Public Health Institutions Research Articles

Do sertão da Bahia a Toronto: a trajetória profissional da enfermeira diplomada Haydée Guanais Dourado (1931-1942)

This article analyzes part of the professional trajectory of nurse and sociologist Haydée Guanais Dourado, from her training as a primary school teacher [normalista] at Instituto Ponte Nova (Bahia, Brazil) to her joining the group of nurses at the School of Nursing at the University of São Paulo. The study is possible by recreating the contexts in which she lived and is inseparable from understanding the social characteristics of the group in which she participated, that of qualified nurses. HGD’s trajectory oscillates between similarities and singularities in relation to the professional group. The investigation uses a reduction in the scale of analysis and an intensive study of the material analyzed. Throughout HGD’s trajectory, it is concluded that a large part of Brazilian registered nurses worked in public health institutions or hospitals and a few others became intellectuals who planned higher education in nursing and reflected on the destiny of the profession.

Crisis and Emergency Risk Communication and Emotional Appeals in COVID-19 Public Health Messaging: Quantitative Content Analysis.

Although COVID-19 is no longer a global health emergency, it remains pervasive in Singapore, a city-state situated in Southeast Asia, with periodic waves of infection. In addition to disease management, strong communication strategies are critical in the government's response to the pandemic to keep the public updated and equip them in protecting themselves. Grounded in the crisis and emergency risk communication (CERC) framework and emotional appeals, this study aimed to analyze public health communication strategies in Singapore during the COVID-19 pandemic. Quantitative content analysis was conducted on 696 Facebook (Meta Platforms Inc) posts and 83 website articles published by Singapore-based public health institutions between January 2020 and September 2022. The results showed that increasing communication on message themes, such as inquisitive messaging and clarification, can enhance communication strategies. The use of emotional appeals also varies with time and should be carefully used as they are context-specific. Theoretically, this study contributes to advancements in the CERC framework and concepts of emotional appeals by exploring the applications and changes of CERC message types and emotional appeals at different phases. The findings can provide practical guidance for authorities and communication practitioners in developing effective communication strategies.

Patient engagement as a collaborative process in a large Dutch COVID-19 vaccination study (RECOVAC) – insight into the contribution of patient engagement and learnings for the future

BackgroundThe need for patient engagement in health research has been increasingly acknowledged and accepted in recent years. However, implementation is still limited due to lack of evidence on its value and lack of guidance on how to implement patient engagement. This study aims to provide insight into the contribution of patient engagement in the RECOVAC project, which studied COVID-19 vaccination in kidney patients, and formulate concrete practice-based action perspectives for patient engagement.MethodsWe used a qualitative participatory mixed methods approach, based on the Patient Engagement Monitoring and Evaluation (PEME) framework. Patient engagement and data collection were based on the Reflexive Monitoring in Action (RMA) approach. Data collection included participant observations, open ended questionnaires and interactive reflection sessions. Qualitative analysis was done via a thematic approach.ResultsWe have described the process of patient engagement systematically, provided insight in its value and found that there is a need for clear aims, expectations and preparations from the start of the engagement process. We have shown that reflection throughout the process is of utmost importance and the same applies to clear communication between researchers and patient representatives. By being part of the consortium patient representatives had direct access to information, straight from the source, on for example the vaccination schedule and medication availability and had indirect influence on decisions made by the National Institute for Public Health and the Environment (RIVM) on preventive measures and treatment against COVID-19. Having experienced patient representatives is important, otherwise training needs to be provided. We also found that patient engagement had impact on conduct and outcomes of research activities itself and may have impact on future research and patient engagement activities in general.ConclusionPatient engagement has changed the course of the project. Concrete practice-based action perspectives have been formulated, which are already being implemented by the Dutch Kidney Patients Association (NVN). Studying patient engagement in a high pace project with high public interest has resulted in lessons learned and will help prepare and implement patient involvement in future research projects.Clinical trial registrationThe RECOVAC studies in which the patient engagement took place are registered at clinicialtrial.gov (NCT04741386 registration date 2021-02-04, NCT04841785 registration date 2021-03-22 and NCT05030974 registration date 2021-08-20).

Recruiting people with selected citizenships for the health interview survey GEDA Fokus throughout Germany: evaluation of recruitment efforts and recommendations for future research

BackgroundGermany is the second most common country of immigration after the US. However, people with own or familial history of migration are not represented proportionately to the population within public health monitoring and reporting. To bridge this data gap and enable differentiated analyses on migration and health, we conducted the health interview survey GEDA Fokus among adults with Croatian, Italian, Polish, Syrian, or Turkish citizenship living throughout Germany. The aim of this paper is to evaluate the effects of recruitment efforts regarding participation and sample composition.MethodsData collection for this cross-sectional and multilingual survey took place between 11/2021 and 5/2022 utilizing a sequential mixed-mode design, including self-administered web- and paper-based questionnaires as well as face-to-face and telephone interviews. The gross sample (n = 33436; age range 18–79 years) was randomly drawn from the residents’ registers in 120 primary sampling units based on citizenship. Outcome rates according to the American Association for Public Opinion Research, the sample composition throughout the multistage recruitment process, utilization of survey modes, and questionnaire languages are presented.ResultsOverall, 6038 persons participated, which corresponded to a response rate of 18.4% (range: 13.8% for Turkish citizenship to 23.9% for Syrian citizenship). Home visits accounted for the largest single increase in response. During recruitment, more female, older, as well as participants with lower levels of education and income took part in the survey. People with physical health problems and less favourable health behaviour more often took part in the survey at a later stage, while participants with symptoms of depression or anxiety more often participated early. Utilization of survey modes and questionnaire languages differed by sociodemographic and migration-related characteristics, e.g. participants aged 50 years and above more often used paper- than web-based questionnaires and those with a shorter duration of residence more often used a translated questionnaire.ConclusionMultiple contact attempts, including home visits and different survey languages, as well as offering different modes of survey administration, increased response rates and most likely reduced non-response bias. In order to adequately represent and include the diversifying population in public health monitoring, national public health institutes should tailor survey designs to meet the needs of different population groups considered hard to survey to enable their survey participation.

The methodology of health education programs in schools—Qualitative study

ObjectiveTo assess strengths and weaknesses of the methodology of health education programs, carried out in the period 2010–2020, in schools in Serbia. DesignQualitative study, a thematic analysis approach. SiteRepresentatives of Public Health institutions, Serbian biggest nongovernmental organization, Youth organization, Ministry of education and municipality. ParticipantsNine professionals working in the field of Public Health and Health education. MethodFocus group gathered nine health and non-health professionals in 2022 year. Focus group was recorded, transcribed verbatim, coded and analyzed by three research team members. A coding template evolved through the analysis, providing the expansion of key concepts. Themes were, one by one, extracted, encoded, classified as the smallest units and interpretive, thematic analysis was applied. ResultsAlthough the Focus group in our study identified among other advantages, support of Health sector to Educational sector as crucial, it emphasized as well following weaknesses: Analyzed health education programs were implemented insufficiently as a separate process in schools, did not have the image of programs shared and integrated into community; Health education needs of schoolchildren, parents, and teachers should be examined prior the education implementation; Well-educated interdisciplinary educators have to be strengthened and supported; Parents participation is necessity; Standards and good practice guidelines are needed, and those developed through Health Promoting Schools program could be practiced. ConclusionIt is necessary to support cross-curricular competence, where health education should be integrated into all school subjects, and should go far beyond the school, grow into a culture of community life, which will interconnect all stakeholders in strong Public Health network.

Linking Maternal and Child Health Data to Enhance Public Health Surveillance in Indiana

Indiana faces significant challenges in maternal and infant health, ranking 45th worst in infant mortality with a rate of 6.5 deaths per 1,000 live-births, and 21st in stillbirths. Indiana further has the 3rd highest rate of maternal mortality with 44 deaths per 100,000 live-births. Despite these alarming statistics, comprehensive surveillance of maternal and infant health is absent, and data often remains fragmented across disparate information systems. In response, the Indiana University Fairbanks School of Public Health and Regenstrief Institute secured a cooperative agreement through the CDC's Pregnant People-Infant Linked Longitudinal Surveillance (PILLARS) program, collaborating with the Indiana Health Information Exchange, Indiana Department of Health, and Marion County Public Health Department. The initiative aims to enhance Indiana's infrastructure for surveillance of maternal and child health (MCH) using electronic health records (EHRs), public health, and administrative data. Key efforts have included development, validation, and application of linkage algorithms across records for mothers and children; integration of case data across data sources; design of routine surveillance reports; and design of longitudinal studies to examine determinants and outcomes in MCH populations. Using deterministic linkage algorithms, we have created over 800,000 mother-infant dyads; this number will expand with the implementation of probabilistic approaches. We also have developed a computational phenotype for identifying cases of pregnancy in the EHR even when not explicitly flagged in the EHR. Future efforts will build on this infrastructure to draw from additional public health data sources and/or expand surveillance efforts to include prioritized MCH outcomes.

T cell responses to repeated SARS-CoV-2 vaccination and breakthrough infections in patients on TNF inhibitor treatment: a prospective cohort study

Understanding cellular responses to SARS-CoV-2 immunisations is important for informing vaccine recommendations in patients with inflammatory bowel disease (IBD) and other vulnerable patients on immunosuppressive therapies. This study investigated the magnitude and quality of T cell responses after multiple SARS-CoV-2 vaccine doses and COVID-19 breakthrough infection. This prospective, observational study included patients with IBD and arthritis on tumour necrosis factor inhibitors (TNFi) receiving up to four SARS-CoV-2 vaccine doses. T cell responses to SARS-CoV-2 peptides were measured by flow cytometry before and 2-4 weeks after vaccinations and breakthrough infection to assess the frequency and polyfunctionality of responding cells, along with receptor-binding domain (anti-RBD) antibodies. Between March 2, 2021, and December 20, 2022, 143 patients (118 IBD, 25 arthritis) and 73 healthy controls were included. In patients with either IBD or arthritis, humoral immunity was attenuated compared to healthy controls (median anti-RBD levels 3391 vs. 6280 BAU/ml, p=0.008) after three SARS-CoV-2 vaccine doses. Patients with IBD had comparable quantities (median CD4 0.11% vs. 0.11%, p=0.26, CD8 0.031% vs. 0.047%, p=0.33) and quality (polyfunctionality score: 0.403 vs. 0.371, p=0.39; 0.105 vs. 0.101, p=0.87) of spike-specific T cells to healthy controls. Patients with arthritis had lower frequencies but comparable quality of responding T cells to controls. Breakthrough infection increased spike-specific CD8 T cell quality and T cell responses against non-spike peptides. Patients with IBD on TNFi have T cell responses comparable to healthy controls despite attenuated humoral responses following three vaccine doses. Repeated vaccination and breakthrough infection increased the quality of T cell responses. Our study adds evidence that, in the absence of other risk factors, this group may in future be able to follow the general recommendations for COVID-19 vaccines. South-Eastern Norway Regional Health Authority, Coalition for Epidemic Preparedness Innovations (CEPI), Norwegian Institute of Public Health, Akershus University Hospital, Diakonhjemmet Hospital.

‘It’s really embarrassing […] to ask for help:’ navigating invisible and intersecting inequities in barriers to getting vaccinated

The arrival of COVID-19 vaccines in Canada marked the first time since the H1N1 influenza pandemic that adult vaccination became central in public health discourse, thus evoking feelings and discourse about individuals’ responsibility to get vaccinated. Public health institutions made efforts to ensure vaccines were accessible, and various local organizations worked to fill gaps in accessibility (e.g. vaccine clinics for equity-denied communities). However, despite knowledge of barriers to accessing healthcare, and specifically vaccines, public and health discourses emphasized individual objection as the main barrier to optimal vaccine uptake. This study explored how individuals who identified as a racialized minority or Indigenous person, perceived their personal responsibility to get vaccinated. We gathered perspectives in qualitative interviews (N = 27) when vaccines were first becoming available to adults living in Canada (May-June 2021). Theory about moral regulation, risk governance, and emotion informed our analysis. Findings suggest that individuals engaged in the governance of oneself and others towards getting vaccinated. However, participants also critiqued discourses that hold individuals responsible for accessing vaccines. They identified substantial barriers to accessing vaccines for individuals with fewer resources (e.g. travel time, missing work, childcare). When referencing individuals who do not know how to access information about vaccination, one participant stated, ‘it’s really embarrassing […] to ask for help.’ Feelings of individual responsibility may prevent some people uncertain about vaccines from asking for more information and support. We argue that the focus on vaccine hesitancy without attention to systemic barriers deflects responsibility for making vaccines accessible from centralized institutions to individuals.

Organizational Innovations, Facility Size and Service Delivery of Public Health Institutions Among Selected Counties in North Rift Region, Kenya

Organizational Innovations, Facility Size and Service Delivery of Public Health Institutions Among Selected Counties in North Rift Region, Kenya

Prevalence of SARS-CoV-2 Antibodies in Kosovo-Wide Population-Based Seroepidemiological Study.

Seroprevalence studies have proven to be an important tool in tracking the progression of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to measure the seroprevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the general population of Kosovo by gender, age group and region and among asymptomatic people. The Institute of Public Health of Kosovo conducted a cross-sectional population-based survey, aligned with the protocols of the WHO Unity Studies, from the beginning of May to the end of June 2021. The survey covered a total of 2204 people with a response rate of 91.8% (41.9% [923] males and 51.2% [1281] females). In May to June 2021, the prevalence of antibodies in the overall population (IgG antibodies ≥ 1.1) was 37.0%. Seroprevalence was 34.4% in men and 38.9% in women (p < 0.05), with the highest percentage (48.7%) found in the 60-69 years' age group. The overall prevalence of acute IgM antibodies (IgM ≥ 1.1) was 1% (95% CI: 0.7%-1.5%), with no significant difference between genders and the highest prevalence among participants of 60-69 years of age (1.6%; 95% CI: 0.7%-3.6%). A high prevalence of antibodies against SARS-CoV-2 was found in Kosovo before the start of the vaccination campaign. However, the results of the survey suggested that, by the end of June 2021, a desirable level of protection from the SARS-CoV-2 virus had not been reached.

171 Decline in adherence to Physical Activity Guidelines among the Dutch population

Abstract Purpose In the Netherlands, the number of people who meet the Physical Activity Guidelines in 2022 has dropped dramatically to a level lower than in 2019. In order to get more insight in this decline, we compared PA behavior in 2022 (after the coronavirus pandemic) with 2019 (before the pandemic). Methods For this study the 2019 and 2022 data collection of the Health Survey/Lifestyle Monitor (Statistics Netherlands (CBS) in collaboration with National Institute for Public Health and the Environment (RIVM)) was used. This is an annual survey including a random sample of the Dutch population (N ± 10,000). Physical activity was measured with the Short Questionnaire to Assess Health Enhancing Physical Activity (SQUASH). Specifically, time spend on walking and biking to work/school and in leisure time, playing sports, household activities, activities at work or school, gardening and, for children, playing outside and physical education was asked. Results In 2022, 44% of the Dutch population 4 years and older was sufficiently physically active compared to 49% in 2019. The decline was highest among young adults aged 18–29 (9.2 percent point), adolescents aged 12–17 (7.5 percent point), people who do paid work (6.4 percent point) and people educated to a higher level (7.5 percent point). All of these groups cycled less in their leisure time (-27, -51, -25 and -22 minutes per week, respectively), although for young adults this difference was not statistically significant. Adolescents also cycled less time to school (-48 minutes per week), but the mean number of days they cycled to school remained the same (4 days a week). In addition, young adults walked less, particularly in their leisure time (-39 minutes per week). Conclusions The decline in adherence to the Physical Activity Guidelines is mainly related to a decline in cycling time and, for young adults, a decline in walking time. Especially among adolescents the decrease in the number of minutes cycling between 2019 and 2022 is striking. However, in both 2019 and 2022, they cycled on average 4 days a week to school. A possible explanation for this is the increased use of electric bicycles.

Epidemiology of Q Fever in Southeast Europe for a 20-Year Period (2002–2021)

This study aimed to assess epidemiological trends of Q fever in six countries of Southeast Europe by analysing surveillance data for 2002–2021 period. In this descriptive analysis, we collected and analysed data on confirmed human Q fever cases, obtained from the national Public Health Institutes of Bosnia and Herzegovina, Croatia, Greece, Montenegro, North Macedonia and Serbia. Overall, 2714 Q fever cases were registered during the 20-year period. The crude average annual notification rate was 0.82 (± 2.06) (95% CI: 0.47–1.16) per 100,000 inhabitants, ranged from 0.06 (± 0.04) (95% CI: 0.04–0.08) /100,000 in Greece to 2.78 (± 4.80) (95% CI: 0.53–5.02) /100,000 in the Republic of Srpska (entity of Bosnia and Herzegovina). Significant declining trends of Q fever age standardized rates were registered in Croatia, the Federation of Bosnia and Herzegovina, North Macedonia and Serbia, with an average annual change of -30.15%; -17.13%; -28.33% and − 24.77%, respectively. An unequal spatial distribution was observed. The highest average age-specific notification rate was reported in the 20–59 age group (0.84 (± 0.40) (95% CI: 0.65–1.02) /100,000). Most cases (53.69%) were reported during the spring. Q fever remains a significant public health threat in this part of Europe. The findings of this study revealed the endemic maintenance of this disease in the including countries, with large regional and subnational disparities in notification rates. A downward trend was found in Q fever notification rates across the study countries with the average notification rate higher than in the EU/EEA, during the same period.

The Role of High-Level Isolation Units in Response to High-Consequence and Emerging Infectious Diseases: Experience of the German STAKOB Network.

This case study describes the experience of the German Permanent Working Group of Competence and Treatment Centers for High Consequence Infectious Diseases, known as STAKOB (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger). STAKOB brings together public health authorities (competence centers) and high-level isolation units (treatment centers) to collaborate on the clinical management of high-consequence infectious diseases (HCIDs) and emerging infectious diseases. The network is coordinated by the Robert Koch Institute, Germany's federal public health institute. The main tasks of STAKOB are to strengthen HCID clinical and public health management and increase expert knowledge on HCID and non-HCID emerging infectious diseases in Germany. STAKOB enables the exchange of knowledge and experiences; development of guidelines on infection prevention and control measures, clinical management, and therapy; and support for the World Health Organization and other outbreak responses internationally. The past years have shown how important the STAKOB network is for Germany-not only in providing critical care for HCID cases but also increasing capacity to support public health and clinical management of emerging infectious disease cases. However, maintaining several high-level isolation units in Germany requires a high commitment of financial, material, and human resources. Due to the rarity of HCID and emerging infectious disease events, maintaining the appropriate level of preparedness and ensuring sufficient investments is an ongoing struggle. Nevertheless, it is essential to have a network ready to react to HCID and non-HCID emerging infectious diseases in times of a changing biosecurity and infectious landscape.

Exploring the Association between Socioeconomic Environment, Eating Habits and Level of Nutrition in Children of High School Age: A Part of National Survey.

One of the raising public health problems in the adolescent population is obesity, which has reached epidemic proportions worldwide. The aim of this work is to determine the prevalence of obesity in the population of children of secondary school, age 15 to 19 years in Serbia and the determinate connection with demographic and socio-economic characteristics of the respondents and their eating habits and physical activity. The research is part of the fourth National Population Health Survey conducted in 2019, which was conducted by the Republic Institute of Statistics, in cooperation with the Institute of Public Health of Serbia and the Ministry of Health of the Republic of Serbia. As a research instrument, questionnaires were used in accordance with the methodology of the European Health Survey. For the purposes of this research, data on the adult population aged 15-19 and over were used. The association of overweight with demographic and socioeconomic characteristics was examined using binary regression. In the univariate model, male gender (OR = 1.95), younger age (OR = 1.57) and Region of Vojvodina (OR = 2.47) stood out as significant predictors of overweight, which was confirmed by the multivariate model. The results of our study emphasize that the prevalence of obesity in the population of high school youth is at a significant level and that a lot more needs to be done to promote healthy lifestyles and raise awareness of their benefits on health status.

Organizational Innovations, Facility Size and Service Delivery of Public Health Institutions Among Selected Counties in North Rift Region, Kenya

Organizational Innovations, Facility Size and Service Delivery of Public Health Institutions Among Selected Counties in North Rift Region, Kenya

Client Satisfaction and Associated Factors Among Insured and Uninsured Adult Clients Visiting Public Health Institution in Enrage Enawga Woreda, Amhara Regional State North West Ethiopia, 2021: Institution Based Comparative Cross Sectional Study

Background: Community-Based Health Insurance is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for rural and urban populations. Knowing the factors for patient satisfaction is an important and direct indicator of quality of health care which is essential for providers to fill their gaps. Although few studies have been conducted on patient satisfaction in Ethiopia; but this study aimed to assess patient satisfaction and associated factors in the insured and uninsured clients under Community-based health insurance. Methods: Institution-based comparative cross-sectional study was conducted from March 15 th2021 to April 30th, 2021. Over all 770 clients were selected from the health center by using simple random sampling techniques. The data were coded and entered into Epi-data3.1 and exported to SPSS Version 25 for analysis. Descriptive statistics and bivariate and multivariable logistic regression analyses were performed to identify the factors that affect client satisfaction with of p values less than 0.05. Results: Out of 753 respondents with a response rate of 97.8% the insured and non-insured patient satisfaction was 215 (56.6%) and 171(45.8%) respectively. The mean score with Standard Deviation of the satisfaction score was 3.6± 0.37 among insured and 3.5± 0.38 among non-insured under the CBHI scheme. The Pearson chi-square test showed a statistically significant difference between insured patients with a higher mean satisfaction score than their counterpart noninsured with x2= 8.67, df =1, P=0.003. Conclusions: The result shows that insured clients have a higher satisfaction score than non-insured clients. Therefore, to improve patient experiences at health centers and achieve financial risk protection through CBHI, program managers and healthcare providers should increase the satisfaction at the health facility to insured and non-insured community members.

Beta-blockers and their impact on metabolic processes

The aim of the study is to determine the effect of beta-blockers on lipid status, triglycerides and Body Mass Index (BMI) in patients using beta-blockers in the treatment of arterial hypertension. Our study included 120 patients at the Public Health Institution "Dom zdravlja" Živinice. The participants were monitored over a period of 3 years. Measurements were made after 12, 24 and 36 months of treatment. Patients were divided into two groups. The experimental group included 60 patients, who used beta-blockers in the treatment of arterial hypertension. The control group included 60 patients who used other antihypertensives as their first choice medication in the treatment of arterial hypertension. By monitoring cholesterol and triglyceride levels in patients using beta-blockers and other antihypertensive medications, and comparing these values within the group, no statistically significant difference in cholesterol and triglyceride levels was found in patients who used beta-blockers after 12, 24, and 36 months of treatment. There was also no statistically significant effect of therapy on the change in cholesterol and triglyceride values at observed time intervals, nor was there a statistically significant difference between these values. BMI monitoring showed a statistically significant difference between patients using beta-blockers and other antihypertensive drugs, with patients using beta-blockers having a higher BMI after 36 months of treatment. There was no statistically significant difference in BMI between patients using bisoprolol and carvedilol and patients using other beta-blockers, but patients using bisoprolol and carvedilol had lower BMI values. In studies conducted in recent years, it has been noted that many beta-blockers cause dose-dependent adverse metabolic effects on glucose and lipid metabolism, with the most adverse metabolic effects observed in patients treated with conventional non-selective beta-blockers. On the other hand, more favorable metabolic profile have drugs with β1 selective activity, such as atenolol and metoprolol, especially those with intrinsic sympathomimetic activity such as pindolol. In fact, with these beta-blockers, the adverse metabolic effects appear to be less prominent. In conclusion, beta-blockers do not lead to an increase in cholesterol and triglycerides, but they do lead to an increase in BMI in patients with arterial hypertension

Study of factors influencing psychosocial and professional characteristics of general practitioners (family doctors): validation of the international questionnaire COPSOQ III (Long version)

Introduction. Professional activity of physicians is associated with high psychological tension, which leads to the development of emotional and physical burnout. The management of factors of potential impact on psychosocial and indirectly on professional characteristics of medical workers in health policy is an important part of providing quality of the medical care to the population. The purpose of the study. Identification of psychosocial predictors forming burnout syndrome in the professional activity of general practitioners (GPs), family doctors (FDs) with using the psychosocial questionnaire COPSOQ III (Long version). Materials and methods. The methods of questionnaire survey, statistical analysis, and generalization of three hundred forty respondents’ answers were applied. The survey was conducted from May to November 2022 using the electronic Russian version of the international questionnaire COPSOQ III (Long version), available on the website of the N.A. Semashko National Research Institute of Public Health. General practitioners (family doctors) of the outpatient and polyclinic level of Moscow health care institutions participated in the survey. Results. Factor analysis of new predictors of psychosocial tension in the work of GPS (FDs), was carried out on a considerable volume of statistical material, which formed a high level of professional burnout — 233.01 ± 82.39 (224.23; 241.80, p = 0.05) points. Research limitations. The study was limited to a representative sample of GPS (FDs) working in healthcare facilities in Moscow within the framework of testing the reliability and construct validity of the full Russian-language version of COPSOQ III (Long version). The results of the study as a whole are not interpolated to the problem area of working conditions of GPs (FDs) in the health care system of the Russian Federation, further research is required. Conclusion. The research has revealed new factors of the development of professional burnout of GPS (FDs) on the basis of their interview with the help of adapted psychosocial international questionnaire COPSOQ III (Long version).

Facilitators and barriers of midwife-led model of care at public health institutions of dire Dawa city, Eastern Ethiopia, 2022: a qualitative study

BackgroundThe midwife-led model of care is woman-centered and based on the premise that pregnancy and childbirth are normal life events, and the midwife plays a fundamental role in coordinating care for women and linking with other health care professionals as required. Worldwide, this model of care has made a great contribution to the reduction of maternal and child mortality. For example, the global under-5 mortality rate fell from 42 deaths per 1,000 live births in 2015 to 39 in 2018. The neonatal mortality rate fell from 31 deaths per 1,000 live births in 2000 to 18 deaths per 1,000 in 2018. Even if this model of care has a pivotal role in the reduction of maternal and newborn mortality, in recent years it has faced many challenges.ObjectiveTo explore facilitators and barriers to a midwife-led model of care at a public health institution in Dire Dawa, Eastern Ethiopia, in 2021.Methodology: A qualitative approach was conducted at Dire Dawa public health institution from March 1–April 30, 2022. Data was collected using a semi-structured, in-depth interview tool guide, focused group discussions, and key informant interviews. A convenience sampling method was implemented to select study participants, and the data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach goes through six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing up.ResultTwo major themes were driven from facilitators of the midwife-led model of care (professional pride and good team spirit), and seven major themes were driven from barriers to the midwife-led model of care (lack of professional development, shortage of resources, unfair risk or hazard payment, limited organizational power of midwives, feeling of demoralization absence of recognition from superiors, lack of work-related security).ConclusionThe midwifery-led model of care is facing considerable challenges, both pertaining to the management of the healthcare service locally and nationally. A multidisciplinary and collaborative effort is needed to solve those challenges.

Evaluation of Rhode Island's Early Geographic COVID-19 Vaccine Prioritization Policy.

Objectives. To determine whether geographic prioritization of limited COVID-19 vaccine supply was effective for reducing geographic disparities in case rates. Methods. Rhode Island allocated a portion of the initial COVID-19 vaccine supply to residents of Central Falls, a community already affected by structural policies and inadequate systems that perpetuate health inequities and experiencing disproportionately high COVID-19 morbidity and mortality. The policy was implemented with a culturally and linguistically appropriate community engagement plan and was intended to reduce observed disparities. Using a Bayesian causal analysis with population surveillance data, we evaluated the impact of this prioritization policy on recorded cases over the subsequent 16 weeks. Results. Early geographic prioritization of Central Falls accelerated vaccine uptake, averting an estimated 520 cases (95% confidence interval = 22, 1418) over 16 weeks and reducing cases by approximately 34% during this period (520 averted vs 1519 expected without early prioritization). Conclusions. Early geographic prioritization increased vaccine uptake and reduced cases in Central Falls, thereby reducing geographic disparities. Public Health Implications. Public health institutions should consider geographic prioritization of limited vaccine supply to reduce geographic disparities in case rates. (Am J Public Health. 2024;114(S7):S580-S589. https://doi.org/10.2105/AJPH.2024.307741).