Healthcare Support Research Articles

Prevalence of Anxiety and Depression among Wives of Men Working or Living Abroad from Sylhet: Exploring Impact on Mental Health

This article finds out the prevalence of anxiety and depression among women whose husbands work abroad and also explores the significance of consequential impact on their mental health imposed by the situation as compared to those who live with their husbands. Based on a comprehensive analysis of relevant literature and empirical studies, the research sheds light on the implied challenges faced by these women, considering factors such as separation, communication barriers, and social support. The results showed significant differences between the study and the control groups. The prevalence of anxiety and depression among the study group was 51.2% and 44.1% and the average anxiety and depression score were 19.82 and 21.24 respectively. The combined odds ratio (OR) for anxiety and/or depression between the study and control groups was 9.87 with a 95% confidence interval of [5.49, 17.86] and a chi-squire test p-value <0.001.The findings are important as they may contribute to a deeper understanding of the mental health implications in this specific demographic, providing valuable insights for healthcare professionals, policymakers, and support networks.

Harnessing the power of infection prevention and public health data systems to support health care in Washington State during the COVID-19 pandemic

State health departments' (SHD) role in infection prevention and control (IPC) includes robust educational and consultative services for various health care settings. During the COVID-19 pandemic, Washington-SHD (W-SHD) IPC staff conducted remote and on-site Infection Control Assessment and Response (ICAR) consultations for long-term care (LTC) and non-LTC health care facilities. ICAR consultations were classified as "reactive" in response to a COVID-19 outbreak or "proactive" to help facilities improve IPC protocols. Facility addresses were geocoded to census tracks, classifying urban or rural areas. Facility types and characteristics were analyzed, assessing theimpacts of repeat visits. All descriptive statistics, Pearson's χ2 tests, and odds ratios were calculated. Between March 2020 and December 2022, W-SHD conducted 3,093 ICARs at 1,703 health care facilities in 94.9% (37/39) of Washington counties. Of the total visits, most were in LTC (90.5%) and 48.9% were reactive. Facilities with initial on-site ICARs had 1.5 times the odds of having a repeat visit than facilities with initial remote visit (95%CI: 1.21, 1.87). Maintaining strong connections with health care facilities can help bolster infection prevention practices and minimize loss of information at the facility level. Evidence-based findings on the sustainability of the W-SHD's ICAR services during the COVID-19 pandemic illustrated the value of public health IPC programs.

Voice Assistants for Mental Health Services: Designing Dialogues with Homebound Older Adults.

The number of older adults who are homebound with depressive symptoms is increasing. Due to their homebound status, they have limited access to trained mental healthcare support, which leaves this support often to untrained family caregivers. To increase access, a growing interest is placed on using technology-mediated solutions, such as voice-assisted intelligent personal assistants (VIPAs), to deliver mental health services to older adults. To better understand how older adults and family caregivers intend to interact with a VIPA for mental health interventions, we conducted a participatory design study during which 6 older adults and 7 caregivers designed VIPA-human dialogues for various scenarios. Using conversation style preferences as a starting point, we present aspects of human-likeness older adults and family caregivers perceived as helpful or uncanny, specifically in the context of the delivery of mental health interventions, which helps inform potential roles VIPAs can play in mental healthcare for older adults.

Barriers to access to cancer care for patients from the conflict-affected region of the Nagorno-Karabakh Republic: A qualitative study.

Access to essential health services is a basic human right, yet many cancer patients living in conflict-affected regions face multiple obstacles to service use. The (former) Nagorno-Karabakh Republic was a conflict-affected region in the South Caucasus populated predominantly by ethnic Armenians. Multiple acute armed conflicts, the recent military occupation of the region, and the prolonged military blockade of the Lachin Corridor (a humanitarian corridor connecting Nagorno-Karabakh to Armenia) exacerbated existing social, health, economic, and political fragilities in this region. As a result, cancer services were disrupted, with limited clarity on how the ongoing military blockade of a humanitarian corridor affected cancer patients' experiences of accessing cancer care locally and in bordering Armenia. Our study aimed to describe the experiences of patients from Nagorno-Karabakh in accessing the cancer care services they needed. We conducted remote semi-structured interviews with adult (aged ≥18 years) cancer patients receiving cancer care from three university hospitals in Armenia and face-to-face interviews with cancer care professionals from these hospitals. Interviews were conducted during the blockade of the Lachin Corridor between March and May 2023. Data were analysed thematically using a deductive approach. Twelve adult cancer patients (9 women) and 12 cancer care professionals participated. A key barrier to accessing cancer services was attributed to the Azerbaijani military occupation of the region and the blockade of a major roadway connecting Nagorno-Karabakh to Armenia. Patients talked in length about the challenges of finding transport and travelling long distances to reach essential cancer services in Armenia. Policies of free anti-cancer medication provision and decentralised medication supply were paused because of the military occupation, affecting patients' timely access to anti-cancer medication. Out-of-pocket expenses for treatment, anti-cancer medication, travel, and temporary accommodation in Armenia placed a significant financial burden on cancer patients, exacerbated by the humanitarian crisis. Conflict-affected regions blockaded by military forces lack the capacity and targeted support to sustain their essential health services and provide care to those in need of life-saving treatments. Coordinated action from national and international organisations and governments is urgently needed to enhance humanitarian assistance and healthcare support to patients, their families and wider communities affected by military blockades and armed conflicts.

Investigating Barriers to Healthcare Access for Parents of Children with Autism Spectrum Disorder in South Punjab, Pakistan

This research explores the Barriers to Healthcare Access for Parents of Children with Autism Spectrum Disorder in South Punjab, Pakistan. It investigates factors such as awareness channels, availability of healthcare facilities, and barriers to healthcare access. Utilizing quantitative methods, including structured surveys and statistical analyses, data from 100 participants were analyzed. Findings indicate diverse awareness channels, with disparities in awareness across different aspects of ASD. While healthcare facilities such as general practitioners and speech therapists are somehow available but, specialized services show notable gaps. Transportation problems, financial constraints, and cultural practices emerge as significant barriers to healthcare access. Statistical analyses reveal no significant differences in perceptions based on demographic variables. This study contributes valuable insights into the multifaceted challenges faced by families navigating the healthcare system for their children with ASD in South Punjab, Pakistan. It informs interventions & policy recommendations to ameliorate healthcare access and support services for this vulnerable population.

Perceived Social Support and Health Care Spending as Moderators in the Association of Traditional Bullying Perpetration with Traditional Bullying and Cyberbullying Victimisation among Adolescents in 27 European Countries: A Multilevel Cross-National Study.

Existing research has documented the association between bullying perpetration and bullying victimisation. However, it is still unclear how different sources of social support moderate the association between bullying perpetration and bullying victimisation at a cross-national level. Using multilevel binary logistic regression models, this study examined the moderating role of public health care spending and perceived social support (i.e., family and teacher support) in the association between traditional bullying perpetration and victimisation by traditional bullying and cyberbullying among adolescents across 27 European countries. Country-level data were combined with 2017/18 Health Behaviour in School-aged Children (HBSC) survey data from 162,792 adolescents (11-, 13-, and 15-year-olds) in 27 European countries. Results showed that adolescents who perpetrated traditional bullying had a higher likelihood of being victimised by traditional bullying and cyberbullying than adolescents who did not bully others. Results also indicated that the magnitude of the positive association between traditional bullying perpetration and victimisation by traditional bullying and cyberbullying was mitigated among adolescents with more family, teacher, and public health care support. These findings support the notion that multilayered systems of social support could play a vital role in bullying prevention and intervention strategies to address bullying among adolescents.

Learning from Health Care Counselors' Perspectives on Health Care Worker Distress: A Qualitative Analysis.

Health care provider stress and emotional distress were well documented long before the COVID-19 pandemic, and there is growing data suggesting these have increased in response to the pandemic. The goal of this study was to take advantage of the unique experiences of licensed mental health (MH) clinicians working with health care trainees and clinicians before and during the pandemic to identify how this crisis affected both ongoing as well as new sources of stress. The Healer Education, Assessment and Referral Program (HEAR) provides MH screening, support, and MH referrals to ~19 000 health care students, trainees, staff, and faculty. Since its inception in 2009, the program has been staffed by 4 licensed counseling professionals who have worked both before and since the COVID-19 pandemic. Qualitative data obtained from semi-structured, 1-hour interviews and a follow-up 1-hour focus group with 4 HEAR counselors was analyzed using reflexive thematic analysis. Several preexisting stressors were amplified during the pandemic: financial concerns; long work hours; exposure to the suffering of illness, death, and dying; bullying; discordant values and moral distress; social inequities; individuals' lack of adaptive coping; and individuals' self-concept as a victim. New stressors included: health care demand greater than the workforce numbers and resources; caretaking for ill family/friends; homeschooling of children; social isolation; experiencing the COVID-19 crisis as a war, fire, or storm; fear of personal illness and death, especially before vaccines; and hopes of a cure with vaccines; followed by perceived opportunities for improvement in leadership response to staff concerns. Authentically responding to staff concerns/ideas, a patient and provider-centered health care culture, grief education and support, and attention to actionable stressors affecting providers' well-being are indicated to meet the amplified and new stressors triggered by the COVID-19 pandemic and sequelae.

Ethnoveterinary treatment of livestock in Ghana: Cultural importance and consensus on plants used

The traditional free-range system of livestock rearing contributes to the socioeconomic well-being of most rural households in Ghana. The traditional management system exposes livestock to a high disease incidence, but healthcare support for animal production is limited. Ethnoveterinary practice is an integral part of livestock treatment, particularly in rural communities where veterinary services are poor. However, documentation of the plants used for ethnoveterinary treatment of livestock is scant in the country. Given the dearth of information on ethnoveterinary treatment, this study aimed to document the cultural significance and level of agreement of plant species used for treating livestock ailments in the Adaklu district. Ethnoveterinary data were collected from 120 respondents using semi-structured questionnaires. Quantitative ethnobotanical indices were used to ascertain the most culturally significant plant species for livestock healing. It was found that 38 plant species were used to treat various livestock ailments. Ethnobotanical indices revealed that Mangifera indica, Elaeis guineensis, Khaya senegalensis, Spondias mombin, and Physalis peruviana were the most culturally significant plant species for treating livestock ailments. Mangifera indica was found to be the most versatile species for treating livestock ailments and had the highest cultural importance (CI). This study reveals the high cultural importance of plants in the Adaklu district to improve livestock healthcare. The perceived efficacy influences the selection and utilization of a resource for folk medicine. The study recommends isolating and characterizing the active compounds in the most culturally significant plants and testing the properties on the medical conditions attributed to these plants.

Challenges and paradoxes in mental health care for transgender people in Brazil: a review of historical contexts and narratives

Individualized interviews with transgender people reveal diverse experiences, offering unique data for mental health care providers. These narratives challenge psychopathological categories and highlight the need for deeper investigation. The study aims to address these experiences comprehensively, understand the importance of each transgender narrative, and counteract biased approaches. Understanding the historical context of transgender assistance in Brazil is crucial. This context reveals a paradox: the need for individualized listening versus the standardization of transgender individuals under "conditions related to sexual health" in ICD-11. Brazil leads in transgender murders. Violence against this population stems from prejudices, ignorance, and pathologization, as historical evidence shows. We consider it essential to investigate these causes further and contribute by listening to this population, revealing the diversity in their experiences. A literature review of articles from 2011 to 2021 in Brazil identified 29 publications on transgender issues and psychology. This qualitative research used refined scales to address diverse transgender experiences, reducing result generalization. The historicization of the problems faced by transgender people in Brazil and the verification of the particularities revealed in the narrative of each participant are necessary counterpoints to the segregation and critical situation of this population in the country. By synthesizing individualized narratives, historical context, and literature, this study contributes to improving mental health care and social support for transgender individuals, emphasizing the importance of individualized listening and culturally sensitive approaches to reduce stigmatization and promote depathologization.

Establishing Best Practices in Telehealth Care for Adults with Developmental Disabilities in the United States: An e-Delphi Study.

Background: Telehealth care is now a key element of mainstream health care since the COVID-19 pandemic, with all types of health care providers joining the digital revolution. As a population experiencing health care disparities, adults with developmental disabilities and their supporters have described variable experiences with telehealth care that contribute to overall care quality and health outcomes. Methods: This e-Delphi study established consensus on best practices in telehealth care for adults with developmental disabilities in the United States. Online surveys and videoconferencing interviews were conducted with 44 expert panelists with experience with telehealth care and developmental disabilities, including adults with developmental disabilities, family members, direct support professionals, nurses, and health care providers. Results: Three rounds of surveys resulted in a set of 9 guidelines consisting of 42 items. The guidelines addressed 1) appropriate situations for telehealth care, 2) communication needs and preferences, 3) support person collaboration, 4) education and anticipatory guidance, 5) reminders, 6) coordination of care, 7) equitable and fair access, 8) privacy and safety, and 9) evidence-based practice. Conclusion: Health care providers can adopt these best practice guidelines to ensure telehealth care is provided equitably and safely to adults with developmental disabilities. Policy advocacy is needed for the uptake of these guidelines and for health care providers and adults with developmental disabilities to access the resources needed for safe and effective telehealth care use.

Living on low-incomes with multiple long-term health conditions: A new method to explore the complex interaction between finance and health.

People on low-incomes in the UK develop multiple long-term health conditions over 10 years earlier than affluent individuals. Financial diaries -new to public health- are used to explore the lived experiences of financially-vulnerable individuals, diagnosed with at least one long-term condition, living in two inner-city London Boroughs. Findings show that the health status of these individuals is a key barrier to work opportunities, undermining their income. Their precarious and uncertain financial situation, sometimes combined with housing issues, increased stress and anxiety which, in turn, contributed to further deteriorate participants' health. Long-term health conditions limited the strategies to overcome moments of financial crisis and diarists frequently used credit to cope. Restrictions to access reliable services and timely support were connected to the progression of multiple long-term conditions. Models that integrate healthcare, public health, welfare and financial support are needed to slow down the progression from one to many long-term health conditions.

Inequalities in the Ability for People With Type 2 Diabetes and Prediabetes to Adapt to the Reduction in In-Person Health Support and Increased Use of Digital Support During the COVID-19 Pandemic and Beyond: Qualitative Study.

The COVID-19 pandemic created unprecedented challenges for people with type 2 diabetes (T2D) and prediabetes to access in-person health care support. Primary care teams accelerated plans to implement digital health technologies (DHTs), such as remote consultations and digital self-management. There is limited evidence about whether there were inequalities in how people with T2D and prediabetes adjusted to these changes. This study aimed to explore how people with T2D and prediabetes adapted to the reduction in in-person health support and the increased provision of support through DHTs during the COVID-19 pandemic and beyond. A purposive sample of people with T2D and prediabetes was recruited by text message from primary care practices that served low-income areas. Semistructured interviews were conducted by phone or video call, and data were analyzed thematically using a hybrid inductive and deductive approach. A diverse sample of 30 participants was interviewed. There was a feeling that primary care had become harder to access. Participants responded to the challenge of accessing support by rationing or delaying seeking support or by proactively requesting appointments. Barriers to accessing health care support were associated with issues with using the total triage system, a passive interaction style with health care services, or being diagnosed with prediabetes at the beginning of the pandemic. Some participants were able to adapt to the increased delivery of support through DHTs. Others had lower capacity to use DHTs, which was caused by lower digital skills, fewer financial resources, and a lack of support to use the tools. Inequalities in motivation, opportunity, and capacity to engage in health services and DHTs lead to unequal possibilities for people with T2D and prediabetes to self-care and receive care during the COVID-19 pandemic. These issues can be addressed by proactive arrangement of regular checkups by primary care services and improving capacity for people with lower digital skills to engage with DHTs.

“Let the Kids Go, I Die”: the Experiences of Older Adults Who Survived the Earthquakes in Türkiye Through Intersectional Perspective

This qualitative study explores the experiences of older adult earthquake survivors in Türkiye, focusing on the intersectional challenges they faced after the earthquake of 6 February 2023. Older adults often have multiple vulnerabilities, such as age-related physical limitations, socioeconomic status, health conditions, and social isolation, which exacerbate their risks and needs during disasters. Using semi-structured interviews with 22 participants from different affected regions, this qualitative descriptive study sheds light on their problems with mobility, access to basic needs, and psychological distress. Using an intersectional framework, it explores how factors such as independence in transport, housing conditions, and family structure influence their experiences. The research emphasizes the importance of tailoring emergency response systems to address these unique challenges, including housing, healthcare, and psychosocial support. The findings show that older adults face both immediate physical and psychological challenges as well as long-term adaptation difficulties, emphasizing the need for comprehensive, inclusive disaster preparedness and response strategies. This study contributes to the literature by detailing the intersectional experiences of older earthquake survivors and advocating for policies and practices that ensure equitable support and resource allocation and ultimately promote more resilient communities.

Reasons for enrolling in safer supply programs: A longitudinal qualitative study on participant goals and related outcomes in the MySafe program.

Safer supply programs are a novel response to the ongoing overdose crisis in Canada - providing people at high overdose risk with a safer alternative to the highly toxic unregulated drug supply. The MySafe program provides pharmaceutical-grade opioids to participants via biometric dispensing machines. This study examines program-related goals and related outcomes across time. Longitudinal semi-structured interviews were conducted with 29 study participants at baseline and one-year follow-up. Interviews covered program functionality, experiences, outcomes, and reasons for enrollment and engagement. Baseline and follow-up interviews were compared to explore changes over time, including the effectiveness of the MySafe program in supporting individuals' achievement of their stated goals. Most participants reported similar goals at their baseline and follow-up interviews. The most common goal for initiating and staying in the program was to stop or reduce using street-purchased drugs, followed by abstinence, and wanting to stop injecting drugs. A number of participants described goals addressing issues related to structural vulnerability (e.g., improving living situations). At follow-up, some participants reported reducing street-purchased drug use, no participants reported abstinence, and all those wanting to stop injecting drugs reported achieving their goals. Our findings highlight a strong desire among study participants to be separated from the unpredictable street-drug supply. Participants reported variable success attaining their stated goals. However, our results demonstrate the need for such programs to better attend to participant goals, especially those impacted by structural vulnerability, that can be supported with wrap-around social and health care supports.

Consumer experiences navigating health care provider directories and support of federal policy action

AbstractMost Americans rely on managed care networks and provider directories to access care. Little is known about how patients experience navigating directories, how it affects their lives, and whether Americans support federal action on the issue. We fielded a large, and demographically diverse survey of US adults (N = 10,739) from January to April 2022. The survey queried respondents about their experience using provider directories, problems they encountered, and support for federal policy action. Analyses were conducted using Weighted Ordinary Least Squares regression. We found that 43% of Americans used provider directories last year. Among these, provider directory inaccuracy affected 56%, with inaccurate network status (34%), providers having left the practice (18%), and wrong contact information (15%) serving as primary problems. A majority of those using provider directories faced challenges in accessing care subsequently. This included 28% delaying care, 10% seeking out Urgent Care and 6% Emergency Care, respectively, 5% going out of network, and 10% forging care. A substantial number suffered health (54%) and financial (51%) problems as a result and about half took some action as a result. Overall, Americans strongly supported various federal actions to improve directory accuracy. Provider directory inaccuracy affects a larger number of Americans, many of whom are severely affected by the challenges. Broad public support should encourage federal action on the issue.

NURS-05. CATALYZING AND INFORMING THE DEVELOPMENT OF MORE COMPREHENSIVE AND ACCESSIBLE PROGRAMS FOR CAREGIVERS OF YOUNG ADULT SURVIVORS OF CHILDHOOD BRAIN TUMORS

Abstract BACKGROUND The chronic and intensive care needs of young adult survivors of childhood brain tumors are most often addressed by their maternal caregivers with limited, specific psychosocial or other programs to reduce caregiving demands and enhance their family management. Using a social ecological perspective, the purpose of this study was to catalyze and inform the development of more comprehensive and accessible programs for caregivers of young adult survivors of childhood brain tumors. METHODS Semi-structured interviews were conducted with 21 maternal caregivers, 6 post baccalaureate students/professional coaches for a problem-solving intervention for maternal caregivers, and 16 neuro-oncology clinical experts using interview guides tailored to their roles and constructed based on the Consolidated Framework for Implementation Science. Qualitative. Interview data were analyzed using content analysis. RESULTS Barriers included: need for internet connected devices (microsystem level); lack of care matched to their identified needs (mesosystem); poor tracking of long-term survivors and lack of survivorship psychosocial services (macrosystem); and lack of supportive health care policies and funding mechanisms for individuals and organizations (exosystem). Facilitators included: web-based platform accessible to the individuals and population (microsystem); widespread acknowledgement regarding gaps in survivorship psychosocial care (mesosystem); partnerships with survivors of childhood brain tumors, caregivers, and organizations that treat them (macrosystem); and dissemination among childhood brain tumor treatment/survivorship programs, healthcare systems, and community organization and endorsement from them (exosystem). CONCLUSIONS Multilevel approaches that address barriers and facilitators for improving health equity for maternal caregivers of young adult survivors of childhood brain tumors incorporate the design and dissemination of accessible, web-based programs designed in partnership with survivors, caregivers, and organizations to build care matched to need, as well as organizational, political, and community advocacy.

Husband's intention to support during pregnancy for the use of maternity waiting home in Jimma Zone, Southwest, Ethiopia: a community-based cross-sectional study.

Husbands are the primary decision-makers about the place of childbirth. Lack of husbands' support for maternal health care is associated with low maternal waiting home utilization and less is known about the husbands' intention to support their wife's use of maternal waiting homes (MWHs) and underlying beliefs in Ethiopia. This community-based cross-sectional survey aimed to study husbands' intention to support during pregnancy through the use of maternity waiting homes in Jimma Zone, Southwest Ethiopia. A cross-sectional study was conducted among 396 randomly selected husbands whose wives were pregnant. Interviewer-administered, a structured questionnaire developed based on the Theory of Planned Behavior (TPB) was used to collect the data. Multivariable logistic regression analyses were used to examine the association between behavioral intention and constructs of the theory of planned behavior. Of the 396 husbands who took part in the study, 42.7% intend to support their partner's use of a maternity waiting home. Intention to support a wife to use a maternity waiting home was associated with subjective norm [AOR = 1.303, 95% CI (1.054, 1.611)] and perceived behavioral control [AOR = 1.446, 95% CI (1.234, 1.695)]. Among the control beliefs, "having childcare"; "having a person who stays with a wife at a maternity waiting home"; and "availability of quality service provided to a wife in the maternity waiting home" significantly separated intenders and non-intenders. The findings suggest that husbands who perceived more social pressure and felt in control of barriers were more likely to intend to support their partner in using a maternity waiting home. Intervention should focus on underlying normative and control beliefs to improve the husband's intention.

Illuminating health aspects for immigrant Thai women in Swedish transnational marriages

BackgroundWomen who are migrants experience discrimination and face major risks, including sexual exploitation, trafficking, and violence, which affect their health and well-being.This study explored critical health incidents experienced by immigrant Thai women in marriage migration.MethodsA qualitative explorative approach with in-depth interviews was used. Forty immigrant Thai women who currently or previously had a Swedish spouse were recruited for the study. An inductive critical incident technique was used to collect and analyze the data as the first step. In a second deductive step, the Newman system model was used to categorize health dilemmas.ResultsThe women reported 438 critical health incidents in five main areas. Psychological health dilemmas included emotional abuse, feeling overwhelmed due to family responsibilities and the stress of leaving family behind. Sociocultural health dilemmas included transnational family duties or not performing family duties. Physiological health dilemmas included experiencing physical violence and environmental, domestic or work accidents. Developmental health dilemmas included failing health, difficulties upholding the duties expected of a spouse in the target culture and caring for an elderly husband. Spiritual health dilemmas included critical incidents in which the women perceived themselves to have failed in their hopes and duties as a wife, which intensified their dependence on faith, particularly the Buddhist concept of karma.ConclusionProfessionals in health and welfare practices in Thailand together with professionals in Western countries who work with women in marriage migration situations need to recognize the psychological, sociocultural, physiological, developmental, and spiritual health dilemmas experienced by these women. Furthermore, civil organizations that meet Thai women in foreign countries, such as Buddhist cultural associations, would benefit from the multicultural knowledge revealed by the present study. This knowledge can facilitate healthcare and welfare support for women in marriage migration situations.

Quality of life and associated factors for community health workers in the context of the COVID-19 pandemic in northeastern Brazil

In this study, we evaluated the quality of life (QoL) and associated factors of community health workers (CHWs) in different urban settings as a contributor to the preparedness of Brazilian primary care for future sanitary emergencies. The sample included 1935 CHWs from 4 state capitals and 4 inland municipalities in northeastern Brazil. Information was collected on QoL (WHOQOL-BREF), work routines, sociodemographics, direct and indirect exposure to violence, general self-efficacy, social support (MSPSS), mental health (SRQ-20) and coronavirus anxiety. The data were subjected to multiple linear regression analysis (α = 5%). In the state capitals, the factors associated with loss of QoL were poor mental health, lack of training, uncertainty about occupational biosafety, and lack of adaptation of services to tend to patients diagnosed with COVID-19. Among the inland municipalities, the main factors were coronavirus anxiety, poor mental health, lack of adaptation of services, lack of training, and lack of personal protective equipment (PPE). A high MSPSS (family and friends) score and self-efficacy had positive impacts on QoL in both urban settings. Our results highlight the need for investment in permanent education, PPE, social support, and mental health care for CHWs.

Childhood Environmental Instabilities and Their Behavioral Implications: A Machine Learning Approach to Studying Adverse Childhood Experiences.

Adverse childhood experiences (ACEs) include a range of abusive, neglectful, and dysfunctional household behaviors that are strongly associated with long-term health problems, mental health conditions, and societal difficulties. The study aims to uncover significant factors influencing ACEs in children aged 0-17 years and to propose a predictive model that can be used to forecast the likelihood of ACEs in children. Machine learning models are applied to identify and analyze the relationships between several predictors and the occurrence of ACEs. Key performance metrics such as AUC, F1 score, recall, and precision are used to evaluate the predictive strength of different factors on ACEs. Family structures, especially non-traditional forms such as single parenting, and the frequency of relocating to a new address are determined as key predictors of ACEs. The final model, a neural network, achieved an AUC of 0.788, a precision score of 0.683, and a recall of 0.707, indicating its effectiveness in accurately identifying ACE cases. The model's ROC and PR curves showed a high true positive rate for detecting children with two or more ACEs while also pointing to difficulties in classifying single ACE instances accurately. Furthermore, our analysis revealed the intricate relationship between the frequency of relocation and other predictive factors. The findings highlight the importance of familial and residential stability in children's lives, with substantial implications for child welfare policies and interventions. The study emphasizes the need for targeted educational and healthcare support to promote the well-being and resilience of at-risk children.