A discussion of chain referral as a method of sampling hard-to-reach populations

'Being Actively Confident in All Contexts': A Qualitative Exploration of Thriving as an Emerging Adult of Diverse Sexual Orientation

When one thrives, they grow, develop and succeed. For people of diverse sexual orientations (DSO) thriving within one's sexuality is often restricted by heteronormativity, minority stress and poor mental health outcomes. Particularly at risk, are DSO "emerging adults" aged between 18-29 years who seek stability before transitioning to adulthood. Therefore, this qualitative study interviewed 12 participants between the ages of 18-29 years to investigate perceptions of thriving within one's sexuality and factors that may foster or hinder its occurrence. The results indicated participants perceived thriving as a spectrum of states and processes involving a sense of personal safety with high levels of self-acceptance to believe one could exist freely as a person of DSO. The findings suggested thriving within one's sexuality during emerging adulthood is fostered through the factors of seeking personal growth, social representation/visibility, affirming social support and opportunities to support other DSO people. In contrast, identity denial, unsupportive social environments, erasure/tokenism, and experiences of discrimination eroded one's ability to thrive. Psychological interventions focusing on establishing a strong sense of identity, building a social support network and encouragement to seek thriving opportunities, may foster thriving experiences for Australian DSO emerging adults.

Implementation of delirium screening in the emergency department: A qualitative study with early adopters

INTRODUCTION

Delirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one-third of cases. Evidence-based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake. Early adopters of ED delirium screening can offer valuable lessons about successful implementation.

METHODS

We conducted semi-structured interviews with clinician-administrators leading ED delirium screening initiatives from 20 EDs in the United States and Canada. Interviews focused on experiences of planning and implementing ED delirium screening. Interviews lasted 15 to 50 minutes and were digitally recorded and transcribed. To identify factors that commonly impacted implementation of ED delirium screening, we used constructs from the Consolidated Framework for Implementation Research (CFIR), an Implementation Science framework widely used to evaluate healthcare improvement initiatives.

RESULTS

Overall, notable facilitators of successful implementation were having institutional and ED leadership support and designated clinical champions to longitudinally engage and educate frontline staff. We found specific examples of factors affecting implementation drawn from the following seven CFIR constructs: (1) intervention complexity, (2) intervention adaptability, (3) external policies and incentives, (4) peer pressure from other institutions, (5) the implementation climate of the ED, (6) staff knowledge and beliefs, and (7) engaging deliverers of intervention, that is, frontline ED staff.

CONCLUSION

Implementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion.

'I wasn't on the front line per se, but I was part of health care': Contributions and experiences of ancillary staff in care homes in England during the COVID-19 pandemic

OBJECTIVES

Ancillary staff - cleaning, catering, housekeeping and laundry workers - play a crucial role in care homes, by promoting infection control, food preparation and hygiene, and contributing to the care home environment. This study sought to understand the experiences of ancillary staff working in English care homes during the COVID-19 pandemic. The results will inform policy makers, employers, care home managers and others, both in England and overseas, as how to best support the ancillary workforce.

METHODS

Between March and August 2021, video and telephone interviews were conducted with those working or living in care homes in England. Participants comprised ancillary staff (n = 38), care home managers (n = 8), care home residents' family members and friends (n = 7), human resource managers (n = 5) and care home residents (n = 5).

RESULTS

Ancillary staff often had increased responsibilities and contributed to pandemic efforts by changing working practices, routines and job roles with the aim of supporting residents and other staff. Teamwork, underpinned by strong leadership, helped ancillary staff feel supported.

CONCLUSIONS

Ancillary staff should be better recognised as being central to care home care. They are essential workers helping to keep residents safe and well.

Navigating challenges and workarounds: A qualitative study of healthcare and support workers' perceptions on providing care to people seeking sanctuary

BACKGROUND

Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care.

AIM

This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice.

DESIGN

A qualitative study was carried out using semi-structured telephone interviews.

SETTING

This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018).

METHOD

We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation.

RESULTS

Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility.

CONCLUSION

Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population.

PATIENT OR PUBLIC CONTRIBUTION

The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co-applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co-applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision-making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice.

Barriers to seeking tobacco cessation services: a qualitative assessment of university students' needs in Qatar

The prevalence of tobacco use in the Middle East is alarmingly high, especially among university students; most users initiate tobacco use during adolescence and young adulthood. Evidence-based cessation services can be beneficial when quitting tobacco use; however, these services are underutilized. This study aimed to explore the barriers preventing university students in Qatar from seeking tobacco cessation services. Semi-structured interviews were conducted with 20 Qatar University students who are current or former tobacco users (n = 18/2); most current cigarette smokers were also waterpipe users. The interviews were transcribed verbatim, coded, and analyzed using thematic analysis. The major barriers to seeking tobacco cessation services included misconceptions regarding nicotine addiction, negative perceptions of the cessation services' effectiveness, self-efficacy regarding the ability to quit without seeking cessation services, concerns and preferences regarding practitioners' characteristics at clinics, masculine culture that discourages men from seeking cessation help, social stigma around women who use tobacco in Arab culture, and a lack of time to visit cessation clinics. Our findings address gaps in the literature regarding the individual and sociocultural barriers to seeking tobacco cessation among youth in Qatar. A better understanding of these barriers can facilitate successful promotion of tobacco cessation services and enhance cessation-seeking behaviors.

"Pleasure to Pain?" The Impact of the COVID-19 Lockdown on Sexual Violence in Marriages: Experiences of Rural Ghanaian Women

In many parts of the world, particularly in rural areas, sexual violence remains a serious issue. However, cultural orientations urge women to be submissive and obedient sexual partners in marriages. Hence, during COVID-19 lockdowns, when women were thought to be sexually assaulted most, this study used a chain referral sample technique to recruit 20 married rural Ghanaian women to examine their lived experiences of sexual violence. The study established that rural culture denies women sexual autonomy in marriages and offers husbands unrestricted access to their wives' bodies. Sexual violence becomes predominant and unbearable for rural wives during lockdown.

An Assessment of Trends in HIV-1 Prevalence and Incidence and Spatio-Temporal Analyses of HIV-1 Recent Infection Among MSM During the Surveillance Period Between 2018 and 2022 in Sichuan, China

Background

Men who have sex with men (MSM) is one main type of high-risk activities facilitating HIV-1 transmission in Sichuan province. Previous works on HIV-1 incidence and prevalence among MSM only concentrated before 2018, the situation after that is unknown. In addition, the distribution of hot-spots related to current HIV-1 epidemic is also rarely known among MSM in Sichuan.

Objective

To update trends of HIV-1 prevalence and incidence and to visualize hot-spots of ongoing transmission in Sichuan province during surveillance period among MSM between 2018 and 2022.

Methods

Limiting Antigen Avidity assay was performed to detect recent infection within new HIV-1 diagnoses founded during surveillance period among MSM. The HIV-1 prevalence and incidence were calculated according to an extrapolation method proposed by publications and guidelines. Trend tests were performed using χ2 tests with linear-by-linear association. The spatial analysis was conducted with ArcGIS 10.7 to figure hot-spots of HIV-1 recent infections among MSM.

Results

Between 2018 and 2022, 16,697 individuals participated in HIV-1 MSM sentinel surveillance program, of which 449 samples (98.25%) were tested with LAg-Avidity EIA, and 230 samples were classified as recent infection. Respectively, the overall prevalence and incidence were 2.74% and 3.69% (95% CI: 3.21, 4.16) and both had significant declining trends (p < 0.001). Luzhou city had a highest HIV-1 incidence (10.74%, 95% CI: 8.39, 13.10) over the study period and was recognized as a hot-spot for recent HIV-1 infection among MSM.

Conclusion

During the surveillance period, both HIV-1 prevalence and incidence were declining. However, Luzhou city had an unusually high HIV-1 incidence and became an emerging hot-spot of recent HIV-1 infection among MSM. This finding suggested focused attention, cross-regional intervention strategies, and prevention programs are urgently required to curb the spread of ongoing transmission.

To Show or Not to Show: Factors within the School Environment That Influence the Expression of LGBTQ Identities

Prejudice against LGBTQ people during their schooling years can be detrimental due to its long-term consequences. This includes the development of beliefs that the world is unsafe, which can perpetuate mental health struggles later in life. Fostering a school environment where LGBTQ people can express their identity can contribute to greater well-being. This qualitative study drew on interviews with 13 school graduates to examine the environmental factors within Australian schools that influenced LGBTQ students' expression of their identity. Drawing on Altman's conceptualization of oppression and liberation, this study found students typically experienced liberation in the form of acceptance and validation within their micro-environment at school. This micro-environment was composed of those close to the student, such as friends, allies, teachers, and other LGBTQ students who provided acceptance and validation, which enabled the student to express their identity regardless of oppression within the broader school environment. Oppression on the other hand originated from the invisibility of LGBTQ identities; the limited representation in curriculum and access to LGBTQ-specific resources and supports; concerns around gendered, gender-neutral, and safe spaces; and limited support from teachers. Based on the findings, implications are drawn to enhance both the micro and macro environment for LGBTQ school students.

Patient partner perspectives on compensation: Insights from the Canadian Patient Partner Survey

INTRODUCTION

There is a growing role for patients, family members and caregivers as consultants, collaborators and partners in health system settings in Canada. However, compensation for this role is not systematized. When offered, it varies in both type (e.g., one-time honorarium, salary) and amount. Further, broad-based views of patient partners on compensation are still unknown. We aimed to describe the types and frequency of compensation patient partners have been offered and their attitudes towards compensation.

METHODS

This study uses data from the Canadian Patient Partner Study (CPPS) survey. The survey gathered the experiences and perspectives of those who self-identified as patient partners working across the Canadian health system. Three questions were about compensation, asking what types of compensation participants had been offered, if they had ever refused compensation, and whether they felt adequately compensated. The latter two questions included open-text comments in addition to menu-based and scaled response options. Basic frequencies were performed for all questions and open-text comments were analyzed through inductive qualitative content analysis.

RESULTS

A total of 603 individuals participated in the CPPS survey. Most respondents were never or rarely offered salary (81%), honorarium (64%), gift cards (80%) or material gifts (93%) while half were offered conference registration and expenses at least sometimes. A total of 129 (26%) of 499 respondents reported refusing compensation. Of 511 respondents, half felt adequately compensated always or often, and half only sometimes, rarely or never. Open-text comments revealed positive, ambivalent and negative attitudes towards compensation. Attitudes were framed by perceptions about their role, sentiments of giving back to the health system, feelings of acknowledgement, practical considerations, values of fairness and equity and accountability relationships.

CONCLUSIONS

Our findings confirm that compensation is not standardized in Canada. Half of survey respondents routinely feel inadequately compensated. Patient partners have diverse views of what constitutes adequate compensation inclusive of personal considerations such as a preference for volunteering, and broader concerns such as promoting equity in patient partnership. Organizations should attempt to ensure that compensation practices are clear, transparent and attentive to patient partners' unique contexts.

PATIENT CONTRIBUTION

Two patient partners are members of the CPPS research team and have been fully engaged in all study phases from project conception to knowledge translation. They are co-authors of this manuscript. The survey was co-designed and pilot tested with patient partners and survey participants were patient partners.

Barriers and facilitators to engagement in care and medication adherence for women living with HIV in the Southern United States

Women living in the South have the second highest rate of HIV and the lowest rate of viral suppression among women in all regions in the United States (U.S.). Viral suppression is achieved by successfully linking women to HIV care and supporting adherence to antiretroviral therapy (ART). We aimed to qualitatively explore perceived barriers and facilitators to HIV care engagement and ART adherence among women living with HIV in the South. Participants (N = 40) were recruited across a broad geographic area of the South, assisted by a location-specific Community/Clinician Advisory Board (CCAB). Qualitative research methods were used to generate in-depth descriptions of women's experiences in accessing HIV care and adhering to ART. Intrapersonal qualities expressed through resilience and self-efficacy were amongst the most prominent themes for both engagement in care and adherence to medications. Structural barriers such as transportation and distance to care continued to be a barrier to engagement, while medication delivery facilitated adherence. Conclusion: Our findings highlight the complexity and interrelated nature of factors impacting care and adherence. Multilevel interventions that incorporate structural factors in addition to individual-level behavioral change are needed to facilitate engagement in care and adherence to ART.

Pharmacists' perceptions about providing COVID-19 vaccines in community settings

Background

Community pharmacists were underutilized in Saudi Arabia. At the start of the coronavirus disease 2019 (COVID-19) outbreak, global healthcare systems experienced significant pressure. To combat the pandemic effectively, there was a need to involve other healthcare providers, such as community pharmacists. As a result, community pharmacists were enlisted to provide vaccines.

Objectives

This study aims to explore community pharmacists' perceptions about providing COVID-19 vaccines in Saudi community settings.

Methods

Ethical approval was granted by the Research Ethics Committee of King Faisal University in January 2022. A qualitative methodology was used to explore the opinions of community pharmacists. Semi-structured interviews were conducted via face-to-face qualitative interviewing. Participants were recruited purposively and represented different types of community pharmacy settings.

Results

A total of 15 face-to-face individual interviews were conducted. The cohort included pharmacists who provided the service (n = 5) and those who did not (n = 10). The results showed that providing the service in a community setting was advantageous to patients, community pharmacy sector, and healthcare system. Moreover, the participants identified several barriers to providing the service.

Conclusion

Although providing the service had several advantages to several parties, the identified barriers need to be considered for the service to be provided appropriately.

"I could not bear it": Perceptions of chronic pain among Somali pastoralists in Ethiopia. A qualitative study

BACKGROUND

Pain is a major public health problem in the Global South, particularly among marginalized communities, such as Somali pastoralists. Yet, the topic of chronic pain has not yet been comprehensively studied in Sub-Saharan Africa, specifically in the Somali region of Ethiopia. Therefore, this study aims to explore the perceptions and notions of chronic pain among Somali pastoralists in this context.

METHODS

This study used an explorative qualitative design. We performed semi-structured, face-to-face interviews with 20 purposively selected female and male Somali pastoralists with chronic pain. For data analysis, we applied the Framework Method by Gale et al. and explained patterns drawing on the Enactive Approach to Pain proposed by Stilwell and Harman.

FINDINGS

Six different themes emerged: (1) "Pain as a symptom of harsh daily life", (2) "Pain descriptions and dimensions", (3) "Temporality of pain", (4) "Pain-related stigma and stoicism" (5) "Mediating role of spirituality", and (6) "Impact of pain on daily life activities".

CONCLUSIONS

Somali pastoralists described their chronic pain as a multicausal and relational experience. Pastoralists (especially women) commonly refrained from communicating their pain and represented aspects of social stigma and stoicism. The mediating role of spirituality aided pastoralists to make sense of their pain and to ease its impact on their harsh daily life. The findings of this study can contribute to raise awareness of chronic pain issues among pastoralists. They highlight the need for policymakers to prioritize the improvement of pastoralist-specific pain management. Necessary resources and skills should be available within health care facilities. Pain management should be accessible, affordable and culturally acceptable for this population.

Professional Roles, Services, and Quality of Life for End-of-Life Doulas in the United States

CONTEXT

End-of-life doulas provide support to the chronically ill, dying, and their families. However, little is known about the roles and services of doulas practicing in the United States.

OBJECTIVES

The purpose of the current study is to gain understanding of the roles and experiences of death doulas in the United States.

METHODS

The current study used concurrent triangulation mixed methods design combining survey data with video and audio file submissions from end-of-life doulas. The survey included demographics information, a questionnaire about the roles, services, and training of doulas, and the Professional Quality of Life Scale.

RESULTS

There were 74 (77.08%) complete responses from doulas practicing in the United States. Doulas shared about the types of services offered and professional roles they filled in work with the dying and their families. Many doulas offered hybrid or virtual services in addition to in-person care. Many worked at least partially on a volunteer basis. Professional Quality of Life Scales indicated a high level of compassion satisfaction, a low level of burnout, and a low level of secondary trauma.

CONCLUSION

In the complex healthcare system of the United States, end-of-life doulas offer valuable interpersonal services like legacy and grief work as well as practical services like financial and logistical end-of-life planning.

Perspectives of professional experts in relation to the development of community-based exercise for young adults with schizophrenia: a qualitative study

Physical activity is a key modifiable factor in protecting physical and mental health in people with severe mental illness including schizophrenia. Therefore, early promotion of physical activity is recommended and programmes supporting long-term maintenance of physically active behaviour are warranted. This study aimed to explore the perspectives of professional experts in relation to the development of a sustainable community-based exercise programme tailored to young adults with schizophrenia and intended to promote change and adoption of physical activity. We conducted 9 semistructured interviews with 11 clinical and professional experts. Qualitative content analysis, as described by Graneheim and Lundman, was applied to analyse data. We identified four categories: (1) living a physical active life with schizophrenia, (2) exercise as promotor of personal recovery, (3) prescribing safe and relevant exercise and (4) instructors' qualifications and formation. When developing sustainable community-based exercise programmes tailored to young adults with schizophrenia, developers should ensure instructors' qualifications and provide an exercise protocol. In addition, developers should consider providing an inclusive and recovery-oriented exercise environment.

Alcohol Use Patterns Among Underage Autistic and Non-Autistic Youth

PURPOSE

We explored factors predicting repeated or hazardous alcohol use among autistic and non-autistic U.S. youth ages 16 to 20 years.

METHODS

Autistic (n = 94) and non-autistic (n = 92) youth completed an online survey. By design, half of each group reported past-year alcohol use. We compared drinking patterns for autistic and non-autistic youth, and within each group between abstinent or infrequent drinkers (0-1 drinking episodes in past year) versus those who drank 2 + times in past year.

RESULTS

Autistic (vs. non-autistic) youth who drank did so less frequently and consumed fewer drinks per occasion. However, 15% of autistic youth who drank in the past year reported heavy episodic drinking and 9.3% screened positive for AUDIT-C hazardous drinking. For autistic youth only, a diagnosis of depression, bullying or exclusion histories were positively associated with drinking 2 + times in the past year. Autistic youth who put more effort into masking autistic traits were less likely to report drinking 2 + times in the past year. As compared to non-autistic youth, autistic participants were less likely to drink for social reasons, to conform, or to enhance experiences, but drank to cope at similar rates.

CONCLUSION

Repeated and hazardous underage alcohol occur among autistic youth. Targeted prevention programs designed to address the specific drinking profiles of autistic youth are needed.

Lifetime Violence, Lifetime Discrimination, and Microaggressions in the Lives of LGBT Midlife and Older Adults: Findings from Aging with Pride: National Health, Aging, and Sexuality/Gender Study

Purpose: There is a dearth of research on violence and adverse experiences among LGBT midlife and older adults. The goal of this article was to present tailored measures and investigate the relationship between adverse experiences, health, and age. Methods: Based on the Health Equity Promotion Model, we examined lifetime violence, lifetime discrimination, and contemporary microaggressions among LGBT adults, aged 50 and older, utilizing data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. We examined subgroup differences, the interrelationships between adverse experiences, and the association with health, taking into consideration interactions by age. Results: Distinct aspects of these experiences were effectively captured by tailored measures. Important subgroup differences emerged with high levels of lifetime violence among sexually diverse adults, gay and bisexual men, and transgender adults. Experiences of violence remained a significant predictor across all three health outcomes, after controlling for both lifetime discrimination and microaggressions. Microaggressions had a significant contribution to comorbidity for those with a low level of lifetime violence. The interaction effects suggest that comorbidity increases as the number of lifetime violence experiences increases for those who are younger. As age increased, the lifetime violence effect on comorbidity diminished whereas the microaggressions effect became stronger. Conclusion: Greater attention to the sequelae of lifetime violence and other adverse events among midlife and older adults is needed as well as the development and testing of both downstream and upstream interventions to reduce and mitigate the impact of these experiences on the well-being of LGBT midlife and older adults.

Perspectives on the Doctor of Public Health (DrPH) education among students and alumni in the United States: a cross-sectional national online survey

BACKGROUND

This study explored the current and desired identity of the DrPH degree, focusing on whether the competencies set by the Council on Education for Public Health (CEPH) adequately prepare DrPH graduates for effective public health practice. Additionally, the study investigated the necessity of standardization in DrPH training, referring to a consensus-driven approach that equips future public health practitioners with practical skillsets applicable in real-world scenarios.

METHODS

A national cross-sectional online survey titled "National DrPH leaders & practitioners needs assessment" was conducted from November 2020 to February 2021. The survey was based on a self-report by DrPH students and DrPH professionals, consisting of the following two main components: (1) how their DrPH training aligns with CEPH competencies and (2) how they perceive the identity of the DrPH degree. Convenience sampling was used to collect the data, which may have limited representation for all DrPH institutions in the United States.

RESULTS

A total of 222 participants (140 current DrPH students and 82 alumni) completed the survey. The mean of the 10-point Likert scale for the degree to which the DrPH training aligns with 26 CEPH competencies (1: not at all - 10: absolutely) ranged from 6.3 (SD: 2.78) to 7.96 (SD: 2.16). The majority of participants (191/222, 86.04%) were satisfied with the knowledge and skills reflected in their training based on the CEPH competencies. However, more than half of the participants (117/222, 52.70%) sought additional professional development/training outside their institutions. DrPH leaders and practitioners faced barriers where the value of their work might not be fully recognized and endorsed. Participants indicated that the DrPH education should be further distinguished from the PhD education.

CONCLUSIONS

The DrPH degree holds significant value within the academic sphere of public health practice in the United States. However, its distinction from PhD programs poses a challenge for employers and organizations in the field, requiring attention from higher education programs. By solidifying the DrPH's identity, graduates can effectively address diverse public health issues and contribute to creating a safe and healthy environment, including addressing the challenges posed by the COVID-19 pandemic.

Survey data of public awareness on climate change and the value of marine and coastal ecosystems

The long-term provision of ocean ecosystem services depends on healthy ecosystems and effective sustainable management. Understanding public opinion about marine and coastal ecosystems is important to guide decision-making and inform specific actions. However, available data on public perceptions on the interlinked effects of climate change, human impacts and the value and management of marine and coastal ecosystems are rare. This dataset presents raw data from an online, self-administered, public awareness survey conducted between November 2021 and February 2022 which yielded 709 responses from 42 countries. The survey was released in four languages (English, French, Spanish and Italian) and consisted of four main parts: (1) perceptions about climate change; (2) perceptions about the value of, and threats to, coasts, oceans and their wildlife, (3) perceptions about climate change response; and (4) socio-demographic information. Participation in the survey was voluntary and all respondents provided informed consent after reading a participant information form at the beginning of the survey. Responses were anonymous unless respondents chose to provide contact information. All identifying information has been removed from the dataset. The dataset can be used to conduct quantitative analyses, especially in the area of public perceptions of the interlinkages between climate change, human impacts and options for sustainable management in the context of marine and coastal ecosystems. The dataset is provided with this article, including a copy of the survey and participant information forms in all four languages, data and the corresponding codebook.

A Qualitative Study Exploring Motivators and Barriers to COVID-19 Vaccine Uptake among Adults in South Africa and Zimbabwe

While vaccines are a well-established method of controlling the spread of infectious diseases, vaccine hesitancy jeopardizes curbing the spread of COVID-19. Through the Vaccine Information Network (VIN), this study explored barriers and motivators to COVID-19 vaccine uptake. We conducted 18 focus group discussions with male and female community members, stratified by country, age group, and—for Zimbabwe only—by HIV status. Participants’ median age across both countries was 40 years (interquartile range of 22–40), and most (65.9%) were female. We conceptualized the key themes within the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE) 3C (convenience, confidence, complacency) vaccine hesitancy model. Barriers to vaccine uptake—lack of convenience, low confidence, and high complacency—included inaccessibility of vaccines and vaccination sites, vaccine safety and development concerns, and disbelief in COVID-19’s existence. Motivators to vaccine uptake—convenience, confidence, and low complacency—included accessibility of vaccination sites, user-friendly registration processes, trust in governments and vaccines, fear of dying from COVID-19, and knowing someone who had died from or become infected with COVID-19. Overall, vaccine hesitancy in South Africa and Zimbabwe was influenced by inconvenience, a lack of confidence, and high complacency around COVID-19 vaccines.

Exploration of how primary care models influence job satisfaction among primary care providers during the COVID-19 pandemic in New Brunswick: a descriptive and comparative study

BACKGROUND

The COVID-19 pandemic has highlighted human resource gaps and physician shortages in healthcare systems in New Brunswick (NB), as evidenced by multiple healthcare service interruptions. In addition, the New Brunswick Health Council gathered data from citizens on the type of primary care models (i.e. physicians in solo practice, physicians in collaborative practice, and collaborative practice with physicians and nurse practitioners) they use as their usual place of care. To add to their survey's findings, our study aims to see how these different primary care models were associated with job satisfaction as reported by primary care providers.

METHODS

In total, 120 primary care providers responded to an online survey about their primary care models and job satisfaction levels. We used IBM's "SPSS Statistics" software to run Chi-square and Fisher's exact tests to compare job satisfaction levels between variable groups to determine if there were statistically significant variations.

RESULTS

Overall, 77% of participants declared being satisfied at work. The reported job satisfaction levels did not appear to be influenced by the primary care model. Participants reported similar job satisfaction levels regardless of if they practiced alone or in collaboration. Although 50% of primary care providers reported having symptoms of burnout and experienced a decline in job satisfaction during the COVID-19 pandemic, the primary care model was not associated with these experiences. Therefore, participants who reported burnout or a decline in job satisfaction were similar in all primary care models. Our study's results suggest that the autonomy to choose a preferred model was important, since 45.8% of participants reported choosing their primary care models, based on preference. Proximity to family and friends and balancing work and family emerged as critical factors that influence choosing a job and staying in that job.

CONCLUSION

Primary care providers' staffing recruitment and retention strategies should include the factors reported as determinants in our study. Primary care models do not appear to influence job satisfaction levels, although having the autonomy to choose a preferred model was reported as highly important. Consequently, it may be counterproductive to impose specific primary care models if one aims to prioritize primary care providers' job satisfaction and wellness.

Post-Rape Experiences of Undocumented Mexican Women in the U.S.-Mexico Border Region: A Critical Ethnography

Introduction: Numerous undocumented immigrant women in the United States have survived rape, and many have experienced physical and psychological consequences. Although rape disclosure can facilitate early intervention and improve health outcomes, most undocumented immigrant women do not disclose rape, and little is known about their post-rape experiences. Methods: This critical ethnography explored the post-rape experiences of undocumented immigrant women of Mexican (UIWM) origin living in the U.S. Mexico border region. Data collection and analysis were guided by Carspecken's framework for critical qualitative research. Six women, who identified as UIWM participated in the study. Each was interviewed using a semistructured approach. Results: Interview data revealed three domains: Glimpses of Support, Barrier After Barrier, and Overcoming. In accordance with Carspecken's framework, a theoretical lens was applied to these domains. The application of Feminist Intersectional Theory and Standpoint Theory united the domains into the theme Struggling to Heal. Conclusion: This study suggests that the marginalization of these survivors detrimentally impacts their post-rape experiences and describes the intersections of multiple forces on their experiences, including the cultural and sociopolitical context of the border region. This study lays the foundation for future research aimed at mitigating disclosure and help-seeking barriers for this marginalized group.

Evaluation of factors associated with HIV self-testing Acceptability and Uptake among the MSM community in Nairobi, Kenya: A cross sectional study

BACKGROUND

Human Immunodeficiency Virus self-test (HIVST) refers to a process where a person collects his or her own specimen (blood or oral), performs a test and interprets the results. The interpretation of results can either be done in private or through support of a trusted partner. Self-test should be seen as screening and confirmatory tests are typically strongly encouraged.

STUDY OBJECTIVE

To determine facilitating factors for HIVST acceptability and uptake among men who have sex with men (MSM).

METHODS

A cross-sectional exploratory study design, targeting MSM in Nairobi was used. Adult men (aged 18-60 years) who reported to be actively engaging in anal or oral sex with men were eligible for the study. Purposive sampling was used to identify the sites where data was collected, snowballing technique was then employed to reach the respondents. Data was collected between July 2018 and June 2019. A total of 391 MSM respondent were recruited of whom 345 MSM completed the questionnaires. The missing data was handled through the listwise approach that omits those cases with the missing data and analyze the remaining data. We also excluded responses with inconsistencies in all confirmatory questions in the questionnaire.

RESULTS

Two-thirds (64.0%) of the participants were aged 18-24 years with 13.4% being married to women and 40.2% having tertiary level of education. Majority, 72.7% were unemployed and two-thirds (64.0%) of participants were young (18-24 years) and self reported as male sex workers (58.8). There were significant associations between willingness to undertake HIV self-tests and frequency of HIV testing as well as with previous knowledge about self-testing. Habitual HIV testers were more likely to have used the HIVST kit than the non-habitual testers. Willingness to undertake confirmatory test within one month of self-testing was associated with acceptability of HIVST. Most of the MSM preferred blood sample self-test kits as compared to oral self-test kits, believing that blood test will be more accurate than oral self-test. Other factors associated with HIVST included consistent use of protection regardless of HIV status, preference of "treatment buddies". High costs of the self-test kits and inadequate knowledge on the use of HIV self-test kits were the main hindrances to HIVST uptake.

CONCLUSIONS

This study has showed that age, habitual testing, self-care/partner care, as well as confirmatory testing and immediate introduction into care if found sero-positive were associated with the use of HIVST kit. This study contributes to the pool of knowledge of the characteristics of MSM that would adopt and embrace HIVST, and demonstrates that these MSM are self and partner care aware and conscious. The challenge however remains on how to encourage those that are not self/partner care aware to embrace HIV testing and particularly HIVST as routine practices. Future studies may need to explore potential motivators to self-testing among the young, elder MSM generations and the MSM with higher economic status in Kenya.

Developing a prototype digital risk mitigation pathway for children and young people admitted to acute paediatric NHS care in mental health crisis: Protocol of the Safety Assessment in Paediatric healthcare Environments (SAPhE) pathway study

Background

Globally, there are increasing numbers of Children and young people (CYPs) experiencing a mental health crisis requiring admission to acute paediatric inpatient care. These CYPs can often experience fluctuating emotional states accompanied by urges to self-harm or attempt to end their life, leading to reduced safety and poorer experiences. Currently, in the UK National Health Service (NHS) there are no standardised, evidence-based interventions in acute paediatric care to mitigate or minimise immediate risk of self-harm and suicide in CYP admitted with mental health crisis.

Objective

To outline the protocol for the SAPhE Pathway study which aims to: 1) identify and prioritise risk mitigation strategies to include in the digital prototype, 2) understand the feasibility of implementing a novel digital risk mitigation pathway in differing NHS contexts, and 3) co-create a prototype digital risk mitigation pathway.

Methods

This is a multi-centre study uses a mixed-methods design. A systematic review and exploratory methods (interviews, surveys, and focus groups) will be used to identify the content and feasibility of implementing a digital risk mitigation pathway. Participants will include healthcare professionals, digital experts and CYP with experience of mental health conditions. Data will be collected between January 2022 and March 2023 and analysed using content and thematic analysis, case study, cross-case analysis for qualitative data and descriptive statistics for quantitative data. Findings will inform the experience-based co-design workshops.

Ethics and Dissemination

The study received full ethical approval from NHS REC [Ref: 22/SC/0237 and 22/WM/0167]. Findings will be made available to all stakeholders using multiple approaches.

Collaboration between fish passage scientists and engineers: Insights from an international questionnaire

Fish passage science and practice seeks to facilitate the movement of fish around obstacles in their habitat, primarily through the construction of fishways and culverts. Successful implementation of fish passage requires collaboration between groups with very different backgrounds and expertise, including knowledge-producers (scientists who study fish passage and related topics such as fish swimming ability) and knowledge users (engineers who apply that knowledge to design fish passage solutions). To investigate the nature of collaboration between these groups, we surveyed fish passage scientists and engineers from around the world. Respondents were asked about the importance of collaboration, mechanisms of collaboration, potential barriers to collaboration, and how collaboration can be improved. Both fish passage scientists and engineers reported high importance of collaboration and that they collaborated frequently with the other group. Respondents reported that consultation with other professionals (of their discipline and the other) was the most important means of obtaining and sharing information related to fish passage science and engineering. Both groups also tended to over-estimate their knowledge and use of the other's discipline. While respondents reported high engagement in collaboration, key themes emerged with respect to barriers to collaboration and means of improving collaboration. These included lacking a shared understanding of both disciplines, professional differences, insufficient institutional support, and inadequate sharing of knowledge (e.g., reporting and publishing). Opportunities for improving collaboration identified by respondents included 1) more interdisciplinary opportunities that facilitate interaction (particularly conferences and workshops); 2) promoting collaborative projects and interactions between fish passage scientists and engineers on project teams; and 3) ensuring that information is shared between groups (e.g., through accessible publications). Findings from this research have the potential to enhance collaboration between scientists and engineers, to the benefit of fish passage and fish populations.

Brazilian Adults’ Attitudes and Practices Regarding the Mandatory COVID-19 Vaccination and Their Hesitancy towards Childhood Vaccination

Background: This study investigated the attitudes and practices of Brazilian adults regarding the mandatory COVID-19 vaccination and their hesitancy towards the vaccination of children. Methods: Between March and May 2022, Brazilian adults answered an online questionnaire distributed through social media. The SAGE-WG questionnaire was adapted to measure hesitancy to the vaccination of children. Results: Of the 1007 participants, 67.4% believed that adult COVID-19 vaccination should be mandatory. Just over half of the participants (51.5%) believed that parents and/or guardians should decide if their children should be vaccinated against COVID-19 or not and 9.1% were unsure. Individuals who were younger, non-religious and had higher awareness of COVID-19 risks and critics of the federal government’s performance in combating the pandemic were more likely to agree with mandatory adult vaccination. However, less agreement among parents and/or guardians concerning children’s vaccination was observed, with lower scores for hesitancy to the vaccination of children. Conclusion: In Brazil, there is still far from a consensus on mandatory COVID-19 vaccination for adults and a significant proportion of the population believes that parents and/or guardians should be free to decide on their children’s vaccination. These views are associated with age, religion, knowledge of COVID-19 risks and political inclination.

Navigating feminist and biomedical conceptual frameworks in educational interventions for eating disorders: Spanish educators’ understandings of the causes and treatment of eating disorders

The biomedical view of eating disorders (EDs) dominates in their classification and treatment regardless of the importance of sociocultural factors in EDs. Critical feminist approaches to EDs try to relate them to oppressive situations, disempowerment and the construction of gender. Educational interventions with people with EDs may be an alternative to biomedical approaches, giving them opportunities to tell their stories, listen to themselves and take control of their lives. This article presents a thematic analysis of semi-structured interviews with professionals who carry out educational interventions for people with EDs. Findings show that the biomedical description and treatment of EDs remain unchallenged and recognising client voice may be a problem, even in educational interventions. Also, the potential negative consequences of the rigid control of the clients’ lives seem to be ignored. Feminist approaches to EDs are acknowledged but do not seem to guide any intervention. Sociocultural critical stances that would recognise the coherence or the transitions between what is considered as healthy and sick eating also seem to be lacking.

Genitourinary and Sexual Symptoms and Treatments in Transfeminine Individuals: A Qualitative Exploration of Patients' Needs

INTRODUCTION

Medical providers may not be familiar with the genitourinary and sexual symptoms of transgender and non-binary (TGNB) individuals. This lack of familiarity may hinder a provider's ability to address these issues as patients may hesitate to report symptoms due to fear of stigma, misgendering, and being treated disrespectfully.

AIM

To describe the array of genitourinary and sexual symptoms in transfeminine individuals.

METHODS

Upon institutional review board approval, researchers used semi-structured interviews with 25 transfeminine individuals assigned male at birth to explore urinary and sexual symptoms on a sample of convenience. Participants were recruited and interviews were conducted until saturation was achieved. Two research assistants independently coded all de-identified transcripts and resolved discrepancies.

OUTCOMES

Thematic codes pertaining to genitourinary and sexual symptoms were defined and assessed in this study.

RESULTS

Some genitourinary symptoms unrelated to hormone therapy or genital gender-affirming surgery (GGAS) included frequency, urgency, nocturia, and incontinence, while those attributed to GGAS included slow stream, spraying, and retention. Sexual symptoms unrelated to hormone therapy or GGAS included sexually transmitted infections, erectile dysfunction, and low libido. Sexual symptoms related to GGAS included delayed ejaculation, penile pain, scar tissue pain, and pain with receptive vaginal penetration.

CLINICAL IMPLICATIONS

Increased provider awareness of and accountability for the treatment of genital and sexual symptoms of transfeminine individuals.

STRENGTHS AND LIMITATIONS

Open-ended questions were used to generate a range of responses and perspectives through conversation instead of quantifiable data. Findings are not applicable to all TGNB people since participants were limited to transfeminine adults assigned male at birth only. Recruitment was limited by the sensitive nature of the topic and hard-to-reach populations and relied on convenience through flyers and a chain-referral sampling approach.

CONCLUSION

Transfeminine individuals experience a wide array of genitourinary and sexual symptoms both similar and different to their cis gender counterparts. Chung PH, Swaminathan V, Spigner S, et al. Genitourinary and Sexual Symptoms and Treatments in Transfeminine Individuals: A Qualitative Exploration of Patients' Needs. Sex Med 2022;10:100566.

Knowledge of Human Monkeypox and Its Relation to Conspiracy Beliefs among Students in Jordanian Health Schools: Filling the Knowledge Gap on Emerging Zoonotic Viruses

Background and Objective: The recent multi-country outbreak of human monkeypox (HMPX) in non-endemic regions poses an emerging public health concern. University students in health schools/faculties represent a core knowledgeable group that can be helpful to study from a public health point of view. As future healthcare workers, assessment of their knowledge and attitude towards emerging zoonotic viral infections can be helpful to assess their taught material and courses with potential improvement if gaps in knowledge were identified. Therefore, we aimed to evaluate the level of HMPX knowledge, conspiracy beliefs regarding emerging virus infections, as well as their associated determinants among university students studying Medicine, Nursing, Dentistry, Pharmacy, Medical Laboratory Sciences, and Rehabilitation in Jordanian health schools/faculties. In addition, we sought to evaluate the correlation between HMPX knowledge and the extent of holding conspiracy beliefs regarding emerging viral infection. Materials and Methods: A convenient sample of university students was obtained through an electronic survey distributed in late May 2022 using the chain-referral approach. Assessment of HMPX knowledge and general attitude towards emerging virus infections was based on survey items adopted from previously published literature. Results: The study sample comprised 615 students with a mean age of 20 years and a majority of females (432, 70.2%) and medical students (n = 351, 57.1%). Out of eleven monkeypox knowledge items, three were identified correctly by >70% of the respondents. Only 26.2% of the respondents (n = 161) knew that vaccination to prevent monkeypox is available. Age was significantly associated with better HMPX knowledge for a majority of items. Older age, females, and affiliation to non-medical schools/faculties were associated with harboring higher levels of conspiracy beliefs regarding emerging virus infections. Our data also indicate that lower levels of HMPX knowledge were associated with higher levels of conspiracy beliefs. Conclusion: The current study pointed to generally unsatisfactory levels of knowledge regarding the emerging HMPX among university students in Jordanian health schools/faculties. Conspiracy beliefs regarding emerging virus infections were widely prevalent, and its potential detrimental impact on health behavior should be evaluated in future studies.

Evaluating the mental health impacts of the COVID-19 pandemic: perceived risk of COVID-19 infection and childhood trauma predict adult depressive symptoms in urban South Africa

BACKGROUND

South Africa's national lockdown introduced serious threats to public mental health in a society where one in three individuals develops a psychiatric disorder during their life. We aimed to evaluate the mental health impacts of the COVID-19 pandemic using a mixed-methods design.

METHODS

This longitudinal study drew from a preexisting sample of 957 adults living in Soweto, a major township near Johannesburg. Psychological assessments were administered across two waves between August 2019 and March 2020 and during the first 6 weeks of the lockdown (late March-early May 2020). Interviews on COVID-19 experiences were administered in the second wave. Multiple regression models examined relationships between perceived COVID-19 risk and depression.

RESULTS

Full data on perceived COVID-19 risk, depression, and covariates were available in 221 adults. In total, 14.5% of adults were at risk for depression. Higher perceived COVID-19 risk predicted greater depressive symptoms (p < 0.001), particularly among adults with histories of childhood trauma, though this effect was marginally significant (p = 0.063). Adults were about two times more likely to experience significant depressive symptoms for every one unit increase in perceived COVID-19 risk (p = 0.021; 95% CI 1.10-3.39). Qualitative data identified potent experiences of anxiety, financial insecurity, fear of infection, and rumination.

CONCLUSIONS

Higher perceived risk of COVID-19 infection is associated with greater depressive symptoms during the first 6 weeks of quarantine. High rates of severe mental illness and low availability of mental healthcare amidst COVID-19 emphasize the need for immediate and accessible psychological resources.

Ergonomic work from home and occupational health problems amid COVID-19

BACKGROUND: The COVID-19 pandemic has displaced millions of people worldwide, forcing them to work from home offices in a situation of “new normal". Many home office workers were pushed to work in less than ideal settings in the pandemic situation. Work from home causes complications for employees related to their home workplaces lacking appropriate support from the employers. OBJECTIVE: This article aims to analyse how pandemic has changed and affected workplace ergonomics. We addressed, amidst the pandemic, how work is being performed, the layout of the workplace, and its effects on an employee at home workplace. METHODS: In this descriptive study, we used chain referral sampling to collect data from 273 home-based faculty members employed in the universities and HEIs of Pakistan. Finally, we used inferential statistics for our data analysis. RESULTS: Results showed that employees faced problems because they had no prior training for setting up an ergonomically proper workspace. According to the results based on home-based ergonomic examinations, difficulties were associated with using laptops, desktop computers, and nonadjustable seats with no functionalities of flexibility and armrests. CONCLUSIONS: It is vital to employ appropriate instruments and mechanisms, like risk assessment, feedback for the actions performed, and the deployment of adaptive measures (similar to the preventive system of management of occupational safety and health - OSH). These tools must be regularly utilised and/or modified as the scenario changes.

Inuit youth and environmental research: exploring engagement barriers, strategies, and impacts

Community leadership in Arctic environmental research is increasingly recognized as one of many pathways to Indigenous self-determination in Nunavut, Canada. While experienced Inuit hunters, trappers, and other recognized environmental knowledge experts are commonly included in research, similar opportunities for Inuit youth to meaningfully engage in environmental research remain limited. Finding ways to increase scientific literacy, particularly among Inuit youth, has been identified as an important step in the continuation of high-quality Arctic environmental research. This paper examines community perspectives on the roles and contributions of Inuit youth in environmental research in Nunavut, barriers that Inuit youth face in becoming meaningfully engaged in field-based environmental research, and strategies for enhancing Inuit youth engagement. Our study was conducted in Pond Inlet, Nunavut, and used interviews, workshops, and observation to gather stories and knowledge from community members about field- and land-based experiential learning pathways. This study found that a complex set of barriers, including a lack of credentials and support systems, among others, may inhibit meaningful Inuit youth engagement in environmental research. Key findings from the study support the view that collaborative land-based research activities can be an effective and meaningful method of enhancing scientific literacy among Inuit youth.

Silent and Lethal: Consequences of Sexual Violence Against Married Women in Ghana

Extant research, mostly in western countries, confirms the consequences of sexual violence against women, but academic scholarship on this topic remains scant for Ghana. This study built on existing research by exploring the consequences of sexual violence against married women in the Eastern Region of Ghana. Data were obtained from in-depth interviews purposely conducted with 15 survivors of sexual violence. The thematic analysis showed that sexual violence was accompanied by physical and emotional abuse. Following sexual violence and abuse, these women experienced physical injuries, psychological problems, sexual and reproductive health problems, and suicidal ideations. These health difficulties significantly undermined their economic activities and depleted their income. Sexual violence clearly affects women's empowerment; campaigns against gender-based violence should make sexual violence a top priority in Ghana and elsewhere.

Medical students' experiences in learning to perform pelvic examinations: a mixed-methods study

OBJECTIVES

We aimed to explore learning experiences among medical students learning to perform pelvic examinations and to identify factors that facilitate their training.

METHODS

A mixed-methods study including a web-based survey and focus group discussions (FGDs) was conducted among medical students who had completed their obstetrics and gynaecology (ObGyn) clerkship. The FGDs were recorded, transcribed and analysed using qualitative content analysis with systematic text condensation. Survey factors were compared using the χ² test or Fisher's exact test.

RESULTS

160 students (97 female, 61 male, two other) at six universities in Sweden responded to the survey. Two mixed FGDs were conducted. The majority (87%) of the students experienced confidence in performing pelvic examinations, stating that sufficient, repeated training opportunities and support from a clinical tutor were crucial components of the learning experience. Prior to the ObGyn clerkship, negative expectations were more common among male students. The male participants experienced having a disadvantage because of their gender, while female students considered their gender an advantage (p<0.001, N=121, Fisher's Exact Test). The clinical tutor and the use of professional patients (PPs) had a fundamental role in providing learning opportunities by including the student in patient care activities.

CONCLUSIONS

The importance of the clinical tutor, as well as the use of PPs, are important factors when planning education in pelvic examinations, and this knowledge could be used when educating other intimate examinations during medical school. In addition, similar investigations on students' experience in training other intimate examinations could be considered.

Students' Experiences in Suddenly Transformed Living and Educational Environments by COVID-19

This manuscript builds on research about how university students felt affected by the Covid19 pandemic and, especially, by the irruption of non-face-to-face classes and mixed teaching methods in this context. How have young people experienced this situation? How has it affected their wellbeing and the learning strategies should develop have had to incorporate into their virtual relationships? their virtual relationships? How have they related and relate to virtual tools for a task that they have always experienced face-to-face? To answer these questions, the TRAY-AP project that investigates how university students learn collected 89 scenes that show the effects of the Covid 19 on their lives and the university. We grouped these scenes into seven key concepts to detect how students were emotionally affected, especially by moving from face-to-face to virtual learning. From this analysis, although primarily negative, the emotional effects have also allowed them to generate positive strategies for readaptation and collaboration with other colleagues. All of which opens the way to rethink the predominant pedagogical and knowledge relations in the university.

Preliminary assessment of the impact of Covid-19 Pandemic in the small-scale and recreational fisheries of the Canary Islands

Covid-19 pandemic has affected worldwide in many different ways. Fisheries around the world are not an exception due to the long-term isolation and the non-activities period suffered. To do an evaluation of its impact on the fishing sectors in the Canary Islands, 87 online and phone questionnaires were carried out between July and September 2020, conducting the interviews to artisanal fishermen, fishmongers, recreational charter boats fishermen and tackle shops along the archipelago. Both, the artisanal and recreational fishing sectors have been affected by this pandemic, but in an unequal manner. The drop of the demand of fresh fishing products in the islands markets due to the closure of hotels, restaurants and other services, and the highly significant decreasing in the number of tourists, provoked an estimated income loss for the artisanal fishermen about the 40% on average, but the majority of vessels continued their activities during the pandemic, with very limited effects on direct employment. However, the fishmonger's activity apparently was not affected and increased their monthly income in relation to the previous year. Likewise, the infeasibility of fishing charter companies due to the great reduction in the number of tourists contrasted with the significant increase in the number of recreational fishing licenses immediately after the confinement ended. Even though that fishing tackle shops increased sales by over 60% in relation to the similar period of the year before, only 4.4% of these shops declared not to have had economic losses.

[The genesis of the Family Health Support Center (NASF) in the primary healthcare agenda in Brazil]

The article reports on the sociogenesis of the Family Health Support Center (NASF) in Brazil, based on document analysis and 16 in-depth interviews with key informants. Based on triangulation of data and sources and with Pierre Bourdieu as the theoretical reference, a sociohistorical analysis was performed to build a timeline of events related to the formulation of the NASF, including conflicts, interests, alliances, and agreements to allow the proposal's implementation. Four moments were identified in the history of the NASF: from 2000 to 2002, the first discussion for building a proposal to expand the family healthcare (PHC) teams; from 2003 to 2005, drafting a proposal to expand the core team, with the design centered on curative and individual interventions (NAISF); from 2005 to 2006, the repeal of the Brazilian Ministry of Health ruling that established the first proposal, revealing a "vacuum" in the debate on the expansion of PHC teams; and from 2007 to 2008, when the NASF was created with the central purpose of inter-consultation support activities with the family health teams. The genesis of the NASF resulted from a favorable situation in Brazil's political and institutional context, featuring important linkage with members of the government administration and pressure on the Ministry of Health from professional societies and municipal health administrators. The two proposals (NAISF and NASF) were designed differently, although both aimed to expand the scope of practices and case-resolution capacity in PHC. The analysis of the policy's genesis allowed understanding possible repercussions on the policymaking process in ambiguities that are still present in NASF practices.

The Interactive Effect of COVID-19 Risk and Hospital Measures on Turnover Intentions of Healthcare Workers: A Time-Lagged Study

COVID-19 has led to a global health emergency worldwide. As a result, healthcare workers undergo distress mainly due to the perceived risk of contracting the virus. Such stress might cause them to leave their jobs. In this context, the current study: (1) introduced the concept of perceived risk of COVID-19 and measured it by adapting and validating an existing scale available on the risk of infectious diseases and (2) investigated its outcomes, underlying mechanisms, and boundary conditions for healthcare workers. With the support of conservation of resources theory, the current study aimed to investigate the association between perceived risk of COVID-19 and turnover intentions among healthcare workers, particularly Doctors, nurses, and paramedics staff. This study also aimed to investigate the mediating role of perceived fear of COVID-19 between perceived risk of COVID-19 and turnover intention. The current study also aimed to examine the buffering role that perceptions of hospital measures against COVID-19 could have on diminishing workers’ turnover intentions. Data were collected through a three time-lag email survey of healthcare workers in Pakistan (N = 178) who currently provide treatment to COVID-19 patients. The results supported the hypothesis that perceived risk of COVID-19 enhances fear of COVID-19 among healthcare workers and, consequently, their turnover intentions. Perceptions of hospital measures against COVID-19 weaken the relationship between perceived risk of COVID-19 and fear of COVID-19, which reduces turnover intentions of health care workers. The current study offers implications for theory, practitioners, and society.

Social referents for dairy farmers: who dairy farmers consult when making management decisions

Social referents provide information that aid in farmer decision making. Some social referents, such as veterinarians, have been well studied in the context of dairy farms, but others have not and the role of social referents may change across management practices. This study aimed to understand (1) who farmers consult when making management decisions across different animal care practices and (2) what characteristics of these social referents influence farmer decision making. Secondary thematic analysis was used on two qualitative datasets with dairy farmers from the lower Fraser Valley region of British Columbia, Canada. The two datasets included non-naturalistic data (i.e. interviews, participatory discussion groups) investigating two dairy farm management practices (calf care and transition period management). Analysis revealed four themes: (1) who farmers consult when making management decisions across practices and the role of these social referents, (2) personal and professional characteristics, and the diversity of opinions of social referents, (3) actions of social referents, and (4) the strength of the relationship between the social referent and farmer. Similarities were found across practices regarding the personal and professional characteristics of social referents, even though the role of these referents varied across contexts. Farmers valued diverse opinions and actions that social referents could provide, such as the provision of resources, recommendations, and interpretation of farm data. We recommend future research focused on strengthening the relationship between farmers and social referents.

The Role of Coping Strategies in Post-Traumatic Growth among Syrian Refugees: A Structural Equation Model

The Syrian conflict has led to a mass migration of Syrians to other countries and exposed them to many possible traumatic events and stressors in their country of origin and in the resettlement process. The possibility of positive psychological effects of adverse life events is less documented among Syrian refugees. Thus, the current study aimed to develop preliminary evidence for the identifying factors: traumatic experiences, post-migration stressors and coping strategies that are associated with post-traumatic growth (PTG) of Syrian refugees residing in Turkey. Structural equation modeling (SEM) was used in the current study to assess the associations among these factors. Data were obtained from Syrian refugees residing in the governorates of Hatay and Mardin. A total of 528 Syrians, aged between 18-77 years (M = 35.60, SD = 11.65) participated in this cross-sectional study. Results from the SEM indicated that past traumatic experiences and post-migration stressors were indirectly related to PTG. The results from the current study provide support for that the association between refugees' traumatic experiences, post-migration stressors and PTG appear to be explained through the presence of coping strategies which could be addressed in the psychotherapies and psychosocial interventions for refugees to promote positive psychological change. Future studies should address the effects of post-migration stressors on PTG in detail.

COVID-19 restrictions and recreational fisheries in Ontario, Canada: Preliminary insights from an online angler survey

The COVID-19 pandemic and corresponding public health mitigation strategies have altered many facets of human life. And yet, little is known about how public health measures have impacted complex socio-ecological systems such as recreational fisheries. Using an online snowball survey, we targeted resident anglers in Ontario, Canada, to obtain preliminary insights on how the pandemic has impacted recreational fishing and related activity. We also explored angler perspectives on pandemic-related restrictions and other aspects of fisheries management. Our results point to the value of recreational fisheries for the mental and physical well-being of participants, as well as the value and popularity of outdoor recreation during a pandemic. Although angling effort and fish consumption appeared to decline during the early phases of the pandemic, approximately 21 % of the anglers who responded to our survey self-identified as new entrants who had begun or resumed fishing in that time. Self-reported motivations to fish during the pandemic suggest that free time, importance to mental and physical health, and desires for self-sufficiency caused some anglers to fish more, whereas a lack of free time, poor or uncertain accessibility, and perceived risks caused some anglers to fish less. Respondents also expressed their desires for more clear and consistent communication about COVID-19 fishing restrictions from governments, and viewed angling as a safe pandemic activity. Information on recreational angler behaviours, motivations, and perspectives during the pandemic may prove valuable to fisheries managers and policy makers looking to optimize their strategies for confronting this and other similar crises.

Determinants of Sexual Violence Against Married Women: Qualitative Evidence From Ghana

Some evidence suggests that in sub-Saharan Africa, sexual violence is commonplace among married women, yet this problem is underresearched. Using qualitative methods and applying Heise's social-ecological model, this study examined the experiences of 15 Ghanaian women suffering sexual violence in their marriages. Results from the thematic analysis indicate several determinants of sexual violence. Whereas some participants identified macro-level and exosystem factors, including poverty, others pointed to micro-level and ontogenic factors, such as husbands' substance abuse. The results corroborate the core idea of Heise's framework, namely, that structural- and individual-level factors make women vulnerable to violence. The study concludes that Ghanaian legal and policy frameworks must be enforced and strengthened to address the etiology of sexual violence and abuse.

A pathway to negative acculturation: marital maladjustment mediates the relationship between the length of residency and depressive symptoms in immigrant women in Taiwan

Background

Immigrant women in Taiwan experience a variety of acculturative and marital problems that result in a mental-health problems. We examined the mediational effect of marital adjustment on the relationship between acculturation and depressive symptoms in immigrant women in Taiwan.

Methods

All participants (N = 127) were interviewed to collect data regarding their basic sociodemographics, depressive symptoms, acculturation (using language proficiency and years in Taiwan as indicators), and marital adjustment. We used a Sobel test to examine how marital adjustment mediates the relationship between acculturation and depressive symptoms.

Results

Our results indicated that an increased length of residency exacerbated depressive symptoms (β = 0.62, p = 0.03) and that this relationship contributed, in part, to the mediational effect of marital adjustment. That is, marital adjustment deteriorated with the length of residency (β =  − 0.26, p = 0.0013), resulting in the development of depressive symptoms (β =  − 0.95, p = 0.0013).

Conclusion

Although the duration of residency may be useful as a proxy for acculturation in the assessment of some health outcomes, our findings imply that it is better to conceptualize it as a cumulative stress when considering the mental health of immigrant women. Marital maladjustment acts as a mediator in this relationship. As such, it is important to provide immigrant families with programs and resources to assist them in adapting to their marriages and to improve the mental health of immigrant women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01334-0.

Using Technology to Conduct Focus Groups With a Hard-to-Reach Population: A Methodological Approach Concerning Male Victims of Partner Abuse in Four English-Speaking Countries

Research shows that the experiences of male victims of partner abuse (PA) are often denied by the public and the professionals who are charged to support PA victims. Recruiting female victims for research on PA victimization is relatively easy because there are existing structures to serve this group of victims. Thus, male victims are considered a hard-to-reach (HTR) population, and studying them can be difficult. This article focuses on the use of technology to collect qualitative data from male PA victims in an international study focusing on male victims. The researchers used their own professional networks to recruit and screen a convenience sample of male victims of female-to-male PA, in four different English-speaking countries: Australia, Canada, England, and the United States. Four web-based, video-enabled, focus groups were held for each country-for a total of 12 groups and 41 male participants. This article addresses recruitment methods, the use of technology in data collection, protecting the confidentiality of male victims, methods for informed consent, and lessons learned to facilitate future research.

Obstetric Patients and Healthcare Providers Perspectives to Inform Mobile App Design for Physical Activity and Weight Control During Pregnancy and Postpartum in a Rural Setting

Background

Mobile health technology offers the opportunity for women to engage with physical activity promotion programs without many of the barriers commonly associated with exercise during and after pregnancy (eg, childcare concerns, rigid schedules, fear of doing harm to fetus or self, access to fitness facilities, uncomfortable with body in front of others) which may be particularly useful in under-resourced rural environments. We conducted the first known study on perspectives of pregnant women, postpartum women, and obstetric healthcare providers in a rural setting on needs related to the development of a mobile app designed to increase physical activity during pregnancy and postpartum.

Methods

Focus groups and in-depth face-to-face personal interviews were conducted with 14 pregnant women, 13 postpartum women, and 11 healthcare providers in a rural community. Semi-structured questions utilizing constructs of the Health Belief Model were used to identify barriers, facilitators, and other influences on physical activity during pregnancy and postpartum. Recordings of all in-depth interviews and focus groups were transcribed and standard content analyses for qualitative data were conducted.

Results

Rural women and healthcare providers expressed several key perspectives about and recommendations to promote physical activity during and after pregnancy. Broadly, these perspectives encapsulated two main themes: 1) physical activity as critical for weight control and 2) the need for evidence-based exercise information. Key desired features of this app identified include goal setting/progress tracking, evidence-based exercise guidance tailored to specific time points of pregnancy and postpartum, social support via community-based forum, symptom tracking, time-efficient workouts, and push notifications.

Conclusion

The perspectives identified by participants should be utilized when designing mobile health physical activity mobile apps for pregnant and postpartum women in rural areas.

A qualitative study of the experience and impact of neuropathic pain in people living with HIV

Painful distal symmetrical polyneuropathy is common in HIV and is associated with reduced quality of life. Research has not explored the experience of neuropathic pain in people with HIV from a person-centred perspective. Therefore, a qualitative interview study was conducted to more deeply understand the experience and impact of neuropathic pain in this population. Semistructured interviews were conducted with 26 people with HIV and peripheral neuropathic pain symptoms. Interviews explored the impact of pain and participants' pain management strategies. Interviews were transcribed verbatim and analysed using thematic analysis. Four themes and 11 subthemes were identified. Theme 1 reflects the complex characterisation of neuropathic pain, including the perceived unusual nature of this pain and diagnostic uncertainty. Theme 2 centred on the interconnected impacts of pain on mood and functioning and includes how pain disrupts relationships and threatens social inclusion. Theme 3 reflects the struggle for pain relief, including participants' attempts to "exhaust all options" and limited success in finding lasting relief. The final theme describes how pain management is complicated by living with HIV; this theme includes the influence of HIV stigma on pain communication and pain as an unwanted reminder of HIV. These data support the relevance of investigating and targeting psychosocial factors to manage neuropathic pain in HIV.

A rapid-cycle assessment strategy for understanding the opioid overdose epidemic in local communities

BACKGROUND

Certain communities in the United States experience greater opioid-involved overdose mortality than others. Interventions to stem overdose benefit from contextual understandings of communities' needs and strengths in addressing the opioid crisis. This project aims to understand multiple stakeholder perspectives on the opioid epidemic in communities disproportionately affected by opioid-involved overdose mortality. Methods: We performed a rapid-cycle qualitative assessment study utilizing in-depth interviews with community stakeholders and observations of community meetings in eight communities in Allegheny County, Pennsylvania, USA, disproportionately impacted by opioid-involved overdose mortality. Stakeholder categories included: current and past illicit users of opioids; medical and social service providers; emergency medical services; law enforcement; spouse or other family members of illicit users/former users of opioids; government officials; school officials; community members. Content analysis was utilized to identify themes and answer study questions. Regular feedback to stakeholders was provided to support targeted interventions. Results: We performed semi-structured, in-depth interviews with 130 community stakeholders and 29 community meeting observations in 2018-2019. Participants perceived similar economic and social determinants as origins of the opioid overdose epidemic including lack of economic resources, loss of jobs, transient populations and dilapidated housing. However, they differed in their awareness of and attention to the epidemic. Awareness was dependent on the visibility of opioid use (presence of paraphernalia litter, location of drug users, media coverage, and relationship to users). Overall, there was good knowledge of naloxone for opioid overdose reversal but less knowledge about local syringe services programs. Perceptions of harm reduction efforts were ambivalent. Conclusions: Members of communities impacted by the opioid epidemic perceived that economic downturn was a major factor in the opioid overdose epidemic. However, the varied beliefs within and between communities suggest that interventions need to be tailored according to the cultural norms of place.

Neoadjuvant endocrine therapy use in early stage breast cancer during the covid-19 pandemic

Purpose

Physician treatment preferences for early stage, estrogen positive breast cancer (ER + BC) patients were evaluated during the initial surge of the COVID-19 pandemic in the US when neoadjuvant endocrine therapy (NET) was recommended to allow safe deferral of surgery.

Methods

A validated electronic survey was administered May–June, 2020 to US medical oncologists (MO), radiation oncologists (RO), and surgeons (SO) involved in clinical trials organizations. Questions on NET use included practice patterns for locoregional management following NET.

Results

114 Physicians from 29 states completed the survey—42 (37%) MO, 14 (12%) RO, and 58 (51%) SO. Before COVID-19, most used NET ‘rarely’ (49/107, 46%) or ‘sometimes’ (36, 33%) for ER + BC. 46% would delay surgery 2 months without NET. The preferred NET regimen was tamoxifen for premenopausal and aromatase inhibitor for postmenopausal women. 53% planned short term NET until surgery could proceed. Most recommended omitting axillary lymph node dissection (ALND) for one micrometastatic node after 1, 2, or 3 months of NET (1 month, N = 56/93, 60%; 2 months, N = 54/92, 59%; 3 months, N = 48/90, 53%). With longer duration of NET, omission of ALND decreased, regardless of years in practice, percent of practice in BC, practice type, participation in multidisciplinary tumor board, or number of regional COVID-19 cases.

Conclusion

More physicians preferred NET for ER + BC during the pandemic, compared with pre-pandemic times. As the duration of NET extended, more providers favored ALND in low volume metastatic axillary disease. The Covid-19 pandemic affected practice of ER + BC; it remains to be seen how this may impact outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10549-021-06153-3.

Educational innovation: trends for higher education in Brazil

Purpose

The purpose of this paper is to characterize the trends for educational innovation in higher education in Brazil, constructing a conceptual model of innovation trends in the sector.

Design/methodology/approach

A preliminary profile online was done with 76 experts in university education, and 17 were contacted for in-depth perceptions. The analysis of the content was made of all material and, as a result, the critical analysis of the results, which culminated in the development of a conceptual model and characterization of trends, dimensions and subdimensions to innovation in higher education.

Findings

The dimension universal design of accessibility and learning had major considerations, contributing to implementation of new innovative practices for higher education. Some subdimensions emerged, namely, governance, risk management, curricular extension and affirmative policies.

Research limitations/implications

The difficulty in performing the deepening of all dimensions involved in terms of plurality of specialties involved.

Practical implications

The use of the model and characterization of trends could serve as tools to support the strategic planning of HEI, and the trends allow planning innovation practices, favoring improvements of higher education institutions (HEI), students, employees and community to learning organization.

Social implications

The identification of trends for higher education, highlighting innovation indicators or successful practices, and the characterization of the dimensions and subdimensions trends, and undeniable contribution to measure the educational innovation in higher education.

Originality/value

Encourages researchers, in partnership with institutions, to develop scientific projects with other institutions and researchers, to meet interests not only of HEI as a whole but also of countries that prioritize education with quality, to reach the real educational objectives.