Support Services Research Articles

Abstract C007: Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention

Abstract Background. Tobacco use remains a significant public health issue, particularly among the LGBTQ+ community. Los Angeles County, which is home to the second-largest LGBTQ+ population in the US, has notably higher prevalence of tobacco use compared to the general population, partly due to targeted marketing by the tobacco industry, social stressors, and discrimination. These factors contribute to higher rates of smoking and tobacco-related health disparities; however, little is known about the capacity of community-based organizations, clinical providers, support staff, and other personnel that work closely with the LGBTQ+ community to provide smoking cessation services. Methods. Cedars Sinai Cancer Center Community Outreach and Engagement (COE) assisted in the facilitation of conducting a needs assessment, Clinical Provider and Staff Survey, to assess the opinions of clinical providers and community leaders about tobacco cessation-related topics related to 1) Building culturally competent tobacco cessation services; 2) Reducing health disparities in tobacco cessation services; 3) Improving access to care (Medicaid/Medi-Cal access and uptake) for diverse populations that are affected by tobacco-related disparities; 4) Improving the utilization of tobacco cessation services. The survey was administered online from December 2022 to April 2023 with providers throughout Los Angeles County. Results. A total of 261 surveys were collected which revealed several key issues at the organization level: they do not prioritize tobacco screening, treatment, or referrals; there is no standardized process for client management; staff have limited knowledge on tobacco prevention and patient navigation; and there is limited staff capacity and funding. To address organizational-focused barriers, COE trained 147 clinical providers and staff from 4 local health clinics and organizations and on capacity building, including the basics of tobacco, evidence-based interventions like "Ask, Advice, Refer," and lung cancer screening. Additionally, to address Client/Patient-Focused Barriers for Organizations, such as: lack of motivation to quit, low perception of the severity of smoking, and a lack of culturally competent or targeted cessation resources, COE staff assisted in navigating resources, ensuring both providers and clients were aware of and could access relevant support services. This involved sharing LGBTQ+ affirming resources, including medical care, behavioral health, and housing, and referred smokers to gender-affirming cessation support groups. Conclusion. The survey highlighted the need to enhance service delivery and support for the LGBTQ+ community. With these findings, our COE staff were able to increase organizational capacity through training and education for clinical providers and staff to enhance their knowledge and skills in tobacco cessation and share gender-affirming resources and navigation, which are crucial towards improving the overall effectiveness of tobacco cessation services for LGBTQ+ populations. Citation Format: Victor Cristanto, Alexandra Caro, Reener Balingit, Zul Surani. Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C007.

Going Underground: Demographics, Services, and Best Practices Endorsed by Practitioners Providing Support for Naturalistic Psychedelic Use

ABSTRACT Psychedelic-assisted therapy (PAT) has shown preliminary efficacy for psychiatric and physical health conditions. Although some people report naturalistic psychedelic use with so-called “underground” practitioners, little is known about PAT that occurs outside of controlled clinical settings or perspectives of these practitioners. We conducted an anonymous online survey of individuals who reported providing psychedelic support services (e.g. trip sitting and/or preparatory/follow-up psychotherapy) in naturalistic settings. We investigated demographics, including education and licensing, details about services provided, and reported client outcomes. Among 107 participants, 40.2% held a full or in-progress license and 44.9% had not obtained a relevant graduate degree. Almost all participants reported pre-screening clients before treatment, offering preparation, integration, and trip-sitting services, and most employed a range of therapeutic modalities, centering primarily on non-directive approaches. Participants reported that clients most commonly consumed psilocybin, and treated numerous conditions, primarily aligning with indications targeted in psychedelic clinical research. Perceptions of clients’ symptom changes were largely positive, although a small proportion reported worsened personality disorder symptoms. Further research delineating client and practitioner perspectives of naturalistic PAT services is warranted, and such work may shed light on the benefits and risks specific to naturalistic PAT as well as inform best practices for practitioners.

Codesigning a Community Health Navigator program to assist patients to transition from hospital to community

Background This study aimed to identify the potential roles for Community Health Navigators (CHNs) in addressing problems faced by patients on discharge from hospital to the community, and attitudes and factors which may influence their adoption. Methods Twenty-six qualitative interviews and an online codesign workshop were conducted with patients, nurses, general practice staff, health service managers, community health workers, general practitioners, medical specialists, and pharmacists in the Sydney Local Health District. Qualitative themes from the interviews and workshop transcripts were analysed inductively and subsequently grouped according to a socio-ecological model. Results CHNs could assist patients to navigate non-clinical problems experienced by patients on discharge through assessing needs, establishing trust, providing social and emotional support that is culturally and linguistically appropriate, engaging family and carers, supporting medication adherence, and helping to arrange and attend follow up health and other appointments. Important factors for the success of the CHNs in the performance and sustainability of their roles were the need to establish effective communication and trust with other healthcare team members, be accepted by patients, have access to information about referral and support services, receive formal recognition of their training and experience, and be supported by appropriate supervision. Conclusions This study was unique in exploring the potential role of CHNs in addressing problems faced by patients on discharge from Australian hospitals and the factors influencing their adoption. It informed training and supervision needs and further research to evaluate CHNs’ effectiveness and the acceptance of their role within the healthcare team.

Unveiling collective grief: A qualitative study of X posts reflecting on the Kahramanmaraş earthquake anniversary in Türkiye

This study aims to explore the collective grief manifested on the first anniversary of the earthquake that occurred in Türkiye on February 6, 2023, through the analysis of 10,000 posts on platform X. Designed with qualitative methodology, thematic analysis was conducted, revealing two main themes: “collective grief as a ground for social solidarity” and “politicization of collective grief.” The results indicated that the sharing of emotions as well as rituals, commemoration ceremonies, etc. made collective grief a ground for social solidarity, collective sense-making, and healing. Likewise, the public’s positive or negative reactions to the government’s disaster management emerged as one of the factors politicizing the grief. The reactions to the Syrians and Hatay’s people reveal the public’s perception of “the subject of grief” and “acceptable grief practices.” The study’s main recommendations include but are not limited to, increasing infrastructure work, and developing psycho-social support and social cohesion services.

NGOs' initiatives and grassroots approach for accessing to health care services for the slum people in Dhaka

ObjectiveThis study holds significant importance as it aims to delve into the impactful NGOs’ initiatives and grassroots approaches instrumental in providing healthcare services to Dhaka's underserved slum people. It focuses on understanding how these factors influence the use and access to health services, which is a crucial aspect for researchers, policymakers, and healthcare professionals.Study designThis study was meticulously designed, utilizing a comprehensive cross-sectional mixed-methods design. By incorporating qualitative and quantitative data collection methods, we ensured a thorough understanding of NGOs’ initiatives and grassroots approaches to providing healthcare services to slum dwellers in Dhaka, thereby instilling confidence in the validity of our research for the audience.MethodsA face-to-face interview was used to survey the participants (n = 722) using semi-structured questionnaires, following a systematic sampling technique. Four focus group discussions (FGDs) were also conducted with the slum people. Binary logistic regression was performed to know NGOs’ initiatives, roles, and grassroots approach as predictors or independent variables and healthcare services as an outcome or dependent variable. The quantitative data were analyzed using SPSS version 23.0. At the same time, thematic analysis was conducted following Philip Adu's Qualitative data analysis process and Braun and Clarke's six steps of the thematic analysis system, integrating the 11 subthemes with the quantitative findings to highlight the interpretative findings of the qualitative data.FindingsMajor findings revealed that NGOs’ initiative roles and grassroots approach had a significant impact on slum dwellers’ use and access to healthcare services. The initiatives included affordable health services (OR = 22.86, 95% CI = 3.87, 35.00, P = 0.01), special health services (OR = 5.63, 95% CI = 3.36, 9.42, P = 0.00), engagement of responsible community leaders (OR = 1.72, 95% CI = 1.14, 2.59, P = 0.01), distribution of health and medicine items (OR = 1.92, 95% 2 CI = 1.40, 2.63, P = 0.01), provision of updated information to slum dwellers (OR = 1.37, 95% CI = .99, 1.90, P = 0.05), telehealth and telemedicine (OR = 1.82, 95% CI = 1.55, 2.13, P = 0.01), BCC strategy (OR = 1.26, 95% CI = 1.00, 1.57, P = 0.05), and doorstep services as NGOs’ grassroots approach (OR = 1.84, 95% CI = 1.00, 3.38, P = 0.05). Qualitative findings supported the quantitative findings through 2 main themes and 11 sub-themes, which were integrated with quantitative findings to highlight the interpretative findings of qualitative data.ConclusionsHealth services and other facilities for urban slum people through NGOs’ initiatives and grassroots approaches are highly affordable and practical, special health services with the involvement of special exceptional health professionals, community supportive services, BCC strategies, and doorstep health services may trigger the use and access to health services for slum dwellers. Results suggest and recommend capitalizing and investing in such initiatives and grassroots approaches from the government, policymakers, and donors with NGOs to find accessible, affordable health services for the unprivileged slum people.

Impact of occupational stress on healthcare workers’ family members before and during COVID-19: A systematic review

We aimed to explore the experiences, needs, and mental health impact of family members of healthcare workers (HCWs) before and during the COVID-19 pandemic. Eleven quantitative and nine qualitative studies were included in this review. Based on the narrative synthesis, we identified five outcomes: ‘Mental health outcomes’, ‘Family relationships, ‘Coping skills and resilience’, ‘Quality of life and social life’, and ‘Practical outcomes’. Our findings indicated that there was a high risk to the mental health and well-being of families of healthcare workers both before and during the pandemic. However, with the COVID-19 pandemic, some experiences and mental health issues of families were worsened. There was also a negative association between working long hours/shift work and family relationships/communication, family social life, and joint activities, and family members taking on more domestic responsibilities. Families tended to use both positive and negative coping strategies to deal with their loved one’s job stress. Organisations and support services working with people in health care work should consider widening support to families where possible. With this understanding, HCWs and their families could be supported more effectively in clinical and organisational settings. Trial registration: Systematic Review Registration Number: CRD42022310729. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310729.

Breastfeeding mothers' self-confidence: A mixed-method study

Objective: To establish the association of the mother's breastfeeding self-efficacy with infant feeding in the first six months of the child's life and identify the mothers’ perception of their confidence to breastfeed. Background: Breastfeeding is a multi-determined process. Many factors contribute to a mother’s ability to exclusively breastfeed until a child reaches six months of age. Among these factors is a mother’s confidence in her abilities to breastfeed her baby, referred to as breastfeeding self-efficacy. Thus, self-efficacy for breastfeeding could be an essential predictor of reducing the risk of early weaning. Study design and methods: This is a mixed-method sequential explanatory study. The short form of the Breastfeeding Self-Efficacy Scale was used to determine the level of the mothers' confidence. 158 mothers were surveyed during their postpartum hospital stay, and 128 were included in a follow-up six months after delivery. Additionally, 22 participants were randomly selected for an in-depth interview (qualitative stage). Data were analysed using inferential statistics and thematic content analysis. Results: High levels of breastfeeding efficacy were identified during the hospitalisation and after discharge among all participants. Exclusive breastfeeding was practised among 45.31% of mothers six months after delivery. Return to work was a key factor contributing to early weaning. Family and health professional support during the breastfeeding process were associated as crucial for the duration of exclusive breastfeeding. Discussion: Exclusive breastfeeding for the first six months after delivery involves various factors, such as the mother’s confidence in her breastfeeding skills and the specific circumstances she faces while breastfeeding. Thus, through the mixed qualitative and quantitative approaches, it was possible to identify the convergence of self-efficacy scores and the breastfeeding mothers' perception of their confidence and intention to maintain exclusive breastfeeding. Conclusion: High self-efficacy to breastfeed alone was not enough to maintain exclusive breastfeeding. It is necessary to combine self-efficacy and family or health service support and guidance to clarify the mother's doubts about potential difficulties that may appear throughout the breastfeeding process, the maintenance of lactation when she plans to return to work, and the breastfeeding technique. Implication for practice: Applying the Breastfeeding Self-Efficacy Scale associated with the breastfeeding mothers' interview during the prenatal and perinatal period facilitates early identification of mothers at risk for early weaning and helps nurses in planning interventions to support the breastfeeding mother and her child in favour of exclusive breastfeeding duration. What is already known about the topic? Exclusive breastfeeding (EBF) is recommended for the first six months of a child's life; however, many mothers do not follow this recommendation due to multiple barriers such as mental health issues (i.e., postpartum depression or anxiety), educational gaps, physical discomfort like sore nipples, engorgement, return to work, and lack of support. Breastfeeding self-efficacy has been associated with the duration of breastfeeding. What this paper adds Breastfeeding mothers' self-efficacy is essential for stimulating maintenance. Questions 3 (I always feed my baby without using powdered milk as a supplement) and 11 (I always breastfeed my baby on one breast and then switch to the other) of the Breastfeeding Self-Efficacy Scale (short form) predicted early weaning risk. Planning nursing care intervention for breastfeeding mothers in their follow-up after birth should include assessing their breastfeeding self-efficacy and factors that could contribute to early weaning, such as returning to work and the lack of a support network.

A Descriptive Study to Assess the Level of Knowledge Regarding National Geriatric Health Care Policies Among Elderly People in a Selected Area of Haridwar

This descriptive study aimed to assess the level of knowledge regarding national geriatric health care policies among elderly people in a selected rural area of Haridwar. Geriatric health care is an important aspect of ensuring the well-being and quality of life for the elderly, a population that is often dependent on external support due to the aging process. The study was conducted among 80 participants aged 60 years and above using a non-probability purposive sampling technique. Data was collected through a self-structured questionnaire designed to evaluate knowledge of national policies such as the Indira Gandhi National Old Age Pension Scheme, Atal Pension Yojana, Ayushman Bharat Yojana, and others. The results indicated that the majority (65%) of the elderly had average knowledge, while 35% had poor knowledge of these policies, and no participant demonstrated a high level of knowledge. Further analysis revealed no significant association between the level of knowledge and demographic factors such as age, gender, education, and income. This lack of awareness suggests a pressing need for greater dissemination of information regarding geriatric health care policies in rural communities, where elderly people may be particularly vulnerable to poor health outcomes due to limited access to healthcare and support services. The study concludes that improving awareness and access to these policies can empower the elderly to better utilize available resources, ultimately improving their health and well-being. The findings highlight the need for targeted health education programs and policy-level interventions to bridge the knowledge gap in rural areas. Future research should explore larger populations and examine strategies to effectively increase policy awareness among the elderly.

Self-Report of Changes in Cognitive-Communication Function and Social Engagement Among Adults With Cancer-Related Cognitive Impairment.

This study aimed to examine the prevalence of cognitive-communication deficits in adult cancer survivors who reported experiencing cancer-related cognitive impairment (CRCI). The study also aimed to determine how these problems impact their ability to engage socially and find satisfaction in their social roles. This study employed a cross-sectional survey to collect data from adult cancer survivors. The survey included questions on demographic characteristics, self-perceived cognitive-communication abilities, social engagement, and satisfaction with social participation. Data analysis included descriptive statistics, Spearman rank-order correlation, Mann-Whitney U tests, and Kruskal-Wallis H tests. Of 172 participants, 78% completed the survey, with 109 self-reporting CRCI. The participants predominantly had breast cancer, and most were diagnosed with Stage II cancers. The results indicated self-perceived impairment in various cognitive-communication domains, with functional daily communication being the most affected. Participants reported more difficulty participating in social roles and activities than their overall satisfaction with social participation. This study explored the relationships between cognitive-communication scores and social engagement, considering variables such as education, cancer type, stage, age, and treatment. This study underscores the multidimensional nature of CRCI, emphasizing the importance of addressing both cognitive-communication and social aspects in interventions and support services. It highlights the clinical implications for speech-language pathology, suggesting a potential role in identifying and addressing cognitive-communication deficits. Future research needs are discussed.

Exploring the Potentials of Digital Economy for Accelerated Economic Growth and Sustainable GDP in Nigeria’s Agricultural Sector

Purpose: The study investigated the potentials of the digital economy for accelerated economic growth in Nigeria. Specifically, the study was guided by the following objectives; potential of the digital economy for accelerated economic growth and sustainable GPD, constraints to attaining the utilization of the digital economy for accelerated economic growth and sustainable GDP and ways of improving the implementation of digital economy for accelerated economic growth and sustainable GDP. Theoretical Reference: Diffusion of Innovation (DOI) Theory, developed by E.M. Rogers in 1962, formed the theoretical foundation of this study. It originated to explain how, over time, an idea or product gains momentum and diffuses (or spreads) through a specific population or social system. The result of this diffusion is that people, as part of a social system, adopt a new idea, behavior, or product. Method: The descriptive survey design was adopted using 130 farmers selected through a convenience sampling approach in the four North Central States of Nasarawa, Benue, Plateau and Niger including the FCT Abuja. Data was gathered using closed-ended questionnaires and measured using modified three-point Likert Scale of Agree = 3, Uncertain = 2 and Disagree = 1. The Lawshe’s formula yielded a content validity ratio (CVR) of 0.99, which confirmed the representativeness and clarity of the questionnaire. A reliability coefficient alpha (r - coefficient) of 0.84 was reported by Cronbach Alpha to determine the internal consistency of the questionnaire. The data was collected on the spot and analyzed using frequency counts (f) and percentages (%), and presented in tables and graphs. Results/Conclusion: The findings showed that the farmers understood clearly the potential of the digital economy in creating jobs and accelerating their economic status and contributing significantly to a sustainable GDP in Nigeria if properly utilized. However, the attainment of these enormous benefits to farmers is affected by the reduction in access to the Internet, affordability and quality of service, training and government support. Digital economy could boost agricultural production with wide project margin if infrastructure for implementation are available and utilization is effective. The study recommended the provision of broadband sufficient to provide extensive access to the Internet in order to accelerate utilization and improve productivity, especially among rural dwellers. Implication: Understanding the potential offered by embracing and utilizing the digital economy, as well as the difficulties and strong tactics farmers must employ to successfully capitalize on these advances in order to boost GDP and economic growth in Nigeria's agriculture sector Originality/Value: The originality of this investigation lay in its empirical evidence regarding the potentials, challenges, and strategies for enhancing farmers' utilization to support economic growth and GDP in the agricultural sector, which helped to expand the body of literature on digital economy in the agricultural sector, particularly in Nigeria.

Analysis of Rural Producers' Performance Indicators: a Case Study of Cooperative Members of the Southern Bahia Cocoa Indication of Origin

Objective: The aim of this study is to investigate performance indicators for cocoa in the southern region of Bahia for the period 2021-2023. Theoretical Framework: Through a literature review, this study aims to understand the concepts and connections between Geographical Indication and its impacts on socio-economic development as a basis for analyzing qualitative data collected from the Cacau Sul da Bahia Association and the Brazilian Micro and Small Business Support Service to evaluate and compare the impacts over time. Method: An applied and exploratory approach was used, using secondary data, which was analyzed according to Bardin's (1997) proposal. Results and Discussion: The research shows the seasonality of cocoa production in the south of Bahia, with production peaks in July, the peak harvest season. Production stability is suggested for the 2021-2023 period. The geographical distribution of producers showed a concentration of production in a few municipalities, as well as the fact that only five maintained regularities over the three years. Research Implications: The research implies the need for management and planning strategies to ensure the sustainability of the sector and promote greater participation by municipalities in cocoa production in the region. Originality/Value: This study proposes a comprehensive assessment of the socio-economic and environmental impacts in a region with a product protected by Geographical Indication.

Family carers as service producers – insights into psychological contracts

ABSTRACT Family carers and caregiving have a role in the service system but family carers are often invisible and go unnoticed in society. In this article we are interested in family carers as service producers in health and social care. We analyze family care using the concept of a psychological contract. A psychological contract is an unspoken, unconfirmed and unwritten agreement where an exchange is based on perception rather than what is explicitly written and agreed. A psychological contract shapes family carers’ expectations and obligations, while providing a concept for understanding their work. The data were analyzed via theory-driven content analysis. Research question is: what are the features of a psychological contract in a family carer´s work? Data were collected from Finland in 2015. Ten family carers, aged between 64–78 years, who take care of their spouses were interviewed. A psychological contract involves the normative and mental schema of the carers, which direct what kind of care they feel they should provide as a spouse and carer. The psychological contract also guides what kind of support the carers may be willing to accept. The psychological contract clearly shows that family carers are primarily spouses rather than service providers. The concept of the psychological contract provides a workable frame to describe the relationship between family carers and the service system. This study enables the development of family care support services for the needs of family carers.

Screening for STIs among criminal legal system involved youth of color in community settings

BackgroundSexually transmitted infections are a significant, and growing, public health problem in this country – particularly among youth. Innovative strategies are needed to reduce the community burden of infection. Preliminary studies indicate that individuals involved in the criminal legal system have high rates of infection. While gaps exist in providing screening for incarcerated individuals, there are minimal efforts that have been initiated to screen individuals diverted from incarceration. In this study, we examined the STI risk profile and feasibility of screening for sexually transmitted infections for youth who were attending an alternative sentencing program after arrest for a minor offense. Youth were screened for chlamydia and gonorrhea using urine-based nucleic acid amplification tests.ResultsOf the 307 participants engaged in a program providing supportive services for criminal legal system involved youth at the Brooklyn Court House in New York City, 186 agreed to screening for sexually transmitted infections, and 8% were positive for chlamydia, gonorrhea, or both.ConclusionsScreening programs within carceral settings have proven effective in identifying individuals with STIs. However, with policy changes diverting more young people away from incarceration and into community-based programs, innovative programs are needed to identify STIs among youth in these settings. Our findings indicate that it is feasible to conduct venue-based screening in these settings, and, doing so may identify youth in need of treatment and further evaluation.

Multilevel factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China: a social-ecological model-informed study

BackgroundHIV-related stigma continues to hinder optimal HIV care, and its determinants should be understood at multiple levels. Based on the social-ecological model, this study aimed to explore factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China.MethodsA cross-sectional study was conducted from July to August 2022 to recruit newly reported women living with HIV with a history of pregnancy or current pregnancy in 2021 in 21 cities in Guangdong Province. HIV-related stigma was assessed using an abbreviated Chinese version of Berger's HIV Stigma Scale. Univariate and multivariable hierarchical regression analyses based on the social-ecological model were conducted to explore factors associated with HIV-related stigma and its four dimensions (personalized stigma, disclosure concerns, negative self-image and concerns about public attitudes) at the community/hospital, interpersonal, and individual levels.ResultsA moderate level of HIV-related stigma was found among the 360 participants included, with a mean score of 45.26. Multivariable hierarchical regression analysis showed that at the community/hospital-level, individuals were more likely to experience high levels of HIV-related stigma if they had experienced the discriminatory behaviors from health care workers (aOR = 2.34, 95%CI: 1.48–3.70) and if they rated serostatus disclosure services as less helpful (aOR = 0.69, 95%CI: 0.48–0.98). At the interpersonal-level, individuals with an HIV-positive partner (aOR = 1.71, 95%CI: 1.01–2.90) were more likely to experience high levels of HIV-related stigma than those with an HIV-negative or unknown partner. Individuals with high resilience (aOR = 0.22, 95%CI: 0.13–0.35) had lower levels of HIV-related stigma at the individual-level. In addition, ever experiencing discriminatory behaviors from health care workers, thinking serostatus disclosure services helpful, having ever seen publicity about personal interest protection services and complaint channels for people living with HIV(PLHIV), knowing about care and support services for PLHIV from social organizations at the community/hospital-level, partner notification and support at the interpersonal-level, and violations of personal interests, resilience at the individual-level were also associated with different dimensions of HIV-related stigma.ConclusionsHIV-related stigma was moderate among women living with HIV. The social-ecological model can facilitate a better understanding of factors associated with HIV-related stigma. Multilevel intervention strategies need to be tailored to reduce HIV-related stigma.

Taboo subject of miscarriage? - Anchoring through mechanisms at the medical, social, and organisational level "It broke my heart and that's just the way it is ..."

Miscarriage is the most common complication of pregnancy. In this work, the experiences associated with miscarriage and their relevance for the women are analysed on different levels. In May 2023, 14 guided interviews were conducted with women. The text material obtained will be brought to a higher level of abstraction using Mayring's content analysis approach and then interpreted. The results of the study underpin the significance of a miscarriage as a dramatic experience and the assumption of a broad taboo experienced as stressful. The deliberately chosen exchange among like-minded people, the concealment of the pregnancy and subsequently the miscarriage for reasons of shame, self-protection from professional disadvantages, and the assumption of overburdening the partner do not weigh as heavily as those mechanisms that operate in the health sector: at this level, mistrust, trivialisation and organisational and spatial inadequacies contribute to tabooing. The stressful circumstance of miscarriage is cushioned by people who recognise the grief and offer support. Based on the results of the study, improvements can be derived primarily in the area of care: Recognition of miscarriage, needs-based support services, improvement of communicative elements and organisational and spatial framework conditions.

What are the barriers and facilitators for health and social care professionals accessing organizational wellbeing support services? A mixed-methods study

Recent years have seen increases in workers’ stress levels and sickness absence rates. Organizations have increased the number of wellbeing support services they offer employees, but uptake has been poor. This study investigated barriers and facilitators to accessing organizational wellbeing support services. A two-study, mixed-methods design in health and social care employees was used. Study 1 conducted a directed content analysis of qualitative interview data based on the Theoretical Domains Framework (TDF) to identify barriers and facilitators. These were translated into survey items. Study 2 conducted a quantitative cross-sectional survey to assess whether the number of barriers and facilitators was associated with the likelihood of service use. Study 1 (n = 20) created a survey list of 23 barriers and 23 facilitators. Study 2 (n = 162) found that a greater number of facilitators was associated with a greater likelihood of service access, but number of barriers was not. We concluded that increasing facilitators may increase employee uptake of wellbeing support services. Facilitators include making access routes to services simple and efficient and circulating regular information to staff about available services.

Az Europol-együttműködés tapasztalatai

Aim: The aim of the article is to present the practical experience of cooperation between Europol, which plays a key role in international criminal cooperation, and Hungary. Methodology: The author collected knowledge about the operation of Europol and its investigative support services by studying the available EU legislation, and by working as the Head of the Hungarian Liaison Bureau at Europol, as well as by carrying out the tasks of the former expert in the cyber-attacks priority and the deputy national EMPACT coordinator. Findings: Europol’s system of cooperation with the Member States and operational and strategic partners provides the law enforcement agencies of the countries concerned with an opportunity that no other agency, institution or organisation can offer. In addition to supporting specific investigations, the institutional system also provides countries with IT, strategic and financial support. Value: The article aims to provide a practical and comprehensive overview of the state of cooperation with Europol, to give a deeper insight into the day-to-day work of the law enforcement and judicial authorities and to provide the interested reader with contextualized insights into the steps and processes involved.

The Impact of Medical Education Quality on Career Adaptability for International Students in China: The Mediating Role of Proactive Career Planning Behavior

Background: The quality of medical education plays a significant role in shaping the career outcomes of international students. As they navigate the challenges of their studies and career paths in a foreign country, understanding the elements that influence their career adaptability is essential. Objective: This study aims to examine the impact of medical education quality on career adaptability among international students in China and to emphasize the mediating role of proactive career planning behavior. It also investigates challenges related to cultural adjustment. Methodology: A quantitative technique is employed in a cross-sectional survey of international medical students in China. Information was collected from 575 valid responses through structured questionnaires. The research utilizes regression analysis and Structural Equation Modeling (SEM) to assess the relationships between medical education quality, career adaptability, proactive career planning behavior, and cultural adjustment challenges. Result: The evaluation revealed that medical education quality positively influences career adaptability (p < 0.001, β = 0.45). Proactive career planning behavior was found to positively influence career adaptability (p < 0.001, β = 0.38). Medical education quality positively influences proactive career planning behavior (p < 0.001, β = 0.50), and proactive career planning behavior mediated the connection between medical education quality and career adaptability (p = 0.013, β = 0.20). Cultural adjustment challenges moderated the relationship between medical education quality and career adaptability, with a significant interaction effect (p = 0.032, β = -0.15). Conclusion: The research emphasizes the significance of high-quality medical education in promoting career adaptability among international students, highlighting proactive career planning and examining cultural adjustment challenges for optimal career outcomes. These insights can inform educational practices and support services for international medical students, aiming to enhance their career readiness and adaptability in a global context.

White privilege, ethnic disadvantage, and stigmatized linguistic capital: COVID-19 infection rates and lockdown law enforcement in Hong Kong

The COVID-19 pandemic has exposed and exacerbated existing disparities in various societies. This study investigates disparities among racial, ethnic, and linguistic groups in Hong Kong's society in COVID-19 infection rates and lockdown enforcement practices that was imposed 545 times from January 2021 to September 2022 and affected 9% of the population. It is found that neighborhoods with more white individuals had lower infection rates than the overall population, while those with more ethnically minoritized groups had higher infection rates. Furthermore, hit rate tests reveal that the government targeted more neighborhoods with a higher share of individuals from linguistically minoritized groups. This novel finding suggests that not only race, but linguistic difference of the same ethnicity can cause bias. The study highlights the positive impact of providing ethnic support services on health outcomes in neighborhoods with a higher share of individuals from ethnically minoritized groups.

Adaptive Scenario Planning Development for Indonesian Digital Health Industry: Case Study of Export Support Services (ESS) in Promoting UK Companies Entering Indonesia

The COVID-19 pandemic, once an unpredictable yet plausible future event, has proven to be a reality, highlighting the urgent need for adaptation. Factors such as varying Universal Health Coverage (UHC) maturity, limitations in healthcare infrastructure, and unpredictable private sector moves, including venture capital investments, add to the uncertainty. Like the COVID-19 pandemic, Brexit was another unpredictable yet plausible event that has become a reality. Export Support Service (ESS), a UK Department for Business and Trade (DBT) initiative, assists UK SMEs in expanding beyond the EU post-Brexit, including Indonesia’s digital health sector. The study refines its strategy to navigate the market’s complexities through adaptive scenario planning. This study identified 25 key factors shaping Indonesia’s digital health future and developed three scenarios: “Cherry Blossom Park,” “Volcano Eruptions Amidst a Forest,” and “High-Tech Greenhouse in a Desert.” Each scenario explores implications and opportunities, providing strategic guidance for ESS.