Public Health and Healthcare

Abstract: Aim: To describe and propose the implementation of a 1:1 coaching model. Background: The nursing faculty shortage has become a significant factor in maintaining qualified educators, but little is known about specific strategies to retain them. A Coach/Player model can this relationship, creating zones where the experienced and novice faculty can share in each other's successes equally. Innovation: The coach and player worked together, assigned to teach multiple sections of a nursing course. The coach and player met 1-2 times per week virtually to prepare material and debrief on the previous week's course lecture, promoting confidence and ensuring continuity between the course sections. Implications: The player reported high satisfaction with their work environment and felt supported and valued, while the coach perceived satisfaction in passing their knowledge on to the player. Conclusion: Implementing the coach/player model is a promising strategy to promote retention, confidence, and success in novice nurse educators.

Abstract: Background/Objectives: To develop a questionnaire assessing knowledge, attitudes, and practices regarding sexual health care among gynecologic oncology nurses and to evaluate its psychometric properties. Methods: The questionnaire was developed using the Knowledge, Attitude, and Practice (KAP) framework as its theoretical foundation, drawing on an extensive literature review and qualitative interviews. The development process was further refined through rounds of Delphi expert consultation and pilot testing. Using convenience sampling, 517 nurses working in gynecologic oncology settings were recruited from nine hospitals across six provincial-level regions in China (Tianjin, Shanghai, Hebei, Xinjiang, Hunan, and Hainan) between November and December 2024. Participants were randomly split into two distinct subsamples, with one allocated to exploratory factor analysis and the other to confirmatory factor analysis. Results: The final version of the questionnaire included 40 items covering three dimensions. It yielded an overall Cronbach’s α of 0.980, a split-half reliability of 0.919, and a test–retest reliability of 0.982, with the mean content validity index being 0.956. Subsequent exploratory factor analysis yielded three common factors, with item loadings spanning 0.596 to 0.828, and the cumulative variance explained reached 73.288%. The confirmatory factor analysis yielded an adequate model fit, which confirmed the structural stability of the questionnaire. Conclusions: The questionnaire exhibited high reliability and validity, making it a rigorous and dependable instrument for evaluating the knowledge, attitudes, and practices of gynecologic oncology nurses related to sexual health care.

Abstract: Background: Community-based mental health and social interventions focusing on housing stability, integrated care and psychosocial support are increasingly recognised as essential for improving the mental health and wellbeing of people experiencing homelessness. This review synthesizes how these interventions address mental health and social determinants of health. Methods: Following PRISMA 2020 guidelines, a search of six electronic databases (2019–2025) was conducted (PROSPERO: CRD420250653260). The review included 29 quantitative, qualitative, and mixed-methods studies examining community-based interventions for people experiencing homelessness and mental health conditions. Results: Community-based interventions, particularly Housing First models, were consistently associated with improved housing stability, mental health outcomes, and programme retention. Integrated multidisciplinary services and outreach promote psychosocial wellbeing, continuity of care and reducing emergency service use. Peer-led programs support social integration, although evidence for technology-based tools remains mixed. Conclusions: Addressing social determinants of health through structured community-based interventions is essential to tackle mental health inequalities. The findings highlight the importance of multidisciplinary and mental health nursing approaches that support continuity of care, psychosocial wellbeing, and social inclusion within vulnerable populations.

Abstract: Background/Objectives: Two sociodemographic characteristics of the nursing workforce — formal level of education and length of professional experience — are widely assumed to shape both how often nurses report adverse events and how safe they perceive their workplace to be for patients. Empirical evidence on these associations remains uneven, however, and large multicentre data from Central and Eastern European secondary-care systems are scarce. The present study examined whether educational level and length of work experience are independently related to (a) the self-reported frequency of adverse-event reporting and (b) the perceived level of patient safety, in a national sample of nurses working in Croatian general and county hospitals. Methods: We conducted a cross-sectional, multicentre survey in 2023 covering all 22 general and county hospitals in the Republic of Croatia. A 99-item paper questionnaire — including 81 items distributed across six previously validated scales (Cronbach’s α 0.730–0.951) — was distributed proportionally to the eligible nursing workforce (N = 6,661). Of the 1,657 questionnaires distributed, 1,518 were returned fully completed (response rate 91.6%). Two outcomes were examined in parallel: self-reported frequency of adverse-event reporting in the past 12 months, and global perceived level of patient safety on the respondent’s ward. Group differences were tested with Pearson’s chi-square and Kruskal–Wallis H tests; effect sizes were assessed using the φ coefficient and Cramér’s V. The study followed the STROBE reporting guideline. Results: Educational level was associated with the frequency of adverse-event reporting (χ² = 29.873, df = 8, p < 0.001; φ = 0.14) and with safety perception (χ² = 16.084, df = 8, p = 0.041; φ = 0.10). The same monotonic gradient was confirmed by Kruskal–Wallis tests, with mean ranks rising from secondary (SSS) through bachelor (VŠS) to master’s or doctoral (VSS+DR) levels for both reporting (719.40; 772.93; 836.56; H = 15.901, p < 0.001) and safety perception (735.29; 775.89; 844.86; H = 10.539, p = 0.005). Length of total work experience was associated with reporting (χ² = 22.708, df = 12, p = 0.030; φ = 0.12; H = 9.249, p = 0.026): mean ranks were lowest for nurses with ≤ 10 years and ≥ 31 years, and highest for mid-career nurses (11–20 and 21–30 years). For safety perception, the experience gradient ran in the opposite direction — highest in nurses with ≤ 10 years (mean rank 795.08) and lowest in those with ≥ 31 years (718.17; χ² = 35.036, df = 12, p < 0.001; φ = 0.15; H = 8.517, p = 0.036). Conclusions: Educational level and length of work experience are independently related to both the reporting of adverse events and the perception of patient safety among Croatian hospital nurses, but the two characteristics operate in different ways. Higher education is associated with more reporting and more favorable safety perception, whereas longer experience is associated with more reporting at mid-career but with a less favorable view of workplace safety in late-career nurses. Investing in continuing nursing education and in mid-career retention, while remaining attentive to the deteriorating safety perception of the most experienced staff, may be more effective than redesigning reporting forms alone. The findings inform nursing leadership, continuing-education planning, and national patient-safety policy in Central and Eastern European secondary-care systems.

Abstract:

Background/Objectives: The aim of the study was to explore the specific relationships between sleep quality, physical activity levels, and demographic characteristics (age, education level, and work experience) in night shift nurses working at hospitals. Understanding these relationships is critical for developing evidence-based scheduling, educational initiatives for sleep hygiene, and physical activity programs that can mitigate the negative impacts of night work, ultimately promoting workforce sustainability and safer patient health outcomes. Methods: A questioning survey was conducted involving 400 night shift nurses. Data were collected using a questionnaire, which included Individual Characteristics Form, Pittsburgh Sleep Quality Index and International Physical Activity Questionnaire – Short Form. Results: The sleep quality of night shift nurses differed statistically significantly by age in almost all sub-scales except for the sub-scale “habitual sleep efficiency”. The youngest nurses rated their subjective sleep quality the best, while the oldest nurses rated their sleep quality the worst. Physical activity levels differed significantly by age among night shift nurses. Specifically, the youngest group showed a higher proportion of high physical activity compared to the oldest group of night shift nurses. Conclusions: Night shift work is a primary driver of poor sleep quality among nurses, regardless of age, experience, or education level. Physical activity is strongly linked to better sleep quality among night shift nurses.

Abstract: Background: Nursing education in Europe has undergone substantial reform over the past two decades, primarily driven by the Bologna Process and European Union directives aiming to harmonise educational standards and facilitate professional mobility. However, growing evidence indicates that structural alignment has not fully translated into equivalent educational outcomes and competencies across countries. Methods: A scoping review was conducted following the Arksey and O’Malley framework and PRISMA-ScR guidelines. Three databases (PubMed, Scopus, and Google Scholar) were systematically searched for studies published between 2010 and 2025. A total of 1,492 records were identified, with 11 studies included in the final qualitative thematic analysis. Results: Significant heterogeneity was observed in curriculum structure (180–240 ECTS), clinical training requirements, and competency frameworks across European countries. Disparities were particularly evident in the implementation and quality assurance of clinical practice. In Bulgaria, key challenges include workforce shortages, limited clinical training capacity, underfunding, ageing student populations, and high emigration rates. Additionally, gaps were identified in the integration of evidence-based teaching, digital competencies, and interprofessional education. Conclusions: While progress towards harmonisation has been achieved, persistent systemic and functional disparities continue to limit educational quality and workforce mobility. Addressing these gaps requires integrated reforms combining educational innovation, health system investment, and targeted national workforce strategies, particularly in countries such as Bulgaria.

Abstract: Background: Pneumothorax, regardless of its aetiology (traumatic or spontaneous), is diagnosed using imaging modalities, while treatment depends on its type and underlying cause. This study aimed to assess the prevalence, treatment approaches, and healthcare needs of patients with pneumothorax in order to better understand its impact on healthcare resources.Methods: This retrospective cohort study analysed pneumothorax cases treated at Varazdin General Hospital between January 1, 2019 and December 31, 2021. Data were extracted from the Hospital Information System and included pneumothorax type, treatment modality, duration of thoracic drainage, and length of hospital stay. Statistical analysis was performed using descriptive and inferential methods.Results: A total of 60 patients were included, with a predominance of males (65%) and older individuals (>60 years: 55%). Thoracic drainage was performed in 73% of patients and was associated with an average duration of approximately 7 days. The average hospital stay was 9 days. Statistically significant associations were observed between age and pneumothorax type (P=0.003), as well as between age and treatment modality (P=0.050). Nursing care needs remained largely stable during hospitalisation, with an average dependency category of 1.92 at admission and 1.93 at discharge. A total of 120 nursing diagnoses were recorded, averaging two per patient.Conclusion: Pneumothorax is more common in older patients and males, with treatment strategies varying according to demographic and clinical factors. The findings highlight the importance of tailored management approaches and emphasise the central role of nursing care in ensuring optimal patient outcomes.

Abstract: This study aimed to verify a prediction model identifying the causal relationships and paths among factors that affect Korean nursing students’ provision of person-centered care to patients with dementia. This was a covariance structure analysis study to establish a hypothetical model of 313 Korean nursing students located in a metropolitan area. IBM SPSS version 18.0(Chicago, IL, USA) and AMOS version 5.0(Chicago, IL, USA) were used to analyze the data. Structural equation modeling analysis was applied to verify convergent and discriminant validity using higher-order factor analysis in the final model analysis. The model fit indices of the research model were as follows: χ²/df=1.83(p<.001), GFI=.91, AGFI=.88, NFI=.91, CFI=.90, RMR=.04, and RMSEA=.05. The factors affecting person-centered care, clinical practice adaptation (γ=.02, p=.014), nursing professionalism (γ=.45, p=.024), and empathy (γ=.21, p<.001) had direct effects, whereas clinical practice adaptation (γ=.21, p=.013) and nursing professionalism (γ=.08, p=.004) had indirect effects. These factors can explain 40% of the variance in person-centered care. This study is significant because it provides basic data for developing an educational program that can improve the person-centered care capacity of domestic nursing students by confirming that clinical practice adaptation, nursing professionalism, and empathy are essential factors that affect person-centered care.

Abstract: The COVID-19 pandemic exposed significant vulnerabilities in health systems, extending beyond infection-related outcomes to multidimensional social, economic, psychological, and healthcare disruptions. This mixed-methods study aimed to assess multidimensional unmet needs and public health system gaps during the COVID-19 pandemic in India. A web-based cross-sectional survey was conducted among 958 community-dwelling adults using a structured questionnaire covering eight domains of unmet needs. Quantitative data were analyzed using descriptive statistics and multiple-response analysis, while qualitative data from open-ended responses (n = 20) were analyzed thematically. Integration was performed during interpretation. Financial instability was widely reported, with 79.1% experiencing income loss and 71.8% reporting difficulty managing expenses. Nutritional insecurity affected 63.4% of participants, with marked dietary changes and weight fluctuations. Social disruption included inability to meet friends (42%) and stigma (35.1%). Psychological distress was substantial, with 40% reporting stress and anxiety and only 15% accessing counseling services. Child-related educational disruption was prominent, including learning difficulties (46.1%) and academic disruption (44.8%). Preventive health gaps were evident, with 45.7% reporting need for COVID-19 awareness and 41–42% reporting insufficient information on treatment and complications. Healthcare access was disrupted, including missed follow-ups (32.4%) and delayed care. Qualitative findings reinforced quantitative results, highlighting compromised childcare, economic hardship, healthcare delays, psychological distress, and informational gaps. Integrated analysis demonstrated convergence across childcare and education, mental health, financial instability, healthcare access, and preventive awareness as key unmet needs. The study concludes that COVID-19 generated interconnected multidimensional unmet needs, highlighting the need for integrated, equity-focused health system strengthening. Findings emphasize the importance of community-based nursing, improved risk communication, continuity of care, and multisectoral coordination in future public health emergencies.

Abstract: Background: Adverse event reporting is a critical component of patient safety systems; however, nurses’ engagement in reporting is influenced not only by reporting procedures but also by broader organizational characteristics of the nursing practice environment. Understanding how these organizational factors shape nurses’ perceptions of reporting systems remains insufficiently explored, particularly in post-Soviet healthcare contexts. Objective: This study aimed to examine how characteristics of the nursing professional practice environment are associated with nurses’ perceptions of the benefits of adverse event reporting in healthcare institutions in Kazakhstan. Methods: A cross-sectional survey was conducted among 468 nurses working in healthcare organizations across six major cities in Kazakhstan. The professional practice environment was assessed using the Revised Professional Practice Environment (RPPE) scale, while attitudes toward adverse event reporting were measured using the Reporting of Clinical Adverse Events Scale (ROCAES), specifically the “perceived benefits of reporting” dimension. Exploratory factor analysis, Spearman correlation analysis, and binary logistic regression were applied. Results: Exploratory factor analysis identified three key dimensions of the professional practice environment: professional motivation and teamwork, interprofessional conflict and communication, and staffing adequacy. Correlation analysis showed that several dimensions of the practice environment were negatively associated with perceived benefits of reporting. However, multivariable regression analysis revealed that cultural sensitivity, internal work motivation, and control over practice were positive predictors of perceived reporting benefits. This contrast between negative bivariate correlations and positive multivariable predictors highlights the complex organizational dynamics underlying nurses’ reporting attitudes. Conclusions: The findings indicate that nurses’ perceptions of adverse event reporting are embedded within a broader organizational ecology of nursing practice. Strengthening supportive professional environments—particularly those promoting motivation, autonomy, and culturally responsive care—may enhance nurses’ engagement in patient safety activities and improve the effectiveness of reporting systems.

Abstract: Background: Psoriasis is a chronic, systemic and immune-mediated disease that affects over 60 million people worldwide. Although phototherapy is a safe and effective treatment, its demanding thrice-weekly clinical regimen imposes a significant treatment burden that can disrupt the patient’s life narratives. Despite its clinical importance, little is known about how patients navigate the logistical and emotional complexities of this therapy within specialised nursing-led units. Objective: To explore the lived experiences, disease management strategies, and healthcare expectations of patients with psoriasis undergoing phototherapy. Methods: A descriptive phenomenological design was adopted. Between 2019 and 2022, purposive and exhaustive sampling was used to recruit 72 participants receiving treatment at a specialised nursing-led phototherapy unit in a tertiary hospital in Spain. Data were collected through semi-structured interviews and analysed using inductive thematic content analysis supported by NVivo 12 Pro. Results: Eleven subtopics emerged within four main thematic areas: (1) Knowledge about the disease and treatment options: A striking dichotomy exists between a well-recognised psychological burden and a persistent lack of awareness regarding systemic physical comorbidities and biological therapies; (2) Triggers of the disease and flare-ups: Psychological stress was identified as the primary driver of disease activity, overshadowing secondary external factors; (3) Functional and logistical stressors: The rigorous frequency of sessions creates an "adherence-stress cycle," where the effort to maintain therapeutic continuity paradoxically generates the stress that exacerbates clinical flares, leading to profound biographical disruption and a perceived incapacity to fulfil professional and family roles; (4) Healthcare expectations and systemic barriers: Participants identified diagnostic delays and inequities in the financing of supportive care, manifesting as a collective demand for a permanent professional nursing referent to act as an anchor for integrated care. Conclusions: Phototherapy functions as a "double-edged sword" where clinical efficacy frequently conflicts with the logistical rigour of the treatment. Clinical skin clearance is insufficient if the biographical and systemic gaps remain unaddressed. This investigation advocates for a paradigm shift toward integrated care models where specialised dermatology nurses provide the necessary clinical navigation to support patients "beyond the surface" of the disease.

Abstract: Applying the International Classification of Functioning, Disability, and Health (ICF) framework, this study examined longitudinal associations among activities of daily living (ADL) limitations, participation, and well-being among community-dwelling older adults with ADL difficulty. We used five waves (2015–2019; Waves 5–9) of the National Health and Aging Trends Study (NHATS; baseline n = 5,346). Well-being was measured using 11 NHATS items spanning affect, life satisfaction, and perceived control/self-efficacy. Participation was operationalized using five dichotomous indicators of engagement in common social and community activities. Autoregressive cross-lagged structural equation models were estimated using full-information maximum likelihood, and indirect associations were assessed with bootstrap standard errors. We found that ADL limitations were associated with lower subsequent participation, while greater participation predicted higher subsequent well-being across waves. Indirect associations linking ADL limitations to later well-being through participation were small and time-dependent. Overall, the findings are consistent with an ICF-informed perspective in which participation plays a dynamic role in linking activity limitations and well-being over time, although effect sizes were modest.

Abstract: Background: China and India represent a large proportion of the Asian birth cohort and have produced extensive but heterogeneous evidence on neonatal hearing screening. This scoping review summarizes studies published between 2005 and 2025 on otoacoustic-emission-based neonatal hearing screening programs in these countries, with emphasis on program implementation, screening coverage, prevalence of congenital and bilateral hearing loss, follow-up, and intervention pathways. Methods: Searches were conducted in PubMed, Scopus, and Google Scholar using predefined keywords. Studies reporting screening protocols, coverage, prevalence, or follow-up outcomes were included. The standard English language filter was used. A total of 19 papers were considered for this review. Results: The data from the two assessed Asian states show two clearly different screening implementation profiles. In China, Universal hearing screening has evolved into a large-scale and increasingly standardized system, supported by technical specifications and regional or municipal databases; The reported screening coverage was 85.8% in early rural programs, 93.6% in Shanghai, and 97.9% in Liuzhou, while national institutional surveys indicate that UNHS has been substantially implemented in many regions. Reported Hearing Loss prevalence estimates generally ranged from 1.66 to 3.43 per 1,000 newborns, although follow-up and regional equity remain problematic, especially in rural settings. In India, the evidence is dominated by tertiary-hospital feasibility studies rather than a uniformly implemented national program. Reported Hearing loss prevalence estimates varied more widely, from 0.29 to 5.60 per 1,000 screened newborns, largely reflecting differences in study design, screening timing, referral completion, and population risk profile. Across both countries, OAE-based two-stage or sequential OAE+AABR protocols reduced referral rates and improved case identification, but loss to follow-up remained a recurrent limitation. Conclusions: China and India provide complementary models of neonatal hearing screening expansion: China demonstrates the effects of system-level scale-up, whereas India highlights the feasibility and constraints of hospital-based implementation in a highly diverse healthcare environment. Future priorities include stronger follow-up systems, harmonized reporting standards, and broader dissemination of outcome data through peer-reviewed publications.

Abstract: Sarcopenia—the progressive loss of skeletal muscle mass and function—is a growing public health challenge in ageing populations. Island territories face compounded vulnerabilities due to distinct epidemiological and socio-economic profiles. This study examines sarcopenia risk prevalence among community-dwelling older adults in Tenerife (Canary Islands, Spain) and estimates the economic burden alongside the cost-effectiveness of evidence-based interventions. A cross-sectional study was conducted among 374 community-dwelling older adults (mean age 80.4 years, SD 4.8; 51.1% female) recruited from primary care health centres across three health zones in Tenerife. Participants were stratified into a control group without established chronic disease-related functional decline (Group 1; n = 274) and a case group with multimorbidity and functional limitations (Group 3; n = 100). Sarcopenia risk was assessed using the SARC-F questionnaire (threshold ≥4). A comprehensive geriatric battery—including the Barthel Index, FRAIL scale, MNA-SF, Pfeiffer test, SPPB, handgrip dynamometry, and IPAQ—characterised multidimensional vulnerability. Annual direct and indirect costs were estimated using unit costs from Spanish national health accounts, and intervention cost-effectiveness was modelled using published meta-analytic data. Overall sarcopenia risk prevalence was 36.4% (n = 136; SARC-F ≥4), rising to 83.0% in the case group versus 19.3% in controls (OR ≈21.5, p < 0.001). Prevalence was 42.1% in males and 30.9% in females. Diabetes was independently associated with elevated risk (44.8% vs. 29.9%; OR 1.90, 95% CI 1.23–2.92; p = 0.003). Health Zone 1 exhibited the highest prevalence (63.0%) versus Zones 2 (23.5%) and 3 (32.8%). Multidimensional vulnerability was pervasive: 71.4% were frail, 56.6% had nutritional compromise, 58.8% showed moderate cognitive impairment, and 89.8% reported low or inactive physical activity. The estimated annual socio-economic cost of sarcopenia in Tenerife is approximately EUR 88.9 million (Spain nationally: EUR 12.1 billion). Combined exercise–nutrition interventions yield cost-per-QALY ratios of EUR 3,800–7,000, far below Spain's EUR 25,000/QALY threshold. Sarcopenia constitutes a major, multidimensionally compounded health burden in Tenerife's older population, concentrated among frail, diabetic, nutritionally compromised, and physically inactive individuals. The economic case for universal SARC-F screening and multicomponent intervention is compelling, exceeding cost-effectiveness thresholds by a wide margin. Territorial disparities in burden call for equity-oriented, place-based resource allocation within the Canarian health system.

Abstract:

Environmental attitude and behaviour play a vital role in developing a responsible and environmentally sustainable culture. Objective: To determine the correlation between attitudes and environmental behavior in nursing students of a public university in Peru. Material and Methods: Observational, analytical, correlational and prospective study, population made up of 450, sample of 207 students, using as an instrument 2 nationally validated questionnaires, adapted to our reality, applying a pilot test to 15% of the sample, reporting the Cronbach’s Alpha coefficient of (0.784) and (0.873), (attitudes and behavior), respectively. Results: The age group of 20-24 years (46.2%) and female sex (79.7%) predominated, X ̅=20.56 SD = 2.875. The descriptive results show that the environmental attitudes of the students are predominantly characterized by an “unfavorable” attitude (52.7%), when analyzing by dimensions, it is observed that the cognitive attitude is favorable (75.8%), the behavioral and affective attitude is unfavorable (79.2%) and (61.4%) respectively. The environmental behavior of students is predominantly evaluated as “good” (55.1%), “fair” behavior (42.5%), and “poor” behavior (2.4%). Conclusion: Pearson’s correlation analysis revealed a moderately and statistically significant positive relationship between environmental attitudes and environmental behavior in students of the Peruvian public university (r = 0.469, p < 0.001). This result indicates that, as students’ environmental attitudes become more favorable, their environmental behavior also tends to improve.

Abstract: Background: In hematologic malignancies, treatment allocation and outcome prediction are traditionally driven by clinical and biological parameters. However, growing evidence suggests that non-clinical factors—such as psychosocial context, caregiver availability, organizational support, and digital health integration—play a pivotal role in patients’ ability to tolerate and adhere to complex therapeutic pathways. The concept of “resilience” may offer a more comprehensive framework to capture this multidimensional readiness to treatment. Methods: we conducted a narrative review of the literature focusing on patient and caregiver resilience in hematologic settings. PubMed, Scopus, and Web of Science were searched for studies published in English over the last 15 years, addressing clinical, psychosocial, organizational, and contextual determinants influencing treatment tolerance, continuity of care, and outcomes in hematology. Results: the literature highlights resilience as a dynamic construct shaped by clinical fitness, psychological resources, caregiver competence, social and family context, healthcare system organization, and access to supportive technologies such as telemedicine. Several domains emerged as recurrent determinants of resilience, yet no standardized, integrated assessment tool is currently available in routine hematologic practice. Conclusions: resilience in hematology should be reframed as a multidimensional, context-dependent construct extending beyond traditional clinical fitness. Incorporating resilience-oriented assessment into clinical workflows may improve treatment personalization, optimize resource allocation, and enhance patient- and caregiver-centered care. Future research should focus on developing pragmatic, clinically applicable tools to operationalize resilience in real-world hematologic settings.

Abstract: Background/Objectives: The assessment of clinical competencies in nursing education requires valid and reliable instruments, especially for essential procedures such as the placement of a cervical collar in the care of polytrauma patients. The objective of this study was to analyze the psychometric properties of a rubric designed to assess the placement of cervical collars in nursing students in a low-fidelity clinical simulation environment. Methods: A quasi-experimental, cross-sectional study was conducted with 186 undergraduate nursing students, organized into 62 groups, over three academic years (2021–2024). An 8-item rubric was applied, with a 4-level Likert scale (1–4). Interrater reliability was analyzed using Cohen’s Kappa index, internal consistency using Cronbach’s alpha, and the internal structure of the instrument using exploratory factor analysis, applying Varimax orthogonal rotation. Results: Inter-rater reliability showed values ranging from moderate to substantial, with greater agreement observed in items related to the selection of the collar and the position of the medical team, and moderate agreement in those related to technical maneuvers and immobilization. The rubric showed adequate overall internal consistency (α = 0.76), with good to very good consistency values in 6 of the 8 items. Exploratory factor analysis identified a two-dimensional structure with a dominant procedural factor (4 items) and a second factor associated with clinical judgment (4 items). Conclusions: The validated rubric has adequate levels of reliability and internal consistency for evaluating the placement of cervical collars by nursing students. Its application can promote more objective and structured evaluation processes in clinical simulation for nursing students, contributing to the development of essential skills in the care of polytrauma patients.

Abstract: Background/Objectives: Maternal mortality is a serious public health problem and reflects social, ethnic, racial, and regional inequalities in access to and quality of obstetric care. Despite advances in the surveillance and investigation of maternal deaths in Brazil, late maternal deaths (occurring between 43 days and 1 year after birth) are still underestimated and underexplored. Therefore, the objective of this study was to analyze the distribution and factors associated with maternal deaths and late maternal deaths in Brazil between 2010 and 2023. Methods: This was a population-based, retrospective cohort study with a quantitative approach, using secondary data from the Mortality Information System. All maternal deaths (Chapter XV of ICD-10) and late deaths recorded during the period were included. Sociodemographic, clinical, and administrative variables were analyzed. Statistical tests of association (chi-square, test of proportions, and 95% CI) were used, with a significance level of 5%. Results: A total of 26,953 deaths were identified, of which 24,387 were maternal and 2,566 were late deaths. Most deaths occurred among single, mixed-race women with 8 to 11 years of schooling, and residing in the Southeast region. Late deaths were more frequent in the South and among women aged 40 to 49. The main causes were direct obstetric conditions. A statistically significant association was observed between the type of death and sociodemographic variables. Conclusions: The results highlight structural inequalities in maternal mortality in Brazil and reinforce the importance of expanding postpartum surveillance beyond 42 days, with a focus on equity and continuity of care.

Abstract: Background: To describe the comparison between Black and White pregnant and postpartum women with COVID-19 regarding the need for hospitalization in the Intensive Care Unit, mechanical ventilation, and outcome to death. Methods: Integrative Literature Review conducted in Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online via the National Library of Medicine, Science Direct from Elsevier Scientific Publications, SciVerse Scopus, and Web of Science. Results: Black pregnant and postpartum women presented worse clinical outcomes; the risk of death among these women was up to five times higher compared to White women, in addition to inequalities in timely access to intensive care. Conclusions: Black pregnant and postpartum women were disproportionately affected by COVID-19, with a higher risk of severe complications and death, which reinforces the need for care strategies that consider racial inequalities to reduce maternal mortality.

Abstract: Background/Objectives: Maternal mortality remains an important indicator of health inequities, reflecting social, regional, and racial inequalities, as well as the responsiveness of health systems. This study aimed to analyze and compare maternal mortality between Brazil and Portugal from 2020 to 2023. Methods: This is a binational ecological and observational study based on secondary data from official records of live births and maternal deaths in both countries. Maternal mortality rates were calculated per 100,000 live births and stratified by sociodemographic and regional variables. Poisson regression models offset by the logarithm of live births were used to estimate adjusted incidence ratios (IRR) and 95% confidence intervals. Analyses were conducted using R and Stata software. Results: Brazil presented rates between 55 and 62 per 100,000 live births, while Portugal maintained lower values, ranging from 8 to 20 per 100,000. In Brazil, higher risks were observed among Black and Indigenous women, residents of the North and Northeast regions, and in age groups above 30 years. Direct and indirect causes showed similar proportions, with an increase in indirect causes during the pandemic. In Portugal, mortality showed low magnitude, but annual fluctuation was attributed to the small number of events and the limitation of microdata. Conclusions: The study highlights strong structural and racial inequalities in Brazilian maternal mortality, contrasting with the lower magnitude and greater stability observed in Portugal. This reinforces the need for intersectoral actions, strengthening the obstetric network, and continuous surveillance to reduce preventable deaths and promote equity in maternal care.