Health Programs Research Articles

UMA ABORDAGEM ACERCA DAS DOENÇAS CONGÊNITAS E SUAS DEVIDAS REPERCUSSÕES

Congenital infections are the main causes of permanent disability in children and have a major impact on morbidity and mortality and treatment costs. Among the main infections that can cause complications in pregnancy are: toxoplasmosis, rubella, cytomegalovirus, syphilis, zika virus, herpes, hepatitis, acquired immunodeficiency syndrome and parvovirus B19. These infections can cause morphological changes in fetal tissues or organs, thus, early identification and treatment can reduce maternal-fetal transmission and / or decrease the impact on the fetus. Thus, the aim of this study was to conduct na updated review of congenital infections, highlighting epidemiological, diagnostic and treatment aspects. This is a literature review, and for the construction of the text, the following databases were used: SciELO, pubmed, BVS and Google academic. Therefore, prevention, early diagnosis of congenital infections and other actions aimed at the adequate treatment of women and their children, with the integration of health programs and local surveillance systems, are extremely important for public health.

Workplace injury prevention and wellness program for orchestra musicians: A randomised controlled trial

OBJECTIVE: To evaluate the effect of a workplace injury prevention and wellness program compared to no intervention (control) on musicians' playing-related musculoskeletal pain intensity. The hypothesis was that musicians who completed the program would have a greater reduction in pain intensity than the control group. DESIGN: Pragmatic parallel randomised controlled trial. METHODS: Sixty-five orchestra musicians were recruited and completed patient-reported outcome measures (primary outcome: pain intensity over 11 months, using the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians; range 0-40, lower is better) at baseline, 14 weeks (T1) and 11 months (T2). Following baseline assessment, participants were randomly assigned to the intervention (n=33) or control (n=32) groups, stratified by instrument and pain prevalence. The intervention group received a 14-week injury prevention and wellness program including education and exercise; the control group received no intervention. RESULTS: Pain intensity means (standard deviation) were 7.8 (6.2), 8.0 (7.5), 8.6 (5.7) in the control group and 9.0 (6.6), 5.0 (4.2), 6.7 (6.6) in the intervention group at T0, T1 and T2, respectively. Using intention-to-treat analyses (three dropouts, n=65 analysed), between-group differences in pain intensity (95% confidence interval [CI]) were T1-T0: -4.2 (-7.5 to -0.9); T2-T0: -3.7 (-7.1 to -0.3), type III (overall) p=0.03, favouring the intervention group. No adverse events were reported. CONCLUSION: A workplace injury prevention and wellness program may have a clinically meaningful effect on reducing orchestra musicians' pain intensity.

Known and novel viruses in Belgian honey bees: yearly differences, spatial clustering, and associations with overwintering loss

ABSTRACT In recent years, managed honey bee colonies have been suffering from an increasing number of biotic and abiotic stressors, resulting in numerous losses of colonies worldwide. A pan-European study, EPILOBEE, estimated the colony loss in Belgium to be 32.4% in 2012 and 14.8% in 2013. In the current study, absolute viral loads of four known honey bee viruses (DWV-A, DWV-B, AmFV, and BMLV) and three novel putative honey bee viruses (Apis orthomyxovirus 1, apthili virus, and apparli virus) were determined in 300 Flemish honey bee samples, and associations with winter survival were determined. This revealed that, in addition to the known influence of DWV-A and DWV-B on colony health, one of the newly described viruses (apthili virus) shows a strong yearly difference and is also associated with winter survival. Furthermore, all scrutinized viruses revealed significant spatial clustering patterns, implying that despite the limited surface area of Flanders, local virus transmission is paramount. The vast majority of samples were positive for at least one of the seven investigated viruses, and up to 20% of samples were positive for at least one of the three novel viruses. One of those three, Apis orthomyxovirus 1, was shown to be a genuine honey bee-infecting virus, able to infect all developmental stages of the honey bee, as well as the Varroa destructor mite. These results shed light on the most prevalent viruses in Belgium and their roles in the winter survival of honey bee colonies. IMPORTANCE The western honey bee ( Apis mellifera ) is a highly effective pollinator of flowering plants, including many crops, which gives honey bees an outstanding importance both ecologically and economically. Alarmingly high annual loss rates of managed honey bee colonies are a growing concern for beekeepers and scientists and have prompted a significant research effort toward bee health. Several detrimental factors have been identified, such as varroa mite infestation and disease from various bacterial and viral agents, but annual differences are often not elucidated. In this study, we utilize the viral metagenomic survey of the EPILOBEE project, a European research program for bee health, to elaborate on the most abundant bee viruses of Flanders. We complement the existing metagenomic data with absolute viral loads and their spatial and temporal distributions. Furthermore, we identify Apis orthomyxovirus 1 as a potentially emerging pathogen, as we find evidence for its active replication honey bees.

Analysis of rare mutations associated with Thalassemia and their hematological characteristics in Chenzhou region of Hunan Province

To explore the distribution and hematological characteristics of rare thalassemia-associated mutations in Chenzhou region of Hunan Province with an aim to provide a basis for genetic counseling and effective prevention. A total of 37 370 individuals enrolled from January 2015 to December 2021 were screened by routine blood test and hemoglobin electrophoresis. The genotypes were determined with high-throughput sequencing. A total of 8 455 thalassemia mutations (including 185 rare ones) were detected, which had involved 27 mutational types. Rare type α-Thalassemia --THAI and CD31 (AGG>AAG) have the typical microcytic hypochromic hematological features, whilst SEA-HPFH, CD14 (CTG>-TG), CD37 (TGG>TAG), -90(C>T), Codon 15 (G>A), IVS-I-128 (T>G), CD86 (GCC>GC-) and Chinese Gγ+(Aγδβ)0 had typical microcytic hypochromic and β-thalassemia-associated hematological features of elevated HbA2 or HbF. In addition, the -50（G>A）heterozygotes of β-thalassemia had normal or slightly decreased MCV and MCH without an increase in HbA2. Various forms of thalassemia-associated mutations have been identified in the Chenzhou region of Hunan Province. Above finding has facilitated development of preventive and control strategies for thalassemia as well as birth health programs.

Pengaruh Kombinasi Kompres Hangat dan Dzikir terhadap Tingkat Nyeri pada Pasien Gastritis

Gastritis is an inflammation (inflammation) of the gastric mucosa caused by irritating and infectious factors, namely increased stomach acid. of the many factors that cause gastritis make the incidence of gastritis increase, due to irregular and unhealthy eating habits, alcoholic beverages, stress and consuming lots of coffee which can stimulate increased production of stomach acid. This community service activity was carried out by providing a combination therapy of warm compresses and dhikr therapy to reduce the pain sensitivity of patients with gastritis, with a total of 17 respondents. The aim of implementing this community service is to increase knowledge, reduce pain levels, empower patients and families, improve the quality of life of patients and to encourage the use of complementary therapies in health care and increase community participation in health programs. After the pre-test and post-test, it can be concluded that the combination of warm compresses and dhikr can reduce pain levels in gastritis patients. So it is recommended for gastritis sufferers to do warm compresses and dhikr as an alternative therapy when feeling pain.

Disability Training and Programme Conduciveness in Counselor Education: A Preliminary Assessment

ABSTRACT Counselors from all speciality areas should be prepared to serve people with disabilities (PWDs). Thus, we examined how counselling students in CACREP accredited programmes evaluate their disability training and their programmes’ disability conduciveness, and how it differs by speciality area. Effects of discrimination, ableism, power, privilege, and oppression on the life of PWDs, disability multicultural counselling competencies, and environmental, attitudinal, and individual barriers for PWDs were the training areas with highest three mean scores, indicating greater student satisfaction. Specific skills for leading a group consists of PWDs, sexual and reproductive concerns of PWDs, and parenting by parents with disabilities had the lowest three mean scores, indicating lower level of satisfaction. Results highlighted the inadequacy in disability training for clinical mental health and school counselling programmes. For disability conduciveness, almost one-fourth of the participants reported their programmes not meeting any of the criteria.

Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada.

In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies. This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban-rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018-2020) received from the 27 PHUs. Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs' activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban-rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities. Findings suggest broad implementation of health equity approaches in public health independent of PHUs' geographic size and population dispersion, though strategies and key challenges differ across units.

How effective is the BNT162b2 mRNA vaccine against SARS-CoV-2 transmission and infection? A national programme analysis in Monaco, July 2021 to September 2022

BackgroundWe quantified SARS-CoV-2 dynamics in different community settings and the direct and indirect effect of the BNT162b2 mRNA vaccine in Monaco for different variants of concern (VOC).MethodsBetween July 2021 and September 2022, we prospectively investigated 20,443 contacts from 6320 index cases using data from the Monaco COVID-19 Public Health Programme. We calculated secondary attack rates (SARs) in households (n = 13,877), schools (n = 2508) and occupational (n = 6499) settings. We used binomial regression with a complementary log–log link function to measure adjusted hazard ratios (aHR) and vaccine effectiveness (aVE) for index cases to infect contacts and contacts to be infected in households.ResultsIn households, the SAR was 55% (95% CI 54–57) and 50% (48–51) among unvaccinated and vaccinated contacts, respectively. The SAR was 32% (28–36) and 12% (10–13) in workplaces, and 7% (6–9) and 6% (3–10) in schools, among unvaccinated and vaccinated contacts respectively. In household, the aHR was lower in contacts than in index cases (aHR 0.68 [0.55–0.83] and 0.93 [0.74–1.1] for delta; aHR 0.73 [0.66–0.81] and 0.89 [0.80–0.99] for omicron BA.1&2, respectively). Vaccination had no significant effect on either direct or indirect aVE for omicron BA.4&5. The direct aVE in contacts was 32% (17, 45) and 27% (19, 34), and for index cases the indirect aVE was 7% (− 17, 26) and 11% (1, 20) for delta and omicron BA.1&2, respectively. The greatest aVE was in contacts with a previous SARS-CoV-2 infection and a single vaccine dose during the omicron BA.1&2 period (45% [27, 59]), while the lowest were found in contacts with either three vaccine doses (aVE − 24% [− 63, 6]) or one single dose and a previous SARS-CoV-2 infection (aVE − 36% [− 198, 38]) during the omicron BA.4&5 period.ConclusionsProtection conferred by the BNT162b2 mRNA vaccine against transmission and infection was low for delta and omicron BA.1&2, regardless of the number of vaccine doses and previous SARS-CoV-2 infection. There was no significant vaccine effect for omicron BA.4&5. Health authorities carrying out vaccination campaigns should bear in mind that the current generation of COVID-19 vaccines may not represent an effective tool in protecting individuals from either transmitting or acquiring SARS-CoV-2 infection.

Barriers to primary care among immigrants and refugees in Peterborough, Ontario: a qualitative study of provider perspectives

BackgroundCanada’s immigrants and refugees have often settled in large Canadian cities, but this is changing with rising costs of living and rural settlement initiatives. However, little consideration is made regarding systemic changes needed to accommodate this distribution, particularly in healthcare in medium-sized cities or smaller communities. For most Canadians, primary care is an entry point into the healthcare system but immigrants and refugees face unique barriers to accessing care compared to the general Canadian population. This project aimed to better understand the barriers to accessing primary care among newcomers in Peterborough, Ontario from the perspective of newcomer service providers.MethodologyParticipants were recruited from community organizations identified by the local settlement agency, the New Canadians Centre, as having regular interactions with newcomer clients including clinics, not-for-profit organizations, and volunteer groups. Four focus groups were completed, each with three participants (n=12). A coding grid was deductively developed to guide thematic analysis by adapting Levesque et al.’s conceptual framework defining access to healthcare with five specific dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness.ResultsParticipants identified lack of awareness of the healthcare system, stigma, competing priorities, and direct costs as some of the barriers for newcomers. Participants highlighted barriers unique to Peterborough including proximity to services, social isolation, and a shortage of family physicians. The results also highlighted strengths in the community such as its maternal-child health programming.ConclusionThe results provide a glimpse of the challenges to accessing primary care among newcomers in medium-sized communities and identify opportunities to prepare for changing settlement patterns.

Towards a lifelong personalized brain health program: empowering individuals to define, pursue, and monitor meaningful outcomes.

Incorporating person-centered outcomes into clinical trials for neurodegenerative diseases has been challenging due to a deficiency in quantitative measures. Meanwhile, the integration of personally meaningful treatment targets in clinical practice remains qualitative, failing to truly inform evaluations, therapeutic interventions and longitudinal monitoring and support. We discuss the current advances and future directions in capturing individualized brain health outcomes and present an approach to integrate person-centered outcome in a scalable manner. Our approach stems from the evidence-based electronic Person-Specific Outcome Measure (ePSOM) program which prompts an individual to define personally meaningful treatment priorities and report level of confidence in managing items that matter to the individual the most (e.g., "Do I feel confident in my ability to contribute to a conversation?"). Deployed either as a single version (person only) or a dyad version (person and care partner), our proposed tool could be used as an endpoint in clinical trials, offering proof of meaningful intervention benefits and in clinical practice, by establishing an anchor for the therapeutic objectives sought by the individual.

Physical rehabilitation program for cardiorespiratory health and quality of life among breast cancer survivors in UAE: protocol for a randomized control trial

BackgroundCancer is a medical condition where some cells of the body reproduce uncontrollably and metastasize to other parts of the body. The burden of the disease is significantly high both at the global and national levels. In UAE, cancer was found to be the third leading cause of death. Breast cancer has been ranked first due to its prevalence, incidence, and mortality in UAE. Breast cancer survivors have significantly poor cardiovascular tolerance which affects their quality of life (QoL), even after the carcinoma has been treated or removed. Thus, the protocol aims to analyze the changes in cardiovascular endurance and QoL domains for breast cancer survivors in the United Arab Emirates using a long-term 2-month physical rehabilitation.MethodsA total of 60 breast cancer survivors would be included in the study using a randomized controlled allocation of a 2-month physical rehabilitation intervention program with 3 months of follow-up. The intervention would target the cardiovascular endurance component of the participants to improve their physical well-being and quality of life ultimately.DiscussionThe findings of the study would have high clinical significance among breast cancer survivors in the UAE. The proposed physical rehabilitation program could be beneficial in improving cardiovascular endurance and thereby reduce the risk of mortality among breast cancer survivors. In addition, the physiological benefits of the exercise program could improve their quality-of-life domains including physical, mental, and social well-being. On a larger view, it could also help to reduce the economic burden on the health system due to associated complications.Trial registrationClinicalTrials.gov NCT06013527. Registered on 28 August 2023.

Evaluating competency-based medical education: a systematized review of current practices

BackgroundFew published articles provide a comprehensive overview of the available evidence on the topic of evaluating competency-based medical education (CBME) curricula. The purpose of this review is therefore to synthesize the available evidence on the evaluation practices for competency-based curricula employed in schools and programs for undergraduate and postgraduate health professionals.MethodThis systematized review was conducted following the systematic reviews approach with minor modifications to synthesize the findings of published studies that examined the evaluation of CBME undergraduate and postgraduate programs for health professionals.ResultsThirty-eight articles met the inclusion criteria and reported evaluation practices in CBME curricula from various countries and regions worldwide, such as Canada, China, Turkey, and West Africa. 57% of the evaluated programs were at the postgraduate level, and 71% were in the field of medicine. The results revealed variation in reporting evaluation practices, with numerous studies failing to clarify evaluations’ objectives, approaches, tools, and standards as well as how evaluations were reported and communicated. It was noted that questionnaires were the primary tool employed for evaluating programs, often combined with interviews or focus groups. Furthermore, the utilized evaluation standards considered the well-known competencies framework, specialized association guidelines, and accreditation criteria.ConclusionThis review calls attention to the importance of ensuring that reports of evaluation experiences include certain essential elements of evaluation to better inform theory and practice.

Analysis of Factors Influencing Health and Safety Programmes in Selected Electricity Distribution Companies

The study determined the factors influencing health and safety programme in the selected electricity distribution companies in Southwest, Nigeria. The study used descriptive survey research design. The study used primary sources of data, and the data were gathered through administration of questionnaire. The population for the study comprised of 11,621 workers of electricity companies in Southwest, Nigeria. A sample size of 400 was determined through the use of Taro Yamane formula and 385 were valid for usage. The sample was selected using two-stage sampling technique. At the first stage, purposive sampling technique was used in selecting employees who have used at least five years in the company; at the second stage, stratified random sampling technique was used in selecting employees using a senior, middle and junior categorisation of workers for stratification. The results also revealed that the human factors (t =5.836, p < 0.05), management factors (t = 3.898, p < 0.05), organisational factors (t = 2.120, p < 0.05) and environmental factors (t = 2.102, p < 0.05) were the factors influencing occupational health and safety practices in the study area. The study concluded that occupational health and safety practices have the potency of reducing the rate at which accidents and injuries occur among the workers and thereby improving the employees’ performance in Southwest, Nigeria. The study recommended that the factors that could reduce the potency of the health and safety programme should be controlled and be prevented.

The Effects of Fossil Fuel Consumption-Related CO2 on Health Outcomes in South Africa

The consumption of fossil fuel significantly contributes to the growth of South Africa’s economy but produces carbon dioxide (CO2), which is detrimental to environmental sustainability with overall effects on health outcomes. This study sought to (i) examine the impacts of fossil energy consumption-related CO2 emissions on the under-five mortality and infant mortality rates in South Africa and (ii) analyse the causal relationship between fossil energy consumption, CO2 emissions, and mortality rates in South Africa. Linear and nonlinear ARDL bounds and the Toda–Yamamoto causality test were used to establish the equilibrium property in the long run and the causal effects of the models’ variables. Health outcome data include the under-five mortality rate (MTR1) and infant mortality rate (MTR2). Other explanatory variables include fossil energy consumption (FOC), inflation (Inf), carbon dioxide emissions (CO2), and government expenditure (GEH). It is evident from the results of linear ARDL that the first lag of the under-five mortality rate in the short run has a positive and significant impact on the under-five mortality rate in South Africa. Holding the other variables constant, the under-five mortality rate in South Africa would increase by 0.630% for every 1% increase in its lagged values. Fossil energy consumption has a positive and significant effect on the under-five mortality rate in South Africa. This significant relationship implies that a 1% increase in fossil energy consumption increases the under-five mortality rate per 1000 persons per year in South Africa by 0.418% in the short run, all things being equal. The results from the Toda–Yamamoto causality test revealed that there is no causality between the under-five mortality rate and both the consumption of fossil fuel and CO2 emissions in South Africa. The results from nonlinear ARDL presented four separate scenarios. In the short run, during increasing levels of CO2 in the initial period (lag of CO2), a 1% increase in CO2 would decrease the under-five mortality rate by 1.15%. During periods of decreasing levels of CO2 in the short run, a 1% increase in CO2 would increase the infant mortality rate by 0.66%. Again, during previous and current periods of decreasing levels of FEC, a 1% increase in FEC would increase the infant mortality rate by 0.45% and 0.32%, respectively. In the long run, during periods of increasing levels of CO2, a 1% increase in CO2 would decrease the infant mortality rate by 4.62% whereas during decreasing levels of CO2, a 1% increase in CO2 would increase the infant mortality rate by 2.3%. The risk posed by CO2 emissions and their effects on humans can then be minimised through a government expansionary policy within health programmes.

The role of governance in the digital transformation of healthcare: Results of a survey in the WHO Europe Region

Optimal governance is among the key facilitators of the digital transformation of health systems intended to improve access to healthcare, quality, safety, and efficiency, and to attain universal health coverage. This paper highlights the findings of a survey assessing the status of governance of digital health in the WHO European Region.The 2022 survey is a continuation of the 2015 WHO Global Survey on eHealth. The survey focused on national digital health governance, monitoring and evaluation of digital health interventions, and funding and investment in digital health and was conducted through April to October 2022. All 53 Member States of the WHO European Region participated in the survey.The results showed that 83% of the Member States reported having a national digital health strategy in place, and 79% of the Member States reported having a health information system strategy. Most of the priorities of the national digital health strategies were devoted to increasing the accessibility, quality, safety, and efficiency of the health systems, strengthening health information systems, and improving information sharing and interoperability of data. Measures to ensure equity in access to digital healthcare services were directed towards improving broadband connectivity, information and communication technology, digital literacy, and digital health promotion. Oversight for the implementation and operation of the national digital health strategies are mostly delegated to government agencies. The prime source of funding for digital health programs was public funding, though a combination of funding sources was also noted. This analysis revealed increasing adoption of national digital health strategies for access to healthcare and creation of digital health agencies and funding programs for digital health.

The Impact of Rural Environments on Reproductive Autonomy Among Women in Appalachia: A Qualitative Analysis

Reproductive autonomy encompasses one’s ability to make decisions around contraceptive use, pregnancy, and childbirth. An individual’s geographic location affects access to a wide range of information and care related to reproductive choice. Individuals in rural areas face additional barriers to reproductive health and decision-making than those in urban areas. This phenomenological qualitative study examined the experiences with and perceptions of reproductive decision-making among women in rural Appalachian communities in the United States. Four themes emerged from the data: autonomy tied to choice, role of religion and church on autonomy and decision-making, navigating limited access to care, and shame. Women should be supported in making reproductive health decisions, and efforts are needed to increase autonomy within reproductive health care and decisions. Sexual health programming within school and other community settings should address shame that often occurs around reproductive health topics, particularly among religious communities.

Two years outcome of an individualized oral health preventive program for preschool children with neurodevelopmental disorders.

Limited data exist on the effectiveness of oral health preventive programs in children with Neurodevelopmental Disorders (NDD). The aim of this study was to evaluate the effectiveness of an individualized preventive oral health program for preschool children with NDD at a rehabilitation center, over a two years period. In this study, 102 preschool children with NDD were assessed for caries (dmft), oral hygiene status (Green & Vermillion Index) and presence of developmental dental defects. An individualized preventive program was applied based on caries risk and children were followed for two years. Effectiveness of the program was assessed for caries and dental plaque change and explanatory individual factors were used in multivariate models. After two years prospective, dmft increased significantly from 1.1 (SD=2.7) to 2.04 (SD=3.6), while GVPI was reduced significantly from 1.8 (SD=0.9) to 1.4 (SD=0.9). Children in the moderate and high-risk groups missed significantly more follow-ups compared to the low caries risk group (p<.001) while older maternal age (OR=1.38, 95%CI=1.057-1.808) and consumption of more than three sugary snacks/day (OR=0.005, 95%CI=0-0.0794) were significantly correlated with dental caries. The individualized preventive program for preschool children with NDD was effective in improving oral hygiene but not dental caries status.

Fiscal space for the immunisation program in Zambia– an efficiency analysis approach

ObjectiveThe immunisation programme in Zambia remains one of the most effective public health programmes. Its financial sustainability is, however, uncertain. Using administrative data on immunisation coverage rate, vaccine utilisation, the number of health facilities and human resources, expenditure on health promotion, and the provision of outreach services from 24 districts, we used Data Envelopment Analysis to determine the level of technical efficiency in the provision of immunisation services. Based on our calculated levels of technical efficiency, we determined the available fiscal space for immunisation.ResultsOut of the 24 districts in our sample, 9 (38%) were technically inefficient in the provision of immunisation services. The average efficiency score, however, was quite high, at 0.92 (CRS technology) and 0.95 (VRS technology). Based on the calculated level of technical efficiency, we estimated that an improvement in technical efficiency can save enough vaccine doses to supply between 5 and 14 additional districts. The challenge, however, lies in identifying and correcting for the sources of technical inefficiency.

Beliefs, Experiences, and Practices of Lady Health Workers in Facilitating Breastfeeding in Rural Communities in Pakistan.

Pakistan has extremely poor breastfeeding indicators: fewer than half of infants under 6months are exclusively breastfed, only 20% of infants are breastfed within the first hour of life, and nearly half are never fed colostrum. The country's high infant morbidity and mortality is in part due to this suboptimal infant feeding. A network of lady health workers (LHWs) employed by the government facilitate maternal and child health programs, including breastfeeding support in their communities. This study describes LHWs' perspectives and experiences regarding breastfeeding. We conducted semi-structured interviews with 14 LHWs and used thematic qualitative analysis to code and analyze the data. Our research revealed that LHWs use their role as members of the community and involve influential members of the family to build trust. Frequent home visits beginning prenatally help them address misconceptions about infant feeding. While they have strong knowledge about the benefits of breastfeeding and the importance of colostrum, they demonstrate gaps in their knowledge regarding breast conditions, the safe preparation of human milk substitutes, the physiology of milk production, and supporting mothers who are separated from their baby. Future training should address these areas where LHWs lack knowledge to help mothers facilitate early and exclusive breastfeeding. With adequate training, LHWs are uniquely positioned to use their role as trusted members of the community to effectively counsel families on the importance of breastfeeding and support the clinical needs of women during the perinatal time.

Identifying Challenges and Solutions for Improving Access to Mental Health Services for Rural Youth: Insights from Adult Community Members.

Semi-structured, key informant interviews were conducted by telephone with adult community members, including parents, teachers, and healthcare providers. Participants answered questions related to barriers to mental healthcare access that confront youth and approaches to improving access. Detailed, de-identified field notes were analyzed using conventional content analysis. Limited resources and stigma were the two primary barriers to accessing mental healthcare that youth encounter in the community. Limited resources included lack of services and transportation, inconsistent funding and mental health programming, and workforce shortages. Stigma associated with seeking mental healthcare was of particular concern for youth with diverse identities who experience additional stigma. Improving access to mental healthcare for rural youth will require building a strong mental health workforce and championing efforts to reduce stigma associated with help-seeking.