WHO Framework Research Articles

Validating the Motives for Online Gaming Questionnaire (MOGQ) within the WHO and APA gaming disorder symptoms frameworks

The increasing interest in digital games and the reasons behind their popularity worldwide warrants further psychometric investigation of motivation factors for engagement in digital games. The present study aimed to validate the Motives for Online Gaming Questionnaire (MOGQ) in a Swedish sample and compare the associations between the seven motivational factors and gaming disorder symptoms across the American Psychiatric Association and World Health Organization diagnostic frameworks. Furthermore, considering the utility of more concise psychological measures, a 14-item version of the MOGQ was developed (MOGQ-14). A sample of 678 Swedish video game players (68.4% men, 29.7% women, and 1.9% other, Mage = 29.5 years, range 15 to 66) were included in the analyses after participating in an online survey. The analyses revealed that the Swedish version of the MOGQ had good psychometric properties. All MOGQ factors showed good reliability (McDonald’s omega), and all intercorrelations among the MOGQ dimensions were consistent with previous findings. The results showed that, on average, men reported higher gaming motivations concerning competition than women. The relationships between six gaming motivation factors (social, escape, competition, coping, skill development, fantasy) and gaming disorder symptoms were consistent with previous research. Findings indicated that the relationship between motivations (escape and recreation) and gaming disorder symptoms varied across APA and WHO diagnostic frameworks, depending on the motivation scale used (MOGQ or MOGQ-14). Recreation significantly differed in its relationship with symptoms when using MOGQ, and the MOGQ-14 showed larger effect sizes in the WHO framework for escape and recreation motivations.

Abstract 4137594: Intrinsic Capacity Trajectories and Cardiovascular Disease Among Chinese Older Adults: A Population-Based Longitudinal Study

Background: WHO defined intrinsic capacity (IC), a composite of physical and mental capacities, is a marker of healthy aging. Monitoring IC trajectories in older adults may guide preventative strategies and delay negative health outcomes. With the rapidly increasing proportion of older adults and the high prevalence of cardiovascular disease (CVD) in China, this study aimed to identify IC trajectories over time and determine whether IC trajectories can predict CVD outcomes. Hypothesis: The IC trajectory among Chinese older adults is heterogeneous; the decline of IC will be associated with increased CVD. Methods: The study used data from five waves (2011 to 2020) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 3,336 adults aged 60 years or older without CVD during the baseline survey in 2011 (T1), who completed the follow-ups in 2013 (T2) and 2015 (T3) were included to determine IC trajectory. IC was assessed through five domains (locomotion, sensory, vitality, cognition, and psychology) using the WHO framework. The CVD outcomes were determined by self-reported diagnoses of heart disease or stroke in the 2020 (T5) wave. A group-based trajectory model (GBTM) was used to identify IC trajectory, and logistic regression was employed to explore the association between IC trajectory groups and CVD outcomes adjusting for covariates. Results: Three IC trajectory groups were identified (Fig 1): high IC-stable group (13.40%), medium IC-stable group (56.12%), and low IC-decline group (30.48%). By the 2020 follow-up, 1204 participants (36.1%) reported CVD diagnosis. Adjusted for sociodemographic, lifestyle factors (smoking, drinking), and cardiovascular metabolic factors (hypertension, diabetes, dyslipidemia), compared to the high IC-stable group, the low IC-decline group had 63.7% higher odds of CVD (OR=1.637, 95%CI=1.268-2.114), and medium IC-stable group had 7.1% higher odds of CVD (OR=1.071, 95%CI=0.851-1.349). Conclusion: IC trajectory among Chinese older adults is heterogeneous, and IC declines predict higher odds of CVD onset. Regular monitoring of IC and tailored intervention to improve IC may facilitate CVD prevention.

Nurturing care: perceptions and practices of caregivers for children under five in the Ecuadorian highlands – a qualitative study

IntroductionThe importance of nurturing care for child development is well-established, and parents play a central role in providing this care. However, cultural values and traditions can influence child-rearing practices, and there are gaps in child welfare in Ecuador. Two research questions delve into caregivers’ definitions of nurturing care for children aged 0–5 and its alignment with World Health Organization’s concept.MethodsA qualitative methodology was applied to comprehensively explore caregivers’ perspectives and application of nurturing care across diverse cultural contexts in rural areas of Cotopaxi and Loja in Ecuador. Using snowball sampling primary caregivers, healthcare professionals, childcare workers, and community leaders were interviewed and participated in focus groups, examining its congruence with WHO’s Nurturing Care Framework for Early Childhood Development.ResultsWhile there is alignment with the WHO framework, the study reveals challenges such as a lack of awareness of the term “nurturing care” among participants. Findings also indicate issues in health communication, reliance on traditional medicine, and myths around nutritional practices. The role of technology in early learning is explored, noting both its advantages and disadvantages. Notably, preventive health activities were not mentioned, emphasizing a universal need for knowledge.ConclusionThis study urges tailored interventions for nurturing care, emphasizing success tied to robust healthcare and child protection. Urgency lies in cultural sensitivity, local adaptation, and targeted training for implementation. These insights contribute significantly to the global discourse, stressing the importance of context-specific approaches. Implications are crucial for policymakers, practitioners, and researchers dedicated to elevating care quality for vulnerable populations worldwide.

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

Climate change and health vulnerability assessments to increase regional climate resilience

Abstract Background The impacts of climate change on health and healthcare systems exhibit complex interrelationships, varying across time and space. Population groups already disadvantaged due to their demographics, health, socioeconomic status, or geographical location tend to be particularly vulnerable to climate-related health risks. Our work aims to develop a method for a systematic quantitative vulnerability assessment to make regional vulnerabilities comparatively measurable. Methods Building on the WHO framework on Climate Change and Health Vulnerability and Adaptation Assessment (2021) a data mapping process was carried out to identify and validate vulnerability factors and quantitative indicators on a small-scale spatial resolution for the five dimensions: demographic, socioeconomic, biological/health, sociopolitical, and geographic/climate. Regional vulnerability scores for each indicator were calculated and visualized as geographic maps and circular barplots to allow for easily understandable interpretation. Results A set of 25 quantitative vulnerability indicators from a multitude of data sources - combining register data, survey data, and geospatial data - was compiled. Main challenges were the identification of sociopolitical vulnerability factors suitable for Austria and data availability on a small-scale level. The indicator set was used to identify regions that are particularly vulnerable due to their population composition, disease burden, and geographical location (e.g. regions in Eastern Austria with high shares of persons < 65 years of age, unemployment, and heat days). Conclusions Systematically assessing vulnerabilities in key dimensions is central to identifying regionally specific pressure points, allowing for a quantitative baseline to derive adequate and tailored climate change adaptation measures to sustain future health. Systematic assessment provides essential insights for policymakers, public health officials, and disaster management agencies.

Tobacco control policies discussed on social media: a scoping review

ObjectiveTo describe the scope of published literature about tobacco-related policy discussions from social media data and discuss implications for tobacco control policy and future research.Data sourcesPubMed, Medline, CINAHL and Web...

Women's suggestions on how to improve the quality of maternal and newborn care: A qualitative analysis from the IMAgiNE EURO survey in Italy during the two years of the COVID-19 pandemic.

Collecting women's views and suggestions for improving quality of maternal-newborn care (QMNC) is a crucial aspect of maternity care evaluation often overlooked in Italy and globally. Childbearing women experienced numerous challenges during the COVID-19 pandemic including the rapid and significant reorganization of maternity services and care. Their perspective on what to prioritize for QMNC improvement is hence pivotal. The aim of this study was to explore maternal suggestions for QMNC improvement from women who gave birth during the two years of the COVID-19 pandemic. Data were collected from an open-ended question included in a validated online questionnaire administered to mothers who gave birth in an Italian hospital between November 2020 to March 2022. The responses were analyzed using thematic analysis and mapped against the WHO Standards for improving QMNC and the WHO Framework of QMNC. The thematic analysis identified five main themes from the 2017 responses: 1) Support for mothers during the postnatal period; 2) Better use of resources; 3) Improvement of the maternity environment; 4) Reconsideration of organizational aspects; and 5) Guarantee of respectful practices. Women commented on all dimensions of the WHO framework except for two provision of care subdomains 'actionable information and functional referral systems'. This is the first qualitative study in Italy focusing on women's suggestions for improving QMNC during the COVID-19 pandemic. Its findings can be used to inform what aspects of QMNC need improvement in Italy. Collection of women's views should be incorporated in routine monitoring of the QMNC, and data should be used for quality improvement purposes.

A process study of early achievements and challenges in countries engaged with the WHO Special Initiative for Mental Health

BackgroundThere is increasing awareness of the importance of the transformation of mental health systems. Launched in 2019, the WHO Special Initiative for Mental Health seeks to accelerate access to quality and affordable care for mental health conditions as an integral component of Universal Health Coverage. Nine countries are currently engaged with the initiative.MethodsThis study reviewed processes of implementation—and progress achieved—across all settings by late 2022. It involved review of 158 documents provided by WHO relating to Special Initiative activities and 42 interviews with country-level stakeholders, WHO Regional and HQ personnel engaged with the initiative, and core donors. Documents were thematically coded using a template based upon the WHO framework of health system building blocks. Responses to structured interviews were coded based on an emergent thematic framework.ResultsDocumentation reported similar achievements across all domains; however challenges were reported most frequently in relation to service delivery, leadership and governance, and workforce. Issues of financing were notable in being twice as likely to be reported as a challenge than a success. Interviews indicated four major areas of perceived achievement: establishing a platform and profile to address mental health issues; convening a multi-stakeholder, participatory engagement process; new, appropriate services being developed; and key developments in law, policy, or governance around mental health. The planning process followed for the initiative, senior country-level buy-in and the quality of key personnel were the factors considered most influential in driving progress. Ambivalent political commitment and competing priorities were the most frequently cited challenges across all interviewees.ConclusionsThe role of the Special Initiative in raising the profile of mental health on national agendas through a participatory and inclusive process has been widely valued, and there are indications of the beginnings of transformational shifts in mental health services. To secure these benefits, findings suggest three strategic priorities: increasing political prioritisation and funding for systems-level change; clearly articulating sustainable, transformed models of care; and promoting feasible and contextualised measures to support accountability and course correction. All are of potential relevance in informing global strategies for mental health systems transformation in other settings.

Tobacco companies, corporate social responsibility and the use of third-party awards: a framing analysis

ObjectiveCorporate social responsibility activities, such as third-party awards, provide an opportunity for tobacco companies (TCs) to promote themselves as socially, economically and environmentally responsible organisations. This study aimed to determine...

Global landscape of nicotine and tobacco products additives policies

IntroductionProduct design is a key tobacco industry strategy to recruit consumers and hinder cessation. An important technology in tobacco product design is the use of additives including those that create...

Assessing the impact of COVID-19 on HIV care cascade for people living with HIV in Ethiopia: a retrospective longitudinal study.

The study aimed to investigate the impact of COVID-19 on the cascade of HIV care for people living with HIV (PLHIV) in Ethiopia. A retrospective longitudinal study. The study was conducted in North Showa Zone, Ethiopia, from pre-COVID-19 (January 2018-December 2019) and during COVID-19 (January 2020-December 2021). We identified 61901 records from 3925 PLHIV, of which 23 848 were recorded during the pandemic. We investigated indicators from four stages of the HIV care cascade, including HIV screening and diagnosis, HIV care, HIV treatment and HIV disease progression, according to a WHO framework. The indicator changes were assessed with incidence rate ratios (IRRs). For HIV screening and diagnosis, the monthly number of HIV tests experienced a 46% decline from 2520 to 1361 since the pandemic (IRR 0.553; 95% CI 0.546 to 0.561). For HIV care, the monthly number of consultations was reduced by 49.6% (from 1582 to 798) since the pandemic (IRR 0.591; 95% CI 0.581 to 0.601). Similarly, the monthly number of viral load tests was reduced by 42.8% (IRR 0.614; 95% CI 0.581 to 0.650). For HIV treatment, the number of antiretroviral therapy (ART) initiations was reduced by 27.8% and the number of ART adherence by 52.5% since the pandemic. For HIV disease progression, the monthly number of PLHIV achieving viral suppression was reduced by 61.6%, while HIV-related deaths doubled during the pandemic. The study highlights pandemic-induced disruptions in the cascade of care for PLHIV. Targeted interventions are necessary to protect PLHIV in public health emergencies.

Antibiotic prescribing patterns in pediatric patients using the WHO access, watch, reserve (AWaRe) classification at a quaternary hospital in Nampula, Mozambique.

Antibiotics are often prescribed inappropriately, either when they are not needed or with an unnecessarily broad spectrum of activity. This is a serious problem that can lead to the development of antimicrobial resistance (AMR). This study was conducted to assess the antibiotic prescribing pattern in pediatric patients hospitalized at a quaternary hospital in Nampula, Mozambique, using the WHO indicators and Framework as a reference. A retrospective study was conducted using secondary data obtained from medical records. The study population consisted of children aged 0-10years who were hospitalized in a quaternary-level hospital ward in Nampula, Mozambique. The pattern of antibiotic prescriptions was assessed using indicators and the WHO classification of antibiotics into AWaRe categories. Descriptive statistics were applied. A total of 464 antibiotics were prescribed during the study. The age groups of 1-3years and 28days-12months were prescribed more antibiotics. The most common antibiotics were ceftriaxone and crystallized penicillin, which were frequently prescribed for patients suffering from bronchopneumonia, gastroenteritis, and malaria. 74.8% of the antibiotics prescribed belonged to the Access group, while 23.7% belonged to the Watch group. There were no prescriptions of antibiotics from the Reserve group. The average number of antibiotics per prescription was 1.51 (SD ± 0.725). The percentage of antibiotic prescribing was 97.5%, with 96.20% by injection. All antibiotics prescribed were on the essential medicines list and prescribed by generic name. These results are concerning and highlight the urgency of strengthening antimicrobial optimization measures, as well as implementing the AWaRe framework in antibiotic prescribing as an essential strategy to combat AMR.

Re-politicizing the WHO's social determinants of health framework.

Although the World Health Organization's (WHO's) framework on social and structural determinants of health and health inequities (SSDHHI) has done much to raise awareness of these determinants, it does not go far enough in considerations of politics and power. The framework has become more de-politicized since its publication, with the definition of social determinants shifting toward downstream and individualized factors. In the meantime, new research fields on legal, commercial and political determinants of health and health inequities have emerged; however, these have not become integrated adequately into broader SSDHHI frameworks. To address these challenges, we argue for a re-politicization and an expansion of the WHO's framework by including the agents who have power over shaping structural determinants and the ways they use power to shape these determinants. We also provide a more detailed conceptualization of structural determinants to facilitate research. We propose a guideline for evaluating studies according to the extent to which they point upstream versus downstream and incorporate agents and considerations of power. We then use this framework to encourage more research on associations among agents, mechanisms of power, and structural determinants; how changes in structural determinants affect power dynamics among agents; and a wider focus on structural determinants beyond laws and policies, such as broad economic and sociopolitical systems. We also urge researchers to consider societal and institutional forces shaping their research with respect to SSDHHI. Research based on this framework can be used to provide evidence for advocacy for structural changes and to build more just systems that respect the fundamental human right to a healthy life.

Biological monitoring of exposure to benzene in water pipe smokers of rural Western Uttar Pradesh (India)

Aim: Present study was performed to investigate the possible human exposure to benzene through water pipe smoking, if any, in the selected rural population of Western Uttar Pradesh. Methodology: Urine samples from water pipe smokers of both the sexes were collected and analyzed for urinary concentration of phenol, creatinine and malondialdehyde employing standard methods. Results: The results showed that tobacco used by selected rural population contained traces of benzene in the range of 2.75 to 9.682µl ml-1. Analysis of urine samples for phenol, a major metabolite of benzene, showed its increased concentrations in water pipe smokers than non smokers. Further, the effects of age and gender differences on the excretion of phenol were also recorded. Female water pipe smokers were found to be more vulnerable to benzene exposure than male smokers. Intriguingly, alcoholic water pipe smokers were less vulnerable than the non-alcoholic smokers. Interpretation: It is concluded that respiratory, cardiac and haematological disorders caused by water pipe smoking might be attributed to long term benzene exposure amongst water pipe smokers. Large scale epidemiological studies are warranted in Indian rural population considering WHO (Framework Convention on Tobacco Control) regulations of water pipe smoking and tobacco products. Key words: Biological monitoring, Benzene, Oxidative stress, Phenol, Tobacco, Waterpipe smoking

Tobacco industry interference to undermine the development and implementation of graphic health warnings in Bangladesh

BackgroundIn Bangladesh, the 2013 Amendment of the Tobacco Control Act made graphic health warnings (GHWs) on the upper 50% of all tobacco packs obligatory. However, at the time of writing...

Disseminating the F-Words for Child Development to Parents of Children With Developmental Disabilities in Iran: A Qualitative Pilot Feasibility Study.

Attitudes toward childhood disability have historically focused on biomedical efforts on 'fixing'. The introduction of WHO's ICF framework for health and Canadian researchers' 'F-words' (functioning, fitness, fun, friends, family and future) have significantly changed the field. To explore whether the F-words ideas influenced parents' perspectives on their child's abilities and rehabilitation goals, this qualitative pilot study introduced the F-words to Iranian parents with a child with a developmental disability. This study was conducted in Tabriz, Iran, in 2023, using Iranian educational F-words materials built on ideas available on the CanChild F-words Knowledge Hub. Data were collected through semistructured interviews with five mothers of children <5 years old with a developmental disability before and after attending an 'F-words Awareness Session' and analysed using thematic analysis. In the preinterviews, six themes (and 20 subthemes) were identified: (i) routines (5); (ii) challenges (4); (iii) parental concerns (3); (iv) child's needs and priorities (3); (v) the role of parents in satisfying needs and challenges (2); and (vi) expectations of rehabilitation (3). In the postinterview, the same six themes and four additional subthemes emerged. Findings from the pilot study showed that the intervention had an impact on the attitudes and behaviours of participants. Specifically, teaching about the F-words reduced parents' emphasis on the concept of 'normality'. Families' positive response to the 'F-words Awareness Session' indicates their openness to incorporating this approach into their daily lives. These findings highlight the potential benefits of utilizing the F-words in rehabilitation in Iran. Studies like these can serve as a foundation for developing effective strategies for integrating the F-words into existing rehabilitation practices in Iran.

Sustainability in Participatory Health: Applying WHO's Operational Framework.

The World Health Organization's Operational Framework for Climate Resilient and Low Carbon Health Systems outlines 10 broad components for the development and maintenance of health systems that respond effectively to climate-related challenges. This work analyses the WHO framework from a participatory health informatics perspective and identifies specific initiatives involving non-professionals that align with the framework. Citizen and patient participation in the development of climate-resilient health systems is not only possible but also necessary to maximize climate resiliency at the community and global levels.

Resolving disparities in access to cancer care in LMIC-positive learning using a 10-year-old model.

156 Background: Despite significant advances in cancer diagnosis and treatment, there are wide disparities in access to cancer care, more so in low- and middle-income countries. The problem is multifactorial, such as patient-related, health system-related, socio-cultural-related to language and literacy, and socio-cultural-related to beliefs and stigma. These disparities extend across the cancer continuum, from diagnosis to end-of-life care. It is imperative to address these disparities. Here we report 10-year experience from an innovative access delivery model in one go, comprehensively addressing many of these challenges. Methods: Learning from the WHO framework of health system strengthening, a model that affects the major contributors to health system strengthening was developed. These include government-owned health departments, district hospitals, and physicians. Various regulations strengthened each of these components. The regulations were issued to create systems in district hospitals, train an alternative oncology workforce, and make oncology drugs available in the periphery. This measure allowed cancer-care-related services to be feasible in the existing peripheral health system. Results: In 2014, one of the states in India decided to initiate cancer care services in government-run district hospitals. One physician and two nurses from every district hospital were trained to offer cancer-related services locally from diagnosis to end-of-life, including cancer chemotherapy, under the 24 x7 mentorship of a senior oncologist. To date, more than 250 physicians and 500 nurses have been trained in this field. The program has been extended to eight states and 198 districts, covering an area of over a million square kilometers and a population of over 380 million. Data from only one district alone showed that nearly 7000 new patients availed of services (average 700 per year) with more than 17000 sessions of chemotherapy (Table). Conclusions: The majority of the world, including LMICs, is dependent on the services provided by government-run health institutions. The empowerment of government health systems appears to be the single most important factor in improving access to cancer care. This model of cancer cere delivery has consistently proven its robustness, replicability, and scalability. This finding deserves consideration for further research and expansion to other countries. [Table: see text]

Genome Editing Dilemma: Navigating Dual-Use Potential and Charting the Path Forward.

Contemporary genome editing techniques have made genomic intervention-from microorganism to human-more accessible, easier to use, and more accurate than previous methods. We argue that, notwithstanding its merits in treating and preventing disease in humans, genome editing represents a potential threat for domestic and international security, requiring an integrated approach in regulating, detecting, preventing, and mitigating the risk of its use for malicious purposes. Despite the global regulatory ambitions of the 2021 WHO framework, we see insufficient attention given to the future prospect of dual-use genomic technology. Drawing parallels with the nuclear field, we suggest tentative practical steps for a way forward in dealing with genome editing technologies, such as: 1) adapting national (bio)security and defence strategies to include genome editing as a possible threat (with conceivable WMD potential); 2) enhancing the international dialogue on genome editing and raising the issue at the highest level; 3) working towards a global, legally binding verification mechanism; 4) tracking genome editing technologies.

Construction of a Full-Process Nursing Service Platform for Day Surgery Patients Based on Kano Model.

This study was based on the Kano model and rely on the Internet hospital to build a day surgery patient full-process nursing service platform. Based on the Internet hospital's HIS system, nursing Yuanzhuo system, patient mobile terminal (WeChat) and other information systems. The platform was designed by following the WHO's conceptual framework for developing a scaling-up strategy. It was tested and refined by a pilot in a hospital in China. The full-process care platform for day surgery patients realizes information interconnection and interoperability of patient surgical consultation, surgical inquiries, and postoperative follow-up. It consists of a WeChat applet (client) and an online website (server). Pre-experiment results show that patients are more likely to recommend the hospital's day surgery to others. The mHealth-based perioperative full-process nursing service platform for day surgery patients can initially meet the health education needs, surgical consultation needs and follow-up needs of day surgery patients.