims to explore the continuity and transformation in healthcare practices from ancient times to the present, highlighting the enduring principles of wellness and the advancements in medical science. Methods and Material: The research employs a comparative analysis of ancient health practices, such as Ayurveda and Traditional Chinese Medicine, against modern health practices influenced by scientific and technological advancements. Sources include archaeological findings, historical texts, and contemporary scientific literature. Results: Ancient health practices emphasized a holistic approach, integrating diet, lifestyle, and spiritual practices to maintain balance and harmony. Modern health practices prioritize evidence-based treatments, technological interventions, and preventive care, leading to significant improvements in health outcomes. Both approaches highlight the importance of preventive measures, personalized care, and a comprehensive understanding of health and well-being. Conclusion: This study reveals that despite the methodological differences, the fundamental objective of fostering health and well-being remains constant across time. Integrating ancient wisdom with modern scientific advancements offers a more holistic approach to health, addressing physical, mental, and spiritual aspects of well-being.

Applying the Multimodal Improvement Strategy framework to understand current gaps in the use of antibiograms in hospitals caring for children with cancer in the Eastern Mediterranean and African regions

Abstract Background Empiric use of antibiotics in sick children guided by local antimicrobial susceptibilities (AMS) increases initial therapy effectiveness. Antibiograms (ABG) are cumulative AMS based on results of isolates susceptible to antimicrobial agents routinely tested in an institution over a specific time period. Although ABG use can enhance healthcare quality, for optimum quality healthcare the World Health Organization (WHO) recommends the use of frameworks such as the multimodal improvement strategy (MMIS). We used the MMIS framework to analyze the literature and understand gaps in using ABG in low- and middle-income countries (LMIC). The 5 WHO MMIS components are: system change, training and education, monitoring and feedback, reminders and communication, and a culture of safety, summarized as “build it, teach it, check it, sell it, and live it”. By combining elements of a scoping methodology with the MMIS framework, we reviewed the literature surrounding ABG and report the results here. Methods We assembled a 24-member working group (WG) interested in improving infection care and prevention (ICP) in their institutions in the Eastern Mediterranean and African regions. The WG members (physicians, pharmacists, and microbiologists) met virtually twice monthly from March to October 2023. We searched PubMed using essential keywords such as antibiogram, antibiotic, antimicrobial, antibacterial, isolate, and sensitivity test, and supporting keywords such as misuse, resistance, adherence, guideline, susceptibility, development, improvement, stewardship, low-income, middle-income and LMIC. Any identified additional papers were screened for relevance. We grouped the literature according to the five components of the MMIS framework focusing on information on the ABG tool, training in ABG, the outcomes of its use, promotion of its use, and elevation of its importance institutionally. The WG members reviewed literature assigned to each of the five MMIS components, and presented oral reports of main points, gaps, and how to fill the gaps according to a rubric encompassing relevance assessment, methodological evaluation, content evaluation and recommendations. Results We identified 66 publications with authors originating from Africa (n=23, 34.8%), the Americas (n=29, 43.9%), Asia (n=13, 19.7%), Europe (n=12, 18.2%) and Oceania (n=2, 3%). The publications fell into MMIS-Build (n=16, 24.2%), MMIS-Teach (n=16, 24.2%), MMIS-Check (n=14, 21.2%), MMIS-Sell (n=10, 15.2%), and MMIS-Live (n=10, 15.2%). WG members reviewed their assigned papers, discussed them in virtual meetings, and identified 20 papers as strongly relevant. According to the WG members, the literature reviews and discussion improved their ABG knowledge and perception of the utility of evaluation and education applied to ABG. The multidisciplinary WG composition and the MMIS allowed ABG perspectives of new solutions and ideas. Although using a complex framework as MMIS applied to a scarce literature of ABG was challenging, it promoted a deeper understanding of topics and enhanced group cohesion and communication. Conclusion We found a gap in the literature of ABG, especially in LMIC, and it was not often recommended. A lower number of publications within MMIS-Live and MMIS-Sell indicated suboptimal emphasis in sustaining this practice in healthcare. Using the MMIS framework focused discussions of WG members, improved ABG knowledge and clarified the utility of educational interventions.

Current policy and practice for the identification, management, and treatment of postpartum anxiety in the United Kingdom: a focus group study

BackgroundPostpartum Anxiety [PPA] is a prevalent problem in society, posing a significant burden to women, infant health, and the National Health Service [NHS]. Despite this, it is poorly detected by current maternal mental health practices. Due to the current lack of appropriate psychometric measures, insufficiency in training of healthcare professionals, fragmentation of maternal mental healthcare policy and practice, and the magnitude of the effects of PPA on women and their infants, PPA is a critical research priority. This research aims to develop a clear understanding from key stakeholders, of the current landscape of maternal mental health and gain consensus of the needs associated with clinically identifying, measuring, and targeting intervention for women with PPA, in the NHS.MethodsFour focus groups were conducted with a total of 21 participants, via Zoom. Data were analysed using Template Analysis.ResultsAnalysis rendered four main themes: (1) Defining Postpartum Anxiety; (2) Postpartum Anxiety in Relation to other Mental Health Disorders; (3) Challenges to Measurement and Identification of Maternal Mental Health; and (4) An Ideal Measure of Postpartum Anxiety.ConclusionsFindings can begin to inform maternal mental healthcare policy as to how to better identify and measure PPA, through the implementation of a postpartum-specific measure within practice, better training and resources for staff, and improved interprofessional communication.

From classroom to collaboration: how pre-graduation interprofessional learning shapes health professional graduates’ interactions in practice

ABSTRACT Interprofessional education (IPE) aims to prepare health professional students with the knowledge, attitudes and skills required for collaborative healthcare practice. Although positive outcomes have been documented at the completion of university-based IPE experiences, or longitudinally across health care degrees, the literature is unclear on how university-based IPE influences graduate practice. This study therefore explores how health professional graduates experience interprofessional interactions in practice and how these may be connected to their university-based IPE experiences. Interviews with seven health professional graduates who had participated in an 11-week IPE course as part of their pre-licensure degrees were analyzed using interpretative phenomenological analysis. The participants were able to articulate instances of effective and less effective collaboration from their professional experiences, making sense of these experiences with explicit reference to the themes of role understanding, collaborative working relationships, interprofessional communication, patient-centered care and contextual influences; all ideas introduced in their university-based IPE. They connected their understanding of roles, collaborative working relationships and interprofessional communication explicitly to their prior university-based IPE, identifying these learnings as foundational knowledge. This connection was not as explicit for patient-centered care and contextual issues. These findings highlight the critical importance of IPE in preparing health professionals for high-quality contemporary practice.

The Mayo Brothers: Pioneers of Modern Medicine and Patient-Centered Care.

The Mayo brothers, Drs. William James Mayo and Charles Horace Mayo, are celebrated for their groundbreaking contributions to modern medicine. This review examines their journey from humble beginnings to establishing the Mayo Clinic, a world-renowned medical institution. They pioneered a collaborative, team-based approach to medicine, which was revolutionary then. They emphasized the importance of specialization and interdisciplinary cooperation, laying the foundation for modern healthcare practices like integrated care and the rise of group medical practices. Their impact continues through the Mayo Clinic's patient-centered approach, which has influenced countless healthcare institutions worldwide.

The Use of Pharyngeal High-Resolution (Impedance) Manometry in Patients With Head and Neck Cancer: A Scoping Review.

This scoping review aims to summarize and explore current literature on the usefulness and clinical implications of pharyngeal high-resolution (impedance) manometry (HRM/HRIM) in head and neck cancer (HNC) patients. Three online databases (MEDLINE, Embase, Scopus, and additionally Google Scholar) were searched until December 2023. Studies using pharyngeal HRM/HRIM to assess swallowing or voicing in HNC patients, written in any language and published in peer-reviewed journals, were considered eligible. Quality check was performed using the Quality Assessment Tool for Quantitative Studies from the Effective Public Healthcare Practice Project. Information about the study population and HRM/HRIM data (equipment, protocol, analysis, and outcomes) were extracted. Eight papers met the inclusion criteria, six utilizing HRM and two HRIM. The study design consisted of case-series (five) and case-control (three). The quality assessment indicated a weak global rating for seven papers and a moderate rating for one for the remaining study. Findings suggest that HNC patients with dysphagia suffer from reduced pressures in the pharynx and upper esophageal sphincter compared to healthy individuals, potentially influenced by tumor characteristics and treatment. Decreased pressures may indicate poor functioning of swallowing musculature and mechanism. Pharyngeal HRM/HRIM is sparsely used for swallowing assessment in HNC patients. However, wider use seems warranted, as it can offer valuable insights into swallowing biomechanics. This can help quantifying the degree and timing of pressures involved in swallowing (problems) and holds potential for clinical applications, such as earlier diagnosis of radiation-induced therapy or surgery complications. Additionally, it can be beneficial in evaluating therapeutic swallowing strategies.

A survey on healthcare professionals’ perspective on the use of benzoyl peroxide cleanser for acne management

Background: Acne vulgaris is a prevalent chronic dermatological condition affecting adolescents and young adults, with significant consequences on quality of life if left untreated. Effective management strategies are crucial to prevent scarring and psychological distress associated with acne. This study investigated the role of cleansers in acne management and explored healthcare professionals' perspectives and practices regarding acne treatment. Methods: An online questionnaire-based study, involving 126 healthcare professionals [HCPs (dermatologists and cosmetologists)] and 459 acne patients was conducted to assess patients’ acne severity, adherence to cleansing regimens, preferred cleansing agents, treatment duration, adjunctive therapies, and the impact of benzoyl peroxide 5% cleanser on acne control and patient satisfaction. Results: The majority of the patients presented with an IGA grade 3 (moderate) acne (48.59%) in the present survey. HCPs rated benzoyl peroxide as the most preferred cleansing agent for acne management in most of their patients (87.33%). Majority of the patients (41.53%) exhibited improvement within 15 days of using the benzoyl peroxide cleanser, highlighting its relatively rapid onset of action. The benzoyl peroxide treatment duration varied for patients, emphasizing the individualized nature of acne treatment. In most of the severe cases (39.87%), HCPs commonly supplemented benzoyl peroxide with topical retinoids, oral antibiotics, oral isotretinoin, or combination therapy. Conclusions: This study emphasizes the effectiveness and preference for benzoyl peroxide-based cleansers among HCPs and patients.

Student Pharmacists’ Reflections on Personal and Professional Development Following a Series of Longitudinal Faith-Based Courses

ObjectiveThis study aims to explore how integrating Judeo-Christian religious education into the pharmacy curriculum influences students’ spiritual and moral development, professional values, and mindset, preparing them for future holistic health care practice. MethodsA series of Judeo-Christian faith-based courses were integrated into the required Doctor of Pharmacy curriculum with the aim of developing student pharmacists’ moral foundation for future health care roles. Student reflections from these courses were compiled and analyzed using WordStat, combining natural language processing and statistical analysis. Content analysis included word cloud visualization, word co-occurrence, phrase extraction, and topic modeling. Thematic analysis with a deductive coding approach was applied. Descriptive statistics were used to analyze coding frequencies. ResultsWord cluster analysis revealed frequently cited and co-occurring words, including God, patient, care, life, love, ethics, personal, professional, health, and people. The frequently occurring phrases included patient care, professional ethics, personal ethics, and professional developments. The topics with high coherence values included love and compassion, empathetic care, caring health professionals, patient care, and leadership based on biblical principles. The major themes that emerged included spiritual growth and connection with God, the cultivation of virtues and ethical principles in personal development, and integration of faith into professional commitments for these aspiring professionals. ConclusionThe findings suggest that integrating spiritual and religious education into the pharmacy curriculum helps students develop a strong moral foundation, guiding their future practice with compassion and integrity.

Latent classes of learners in people with type 2 diabetes, stratified by educational status: A cross-sectional study

ObjectiveResearch suggests that people with type 2 diabetes (PWT2D) exhibit different approaches to learning about disease-management. This study’s aims to identify distinct learner groups among PWT2D and stratify them by educational status (ES). MethodsCross-sectional data from 227 PWT2D, collected through 46 Likert-scale questions on learning behaviors, preferences, and attitudes, were analyzed using latent class analysis, to identify learner groups. Participants were recruited via healthcare practices in central Germany and a countrywide online survey. Group membership was displayed according to low, medium, and high ES, defined by years of schooling. ResultsFour learner groups were identified: casual, versatile, insecure, and theorist learners. Insecure learners accounted for almost half of all respondents in the low ES group (46 %), casual learners were most prevalent among PWT2D with a medium (27 %), versatile (34 %) and theorist (29 %) learners among those with a high ES. ConclusionThis study sheds light on learner groups among PWT2D, which differ by ES, suggesting social disparities in diabetes care. Further research is needed to validate these findings. Practice ImplicationsUnderstanding individual learning preferences and motivations is crucial for developing effective diabetes self-management trainings, which may involve providing additional background material for theorists and practical applications for insecure learners.

Editors' Picks: Top 10 Diversity, Equity, Inclusion, and Antiracism Papers in Family Medicine Journals.

Physicians within the family medicine workforce are the most diverse compared to other medical specialties in both primarily clinical and academic settings. Family physicians also provide care to the most diverse patients and communities across the United States. As such, research and scholarly work from family physicians on diversity, equity, inclusion, and antiracism (DEIA) can be incredibly impactful. Yet many practicing and teaching physicians are unaware of their colleagues' scholarly DEIA work, which aims to elucidate inequities and barriers to optimal care and, importantly, to educate on ways physicians and learners can recognize and address specific needs of patients and communities marginalized by health care policies and practices. In collaboration with editors from several family medicine journals, the authors move beyond the traditional editorial space to share recent practice-changing and innovative articles, adding voice and momentum to improve DEIA efforts in all spaces where the practice and teaching of family medicine exists.

Anxiety among Medical Students Regarding Generative Artificial Intelligence Models: A Pilot Descriptive Study

Despite the potential benefits of generative artificial intelligence (genAI), concerns about its psychological impact on medical students, especially about job displacement, are apparent. This pilot study, conducted in Jordan during July–August 2024, aimed to examine the specific fears, anxieties, mistrust, and ethical concerns medical students harbor towards genAI. Using a cross-sectional survey design, data were collected from 164 medical students studying in Jordan across various academic years, employing a structured self-administered questionnaire with an internally consistent FAME scale—representing Fear, Anxiety, Mistrust, and Ethics—comprising 12 items, with 3 items for each construct. Exploratory and confirmatory factors analyses were conducted to assess the construct validity of the FAME scale. The results indicated variable levels of anxiety towards genAI among the participating medical students: 34.1% reported no anxiety about genAI‘s role in their future careers (n = 56), while 41.5% were slightly anxious (n = 61), 22.0% were somewhat anxious (n = 36), and 2.4% were extremely anxious (n = 4). Among the FAME constructs, Mistrust was the most agreed upon (mean: 12.35 ± 2.78), followed by the Ethics construct (mean: 10.86 ± 2.90), Fear (mean: 9.49 ± 3.53), and Anxiety (mean: 8.91 ± 3.68). Their sex, academic level, and Grade Point Average (GPA) did not significantly affect the students’ perceptions of genAI. However, there was a notable direct association between the students’ general anxiety about genAI and elevated scores on the Fear, Anxiety, and Ethics constructs of the FAME scale. Prior exposure to genAI and its previous use did not significantly modify the scores on the FAME scale. These findings highlight the critical need for refined educational strategies to address the integration of genAI into medical training. The results demonstrate notable anxiety, fear, mistrust, and ethical concerns among medical students regarding the deployment of genAI in healthcare, indicating the necessity of curriculum modifications that focus specifically on these areas. Interventions should be tailored to increase familiarity and competency with genAI, which would alleviate apprehensions and equip future physicians to engage with this inevitable technology effectively. This study also highlights the importance of incorporating ethical discussions into medical courses to address mistrust and concerns about the human-centered aspects of genAI. In conclusion, this study calls for the proactive evolution of medical education to prepare students for new AI-driven healthcare practices to ensure that physicians are well prepared, confident, and ethically informed in their professional interactions with genAI technologies.

Methodological path of an action research project in Brazil’s unified health system research program

ABSTRACT This paper analyzes the cyclical process of an action research project conducted by a group of academics, policy advocates, and humanization supporters under the aegis of Brazil’s Unified Health System Research Program. The project uses a qualitative approach, based on Institutional Analysis and Intervention Research principles. As nested cycles often pass through reflection-action moments, the findings are presented according to several such moments: method construction, participation type, search for theories, and cyclical action research process. They suggest that AR’s cyclical nature can enrich knowledge production and transform healthcare practices, and that well-qualified advocates and humanization supporters can contribute to this by understanding local health needs and providing valuable suggestions to enhance administrative and healthcare actions. These findings underscore the importance of the cyclical nature of action research, which constantly deepens and adds flexibility to participation, knowledge and data production, thereby providing a crucial element which enables research to continue, despite adverse conditions, such as the COVID-19 pandemic.

Comprehensive Review on Nilofar (Nymphaea alba Linn): Unani Perspectives and Therapeutic Potentials

Nilofar (Nymphaea alba Linn) is commonly known as the white-water lily. It is a hydrophyte with enormous medicinal properties, renowned for its alluring white flowers. It is distributed worldwide in ponds, lakes, and marshy areas. Its various parts have been extensively utilized in Unani medicine globally, particularly in the Indian subcontinent, to prevent and treat a variety of ailments. Numerous research findings have documented its therapeutic effects, including anti-inflammatory, anti-hepatitis C, anti-diarrheal, hepatoprotective, antibacterial, anticarcinogenic, antiurolithiatic, uterotonic, anxiolytic, antidepressant, CNS depressant, anticonvulsant, antihyperlipidemic, and antioxidant activities. In Unani medicine, Nilofar is used to treat various illnesses such as palpitations, diarrhea, hepatotoxicity, inflammation, migraines, anxiety, depression, and convulsions. Nilofar contains a variety of chemical constituents, including alkaloids, tannins, flavonoids, phenolic content, glycosides, aglycons, phenolic acids, cardiac glycoside nymphalin, and others. This review explores the therapeutic potential of Nilofar, shedding light on its pharmacological properties, traditional uses, and emerging research. By combining traditional knowledge with the latest scientific findings, this review aims to encourage further research and facilitate its integration into mainstream healthcare practices.

Breastfeeding During COVID-19 Stay-at-Home Orders: Implications for Future Maternal Work Policies and Health Equity.

This study aimed to explore the impact of the COVID-19 pandemic and associated stay-at-home orders on the breastfeeding experiences of U.S. people a identify facilitators and barriers to breastfeeding during this period, and to assess the effects of maternal stress and misinformation on breastfeeding practices. U.S. women with infants were selected through purposive and convenience sampling. An online survey, distributed during summer 2020, measured changes in infant feeding practices, maternal stress levels, use of lactation support resources, and the influence of misinformation on feeding decisions. Quantitative data were analyzed using descriptive statistics, and qualitative responses underwent thematic analysis. Our sample (n = 1,861) revealed that 34% of U.S. women realized the pandemic affected their feeding practices, 544 women provided qualitative data. Major themes from qualitative analysis included ease of breastfeeding at home, bonding, increased breastfeeding duration, and challenges like limited access to lactation support. Logistic regressions highlighted demographic influences on breastfeeding practices, with no significant effects found related to the child's age or women's income on changes in feeding practices. The COVID-19 pandemic substantially impacted breastfeeding experiences of U.S. women, yielding insights for future policy and healthcare practices. The findings underscore the potential benefits of telehealth lactation support services and flexible remote work environments for breastfeeding people. Clear and scientifically-grounded communication regarding breastfeeding, mental health support, and policy development, are essential to promote equitable and flexible work and maternity leave options for breastfeeding people especially during global health crises.

Customizing Yoga for Global Diversity: A Comparative Study of Eastern and Western Practices for Effective Integration Into Complementary Healthcare.

This cross-sectional study aimed to examine differences in yoga practices to enhance the validity and comparability of yoga research findings. It addresses the "black-box" approach to yoga interventions by highlighting various delivery components that can impact the validity of outcomes. By moving away from the generalization of yoga outcomes, this study provides deeper insights into yoga practices across culturally diverse populations. These insights are crucial for improving the reliability of outcomes and facilitating the integration of yoga into global complementary healthcare. The study included 2,619 participants, with a balanced representation from India (1,296) and the United States (1,323). The participants were diverse, with 47.5% being yoga masters, gurus, therapists, and experts. The study utilized the 14 subscales of the Essential Properties of Yoga Questionnaire (EPYQ) to assess four factors of yoga practice: region (India/United States), sex (male/female), delivery mode (remote/in-person), and participation status (instructor/practitioner). The EPYQ demonstrated strong internal consistency (Cronbach's alpha = 0.928). The total EPYQ score was higher in India than in the United States. Significant differences (p < 0.05) were observed for the 14 subscales across all four factors: region, sex, delivery mode, and participation status. Notable observations include that, by region, the United States sample scored higher than the Indian sample on the subscales of body awareness and acceptance/compassion (mean differences of -0.06 and -0.03, respectively), while the Indian sample scored higher on the spirituality and social aspects subscales (mean differences of 0.54 and 0.57, respectively). The remote delivery mode scored higher for the subscales of yoga philosophy and health benefits (mean differences of 0.17 and 0.13, respectively), and lower for the subscales of individual attention and active postures (mean differences of -0.17 and -0.04, respectively). By sex, the scores on the subscales of social aspects and yoga philosophy were higher for men than for women (mean differences of -0.26 and -0.24, respectively), whereas women scored higher for the subscales of body awareness and restorative postures (mean differences of 0.19 and 0.17, respectively). By participation status, practitioners showed higher scores for the subscales of physicality and active postures (mean differences of -0.05 and -0.02, respectively), whereas instructors scored higher on the subscales of yoga philosophy and meditation/mindfulness (mean differences of 0.37 and 0.32, respectively). This study emphasizes the importance of recognizing variations in yoga practices and highlights the need for customization to enhance its integration into healthcare. To address the challenges posed by global diversity and practice heterogeneity, the study suggests moving from "black box" evaluations of yoga interventions toward data-driven analysis of macro- and micro-level factors. These insights can guide developers, healthcare providers, and researchers in creating culturally sensitive, user-friendly solutions and inform future cross-cultural research. Further related research will help create robust standards for yoga practices and delivery, applying the same rigor as that applied to conventional healthcare practices.

Included and engaged: thesignificance of perceived inclusion among healthcare workers.

This study investigates the impact of perceived inclusion among healthcare employees on intrinsic motivation and its subsequent effects on work engagement and stress levels. Drawing from multiple theoretical frameworks, the study hypothesizes the following: (a) perceived inclusion positively influences employees' intrinsic motivation, and (b) perceived inclusion and intrinsic motivation serve as resources that enhance employee well-being by promoting work engagement and reducing stress. Data were collected from 407 healthcare workers across the European Union. The research objectives were achieved through statistical analysis of the gathered responses. The results indicate a positive relationship between perceived inclusion and intrinsic motivation. Importantly, both perceived inclusion and intrinsic motivation emerged as significant predictors of work engagement. Additionally, perceived inclusion was found to have a negative association with stress levels, underscoring its importance in healthcare management. The study is subject to certain limitations, including the cross-sectional design and reliance on self-reported data, which may affect the generalizability of the findings. The findings highlight the importance of fostering perceived inclusion and intrinsic motivation among healthcare employees to enhance work engagement and reduce stress, thus offering valuable insights for healthcare management practices. This study contributes to the existing literature by examining the complex interplay between perceived inclusion, intrinsic motivation, work engagement and stress within the healthcare sector. It also identifies avenues for future research in this area.