Type 1 diabetes (T1D) has shown an increase in the incidence rate of about 3% per year over the last two decades. Continuous Insulin Subcutaneous Therapy (CSII) is widely used in the paediatric population with diabetes; however, it requires more preparation by the treating team and careful selection of potential users. Prescriptive provisions vary from Region to Region and the perspective of health workers still remains an unexplored area. The aim of the research project is to explore the representations of a group of diabetologists and psychologists working in pediatric diabetology on the national territory, regarding roles, functions and activities as part of a multidisciplinary team; their views on the potential benefits of CSII and the types of individuals applying for the use of technology. A socio-anagraphic data sheet was administered and two homogeneous focus groups were conducted by profession; they were audio recorded. The transcripts produced were analysed using the Emotional Text Mining (ETM) methodology. Each of the two corpus generated three clusters and two factors: for diabetologists, a focus on the patient in different levels of care emerged, collaborating both with other health professionals and with the territory, through the proposal of an intervention where the medical aspect is often represented by technology; also for psychologists there was a representation of interdisciplinary networking, with a greater focus on the processes inherent the management of pathology, from acceptance to the elaboration and integration of diabetes in the family narrative. The understanding of the representations of health professionals working in pediatric diabetes about new technologies can contribute to the consolidation of a network of professionals through a targeted work on possible critical issues emerged.

Smoking is a major risk factor for non-communicable diseases and remains a significant public health challenge in many lower- and middle-income countries (LMIC) including Namibia. The purpose of the study was to estimate the prevalence of smoking and its associated risk factors among HCWs and non-HCWs in Zambezi region. An exploratory cross-sectional survey was conducted between March and October 2020 among residents of the eight (8) constituencies of Zambezi region. Four hundred and sixty-one (461) respondents who had been residents of the selected constituencies for over five years and aged between 17-60 years were selected for the study. The main outcome measure was current cigarette smoking status. Descriptive statistics were used to summarize the socio-demographic characteristics of the respondents. We stratified data analysis by individual being health workers or non-health workers. A bivariate Pearson Chi-square test was used to determine the association between socio-demographic characteristics and the smoking status. Statistically significant variables in the bivariate analysis were used as predictors in the univariate and multivariate models. The response rate of potential participants was 95% (n=434). The mean (±SD) age of participant’s was 32.5 (± 11.34 years). Significant relationships were observed between smoking status and area of residency (constituency), gender, age category, level of education, age of onset of smoking and the daily smoking frequency. The majority of smokers (n=108) were none-HCWs with males being the majority (n=62). Age (p=0.001), education levels (p=0.001) and area of residency (p=0.022) were highly associated with smoking among none-HCW while marital status was associated with smoking among HCWs (p=0.013). In the final multivariate model, the odds of smoking among female non-HCWs were significantly lower (OR: 0.386; 95% CI: 0.228 – 0.655). Furthermore, the odds of smoking among this same group were lower among those who had secondary level education (OR: 0.178; 95% CI: 0.0659 – 0.483), post-secondary (OR: 0.117, 95% CI: 0.0412 – 0.330) and first stage tertiary (OR: 0.306: 95% CI: 0.106 – 0.881) compared to those who had primary school education. In conclusion, smoking prevalence among none HCWs and HCWs working in Zambezi included in the study was similar to that of the general Namibian population but higher than other neighboring countries within SADC. The results showed a need for the establishment of specific smoking related strategies that target HCWs to address smoking use parallel to the running of none HCWs which would ultimately decrease the smoking prevalence and improve health.

Type 2 diabetes (T2DM) presents an enormous global healthcare challenge, especially among rural communities due to limited access. To overcome this, many low- and middle-income countries are resorting to task shifting, using community health workers (CHWs) for diabetes management. However, its successful implementation depends on the practice behaviours and knowledge of these workers. This cross-sectional study from rural South India aimed to evaluate the proficiency of 275 CHWs in diabetes screening and management. A customized questionnaire, developed through experts and government was used to evaluate the practice behaviours and knowledge. Analytical methodologies consisted of descriptive statistics, logistic regression, and mosaic plots for comprehensive data interpretation. Results showed significant deficiencies of mean correct practice behaviours at 48 and 50% respectively. The identified gaps included diabetes diagnosis, HbA1c testing, diet, self-management, complications screening and risk assessment. In several areas, correct practice behaviour was reported by a relatively large number of CHWs despite incorrect answers to the related knowledge questions such as referral to the health centres, self-management and calculation of diabetes risk assessment. Addressing these deficiencies requires a thorough needs assessment and tailored training for improved diabetes management by CHWs. Training of CHWs, should not only identify prior knowledge and/or behaviour but also their interrelationship to help create a robust and flexible set of practice behaviours.

The COVID-19 pandemic has caused significant medical and psychological challenges worldwide, and not only exceeded the capacity of hospitals and intensive care units but also an individuals’ ability to cope with life. Health-care workers have continued to provide care for patients despite exhaustion, fear of transmission to themselves and their family, illness or death of friends and colleagues, and losing many patients. They have also faced additional stress and anxiety due to long shifts combined with unprecedented population restrictions, including personal isolation. In this study, we study the effect of an app-based Yoga of Immortals (YOI) intervention on mental health of healthcare workers. In this study, the health care workers were digitally recruited, and their psychological parameters were measured using validated questionaries. The participants were randomly grouped into control and test groups. The validated psychological measures were the Patient Health Questionnaire-8 (PHQ-8), Insomnia Severity Index (ISI) and generalized anxiety disorder (GAD-7) scales. The digital YOI intervention significantly reduced the anxiety, depression symptoms, and insomnia in healthcare workers of all age groups. In contrast, there was no improvement in the control group. This study details the effectiveness of an app-based YOI intervention in healthcare workers.

Background: The COVID-19 among humans is spreading heavily and is largely impacting the mental health of the general population, students, and health care workers worldwide. Hence, this review aims to summarize the literatures addressing the impact of the COVID-19 pandemic on the mental health of the general population, students, and health care workers. Methods: Published articles concerning mental health of the general population, students, and health care workers related to the COVID-19 outbreak have been considered and reviewed. Results and Discussion: Mental health symptoms of stress, anxiety, and depression are common psychological reactions to the COVID-19 pandemic in the general population, students, and health care workers. This collectively influences daily behavior, economy, prevention strategies and decision making from policy makers and health organizations, weakening the strategies of COVID-19 control leading to more morbidity and mental health needs at the global level. Conclusion: There is a need for more evidence-based research from other affected countries, particularly in vulnerable populations such as children and adolescents, people of lower socioeconomic status, and those residing in rural areas, so that valid strategies can be developed and COVID-19 and outbreaks of similar types in the near future can be prevented.

Healthcare workers (HCWs) in long-term care (LTC) faced and continue to experience significant emotional and psychological distress throughout the pandemic. Despite this, little is known about the unique experiences of LTC workers. This scoping review synthesizes existing research on the experiences of HCWs in LTC during the COVID-19 pandemic. Following Arksey and O’Malley’s framework, data were extracted from six databases from inception of the pandemic to June 2022. Among 3,808 articles screened, 40 articles were included in the final analysis. Analyses revealed three interrelated themes: carrying the load (moral distress); building pressure and burning out (emotional exhaustion); and working through it (a sense of duty to care). Given the impacts of the pandemic on both HCW wellbeing and patient care, every effort must be made to address the LTC workforce crisis and evaluate best practices for supporting HCWs experiencing mental health concerns during and post-COVID-19.

Abstract: (1) Background: Post-COVID syndrome is defined as symptoms that occur simultane-ously with or after COVID-19 infection, last for 12 weeks, and are not due to another diagnosis. Limited data are available on people’s long-term quality of life (QoL) following COVID-19 infection. The aim of this cross-sectional study was to investigate long-term QoL after COVID-19 among employees of the St. Josef Hospital in Paderborn, Germany, and to identify risk factors. (2) Methods: A monocentric, cross-sectional study was conducted using the validated and digitized WHOQOL-BREF questionnaire via Netigate® between 10/2022 and 02/2023. Data on QoL and global health status were collected in the following four domains: physical health, mental health, social relationships, and environment. (3) Results: The response rate was 73.84% (923/1250). Furthermore, 63.45% of hospital staff respondents reported at least one persistent symptom after COVID-19 infection, leading to significant differences in QoL. Pre-existing conditions, persistent symptoms, and disability after COVID-19 infection, as well as high BMI, no partnership, and low educational level were found to significantly contribute to long-term low QoL. (4) Conclusions: Obesity, lack of partnership, and a low level of education were independent risk factors for lower QoL post-COVID-19 infection in this cohort of hospital staff. Further multicenter studies are re-quired to validate the incidence and their suitability as independent risk factors for post-COVID syndrome.

Background: Since 2010, Burkina Faso has developed and initiated community-based management of childhood illnesses. Following the increased presence of community health workers and the adoption of free community health care, this study aims to assess community satisfaction with curative care administered by community health workers. Methodology: It was a descriptive and analytical cross-sectional study. Data were collected in the health districts of Boussé and Boussouma from 20 February to 30 March 2023 for quantitative data and from 12 to 30 January 2024 for qualitative data using a questionnaire (household survey) and an interview grid (focus groups). Analyses were conducted using SPSS IBM 25 and Nvivo 14. Results: Households benefit from oral curative care when using CHWs, but are not satisfied with the temporal accessibility of these community health workers. Temporal accessibility and awareness during care have a significant influence on household satisfaction. Conclusion: Curative care by community health workers is effective, but its use could be improved by addressing the unavailability of community health workers, inputs and better communication during care.

Under the dual background of underemployment and health inequality, this paper empirically analyzes the impact of education level on underemployed workers’ health based on CLDS2016 data. The results show that underemployment is significantly related to the decline of self-rated health, increased depression tendency, and morbidity in a certain period. The results indicate that underemployment can significantly reduce the health level of workers in the low education level group and the high education level group. However, it has no significant impact on workers’ health in the middle education level group; even if we change the measurement method of indicators and consider endogeneity, the research conclusion is still robust. Moreover, this kind of health inequality mainly comes from the difference in economic effect and leisure effect of underemployment to workers with different educational levels. This paper provides empirical support for increasing the labor protection mechanism of underemployed people and reducing the health inequality caused by educational level differences.

: (1) Background: Healthcare workers (HCWs) are a well-known risk group for coronavirus infections with increased working hours in a potentially infectious environment. We evaluated both IgG and Neutralizing antibody levels, with IgG avidity index and persistence among health workers. (2) Methods: 1001 HCWs were tested for both IgG and Neutralizing antibodies. IgG avidity testing and one-year follow-up testing were done on selected HCWSs. (3) Results: COVID-19 IgG antibody levels were high among 299 (94.62%) HCWs with a history of COVID-19 infection (p <0.0001) compared with 479 (69.92%) HCWs who were not infected with COVID-19 during the first and second wave. A total of 899 (89.81%) HCWs had more than 50% neutralizing antibodies while the remaining 102 (10.19%) HCWs had less than 50% of Neutralizing antibodies. The avidity index was maintained at almost 40% (Gray zone). Both antibody levels were found markedly increased after one year when compared to initial results. (4) Conclusions: Healthcare workers are at a 2.29-fold higher risk of infection; Two folds higher IgG levels in HCWs involved in COVID-19 duty and their persistence for a longer time than in other groups signifies IgG antibody role in the prevention of severe disease in HCWs involved in Covid-19 patient care.

Objectives: Female genital mutilation (FGM) is a significant public health problem. It is estimated around 14,700 women affected by FGM live in Switzerland, primarily among women with a history of migration. Our qualitative research investigated the sexual health of immigrant women living with FGM in Switzerland, describing their own perception of health, reproductive life and sexuality. Methods: We conducted semi-structured, in-depth interviews with a group of eight immigrant women of African origin living in Switzerland with Type III FGM (infibulation). Results: Seven of the women were from Somalia and one from Ivory Coast. All of the Somali women were mothers and married (two separated), and the Ivorian woman was a single mother. The women in our study reported a low level of sexual satisfaction and reproductive health. They affirmed their desire to improve, or at least change, their condition. Although they rarely talk with their husbands about sexual subject matter, they would like to include them more and improve dialogue. Conclusions: Specific socio-sexual management is recommended when caring for immigrant women living with FGM in order to respond to their specific health care needs. Multidisciplinary approaches may be able to offer more comprehensive health care, including facilitated communication to improve dialogue between women and health care professionals, and eventually between women and their husbands in discussing sexual matter.

The supply of mental health processes in primary care has gaps. This study aims to analyze the association of agreement criteria and flows between primary care teams and the Family Health Support Center (NASF) for mental health collaborative care, considering the difference between capital and non-capital cities in Brazil. This cross-sectional study was conducted based on secondary data from the Primary Care Access and Quality Improvement Program. Agreement criteria and flows were obtained from 3883 NASF teams of the matrix support or collaborative care. The Chi-square test and multiple Poisson regression were used; p < 0.05 was considered statistically significant. Prevalence ratios of negative associations demonstrated protective factors for support actions: follow-up at Psychosocial Care Center, management of psychopharmacotherapy, offer of other therapeutic actions, care process for users of psychoactive substances, and offer of activities to prevent the use of psychoactive substances. Collaborative care in primary care was effective, and capital cities were a protective factor compared with non-capital cities.

Migrants are mainly employed in "3D Jobs" dirty, dangerous, difficult, characterized by monotony, intense rhythms, in sectors at higher risk as construction, heavy industry, agriculture. Aim of this study is to elaborate a systematic review, in order to identify the main occupational risks and occupational diseases of this category. Research included articles published from 2013 to 2018 on the major online databases (PubMed, Cochrane Library and Scopus), using a combination of some keywords (migrant workers, expatriates, physical health, diseases, illnesses, travel, travelers, work and occupational). The online search indicated 1.109 references. We excluded 977 studies, because unrelated to physical health and 64 due to duplication. They were analyzed 68 articles, including 6 reviews and 62 original article. The main risk emerged are to developing infectious diseases, metabolic cardiovascular diseases and to manifesting a lower quality of life, in particular due to difficulties in accessing local health services. It will be crucial to implement the role of occupational medicine in order to introduce multilevel interventions designed to prevent work-related injuries and illnesses and to promote healthier working environments.

Hospital-acquired infections (HAIs) contribute to increased length of hospital stay, high mortality and higher health-care costs. Prevention and control of HAIs is a critical public health concern. We conducted a cross-sectional survey of 213 hospital health-care workers in Qassim, Saudi Arabia. We assessed Knowledge, Attitude and Practice (KAP) of standard infection control precautions using a structured questionnaire. Predictors of KAP were investigated using multivaraible logistic regression analyses and independent sample t tests. Prevalence of good (≥80% correct response) knowledge, attitude and practice were 67.6%, 61.5% and 73.2%, respectively. Predictors of good knowledge included age over 34 years (adjusted odds ratio: 30.5, p<0.001), and receiving training (13.3, p<0.001). Predictor of positive attitude was having >6 years of experience (5.5, p<0.001). While, the predictors of good practice were having >6 years of experience (2.9, p<0.01), previous exposure to HAIs (2.5, p<0.05) and training (3.5, p<0.01). However, being female (0.22, p<0.001) and older (>34 years) (0.34, p<0.01) were negatively associated with knowledge. Results indicate that older academic programs might not have adequately covered infection crontrol. Arranging training for HCWs might be useful in improving their knowledge of standard infection control precautions and is also expected to facilitate positive attitude and practice.

Keywords: Oral health, diabetes, periodontal disease, caries, periodontitis.

Little research has been done on occupational health ramifications of informal electronic waste (e-waste) recycling work, which is increasingly common in low- and middle-income countries, and very little is known about this in high-income countries. Our study evaluated informal and formal e-waste recycling workers in Chile, which was recently recognized as a high-income country. In 2017 we recruited 78 informal recycling workers from two cities, and 15 formal e-waste recycling workers from one recycling facility. Participants completed a questionnaire and health assessment regarding their involvement in, and potential impacts of, e-waste recycling, among other measures. Participants were primarily male, middle-aged, married with children, and had worked in e-waste recycling for an average of 12 years. Participants generally reported good health status, and chronic disease prevalence was similar to the national prevalence. Workers commonly reported exposures to several occupational stressors, including mental health stressors and noise, as well as insufficient income. Occupational injuries were common and use of safety equipment was low. No significant differences were found between informal and formal workers. Informal e-waste workers in Chile face occupational health challenges. The extent to which these issues impact the health of informal Chilean e-waste workers is unclear and warrants further research.

Dust inhalation is a huge concern in the mining environment and within all its operations. In fact, dust to be one of the most serious occupational hazards in the mining industry. Coal and crystalline silica dust are the causes of serious, sometimes fatal lung diseases such as pneumoconiosis, which affects coal miners, as well as silicosis, tuberculosis, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, and chronic renal disease, which affect coal and other types of miners. The resulting effects both affect workers and nearby communities. The mining industry has in the past, employed several approaches to reduce effects of dust. But these strategies have often been ineffective because the grass withers during the dry season and sprayed water is rapidly absorbed or evaporates. This paper endeavors to review information on dust in the mining environment and how it is a nuisance to workers and communities and establish what strategies exist for this.

Widespread patterns of poor dietary behavior are a key factor causing the increasing prevalence of chronic diseases around the world. Research provides initial insights into the potential of food literacy (FL) to empower individuals to improve their dietary behavior. Yet, studies on FL interventions in working adults are scarce. This study aimed to investigate the short- and long-term effects of a comprehensive 3-week workplace health promotion program (WHPP) on FL and dietary intake (DI) and to examine the association between FL and DI in a sample of 144 German office workers (30.0% female). Using two random intercept mixed linear regression models, we found significant strong improvements for both FL (β = 0.52, p &lt; .0001) and DI (β = 0.63, p &lt; .0001) after the WHPP when compared to baseline. Significant long-term improvements at 18 months where strong for FL (β = 0.55, p &lt; .0001) and small for DI (β = 0.10, p &lt; .0001). FL showed a significant moderate effect on DI across all measurement time points (β = 0.24, p &lt; .0001). Our study fills a gap of long-term findings in the literature on FL interventions, offers insights into underlying mechanisms, and provides recommendations for effective WHPPs.

Purpose: During the COVID-19 pandemic, the health care workers (HCWs) at the frontline have been largely exposed to infected patients, running an high risk of being infected by the SARS-CoV-2 virus. This study investigates the epidemiological, clinical and lifestyles characteristics that might play roles in the susceptibility of HCWs to COVID-19 in a hit Italian hospital. Methods:Demographic, lifestyle, work-related and comorbidities data of 1447 HCWs which underwent a nasopharyngeal swab for SARS-CoV-2 were retrospectively collected. For the 164 HCWs positive for SARS-CoV-2, data about safety in the workplace, symptoms and clinical course of COVID-19 were also collected. Cumulative incidence of SARS-CoV-2 infection was estimated. Risk factors for SARS-CoV-2 infection were assessed using a multivariable Poisson regression. Results: The cumulative incidence of SARS-CoV-2 infection among the screened HCWs was 11.33 (9.72-13.21). Working in a COVID-19 ward, being a former smoker (vs being a person who never smoked) and BMI were positively associated with SARS-CoV-2 infection, whereas being a current smoker was negatively associated with this variable. Conclusions: Assuming an equal accessibility and proper use of PPE of all the HCWs of our Hospital, the great and more prolonged contact with COVID-19 patients remains the crucial risk factor for SARS-CoV-2. Therefore, increased and particular care needs to be focused specifically on the most exposed HCWs groups, which should be safeguarded. Furthermore, in order to limit the risk of asymptomatic spread of SARS-CoV-2 infection, the HCWs mild symptoms of COVID-19 should be considered when evaluating the potential benefits of universal staff testing

Accountable Care Organizations (ACOs) are healthcare delivery systems that aim to coordinate and improve the quality of care for patients while reducing costs. ACOs bring together doctors, hospitals, and other healthcare providers to work as a team to care for a defined population of patients. The idea behind ACOs is to shift the focus from paying for each individual service provided to patients, known as fee-for-service, to paying for the overall care and well-being of patients.ACOs typically operate under a shared savings model and also encourages providers to use data and technology to better coordinate care and improve patient outcomes.ACOs can be physician-led organizations, hospital-led organizations, and collaborations between healthcare providers. The success of ACOs depends on many factors, including the level of cooperation and collaboration among healthcare providers, the quality of care provided, and the ability to effectively manage costs.Despite their potential benefits, ACOs also face challenges, including the difficulty of coordinating care across multiple healthcare providers, the need to invest in technology and data management systems, and the challenge of changing provider behavior.This study assessed a number of systemic reviews and journals to assess the impact of ACO’s on population health. ACO’s have shifted away from costly care patterns and thus helped many countries.

: Suicide is a serious public health problem, with a global mortality rate of 1.4% of all deaths worldwide, and the leading cause of unnatural death in Spain. The use of clinical simulation has proven to be a beneficial tool in the training of nursing students. Such experiences allow them to develop cognitive and affective skills that are fundamental for the detection of warning signs and use of interventions in cases of people who want to take their own lives. Working in a mental health environment can be difficult for nursing students; therefore, the purpose of this study was to explore the perceptions of nursing students on the approach, management and intervention of suicidal crisis through clinical mental health simulation. Methods: qualitative descriptive phenomenological study through focus groups and reflective narratives in a sample of 45 students. A thematic analysis was performed using ATLAS-ti. Results: After the analysis, three themes were obtained: (a) management and handling of emotions (b) identification of suicide motives (c) intervention in suicidal crisis. Discussion: Clinical simulation in mental health allows students to exercise clinical judgment reasoning, detect warning signs for a better treatment approach, and provide tools for effective intervention and management of patient care. The results of this study indicate that nursing students face challenges in approaching mental health clinical simulation due to lack of prior exposure.

MDA, as a sign of oxidative stress, was increasing as a factor that changes the toxicity of responses in the workplace and causes male infertility etiology. This study aims to measure the MDA levels of workers in the casting industry metal. This type of research was analytical explanatory research with a cross-sectional design. This study's variables include the variables taken are MDA levels while the independent variables were age, years of service, type of work, IMT, marital status, and smoking habits. A saturated sampling technique took the research sample of 34 workers. Data analysis used univariate and bivariate methods. The results determined that respondents had MDA hormone levels below the average of 24 or 70.6%, while respondents who had MDA levels above an average of 10 or 29.4%. MDA levels relating to the length of work and marital status, while the type of work, IMT, and smoking habits are not associated with MDA levels in metal casting industry workers in the CV. Bonjor Jaya Klaten.

Introduction: Type 2 diabetes (T2D) is a major driver of health care costs, thus treatments enabling T2D reversal may reduce expenditures. We examined the impact of a T2D continuous care intervention (CCI) on health care utilization. Previous research documented that CCI, including individualized nutrition supported by remote care, simultaneously reduced hemoglobin A1c and medication use and improved cardiovascular status after two years; however, the impact on utilization is unknown. Methods: This study used four years of data (two years pre-intervention, two years post-intervention) from the Indiana Network for Patient Care (INPC) health record. Two methods estimated the impact of CCI on utilization. First, an interrupted time series (ITS) including only CCI participants (n=193) compared post-intervention utilization to expected utilization had the pre-intervention trend persisted. Deviation from the trend was estimated non-parametrically for each 6-month interval after the implementation of CCI . Second, a 1:3 matched comparator group (n=579) was constructed and used for a difference-in-differences (DiD) analysis. The primary outcome was annualized outpatient encounters. Secondary outcomes included emergency encounters and hospitalizations. Results: In two years prior to intervention, CCI participants had a mean of 5.77 annualized encounters (5.62 outpatient, 0.04 hospitalizations, 0.11 emergency). The CCI group showed a reduction in outpatient utilization after intervention. In ITS analysis, 1.6 to 1.9 fewer annualized outpatient encounters occurred in each 6-month interval post-intervention relative to expected utilization based on pre-intervention trends (p<0.01 each 6-month period; 28-33% reduction). The DiD analysis suggested a larger reduction; 5 fewer annualized outpatient encounters in the quarter after intervention, diminishing to 2.5 fewer after 2 years (p<0.01 each quarter). The study was underpowered to draw conclusions about hospitalization and emergency encounters due to the limited number of CCI patients and the rarity of encounters. Conclusions: Outpatient encounters were significantly reduced for a T2D patient population up to 2 years after receiving an individualized intervention supporting nutrition and behavior change through remote care.

In this article, we analyse the ESG determinants of the “Elderly People Treated in Integrated Home Care”-EPIHC in the Italian regions between 2004 and 2022. We used data from the ISTAT-BES database. We used different econometric techniques i.e.: Panel Data with Random Effects, Panel Data with Fixed Effects, Pooled Ordinary Least Squares-OLS and Weighted Least Squares-WLS. The results show that the EPIHC is positively associated with “Nurses, midwives, and Soil sealing by artificial cover" and negatively associated with "Museum heritage density and relevance" and "Trust in law enforcement agencies and firefighters fire". Furthermore, we have applied a k-Means algorithm with the Silhouette Coefficient and we find the presence of two clusters. Finally, we propose a confrontation among eight different machine-learning algorithms and we find that Linear Regression is the best predictive algorithm.

To assess the community health workers’ (CHWs) knowledge, attitude, and practices (KAP) in type-2 diabetes (T2D) and hypertension (HTN) management. We thus also sought to assess the potential health system barriers for incorporating CHWs in T2D and HTN management. Mixed-method study comprised (1) a survey among 153 active CHWs to assess their KAP of T2D and HTN, and (2) semi-structured interviews with key informants to understand challenges of the health system and proposed solutions in incorporating CHWs in T2D and HTN management. The majority of CHWs correctly answered general knowledge questions on NCDs, risk factors, and prevention; however, only one-quarter correctly answered questions on smoking, family history, or tobacco use as risk factors. Most respondents appeared to have positive attitudes and have been practicing some activities related to T2D and HTN. Both financial and non-financial resource constraints were cited as challenges of the health system; therefore, re-structuring the role definition of CHWs and task of responsibilities, and assessment the need and workload have been proposed as ways forwards to effectively incorporate CHWs in T2D and HTN care. CHWs in Cambodia have shown their potential in T2D and HTN management; however, a well-designed strategy including technical training, clearly defined roles and responsibilities, and strong supporting structure are important to maximize their potential in the health system.

(1) Background: Metabolic syndrome is associated with cardiovascular complications. Therefore, this study aims to establish cut points for the conicity index based on the components of the metabolic syndrome and to associate it with characteristics sociodemographic, food consumption and occupational factors in Brazilian rural workers; (2) Methods: Cross-sectional study carried out with farmers. The receiver operating characteristic curve was calculated and the cutoff points for the conicity index were identified by the area under the curve, sensitivity and specificity. The variables included in the binary logistic regression analysis were selected by considering p &lt; 0.20 in the bivariate test; (3) Results: The cut points were similar in females according to both criteria, resulting in a single cut-off of 1.269. In males, the cut points showed differences, resulting in 1.272 according to the NCEP-ATP III and 1.252 according to the IDF. We have shown that younger people, those who work more than 40 hours a week and the lowest contribution of culinary ingredients are associated with increased odds of abdominal obesity. While the consumption of the products they sell or produce decreases these chances; (4) Conclusions: The conicity index showed high discriminatory power for the identification of abdominal obesity in rural workers.

The ageing of workers is one of the most important issues for occupational health and safety in Europe. A number of intervention studies on health promotion for older workers were conducted in European workplaces between 2000 and 2015. This review gives an overview of these studies and considers perspectives for workplace health promotion.

Background: During the COVID-19 pandemic some family physicians were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psycho-social support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW in-terventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

Self-perceived health is an important indicator of occupational health. This research explores the relationship between poor self-perceived health and exposure to psychosocial risk factors, taking into account potential socio-demographic, occupational and employment determinants. Using data from the First Survey of Occupational Safety and Health Conditions covering 1049 salaried workers in Guayaquil, Ecuador descriptive and stratified binary logistic regression analyses (Odds Ratios with corresponding 95% confidence intervals) were carried out. No significant relationship was found between exposure to psychosocial risk factors and the probability of presenting poor self-perceived health by socio-demographic, occupational and employment characteristics. Occupational exposure factors to psychosocial risks are predictors of self-perceived ill health and are related to the variables analyzed; the most frequently expressed factors among the respondents were Cognitive Demands (DGOG) and Job Insecurity (IL). The results have implications in terms of designing effective workplace interventions pursuant of ensuring the health and wellbeing of employee.

Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used equity indicators. Despite some conflicting results, all identified SEDH (social deprivation, income, education level, social class, insurance coverage and health literacy) are associated with inequalities in access to and use of emergency care. In conclusion, the use of administrative data-derived indicators combined with identified SEDH could improve healthcare equity measurement in emergency care settings across health care systems worldwide.

Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we describe how patients, their families (and caregivers) can work with members of the medical care team to achieve these twin goals of maintaining (and perhaps improving) high-quality care and minimizing costs. We describe how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs) as frequently as the patient or the medical care team consider appropriate. These capabilities also allow greater reliance on the use of mobile technologies (mHealth) to provide ongoing assessments of physiologic measurements/phenomena. Remote surveillance of these communications allows longer intervals between (fewer) visits of patients to the medical-care team when this is appropriate and earlier interventions when that is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.

The focus of this article is the evaluation of the quality and the degree of community engagement in an expert-based, public-health communicative intervention for Alcohol Use Disorder (AUD). In 2023 the Canadian Alcohol Use Disorder Society collaborated with a grass-roots community health group, a regional health authority, and an academic participatory researcher to organize a working group to mount a social-marketing campaign to increase community support for AUD medical treatment in family-practice settings in a rural community in British Columbia. The partnership working group conducted a series of activities in the school system, the town council, and the community. This article covers the formative evaluation and the summative evaluation of the working group's effectiveness. The formative evaluation ("lessons learned" and "recommendations") consists of consensus evaluations of the quality of each activity using a variety of data sources. The formative evaluation followed improvement science methods and used consensus meetings to provide and reflect on formal and informal feedback. Formative results reflect the consensus of the participants in the working group and they record the reactions in the community. The summative evaluation measures evidence of community engagement found in transcribed text from meeting minutes. The summative evaluation used theory-based frameworks and text data visualization to assess the engagement dynamics of the working group. The summative evaluation helps to put the formative evaluation into perspective as communicative action. The summative evaluation validates the formative evaluation by revealing the communicative dynamics of engagement which resulted in the community’s increased capacity to understand and support Alcohol Use Disorder Treatment options. The working group and the entire intervention was seen by the participants and the public as a success and capable of replication. In a small community, it instilled new understandings and attitudes, bringing an emerging awareness of medication as an optional health mitigation strategy for Alcohol Use Disorder. Our study furthers this overall assessment by using theoretical constructs and analysis of communicative records to trace engagement characteristics of interest to researchers, societies, and community groups contemplating similar interventions in the future. The study also validates the effectiveness of communicative analysis as a measure of social-marketing for expert-based public health interventions.

Syncope and presyncope occurring during work can affect safety and impair occupational performance. Few data are available regarding the prevalence of these events among workers. The possible role of sleep quality, mental stress and metabolic disorders in promoting syncope, presyncope and falls in workers is unknown. In the present study, 741 workers (male 35.4%; mean age 47±11 years), employed in different companies, underwent clinical evaluation and blood tests and completed questionnaires to assess sleep quality, occupational distress and mental disorders. The occurrence of syncope, presyncope and unexplained falls during their working life was assessed by an ad hoc interview. The prevalence of syncope, presyncope and falls of unknown origin was 13.9%, 27.0%, and 10.3%, respectively. The occurrence of syncope was associated with an increased risk of occupational distress (adjusted Odds Ratio aOR: 1.62, Confidence Intervals at 95%: 1.05-2.52), low sleep quality (aOR: 1.79 CI 95%: 1.16-2.77) and poor mental health (aOR: 2.43 CI 95%: 1.52-3.87). Presyncope was strongly associated with occupational distress (aOR: 1.77 CI 95%: 1.25-2.49), low sleep quality (aOR: 2.95 CI 95%: 2.08-4.18) and poor mental health (aOR: 2.61 CI 95%: 1.78-3.84), while no significant relationship was found between syncope or presyncope and metabolic syndrome. These results suggest that occupational health promotion interventions aimed at improving sleep quality, reducing stressors and increasing worker resilience might reduce syncope and presyncope events in the working population.

Objectives: 1) To describe the cardiovascular health of the construction workers in Hong Kong, 2) to examine the demographic differences in cardiovascular health, and 3) to examine the association between modifiable lifestyle behaviors and cardiovascular conditions. Methods: 626 registered construction workers were included in the analysis. Blood chemistry, blood pressure, weight and height were measured. Face-to-face questionnaire interview was conducted. T-tests and One-way ANOVAs were used to compare the cardiovascular health score, cardiovascular outcomes, and lifestyle behaviors by demographic characteristics. Logistic regressions were performed to assess the cardiovascular outcomes by lifestyle behaviors. Results: Two-thirds of the construction workers failed to achieve three out of the seven “ideal” cardiovascular health indicators. The younger, more educated, and female subjects had better cardiovascular health scores than their counterparts. The ideal fish and seafood consumption was associated with 1) ideal weight status and 2) ideal cholesterol level, whereas less soft drink consumption was associated with ideal cholesterol level. Conclusions: The findings highlighted the importance of promoting cardiovascular health in the construction industry. This study provided insights for future interventions, which should include increasing fish and seafood intake, decreasing soft drink consumption, and enhancing the health literacy amongst older, less educated, and male construction workers.

Patient engagement is receiving a growing attention in the healthcare context. However, although worldwide healthcare stakeholders agree that patient engagement is a priority for quality and effective care, no shared recommendations on how to promote patient engagement are currently available. Based on these premises, a Consensus Conference (CC) was promoted to address four main issues: What is the definition of Patient Engagement? How measuring Patient Engagement? What are the most recommended methodologies and the tools to promote Patient Engagement? What is the role of new technologies in promoting of Patient Engagement? The consensus was obtained through an iterative process that began with a systematic synthesis of the available literature in each domain followed by plenary expert discussions. This CC - including the systematic analysis of internationals scientific evidences (2749 sources across the major international scientific databases) together with experiences of a multi-disciplinary consortium of investigators and key stakeholders - attempted to provide the first evidence-based Expert Consensus Statement for the promotion of Patient Engagement in chronic care. These recommendations should be envisaged as inspirational principles to promote a real eco-system of engagement and might orient health services research and interventions.

Previous studies have shown that agricultural works bear a disproportionately higher burden of HIV, which is the highest HIV prevalence ever reported in any working population in South Africa. This study aimed to assess HIV knowledge, attitudes and practices of agricultural workers, as a precarious and vulnerable workforce. A cross-sectional study design was employed. A pre-piloted paper-based questionnaire was administered to a consenting sample of agricultural workers. Descriptive and inferential statistics were performed using stata version 16.1 software, 0.05 level was used as a measure of significance. The majority of agricultural workers had adequate knowledge level (72.1%) regarding HIV/AIDS. Knowledge was significantly associated with having some level of education,) secondary education (AOR: 1.46, 95% CI:1.01-2.12), and post-matric qualification (AOR: 3.07, 95% CI: 1.61-5.83). The attitudes level of workers towards HIV was good (88.1%). Attitude was negatively associated with residing in informal settlements (AOR: 0.64, 95% CI 0.43-0.97). Majority of participants exhibited poor prevention practices regarding HIV (60.9%). Half of participants reported low condom usage (50.9%) and multiple sexual partners (50.6%). The portrayed risky sexual behavior establishes agricultural workers as an HIV high-risk population. Strategizing non-conventional approaches to HIV prevention and behavior change communication targeting agricultural workers is recommended.

The aim was to analyze the coping strategies used by primary health care (PHC) professionals. A cross-sectional, descriptive-analytical study was conducted with professionals working in primary health care units in São José do Rio Preto, a large city in the interior of São Paulo, Brazil. For data collection we used an instrument developed by the researchers, containing sociodemographic and professional variables, as well as the Problem Coping Modes Scale (EMEP). We evaluated 333 PHC professionals. A difference was observed between the scores of the four coping strategies (p<0.001), with the highest score for the problem-focused strategy (3.8) and the lowest score for the emotion-focused strategy (2.4). Physicians had the lowest scores in coping strategies focused on religious practices/fantastical thinking (p<0.001) and pursuit of social support (p=0.045), while community health agents had the highest scores in these coping strategies). Professionals working in PHC have different coping strategies for the problems and stressful situations experienced in the work environment. These strategies can involve more positive attitudes focused on confrontation and problem solving, to emotional responses that involve attitudes of avoidance and denial that involve attitudes of avoidance and denial of the problem.

Background: Delivery of quality family planning services depends on availability of skilled health care providers, which is often a challenge in Low- and middle-income countries. This study evaluates the effects of a targeted training program on family planning services delivered by the Lady Health Workers (LHWs) in six districts of Punjab, Pakistan. The primary goal was to enhance the quality and accessibility of family planning services, recognizing the pivotal role of LHWs in community health. Methods: Using a robust panel data difference-in-differences (DiD) approach, we analyzed the electronic medical records (EMR) of 1,410 LHWs over a nine-month period. This timeframe in-cluded both pre-training (July to December 2022) and post-training (April to June 2023) phases. Our assessment focused on the impact of training on five outcome variables: the number of follow-up clients, the number of Intrauterine Contraceptive Device (IUCD) clients, the number of condom clients, the number of modern method clients, and the number of injection clients. We also con-sidered control variables such as LHW age, LHW education, the number of eligible couples in each LHW's catchment area, and a categorical variable for the districts. Results: The positive and statistically significant (p<0.05) coefficients across various service cat-egories – Follow Up Clients [Coeff: 1.00, CI: (0.30 - 1.70)], IUCD Clients [Coeff: 0.23, CI: (-0.01 - 0.46)], Condom Clients [Coeff: 1.41, CI: (0.97 – 1.86)], Modern Method Clients [Coeff: 1.82, CI: (0.96 – 2.68)], and Injection Clients [Coeff: 0.32, CI: (0.14 – 0.50)]. These findings indicate enhanced productivity among LHWs who have received training, with results significant at the 95% con-fidence interval (CI). Conclusion: The study highlights the effectiveness of targeted training programs in boosting family planning services at the community level and offers insightful implications for policy-makers and health practitioners. While focused on six districts in Punjab, these promising results emphasize the need for ongoing training and support for frontline health workers to bolster family planning initiatives.

Objectives This article focuses on exploring the evolution of Palliative Care in Portugal. Ten years after the approval of its Basic Law, the aim was to investigate the quality of the path followed and the guidelines that could promote its development. Thus, this study sought to identify a) the goals of the current members of parliament concerning Palliative Care, b) the major priorities that should guide the development of Palliative Care in the coming decade, c) the facilitating or hindering factors to accelerating the process, and d) to propose consensually agreed measures for an integral development of Palliative Care within the health system. Methods Qualitative data analysis was performed from the reading of literature and interviews conducted via Zoom with several intentionally chosen participants, leading to the creation of a Focus Group. The NVivo® 10 was used for data processing and categorisation. Results Three key themes emerged concerning the current status of palliative care: the policymakers, the technicians, and the society. This first line of structuring is explained by a second set of categories, namely, a) knowledge about palliative care; b) Palliative care organisation from the policymakers’ perspective. In the technicians' domain: a) knowledge about palliative care, b) clinical training, and c) medical specialty. Finally, in society: a) knowledge about palliative care. Significance of the Results Advancing general education, increasing qualitative training for the different health professionals, reformulating laws supporting them, promoting flexibility of the implementation methodologies, and establishing medical specialty, are crucial to achieving the proposed goal.

International migrants comprised 14% of the UK population in 2020, but migrant health in the UK has rarely been studied at a population level using primary care electronic health records (EHRs). Given the difficulty of determining migration status using EHRs, this study developed a migration phenotype and assessed its validity. We developed a phenotyping algorithm using codes for country of birth, visa status, non-English main/first language and non-UK origin. It was applied to a Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country of birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997-2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified using the phenotype. 178,749 (1.11%) of these migrants were identified by codes indicating foreign country of birth or visa status, 216,731 (1.35%) a non-English main/first language, and 8,288 (0.05%) non-UK origin. The cohort was similarly distributed compared to ONS migration statistics in terms of sex and region of birth. Recording of migration improved from identifying approximately one-tenth of the expected proportion of migrants according to the ONS in 2004 to a quarter in 2018. Younger migrants were better represented than those aged 50 and over. The migration phenotype identified a large number of migrants and can be used to undertake large-scale migration health research in CPRD GOLD to inform healthcare policy, practice and action. While the cohort was representative of the UK migrant population in terms of sex and region of birth, migration status was under-recorded in earlier years and older ages, and future studies for these groups should therefore be interpreted with caution.

Patients with a psychotic disorder frequently report oral health problems, while mental health nurses (MHNs) seem not to be fully aware of these problems and the risk factors. Therefore, this study aims to develop supportive tools for MHNs regarding oral health to increase sensitization among MHNs and to provide MHNs with knowledge to recognize (potential) oral health problems in patients with a psychotic disorder. We used a human-centered design in which the user, MHNs as well as experts by experience, were placed in the centre of the research process. Problems and needs in MHNs working with patients with a psychotic disorder were addressed. To identify key issues of problem as well as the needs in terms of resources, we started with focus groups (n = 9). We analysed the data thematically based on context of patients and MHNs in practice regarding oral health, preferred oral health tools focused on MHN, and intended outcomes of tools. A Multi Criteria Decision Matrix was developed and analysed (n = 9) to identify the most optimal and viable solution based on established criteria and issues that are prevalent in the work of MHNs. Most promising result was the development of a brochure with an awareness screener. The brochure with awareness screener was developed as a low-fidelity prototype for MHNs regarding oral health in patients with a psychotic disorder, based on the latest scientific evidence. After testing it, the feasibility was tested through semi-structured interviews (n=19). MHNs and experts by experience were satisfied with the tool and provided recommendations for adjustments to the content. Significant augmentations to the brochure include a clinical lesson and a toothbrush with toothpaste for patients. We can conclude that a brochure with an awareness screener is feasible for MHNs. Future steps aiming to further refine and optimize care processes for oral health tools in MHNs, should take refining eligibility criteria for psychiatric populations and the language level of the target group of a tool into account.

Mood and anxiety disorders affect pregnant people and their families at increased rates throughout the perinatal period. Geographic, financial, and social barriers persist in identification and access to care that preclude adequate diagnosis and treatment of anxiety and mood disorders. These challenges have been exacerbated by the COVID-19 pandemic, particularly for Black and Indigenous People and People of Color (BIPOC) who already experience increased risk for adverse mental health outcomes and faced structural barriers to accessing perinatal mental health care at baseline. The literature shows that integrated care can improve mental health outcomes and save billions of dollars in annual healthcare costs. This study evaluated a novel statewide integrated care effort designed to facilitate access to perinatal mental health care for OB/GYN patients. In addition to enrollment data, variables studied were maternal program satisfaction, retention rates, and preliminary maternal mental health outcomes. 285 patients were ever referred for care. Of this, we contacted 259 patients (91%) and enrolled 209 (72%). Of the 209, 48 were lost to follow up, while 107 remained enrolled at the time of data analysis. 54 patients met their treatment goals. 97% of individuals asserted they were satisfied with the services they received. Black race and public insurance predicted faster attrition from treatment; risk for interpersonal violence exposure and substance use were not related to attrition. Preliminary mental health outcomes showed significant decreases in anxiety and depression, with the most dramatic decreases in the first month of treatment. The MC3 Perinatal care program is a viable, patient-endorsed collaborative care model that increases access to perinatal mental health and facilitate access to outside resources.

In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem. In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing, and more than 10 thousand open or pending prosthetic / sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment. In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system, and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans while phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes. A central payer solution under the CMS would also be viable consideration. A Friedman’s test with Wilcoxon rank sum post-hoc tests suggests that TRICARE patient perceptions of quality are superior to VHA and non-VHA / non-DoD (p<.001), that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance, and that the cost per beneficiary of a TRICARE solution ($6.5K / beneficiary) is far better than a VHA-only solution ($14.0 K / beneficiary), the CMS central payer solution ($12.2K / beneficiary), or the status quo (between $12.2K and $14.0K / beneficiary). The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within our outside of the VHA. In this policy analysis, separate interventions that address the gaps between cost, quality, and access are explored. These policy interventions include maintaining the status quo, returning to a VHA-only option, transitioning to a CMS central payer system, and consolidating care under TRICARE.

The pandemic of Covid-19 has contributed to the increase of the number of cases of anxiety, depression, and stress, especially in vulnerable workers. The objective of this study was to analyze factors associated with mental health of waste pickers and street sweepers in Brasília, Brazil, during the Covid-19 pandemic. It was a cross-sectional cohort study with a quantitative approach. SRQ-20 test was used to assess mental health. The study sample included 886 workers: 601 street sweepers and 285 waste pickers. Of the total, 71 workers (8.0%) had SRQ-20 ≥ 7, which is equivalent to adverse mental health. The characteristics associated with adverse mental health were women (PR: 3.36; 95%CI:1.86;6.08), worker between 18-39 years old (PR: 2.19; 95% CI 1.32;3.65), waste pickers (PR: 1.65; 95%CI:1.01;2.70), worker who reported two (PR: 3.24; 95%CI:1.72; 6.12), three or more (PR: 4.73; 95%CI:2.40;9.32) health problems. For the symptoms, 17.05% of the people interviewed said they felt sad and 18.25% nervous, tense, and worried. Female waste pickers, young adults, with many health problems were more susceptible to adverse mental health and it doesn't just affect them, but also their families. Public policies are needed to protect these professionals so that they can work safely and establish early interventions to maintain these workers' mental integrity.

Telecommuting is a flexible form of work that has progressively spread over the last 40 years and which has been strongly encouraged by the measures to limit the Covid19 pandemic. There is still limited evi-dence on the effects it has on workers' health. In this survey we invited 905 workers of companies that made a limited use of telework to fill out a questionnaire to evaluate: Intrusive leadership of managers (IL), the request for work outside traditional hours (OFF-TAJD), workaholism (BWAS), effort / reward imbalance (ERI), happiness and common mental issues (CMIs), anxiety and depression, assessed by the Goldberg scale (GADS). The interaction between these variables has been studied by structural equation modeling (SEM). Intrusive leadership and working after hours were significantly associated with occu-pational stress. Workaholism is a relevant moderator of this interaction: intrusive leadership significantly increased the stress of workaholic workers. Intrusive leadership and overtime work were associated with reduced happiness, anxiety and depression. These results indicate the need to guarantee the right to disconnect, to limit the effect of the OFF-TAJD. In addition to this, companies should implement policies to prevent intrusive leadership and workaholism.

In the following article, it is presented an investigation of the determinants of Beds for High-Care Specialties-BHCS in the Italian regions in the context of Environmental, Social and Governance-ESG approach. Data from ISTAT-BES for 20 countries in the period 2004-2021 are been used. Different econometric techniques have been applied i.e.: Pooled Ordinary Least Squares, Panel Data with Fixed Effects, Panel Data with Random Effects, Dynamic Panel at 1 stage. Furthermore, a cluster analysis performed with a k-Means algorithm optimized with the Silhouette Coefficient indicated the presence of three clusters. Finally, eight different machine-learning algorithms are analysed to predict the future value of BHCS. The results show that the Artificial Neural Network-ANN algorithm is the best algorithm. The future value of BHSC is expected to growth on average of 4.88% for the analysed regions.

Background: COVID-19 crisis has changed the conditions of many throughout the globe. One negative consequence of the on-going pandemic is anxiety brought by uncertainty and the COVID-19 disease. Increased anxiety is a potential risk factor for wellbeing at work. This study investigated psychological, situational, and socio-demographic predictors of COVID-19 anxiety using longitudinal data. Methods: Nationally representative sample of Finnish workers (N = 1308) was collected before and during the COVID-19 crisis. Eighty percent of the participants responded to the follow-up study (N=1044). COVID-19 anxiety was measured with a modified Spielberger State–Trait Anxiety Inventory. Psychological and situational predictors included perceived loneliness, psychological distress, technostress, personality, social support received from work community, and remote working. Also, number of socio-demographic factors were investigated. Results: Perceived loneliness, psychological distress, technostress, and neuroticism were identified as robust psychological predictors of COVID-19 anxiety. Increase in psychological distress and technostress during the COVID-19 crisis predicted higher COVID-19 anxiety. Recent change in work field and decreased social support from work community predicted COVID-19 anxiety. Women and young people experienced higher anxiety. Conclusions: Different factors explain workers’ COVID-19 anxiety. Increased anxiety can disrupt wellbeing at work, emphasizing organizations’ role in maintaining an inclusive and caring work culture and providing technical and psychological support to workers during crisis.

Alzheimer’s disease and related dementias (ADRD) remain a public health challenge in developing counties. We developed a needs-based essential care service package (ECSP) for care planning of persons living with dementia (PLWD) using a cross-sectional survey among PLWD in institutions in six cities in China (n= 1,299). Face-to-face interviews were conducted with caregivers of PLWD by trained staff between 2018 and 2019. Care service needs and utilization by the level of cognitive impairment were summarized. The average age of PLWD was 80.7 years. 76% of participants had severe cognitive impairment. The needs-based ECSP with 30 service items would be sufficient in supporting care services of PLWD in China, of which seven items are core care. The selection plan for ECSP at different levels is designed as “General Care Services + Selective Care Services”, in which service items for low-, mid-and high-level care for PLWD are 7+3, 7+6, and 7+10, respectively. The findings provide the first large-scale data on service needs and utilization of PLWD in mainland China. The ECSP for PLWD advanced in the paper was a practicable and effective quantitative management means. It is deserved to application in a large scale.

Background The workload of nurses in the intensive care unit (ICU) can affect the quality of nursing services. Aim This study aimed to determine the relationship between the nursing activity score and missed care in patients hospitalized in the ICU in Zanjan, Iran. Methods This observational and prospective study was conducted from April 3 to September 18 in 2021. In this study, the tools used included a patient and nurses' profile questionnaire, Nursing Activity Score (NAS). Missed care was observed in the 301 patients for whom the NAS was calculated. Analysis of variance (ANOVA) was used to investigate the differences in mean levels of missed care. Logistic regression models were used to assess the association between factors and missed nursing care. Results Results show that the Medical ICU's mean NAS was 76.31 (95% CI: -13.06 -14.89). In 9 dimensions of care, the extent of missed care was 40.7%. In the care dimensions of assessment, hand hygiene, and infection control, the mean NAS had a statistically significant increase at higher levels of missed care (P<.5). Furthermore, work experience was identified as a protective factor for missed care (OR =.59, 95% CI: .37–.94, χ2= =4.97, p =.026). Conclusion The study revealed a high incidence of missed care. The study revealed that the mean workload was high in certain dimensions of care such as assessment, hand hygiene, and infection control. The increase in workload for nurses results in lost care. Nonetheless, the utilization of experienced nurses can help mitigate this problem. However, utilizing experienced nurses can help reduce this problem.

Since the college years represent an important period for forming oral health behaviors during adulthood, it is important that college students establish proper oral health-promoting behaviors. Therefore, this study aims to identify the effects of oral health education experience, knowledge, and practice behaviors on oral health care self-efficacy among college students, as studies related to this topic are scarce. A total of 236 college students participated in a questionnaire survey comprising 21 questions. The collected data were analyzed through a chi-square test, independent-samples t-test, and logistic regression analysis using SPSS version 22.0. Participants with oral health education experience showed higher levels of oral health knowledge and practice behaviors than those who did not, and the odds of them having oral health care self-efficacy was 3.743 higher. Moreover, a one-unit increase in oral health knowledge and practice behaviors was associated with a 1.199 and 1.351 increase in oral health care self-efficacy, respectively. For oral health promotion among college students, oral health care self-efficacy reinforcement programs tailored to college students should be developed. These should focus on expanding oral health education opportunities to promote improvement in oral health care self-efficacy by strengthening oral health knowledge and the motivation to practice oral health behaviors.

Any Hospital’s primary goal is to restore human health and save lives through health services provided to patients, but at the same time, hazardous wastes are produced. Inconsistent management of unsafe wastes might cause adverse effects and other issues to workers, the environment and public health. Segregation is considered the critical stage for a successful Healthcare Waste Management. Mixing hazardous waste with non-hazardous waste will be avoided by correctly applying practices at the segregation stage. This study aimed to assess personnel’s knowledge about Infectious Medical Waste and segregation practices used at six wards in Nicosia General Hospital. An analytical cross-sectional study was conducted, and data were collected through a structured self-administered questionnaire. The Statistical Package of Social Science (SPPS) version 25 was used with a minimum statistical significance α=0.05. The study population was nurses, nurse assistants, ward assistants and cleaners working at the study wards. Out of 191 questionnaires, 82 were received, with a response rate of 42.93%. Most participants were female (72%) and nurses (85,4%). Participants had medium to good knowledge about Infectious Medical Waste management and good knowledge regarding segregation practices applied in their ward. Segregation was not carried out as it should have since most participants stated that Infectious Medical Wastes were mixed with non-hazardous waste. Correct answers given by the participants regarding color-coding of different Healthcare Waste categories was 67.5%, and only four answered correctly to all questions. Although participants knew segregation practices and the colour-coding process applied for Healthcare Waste, they didn’t use them satisfactorily. They applied methods regarding segregation without specific training, knowledge and guidance. Due to the issue's importance, training programs must be implemented and performed.

A wide range of research has been developed in the empirical literature regarding income and price elasticities of health care expenditure (HCE). The results are mixed, as researchers employ different methodologies and data sources. The benefits of the panel data method, such as greater data variation, less collinearity, and more degrees of freedom, made it attractive among economists. However, the pooled mean group (PMG) method provides robust estimates compared to conventional methods, such as the mean group estimator and dynamic fixed-effects estimator. As such, this paper applies the PMG method to scrutinize the effect of income and price on U.S. health care consumption using a panel of 46 states. The income and price elasticities were found to be 0.85 and -0.48, respectively, which partially describes the recessionary decline in health care consumption following the Great Recession. In addition, the model reveals that the short-run income elasticity is smaller than the long-run. This confirms that U.S. health care consumption follows the permanent income hypothesis. Consequently, the short-run efficacy of public policies targeting HCE remains limited. The results of this paper suggest reconsidering and adjusting health care policies during a recession so as to avoid probable long-run adverse effects on HCE.

Today, issues related to people’s mental health and well-being have been described as a challenge for society, globally as well as in Sweden. This calls for new approaches to mental health promotion. The aim was to evaluate the adequacy of the content and structure, describing experiences of study circles as a means of supporting participants' self-care and self-compassion. The overall design is a descriptive, QUAL+quan design, where quantitative and qualitative results are integrated. Five participants participated in a focus group interview, of whom four completed questionnaires. One individual interview was conducted with the study circle leader. Study circles can be an arena for mental health promotion as learning and sharing of experience contributes to a sense of coherence, as well as self-compassion and a genuine concern for one’s own and others' wellbeing, but not considered an alternative to psychiatric care, for those in need of professional services. Study circles can be a possible means to support self-care and thereby promote mental health in the general population, and a valuable contribution to public health. However, in addition to modifications of the content, further research is needed on the qualifications for study circle leaders as well as the dissemination of study circles.

Background: Work experience is a key factor that influences safety awareness among workers. This study investigated the influence of work experience on the level of awareness on adverse health effects of silica dust exposure among stone quarry workers in Ghana while controlling for theoretically relevant compositional and contextual factors, evaluated the magnitude and order of association between the predictors and the predicted variable. Method: A cross-sectional survey data of 524 randomly selected stone quarry workers were subjected to multivariate statistical analyses. Results: Stone quarry workers who had 6 to10 years and more than 10 years of work experience were 48% (OR = 1.475, P = 0.021) and 82% (OR = 1.816, P = 0.003) respectively more likely to be aware of the adverse health effects of silica dust exposure compared to their counterparts who had 1 to 5 years work experience. Workers who had secondary or higher education were 32% (OR = 1.320, P = 0.036) more likely to be aware of the adverse health effects of silica dust exposure compared to their counterparts who had no education. Conclusion: These findings provide relevant information for managers and policymakers to plan and maximize awareness on silica dust health hazards among silica exposed workers.

(1) Background: With continuous globalization and modernization of people's lives, lifestyle has changed dramatically, with decreased physical activity and increased unhealthy eating patterns in many nations throughout the world. With the COVID-19 pandemic and changes taking place in people’s health and lifestyles around the world, the need for rehabilitation is expected to rise in the coming years.(2)Methods: This paper analyzes the integration model of sports and health care using theoretical analysis, literature reviews, logical reasoning, and other methods.(3)Results: The integration of sports and health care in China has entered the stage of practical implementation after many years of development, forming a few representative integration patterns. Governments, communities, community hospitals, hospitals, and third-party institutions are the main participants, with the community playing an important role in the integration. Pharmacies, sports venues, and schools with sufficient staff have a relatively low participation rate.(4)Conclusion: The grading treatment has been applied in health management and sports rehabilitation, based on the development of digital medicine, a government-led grading treatment model of "health management center" can promote the participation of multiple subjects in the integration of sports and health care, solving the problems existing in the current integration process to a certain extent.

AbstractBackground: In digitalization era, health care system was conditioned with the health worker’s ability to adapt media of digital technology. Digital technology media was used to strengthening and fasted the health care for patient and community. Aims: This study aimed to explore the accurate information of health professional utilization digital technology during doing the job at the health facilities in Timor-Leste. Methods: This study was used correctional study with 56 respondents was participated in the study. Was collected the data from 1 to 30 February 2023. Was used questioner of google form based for data collection. Data collection was distributed via online with google form to social media as WhatsApp’s, email and face book and twitter to completed by respondents. The inclusive Criteria are: health professional living in Timor-Leste, to able response the questioner. Was used descriptive analysis in this study. Finding: This study was indicated that majority of health professional was participated in the study as 54,2% man then women have 45,8%. About 100% health professional used hand phone to facilitate their daily activities including related with their work activities. Other side indicated in digital technology tools use are able to use Microsoft word is 78,3%, able to use Microsoft Excel is 76,7% and able to use Power Point is 81,7%. E-mail use about 89,2%, WhatsApp’s use 81,7%, About 74,2% was used zoom/webinars/Google meet application, about 72,5% sad that they were used computer in the work place until now. Around 96.4% need to improve or deepen their knowledge and skills in using ICT in the future to facilitate they are activity. Conclusion: Majority of health professional in Timor-Leste was used the computer, internet, hand phone in daily activities. Majority need to gate the training to improve their knowledge, attitude and psychomotor in the future.

Coronavirus Disease 2019 (COVID-19) has become a global health threat and has placed an extraordinary demand for healthcare workers around the world. In this study, we aim to examine the prevalence of burnout, its associating factors, and experience among Malaysian healthcare workers through an embedded mixed-method study design. We found that more than half of Malaysian health care workers in this sample experienced burnout. Direct involvement in COVID-19 screening or treatment, having a medical condition, and less psychological support in the workplace emerged to be the significant factors for personal-, work- and patient-related burnout. Participants described workload, uncertainties from the pandemic, challenged work-family balance and stretched workplace relationships as the sources of burnout. Exhaustion appeared to be the major symptom and many participants utilized problem-focused coping to deal with the adversities experienced during the pandemic. Participants reported physical, occupational, psychological, and social-related negative impacts emanating from burnout. As the pandemic trajectory is yet unknown, the findings provide early insight and guidance for possible interventions.

The aim of this systematic review and meta-analysis is to evaluate the prevalence of depression, anxiety, insomnia, stress, PTSD, and distress in Chinese healthcare workers (HCWs) and the changes in prevalence before and after the peak incidence of COVID-19 in China. 20 cross-sectional studies assessing the aforementioned psychological outcomes were included. Eligible studies were searched from the following databases: PubMed, Scopus, and Web of Science. Comparative analysis based on the time period of the included studies was conducted to assess changes in prevalence before and after peak incidence. Additionally, subgroup analyses based on study quality, province, survey tools, gender and healthcare profession, frontline or non-frontline working status, and severity of psychological outcomes were conducted to evaluate the prevalence of outcomes across various study methods, geographic regions, and professions. The findings of this study suggest that the overall prevalence of depression, anxiety, insomnia, stress, PTSD, and distress before peak incidence were 36.2%, 34.2%, 22.4%, 31.3%, 9.8%, and 56.7% as opposed to 31.8%, 24.1%, 34.4%, 59.0%, 20.9%, and 40.7% after the peak. The higher prevalence of depression, anxiety, and distress prior to the peak incidence of COVID-19 in China and of insomnia, stress, and PTSD thereafter serve as evidence that the mental health decline of HCWs is dynamic and should be addressed with adaptive approaches that provide tailored treatments.

Using the culture-work-health model, this study investigates the factors influencing the quality of life of maritime workers. This study conducted a survey of 320 maritime workers who have experience living and working on a ship for more than six months. This self-administered questionnaire included questions on organizational culture and support, self-efficacy, perceived fatigue, as well as the quality of work life. Organizational culture and self-efficacy were identified as factors affecting the quality of work life, while organizational support was found to have an indirect effect after passing through self-efficacy and perceived fatigue. The final model accounts for 63.1% of the variance in maritime workers’ quality of life. As such, this study shows that self-efficacy is important for the quality of life of maritime workers, having both direct and indirect effects. Moreover, organizational support may prove the primary intervention point for relieving perceived fatigue and enhancing self-efficacy, thus improving the quality of work life.

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling condition affecting millions of adults and children worldwide. Despite the development of multiple criteria sets for defining this disorder, agreement on the core symptoms and other implications of ME/CFS point to the importance of understanding their role in oral health care. Overall, care for the homebound and bedbound population with ME/CFS issues has been under-addressed in the literature to date and there has been little consideration of the oral health needs of this population. Evaluation, diagnosis and treatment of dental concerns may be hindered by many of the diverse symptoms of ME/CFS. The present paper utilizes the International Consensus Criteria (ICC) in discussing treatment considerations for the most severely affected patients with ME/CFS, both in oral evaluation and active care. While no specific dental pathology is linked to ME/CFS, proper care for the patient so affected must take into account the disorder’s symptoms and severity.

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and out-comes including disabling and life-threatening complications. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordina-tion, and psychosocial support for patients and their caregivers. This study examined factors as-sociated with hospital discharge to home health care and subsequent utilization of home health care among a cohort of Medicare beneficiaries with diabetes, age 50 and older, living in the United States. The cohort (n=786,758) was followed for 14 days after a diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014-2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood area deprivation, and rural/urban setting. In ful-ly adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8-0.8) and American Indian (OR 0.8, CI 0.8-0.8) compared to white patients. Among those discharged to home health care, all racial/ethnic minority patients were less likely to receive services within 14-days. Further work should focus on eliminating systemic racism in home health care referral and systemic barriers to receiving home health care services.

Background: Health management is gaining importance as a business resource to enhance employee well-being. The rise of remote work during COVID-19 impacted lifestyle habits. This study explores the impact of tele-exercise intervention on remote workers' lifestyle habits, aiming to improve health and productivity. Methods: This study divided into remote (G1) and face-to-face (G2) groups. Over three months, G1 followed a 30-minute weekly exercise program. Measurements and questionnaires were collected at three time points covering areas like presenteeism, weight, sleep, stress, job satisfaction, and happiness. Data underwent Two-way repeated measures ANOVA, Autocorrelation, Correlation Analysis, and Correspondence Analysis to assess differences and relationships between G1 and G2. Results: ANOVA showed that a significant difference was observed in Daily Stress (DS) between G1 and G2, with G1 exhibiting higher DS. Autocorrelation Analyses showed for G1 that strong relationships each of BMI, Presenteeism (PST), Daily Stress (DS), Stress Relief (SR), Sleep Quality (SQ), Purpose of Work (PW), and Satisfaction of Life (SL) in the time frame. Correlation Analysis showed for G1 that the pairs of PRS and SQ, and DS and SL had strong positive relationships, and the pairs of BMI and PRS, and BMI and SQ had strong negative relationships. Autocorrelation Analyses showed for G2 that strong relationships each of SR, Stress due to Remote Work (SRW), ST, SQ, and PW in the time frame. Correspondence Analysis showed that that G1 was encompassed in a job and life satisfaction area, and G2 was encompassed in a sleep and stress for weight control area.

The quadruple burden of diseases, early discharge from hospital and hospital at home have resulted in home-based care services becoming a requirement in South Africa. The home-based care services generate a significant amount of health care risk waste that is mismanaged. However, more attention is given to the health care risk waste generated in hospitals and clinics than to health care risk waste generated by home-based caregivers. Therefore, this study investigates the health care risk waste management practices by home-based caregivers. The study adopted a mixed research approach, qualitative and quantitative methods, using a literature review, interviews, and questionnaires as means of data collection. Results show that there are different types of health care risk waste generated as a result of different activities performed by home-based caregivers, but that the waste was found to be managed in an unsafe manner. The majority of households receiving home-based care did not have basic sanitation facilities such as toilets, running water and waste removal services, aggravating the issue of health care risk waste mismanagement. The study recommends a new policy framework that will lead to safe management practices of generated health care risk waste to be adopted by home-based caregivers.

(1) Background: The usage of digital technologies in hospital nursing provides potential solutions to the shortage of qualified nurses and current pandemic challenges. The process involves changes and requires willingness to learn. In this respect, leaders can motivate nurses. Therefore, this vignette study examined which motives and values leaders must address in order to promote nurses’ motivation to use different digital technologies. (2) Methods: We asked hospital nurses in an online vignette study to assess fictitious situations about the imminent introduction of a digital technology. The situations differed regarding the devices (tablet/smart glasses), addressed motives (extrinsic/intrinsic), and values (efficiency/patient orientation). (3) Results: We included 299 responses in the analysis. The tablet vignettes caused especially high motivation, more than the vignettes of the smart glasses (Z = -6.653, p = <0.001). The leader was more motivating when emphasizing effi-ciency rather than patient orientation (Z = -2.995, p =0.003). The dataset did not give significant re-sults regarding extrinsic and intrinsic motives. (4) Conclusions: The results suggest efficiency as a motive for using known digital technologies. Management actions can provide the structural framework and training so that responsible leaders can ensure their staff’s engagement to also use unknown devices.

Introduction: COVID-19 vaccines have been the most effective means in curbing the infection, however, vaccine hesitancy has been seen as a threat to global health. Objective: the study aimed to assess the prevalence and predictors of COVID-19 vaccine hesitancy among healthcare workers in infectious disease centers in Ghana. Method: A cross-sectional study and proportionate stratified sampling method was used to recruit participants from various infectious disease centers. Result: data from 170 participants were analyzed, revealing a low prevalence of COVID-19 vaccine hesitancy (11.2%) among healthcare workers. However, only 31.1% of the fully vaccinated participants had taken the booster dose. Factors such as concerns about vaccine safety and side effects from previous doses, indecisiveness, a lack of time to receive the vaccine and lack of access to accurate information, prefered natural immunity were the significant predictors of vaccine hesitancy among healthcare workers. Participants with good perception of the risk posed by COVID-19 was positively correlated with COVID-19 vaccine acceptance. Conclusion: the study suggests that policies should be enacted to ensure health workers are vaccinated against highly contagious infectious diseases to prevent their spread among the general population. Training and health promotion campaigns should also be organized to encourage healthcare workers to accept and patronize the vaccines.

Automobile industries worldwide extensively use organic solvents. Yet, limited evidence examined the health and safety in handling these solvents, which can only be assured if workers have appropriate knowledge and demonstrate safe practices. A cross-sectional study was conducted to explore the knowledge and practice among workers who are involved with handling organic solvents in the automobile industry in the largest most urban district in Brunei Darussalam. Qualitative data were sought from open-ended questions; observations and pictorial evidence through still photographs. Quantitative analysis showed that 75% of the workers practice reading labels, 94.1% use fully covered clothes, 82.4% wear gloves and 98.5% practice proper hand washing as well as 98.5% cover container lids. The qualitative analysis illustrated workers have general knowledge of materials containing solvents but did not identify the exact solvents, the harmful effects of the solvents, pathophysiology and harmful effects on specific body systems. Health and safety were practiced albeit not consistent. Health and Safety Authorities in Brunei Darussalam must review and enforce specific policies on use of organic solvents so that they can be practiced consistently and safely in automobile industries. Cooperation and collaboration in adhering to the policies are mandatory to ensure health and safety at work.

Obesity in Australia is rapidly rising, and is a major public health concern. Obesity increases risk of breast cancer and worse associated outcomes, yet breast screening participation rates in Australia are suboptimal and can be lower in higher risk, obese women. This study qualitatively explored barriers to breast screening participation in obese women in Australia. In-depth interviews (n=29), were conducted with obese women (BMI 30) and key health stakeholders. A disconnect between stakeholders’ and women’s perceptions was found. For women, low knowledge around a heightened need to screen existed, they reported limited desire to prioritize personal health needs, reluctance to screen due to poor body image and prior negative mammographic experiences due to issues with weight. Stakeholders perceived few issues in screening obese women beyond equipment limitations, and health and safety issues. Overall, weight was a taboo topic among our interviewees, indicating that a lack of discourse around this issue may be putting obese women at increased risk of breast cancer morbidity and mortality. Consideration of breast screening policy in obese women is warranted. Targeted health promotion on increased breast cancer risk in obese women is required as is a need to address body image issues and encourage screening participation.

Objectives: to assess the knowledge level of parents from the central region of Saudi Arabia about oral health and care of preschool children and its relation with sociodemographic variables, parents‟ self-perception toward their dental health, importance of teeth and frequency of dental visits. Methods: a random sample of 754 parents participated in this cross-sectional study and completed an internationally accepted questionnaire. Chi square test and logistic regression analysis were used to analyze the data (p<0.05). Results: mean knowledge score of the parents was 4.8 (out of 11). Less than 20% of the parents were knowledgeable about the best position for tooth brushing, the concentration of fluoride in a child‟s toothpaste, timing of first dental check-up, and best time to give a sugary snack. Mothers, parents with high educational level and family income, parents with positive attitude towards teeth and excellent self-perception of their dental health were significantly more likely to score higher (p<0.05). Conclusions: knowledge of parents about oral health and care of preschool children in the central region of Saudi Arabia was deficient. Gender, education level of parents, family income, attitude about teeth and self-perception of parents‟ own dental health were factors which influenced their knowledge. To improve parents‟ knowledge, role of health professionals should be improved and TV commercials directed toward the areas which had gaps in knowledge.

Background Community health workers (CHWs) drawn from the general population are an important human resource in health care systems, preventing non-communicable diseases (NCDs) and contributing to an increase in healthy life expectancy in Japan. Thus, we have developed the COmmunity health workers perceptual and behavioral Competency Scale for preventing Non-communicable diseases (COCS-N) to measure CHWs’ competence in preventing NCDs. The purpose of this study is to examine individual and community factors affecting CHWs’ COCS-N scores. Methods Municipal public health nurses and other public health professionals are responsible for training and supporting CHWs in Japan. Therefore, the existence of CHWs and their willingness to participate in the study were confirmed with the municipalities, who were asked to distribute the self-administered questionnaire to CHWs where consent was obtained (N = 6,480). Variables used included demographic characteristics, COCS-N scores, and individual- and community-related factors. Logistic regression analysis was used to assess associations between variables. Results A total of 3,120 people completed the questionnaire, a valid response rate of 48.1%. The respondents’ mean age was 67.0 years (standard deviation = 9.0), and 88.0% were female. Comparison of the high- and low- competence groups in terms of NCD prevention based on COCS-N scores identified 13 factors associated with significant differences, including years spent working as a CHW (p < 0.001), subjective sense of health (p = 0.005), European Health Literacy Survey Questionnaire (HLS-EU-Q47) scores (p < 0.001), and community commitment scale (CCS) scores (p < 0.001). Logistic regression analysis revealed that HLS-EU-Q47 scores (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.02–1.03) were a significant individual factor, while CCS scores (OR: 1.14, 95% CI: 1.11–1.16) were a significant community factor. Conclusions We found that the COCS-N score was associated with the individual factors overall health literacy (HL), perceptions of HL, and subjective sense of health, and with the community factor CCS scores. These results suggest that strengthening individual factors such as HL and subjective sense of health, and community factors such as sense of community is an effective strategy for increasing CHWs’ competence in preventing NCDs.

The agricultural sector, even though it has been greatly reduced and is in constant transformation, continues to be of strategic importance. Although it does not represent a quantitatively relevant employment sector, the dynamics are interesting because they reflect the structural, economic and social transformations that are affecting the sector in recent years; there is a growing need for external labour that corresponds to a massive recourse of foreigners to work. Innovative approaches are required to explore the capacity of social farming to create a sustainable and inclusive workplace for migrant. The overall methodological approach of the paper seeks to synthesize fieldwork research and qualitative interviewing to validate the Italian inclusive model. To do this, we have selected four experiences of Italian social agriculture in which migrants are included.

The growth of the wind power sector has been marked by environmental, economic, and political drivers. Its starring role is also visible in the emergence of the so-called “green jobs”. Notwithstanding, its evolution ought not to compromise issues related to occupational risks. This exploratory study examines psychosocial risks in the operation and maintenance of onshore wind turbines in a leading Portuguese company. We conducted interviews with main stakeholders (Human Resources, OHS professionals, and team leaders); developed an “activity diary” for the operation and maintenance technicians to describe their activity and perceived impacts on health, complemented with collective interviews; and applied the Work and Health Survey. The results revealed particular risks and health impacts: working under adverse weather conditions; working at heights and in confined spaces; spending long work hours inside of the nacelles to achieve an optimum balance between favorable wind slots to intervene and avoiding additional trips up and down the wind turbines without lifts (70m-120m); and the feeling of early ageing. At a time when these workers are striving for recognition of their profession as a “rapid wear profession”, it is a key moment to discuss these results to guarantee sustainable conditions for future generations of workers.

Roma is the largest ethnic minority of Europe with poor health status, which is poorly explored due to legal constrains of ethnicity assessment. We aimed to elaborate health-indicators for adults living in segregated Roma settlements (SRS) representing the most vulnerable Roma subpopulation. SRSs were mapped in a study area populated by 54682 adults. Records of all adults living in the study area were processed in the National Institute of Health Insurance Fund Management. Aggregated, age-sex standardized SRS-specific and non-SRS-specific indicators on healthcare utilization and premature death along with the ratio of them (RR) were computed with 95% confidence intervals. The rate of GP appointments was significantly higher among SRS inhabitants (RR=1.152, 95%CI: 1.136–1.167). The proportion of subjects hospitalized (RR=1.286, 1.177–1.405), and the reimbursement for inpatient care (RR=1.060, 1.057–1.064) were elevated for SRS. Premature mortality was significantly higher in SRSs (RR=1.711, 1.085-2.696). Our study demonstrated that it is possible to compute the SRS-specific version of the routine healthcare indicators without violating the protection of personal data by converting a sensitive ethical issue to a non-sensitive small area geographical analysis; there is an SRS-specific healthcare utilization pattern, which is associated with elevated costs and increased risk of premature death.

Background: There is a lack of knowledge about how nurses and general practitioners (GPs) collaborated during the COVID-19 pandemicin primary care settings. Our study examined the roles of primary care nurses during the pandemic’s first wave, between March and June 2020, in Switzerland. Methods: The study involved all eight general practices implementing of a nursing role to the practice’s team. Primary care practice staff members (nurses, GPs and medical assistants) have been involved on the development of a new organizational model. A mixed-methods design study collected quantitative data using daily activity monitoring and an electronic survey. Additionally, eight nurses and nine GPs participated in a focus group discussion and individual interviews. Results: GPs recognized the substantial contributions, versatility, and autonomy of the primary care nurses in their practices during the pandemic. Those nurses experienced their involvement positively, mainly thanks to their perceived autonomy. The distribution of activities between primary care practice professionals was heterogenous due to extrinsic and intrinsic factors. Conclusion: Both nurses and GPs agreed that there was added value in having primary care nurses ingeneral practices in time of crisis, and this agreement will bolster plans to integrate this workforce across the canton. The development of nurses’ roles in primary care during the pandemic was reliant on many factors, including practice organization and Switzerland’s healthcare reimbursement and payment system

(1) Background: The aim of this study was to identify predictors of the unmet health care needs during the financial and recent health crisis in Greece. (2) Methods: Time series analysis was performed for the years 2008 through 2022 using the Eurostat database. The dependent variable was the percentage of people who reported unmet need for medical care. Demographic, socioeconomic and health data as well as health expenditures were used as independent variables. Correlation analysis and simple linear regression models were conducted to analyze the results. (3) Results: Unmet health needs in Greece increased from the start of the crisis until 2016, as a gradual de-escalation of the crisis is observed. However, in 2019 the country recorded the second highest level of unmet needs for medical care before the health crisis. People with limitations in usual activities, those who report bad/very bad health status, unemployed and with low-income increased the likelihood of unmet needs. Health expenditures (public or private) were also significant determinants of unmet healthcare needs. (4) Conclusions: The increased unmet health needs widen inequalities in health and healthcare access. Therefore, health policy should eliminate barriers which restrict the access to health and enhance healthcare services, developing conditions for citizens' well-being.

Bacground, the increasing number of elderly is a new challenge for health care systems around the world. The phenomenon of the complex health problems experienced by the elderly encourages families to bring the elderly to a nursing home. The purpose of this study was to describe the condition of the elderly living in nursing homes and their care needs. Methodology, this research design is a literature review, article search using 5 databases, namely Scopus, ProQuest, Pubmed, CINAHL and Scient Direct. Articles reviewed from 2019 to 2021. Protocol and evaluation of literature review using the PRISMA checklist, and the assessment guide using the Joanna Briggs Institute Guideline. Results, the health conditions of the elderly who live in the orphanage are mostly aged 60 years and over, physically experiencing disturbances in their daily activities and dependence. Psychologically experiencing anxiety, depression, loneliness and even mental disorders and socially need family support. The care needs of the elderly in nursing homes include services by competent and culturally sensitive staff and nurses, safe and comfortable nursing home environmental services, privacy needs and social interactions, spiritual needs services, social guidance services, and skills guidance services. Conclusion, based on the literature review, it can be seen that nursing services should be provided in a humanistic and holistic manner, the elderly are clients who have both bio-psycho-socio-cultural and spiritual needs. So that nursing services are aimed at meeting the needs of the elderly in a comprehensive manner.

(1) Background: There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. (2) Methods: 155 Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. (3) Results: Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. 4) Conclusion: This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.

Although the universal health coverage (UHC) is pursued by many countries, not all countries with UHC include dental care as their benefits. Japan, with its long-held tradition of UHC, has covered dental care as essential benefit and majority of dental care services are provided to all patients with minimal copayment. Being under the UHC, the scope of services as well as prices are regulated by the uniform fee schedule and dentists submit claims according to the uniform format and fee schedule. The author analyzes the publicly available dental health insurance claims data as well as a sampling survey on dental hygiene and illustrates how Japan’s dental care is responding to the challenges of the population ageing.

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. government in deciding the fate of the ACA.

Migrant population have always been vulnerable for high burden of social exclusion, mental disorders, physical illness and economic crisis. The current COVID-19 pandemic has further created the frantic plight among them, particularly for the undocumented migrant workers in global south. We have conducted a mixed method study among the undocumented Myanmar migrant workers (UMMWs) in Thailand to explore how the COVID-19 disruption has impacted on their mental health and what are the coping strategies adopted by them. Following the onset of COVID-19 and the recent coup d'etat in Myanmar, our current study is the first attempt to understand the mental health status and predicament of this neglected migrant group. A total of 398 UMMWs were included in the online survey among whom 23 participated in qualitative interviews. The major mental health issues reported by the study participants were depression, generalised anxiety disorder, frustration, stress and panic disorder while loss of employment, worries about the pandemic, social stigma, refused access to healthcare, lockdown and fear of detention were the predominant contributing factors. In response, we identified two key coping mechanisms- coping at personal layer (listening to music, playing online game, praying, self-motivation) and social layer (chatting with family and friends, visiting religious institutions). These findings point to the importance of policy and intervention programs aimed to uphold mental health at such humanitarian conditions. Sustainable institutional mental health care support and social integration for the migrant workers irrespective of their legal status should be ensured.

The process of international migration causes a situation of vulnerability in people's health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from 4 communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the Primary Care Centres of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the sub-Saharan community. Psychological distress showed a mean value of 0.66, with the sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations.

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical, geographic variables, and neighborhood socio-economic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to patients who received home health care within the recommended first two days, patients who received delayed services (3-7 days after discharge) had higher odds of rehospitalization (OR 1.28, 95% CI 1.25-1.32). Among patients who received late services (8-14 days after discharge), the odds of rehospitalization were four times greater than for patients receiving services within 2 days (OR 4.12, 95% CI 3.97-4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

COVID-19 pandemic has the potential to adversely affect the mental health of healthcare workers (HCWs). The public healthcare system in Greece was already facing serious challenges at the outset of the outbreak following years of austerity and an escalating refugee crisis. The multi-center, cross-sectional study aims to assess the levels and associated risk factors of anxiety, depression, traumatic stress and burnout of frontline staff in Greece. A total of 464 HCWs in six reference hospitals completed a self-administered questionnaire comprising of sociodemographic and work-related information and psychometric scales. The proportion of HCWs with symptoms of moderate/severe depression, anxiety and traumatic stress were 30%, 25% and 33% respectively. Burnout levels were particularly high with 65% of respondents scoring moderate/severe in Emotional Exhaustion, 92% severe in Depersonalization and 51% low/moderate in Personal Accomplishment. Predictive factors of adverse psychological outcomes included fear, perceived stress, risk of infection, lack of protective equipment and low social support. The psychological burden associated with Covid-19 in healthcare professionals in Greece is considerable with more than half experiencing at least mild mental health difficulties. Findings signal the need for immediate organizational and individually tailored interventions to enhance resilience and support wellbeing under pandemic conditions.

Migratory movements are a political, social and public health issue on a global scale. Access to sexual and reproductive health services for irregular migrant women (IMW) is a public health issue. The aim of this study is to identify qualitative evidence on IMW's experiences of sexual and reproductive health care in emergency and primary care settings. Methods: meta-synthesis of qualitative studies. Synthesis includes assembling and categorising findings based on the simili-arty in meaning. The search was conducted between January 2010 and June 2022 using PubMed, WOS and CINAHL databases. Results: of 131 articles found in the initial search, only 9 articles met the criteria and were included in the review. Four main themes were established: (1) The need to focus emergency care on sexual and reproductive health, (2) Unsatisfactory clinical experiences, (3) Forced reproduction, (4) Alternating between formal and informal healthcare services. Con-clusions: IMW’s attitudes towards sexual and reproductive health are influenced by culture, ed-ucational level, fear, barriers and the attitude of healthcare providers. Healthcare institutions need to be aware of the IMW’s experiences to understand the specific difficulties they face. IMW call for socially and culturally sensitive health care, cultural mediators, improved communication and safe environments that ensure confidentiality.

(1) Background: Mpox was declared an international public health emergency by WHO. Initially, Smallpox vaccine in Italy was offered only to laboratory personnel at direct risk of infection. Currently, Healthcare workers (HCWs) are all considered by European Centre for Disease Prevention and Control (ECDC) to be at low or moderate risk. (2) Methods: To assess smallpox vaccination coverage among HCWs in an Italian hospital with different levels of risk of exposure to Mpox infection and to assess their attitudes toward vaccination, a self-report was administered to HCWs stratified at high and low/moderate risk. (3) Results: Of the 338 HCWs evaluated, 60.36% provided the requested data; among them the percentage of previously vaccinated staff was 38.7%, which corresponds to 23.4% of the total HCWs in the departments considered. Considering those born before 1979 as vaccinated, vaccination coverage increases from 23.4% to 41.4%. The department with the highest percentage of vaccinated is infectious diseases (60.5%); The percentage of HCWs who adhered to vaccination is 23%; only 8.8% of laboratory staff want to vaccinate, compared with 100% of midwives. The department with the highest percentage of vaccination adherence is proctology (85.7%). (4) Conclusions: Given the vaccination adherence rate and the vaccination coverage of the departments analyzed, it would be useful to extend vaccination against Smallpox to frontline HCWs involved in patient care in Italy too.

The aim was to evaluate levels of compassion fatigue in nursing professionals working in complex care units of a Brazilian university hospital. A cross-sectional, descriptive, and correlational study was carried out with nursing workers from complex care units of a University Hospital. Data were collected in the second half of 2019, in the pre-pandemic period of COVID-19, using the Brazilian version of the Professional Quality of Life Scale (ProQoL-BR). A total of 146 individuals partici-pated, including 41 (28.1%) nurses, 92 (63.0%) nursing technicians and 13 (8.9%) nursing assis-tants. It was observed that 26.1% presented high level of compassion satisfaction. For 17.5% there was level of burnout and 49.7%, medium level of burnout; and 22.0% with high and 46.1% with medium level of secondary traumatic stress. Twenty-eight (19.2%) professionals had compassion fatigue, of which 16 (57.1%) were nursing technicians. There is a high percentage of professionals with medium and high rates of burnout and secondary traumatic stress, a fact that is reinforced by the presence of compassion fatigue in almost one fifth of the studied individuals. These results highlights how much the health of these workers can be affected by living with traumatic patient experiences.

On March 11^th 2020, the World Health Organization (WHO) declared the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV2) as a pandemic. Until an effective treatment or a vaccine is developed, the current recommendations are to contain the disease, and control its transmission. It is now clear that the primary mode of SARS-CoV2 transmission is aerosol/droplet spread, and by contacting virus contaminated surfaces acting as fomites (inanimate vectors). Furthermore, recent data indicate that the live virus particles are present in saliva, and, more alarmingly, asymptomatic individuals may transmit the infection. By virtue of the nature of the practice of dentistry where intrinsically, a high volume of aerosols are produced, as well as the close proximity of dentists and patients during treatment, dentists and allied dental staff are considered the highest risk health professional group for acquiring SARS-CoV2 during patient management. Therefore, several organizations and specialty associations have proposed guidelines and recommendations for limiting the transmission of SARS-COV2 from carriers to dentists and vice versa. This paper aims to provide a review of these guidelines, and concludes with a brief look at how the practice of dentistry may be impacted by COVID-19, in the post-pandemic era.

Background: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. Methods: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts, and national media. Results: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%) or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with an increased risk of adverse mental health outcomes. Feeling appreciated by the community mitigated this risk in healthcare workers. Conclusions: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.

This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in the population aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for years 2006 (before the crisis), 2014 and 2017 (after the crisis). Log-binomial regression was used to quantify the association between region of origin and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR:1.36, 95% CI:1.10–1.67) and Africa (PR:1.16; 95% CI:1.05–1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants compared to the natives, with the greatest odds for those from Africa (PR:1.71; 95% CI:1.46–2.01) and Asia (PR:1.3; 95% CI:1.23–1. 47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services.

Background: Occupational accidents contribute 46-65% of hepatitis B virus (HBV) infections among healthcare workers (HCWs). Vaccine against HBV infection offers protection of more than 90%. Despite availability of the vaccines in Tanzania, it’s uptake among HCWs in primary health facilities remains understudied. This study explored HBV vaccine uptake and associated factors among HCWs in rural and urban settings of north western Tanzania. Methodology: A cross-sectional analytical study was conducted between June and July in 2022 among HCW in Misungwi and Ilemela districts. Data were collected using a self-administered questionnaire and analyzed using IBM SPSS® version 25. Results: A total of 402 HCWs were recruited, their mean age was 34.9±7.77 years. Approximately half (54.7% (220/402) of HCWs had received at least one shot of HBV vaccine with only (18% (76/402) being fully vaccinated. Ilemela showed significantly higher uptake (χ2=23.64, df=1, p=0.00) of HBV vaccine as compared to their counterparts in Misungwi. Being male (aOR=2.38, 95% CI 1.28-4.45, p=0.006), working in urban (aOR=5.75, 95% CI 2.91-11.35, p=0.00) and employment duration of more than two years (aOR=3.58, 95%CI 1.19-10.74, p=0.023) were significantly associated with higher odds of HBV vaccination. Moreover, high perceived susceptibility to HBV infection (aOR=2.20, 95% CI1.02-4.75, p=0.044) and history of needle prick injuries (aOR=6.87, 95%CI 3.55-13.26, p=0.00) were also significantly associated with higher odds of HBV vaccination. Conclusion: There was low uptake of HBV vaccine among HCW in primary health facilities with a noteworthy difference between rural and urban settings.. Therefore, advocacy campaigns as well as resource mobilization towards promotion of HBV vaccination in primary health facilities are pivotal.

This study presents the development and pilot implementation of an assessment and shared deci-sion-making methodology called the Gezamenlijk Inschatten van Zorgbehoeften (GIZ), designed for youth (health) care professionals working with children and families. The three-phase approach included a needs assessment, development of the GIZ methodology, and pilot implementation in a preventive youth health care and youth care setting, involving parents, adolescents, and youth (health) care professionals. The needs assessment produced nine criteria that the GIZ methodology needed to meet. Based on these criteria, the GIZ methodology was developed and described using the Template for Intervention Description and Replication (TIDieR). The pilot implementation demonstrated high client engagement, satisfaction, and feasibility in daily practice. The GIZ ap-proach promotes appropriate support for families by improving the joint assessment and shared decision-making process in youth (health) care. This study supports the implementation of GIZ in youth (health) care practice and highlights the need for further focus on implementation and sus-tainability.

The Covid-19 pandemic has severely tested the mental health of frontline health care workers. A repeated cross-sectional study can provide information on how their mental health evolved during the various phases of the pandemic. The intensivists of a COVID-19 hub hospital in Rome were investigated with a baseline survey during the first wave of the pandemic in April 2020 and were contacted again in December 2020, during the second wave. 152 of the 205 eligible workers responded to an online questionnaire designed to measure procedural justice, occupational stress (effort/reward imbalance), sleep quality, anxiety, depression, burnout, job satisfaction, happiness, and turnover intention. Workers reported a further increase in workload and compassion fatigue, which had already risen during the first wave, and a marked reduction in the time devoted to meditation and mental activities. A low level of confidence in the adequacy of safety procedures and the need to work in isolation, together with an increased workload and lack of time for meditation were the most significant predictors of occupational stress in a stepwise linear regression model. Occupational stress was, in turn, a significant predictor of insomnia, anxiety, low job satisfaction, burnout, and intention to leave the hospital. The number of workers manifesting symptoms of depression increased significantly to exceed 60%. Action to prevent occupational risks and enhance individual resilience cannot be postponed.

Very little is known about laboratory confirmed blood stream infections (LCBIs) in neonatal intensive care units (NICUs) in resource-limited settings. The aim of this cohort study was to determine the incidence, risk factors, and causative agents of LCBIs in a level-2 NICU in India. The diagnosis of LCBIs was established using the Centre for Disease Control, USA criteria. A predesigned questionnaire containing risk factors associated with LCBIs was filled-in. A total of 150 neonates (43% preterm) were included in the study. The overall incidence of LCBIs was 31%. The independent risk factors for LCBIs were: preterm neonates (relative risk (RR) 2.23), duration of NICU stay more than 14 days (RR 1.75), chorioamnionitis in the mother (RR 3.18), premature rupture of membrane in mothers (RR 2.32), neonate born through meconium-stained amniotic fluid (RR 2.32), malpresentation (RR 3.05), endotracheal intubation (RR 3.41), umbilical catheterization (RR 4.18), and ventilator-associated pneumonia (RR 3.17). The initiation of minimal enteral nutrition was protective from LCBIs (RR 0.22). The predominant causative organisms were gram-negative pathogens (58%). The results of the present study can be used to design antibiotic interventions to reduce LCBIs in resource-limited settings.

This study assessed health inequality trends and the degree of maternal healthcare services utilization in the DRC, using two consecutive Demographic and Health Surveys, 2007 and 2013-2014. First, we assessed the changes in the magnitude of inequality in the utilization of MHCS using logistics and regressions. Second, we analyzed the distribution of inequality in each MHCS utilization variable using the Gini coefficient and the Lorenz curve. Third, we used the Wagstaff two groups concentration indices comparison method to assess health inequality trends. Finally, we fitted the concentration curves to estimate the inequality in the utilization of MHCS to the economic condition of women. Women were less likely to have their first ANC visit within the first trimester, less likely to receive checkups during ANC visits, and less likely to attend more ANC visits when living in eastern DRC compared to western DRC. Women in rural areas were less likely to have their last birth by C-section, and less likely to receive PNC than women in urban areas. Women with middle, richer, and richest wealth indexes were more likely to complete more ANC visits, more likely to deliver by C-section, most likely to receive PNC, and more likely to receive ANC than those with lower wealth indexes. Over time, inequality in the utilization of MHCS decreased for ANC and PNC but increased for the delivery by C-sections. These findings suggest that innovative strategies are still needed to improve the utilization of MHC services among poorer, rural, and underserved women in post-conflict DRC.

Healthcare workers have atypical working schedule and are exposed to experienced stress that led to poor sleep health and frequent mental complaints, particularly since the Covid-19 crisis. We conducted a cross-sectional study to determine the prevalence of poor sleep hygiene and mental complaints and their associations among healthcare workers. Usual sleep-wake timings were ex-plored during workdays and free days and used to compute sleep duration, sleep efficiency and social jetlag. Insomnia, sleepiness, anxiety and depressive symptoms, and fatigue were calculated using validated scales. A total of 1,562 participants were included (80.5% of women and mean age of 40.0). Among them, 25.9% slept less than 6 hours, 24.3% had a poor sleep efficiency, and 11.5% reported a social jetlag. A total of 33.9% of participants reported insomnia, 45.1% reported EDS, 13.1% reported fatigue, 16.5% reported depression and 35.7% reported anxiety. After ad-justment, sleep duration and sleep efficiency were associated with mental complaints. Social jetlag was associated with significant insomnia but not with anxiety or depression symptoms. Healthcare workers have a high prevalence of poor sleep hygiene and mental complaints. The promotion of sleep health through behavioral sleep strategies should be encouraged to ensure good health for these professionals.

The aim of this study was to estimate the association between fear of COVID-19 and risk perception with preventive behavior in health professionals from three Latin American countries. An analytical cross-sectional study was conducted. Health professionals with on-site care in Colombia, Ecuador, Guatemala, and Peru were surveyed. Information was collected through an online self-report questionnaire. The main variables were preventive behavior as the dependent variable and fear of COVID-19 and risk perception as independent variables. Linear regression was used, and Beta coefficients and p-values were calculated. 435 health professionals were included, the majority were aged 42 years or older (45.29%, 95%CI: 40.65%-50.01%) and female (67.82%, 95%CI: 63.27%-72.05%). It was shown that the greater the fear of COVID-19, the greater the preventive behavior of COVID-19 infection (B=2.21, p=0.002 for total behavior; B=1.12, p=0.037 for additional protection at work; B=1.11, p<0.010 for hand washing). The risk perception of COVID-19 infection had a slight direct relationship with preventive behaviors (B=0.28, p=0.021 for total behavior; B=0.13, p=0.015 for hand washing), with the exception of the preventive behavior of using additional protection at work (p=0.339). We found that fear and risk perception are associated with increased practice of hand washing and use of additional protection at work. Further studies are required on the influence of working conditions, job performance and the occurrence of mental health problems in frontline personnel with regard to COVID-19.

In order to cope with the challenges of physical and psychological aging in the indigenous people in Taiwan, most of the tribes in Taiwan set up cultural health stations for indigenous elderly. These community care facilities have practiced many health promotion activities, such as the reminiscence, life review, and arts activity. However, there was little exploration into the benefit of indigenous people’s practice the life review activity in Taiwan—the gap this study aimed to fill. This study adopts life review therapy through a set of innovative life review activity designs in indigenous older adults, including activity planning, and indigenous cultural elements. A qualitative study design using semi-structured interviews was used to obtain data from a purposive sample. Ten participants who assessed to the cultural health stations services and participated in the life review activities of the indigenous older adults in southern Taiwan were interviewed individually. The data were analyzed using Graneheim and Lundman’s qualitative content analysis. The theme—“experiences and benefits of participating”—and two categories with six subcategories emerged. The results demonstrated that the participation of the indigenous elderly in life review activities with cultural elements had obvious benefits for their mental health. Life review therapy can be incorporated as a supplementary LTC treatment for the indigenous people, thereby, promoting the positive emotions of the indigenous elderly.

People from Black and Asian backgrounds are more likely to die from Covid-19 but less likely to be vaccinated, threatening to exacerbate health inequalities already experienced by ethnic minority groups. Literature suggests that mistrust rooted in structural inequality may be a key barrier to Covid-19 vaccine uptake. We need to better understand how structural inequalities influence vaccine confidence. Understanding and addressing these processes is likely to lead to longer-term impacts than information alone. We draw on health and sociological theories of structure and agency to inform our understanding of structural factors. We conducted qualitative interviews and focus groups with 22 people from London and surrounding areas in December 2021 to March 2022. Fifteen participants were members of the public from ethnic minority backgrounds and 7 were professionals working with the public to address concerns and encourage vaccine uptake. Our findings suggest that people from ethnic minority backgrounds make decisions regarding Covid-19 vaccination based on a combination of how they experience external social structures (including political authority, social positioning and racial inequality) and internal processes (what they believe and understand about Covid-19 vaccines). We may be able to support knowledge accumulation through the provision of reliable and accessible information, particularly through primary and community care. But we recommend a number of changes to research, policy and practice which address structural inequalities. These include working with communities to improve ethnicity data collection, increasing funding allocation to health conditions where ethnic minority communities experience poorer outcomes, greater transparency and public engagement in the vaccine development process, and culturally adapted research recruitment processes.

The accelerated pace with which new diagnostic possibilities are produced and the budget re-strictions of the healthcare sector require that the decision-making process of acquiring new technologies becomes systematic in nature. There are some methodologies such as the Health Technology Assessment (HTA) that encompasses technological domains, clinical effectiveness, patient safety, organizational and financial aspects, among others. However, these methods do not contemplate the learning curve (LC) which is a differential factor in operator-dependent technologies. An assessment model was conceived based on the assessment domains of the AdHopHTA project with the addition of LC. The model was validated and calibrated through System Dynamics (SD) and using as case study the assessment of Point-of-care Ultrasound (POCUS) equipment in dengue screening. The model helped identify the influence of the LC and patient demand on the income and costs for the healthcare system regarding dengue screening as well as the cost-benefit indicator. The control charts LC-CUSUM and CUSUM are graphic tools to intuitively assess the learning curve which can be used for real-time monitoring once students reach a certain skill level.